Evaluation the cases of neonatal sepsis and of antibiotic sensitivities in a neonatal intensive care unit

AMAÇ: Yenidoğan yoğun bakım ünitelerinde (YYBÜ) sepsis etkenleri ve antibiyotik duyarlılıkları zaman içinde ve kullanılan antibiyotiklere bağlı olarak değişir. Neonatal sepsise neden olan bakteriyel mikroorganizmaların ve antibiyotik duyarlılığının saptanması, ampirik antibiyotik tedavi rejimlerinin belirlenmesi ve uygun antibiyotik seçimi açısından önemlidir. GEREÇ veYÖNTEM: Ocak 2004-Haziran 2008 tarihleri arasında Adnan Menderes Üniversitesi Tıp Fakültesi YYBÜ'de izlenen 900 yenidoğan içerisinde sepsis tanısı alan 87 olgunun dosyaları incelendi. Kültür pozitif olan 45 olgunun klinik belirti ve bulguları, risk faktörleri, laboratuvar sonuçları, kültürde üreyen etkenler ve antibiyotik duyarlılıkları değerlendirildi. BULGULAR: Sepsis sıklıgı %9.6 bulundu. Kesin sepsis tanısı alan 45 olguda (%5), 49 kan kültürü üremesi oldu. Bunların %82'si prematüre ve%53'ü erkekti. Erken neonatal sepsiste Koagülaz Negatif Stafilokok (KNS) ve Staphylococcus aureus (S. aureus), geç neonatal sepsiste ise KNS'den sonra Candida spp. en sık üreyen mikroorganizmalardı. Mortalite oranı %13.3'tü. KNS'ler glikopeptidlere %100 duyarlı bulunurken, penisiline %96, metisiline %90 dirençliydi. S. aureus suslarının tamamı glikopeptidlere, metisiline, eritromisine ve klindamisine duyarlı bulunurken, penisiline direnç oranı %71.4 idi. Enterococcus spp. suslarında test edilen antibiyotiklere direnç saptanmadı. Enterobacter spp. susları 3. kusak sefalosporinlere ve karbapenemlere %100 duyarlı iken ampisilin-sulbaktama %100 dirençliydi. Acinetobacter spp. ve Pseudomonas spp. suslarının tamamı piperasiline dirençliydi. Klebsiella spp suslarının tamamı karbapenemlere, kinolonlara ve aminoglikozidlere duyarlı idi. Serratia spp., Escherichia coli ve Enterococcus spp. suslarında test edilen antibiyotiklere direnç saptanmadı. SONUÇ: Erken neonatal sepsiste Gram pozitif mikroorganizmaların ön plana geçmesi ve bu mikroorganizmalarda yüksek penisilin direnci görülmesi, ampirik antibiyotik uygulamalarının gözden geçirilmesi gerektiğini düşündürmektedir. Bununla birlikte S. aureus suslarında metisilin direncine rastlanmamıştır. Acinetobacter spp. ve Pseudomonas spp. suslarındaki yüksek piperasilin direnci önceki yıllarda bu antibiyotiğin sık kullanımına bağlandı.PURPOSE: Type and antibiotic sensitivity of pathogens leading sepsis in neonatal intensive care units (NICU) change over years. It is important to identify type and antibiotic sensitivity of pathogens leading sepsis for establishment of the local antibiotic policy. MATERIALS and METHODS: 87 cases with sepsis were investigated among 900 newborns followed in “Adnan Menderes University” NICU between January 2004-June 2008. Clinical symptoms and signs, risk factors, laboratory results, positive cultures and antibiotic sensitivity factors were evaluated in 45 cases with positive culture. RESULTS: Sepsis was found to have a 9.6% rate. 45 cases were diagnosed as definite sepsis with 49 positive blood cultures. 53% were males and 82% were premature. Most common pathogens were coagulase-negative staphylococci (CNS) and Staphylococcus aureus (S. aureus) in early neonatal sepsis, whereas CNS and the Candida in late neonatal sepsis. Mortality rate was 13.3%. Glycopeptide sensitivity of CNS was 100% , penicilline and meticilline resistance were 96% and 90% respectively. All S. aureus strains were sensitive to methicillin, clindamycine and eritromycine while penicillin resistance rate was 71.4%. No resistance was detected in Enterococcus spp. strains. Enterobacter spp. were 100% sensitive to 3. generation cephalosporins and carbapenems but resistant to ampicillin-sulbactam. Acinetobacter spp and Pseudomonas spp were resistant to piperaciline. All Klebsiella spp were sensitive to carbapenems, and aminoglycosides. No resistance was detected for the Serratia spp, Escherichia coli ve Enterococcus spp strains. CONCLUSION: Gram positive microorganisms as the leading etiologic agent in early neonatal sepsis, and their high penicillin resistance necessitated a revision in our ampiric antibiotic practices. However, no meticilline resistance was found in S. aureus species. High piperacilline resistance of Acinetobacter spp and Pseudomonas spp was associated with the recent frequent utilization of this agent

Baby Walker Use and Child Development

Abstract Objective: To evaluate the effect of baby walker (BW) use on child development. Methods: The study was conducted in İstanbul University İstanbul Medical Faculty Social Pediatric Outpatient Clinic. Children aged 18-30 months who used BW for 30 minutes or more a day for at least 1 month constituted the user group (n = 100) and those who never used a BW were in the control group (n = 100). Information was obtained through the personal health record of the unit and by a face-to-face questionnaire applied to the families during their visits to the unit. The Ankara Development Screening Inventory (ADSI) was used to assess language-cognitive, motor and mental development. Sitting without support and independent walking age and four measures (history and physical, neurological and orthopedic examinations) of gait disorders were evaluated in relation to child development. Results: There was no developmental problem in any of the children, but there was a statistically significant difference in terms of an atypical gait pattern between the two groups Atypical gait pattern and especially toe-walking were more frequent in children who used BW. The accident rate in BW users was also significantly higher than those who did not use BW. The most common reasons for BW use were keeping the child occupied and improving his/her development. Conclusion: The use of BW should be considered while evaluating toe-walking in children. To convince families in avoiding use of BW, they need to be informed that it has no positive influence on motor development but carries a risk for accidents and toe walking. This information should be part of the parent education offered in Well Child Clinics

NAIL BITING IN PRESCHOOL: A CASE REPORT

Nail biting behavior is a common problem in childhood. Nail biting behavior which is associated with severe anxiety disorders may occur as a result of emotional and/or physical abuse. This behavior problem has negative effects on physical and psychological health of children. Tooth root damage, malocclusion, jaw disorders and parasitosis may develop in severe cases. There are controversial approaches for the treatment. The nail biting behavior of a 57-month-old boy was issued by his parent during the well-child visit. There was no pathological sign in the examination of the patient, who later was directed to the Child Development and Education specialist. His development was already evaluated as age-appropriate with various developmental screening tests during his previous controls. In the patient's detailed history, it was ascertained that the nail biting behavior has developed after the verbal and potential physical violence that had been applied by his mother one year ago. Knowing the fact that this behavior was an anxiety linked disorder, several meetings had been carried out separately with the mother, the child and his brother. While behavioral therapy was being applied to the patient, approach model of the mother and other family members were schematized in the interviews. After a four month-follow-up period, it was observed that the nail biting behavior has decreased and the behavior model of the family had been corrected. Nail biting behavior should be considered and evaluated carefully in terms of children's mental health. Regular behavioral therapies and cooperation with the family members are important in the management of these cases

Seroprevalence of HBsAg, Anti-HIV1/2 and Anti-HCV in Pregnancies at Ege University Medical Faculty Hospital

Giriş: Hepatit B virüsü (HBV), hepatit C virüsü (HCV) ve insan immünyetmezlik virüsü (HIV) infeksiyonlarında vertikal geçiş önemli bir bulaşma yoludur. Bu viral infeksiyon etkenlerinin gebelik döneminde belirlenmesi, anne ve bebek sağlığı açısından önemlidir. Bu çalışmada Ege Üniversitesi Tıp Fakültesi Hastanesine başvuran gebelerde, hepatit B yüzey antijeni (HBsAg), hepatit C antikoru (anti-HCV) ve HIV antikoru (anti-HIV1/2) pozitifliğinin araştırılması amaçlandı.Materyal ve Metod: Ocak 2014-Temmuz 2017 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Gebe Polikliniğine başvuran ve Tıbbi Mikrobiyoloji Anabilim Dalı Viroloji Laboratuvarında HBsAg, anti-HCV ve anti-HIV testleri Architect i2000SR (Abbott, ABD) sistemi ile çalışılan, yaşları 16-49 yıl arasında (yaş ortalaması 30.3 ± 5.9) olan gebelerin sonuçları değerlendirmeye alındı. Bulgular: Çalışmaya alınan 8967 gebenin 127 (%1.4)'sinde HBsAg pozitif, 8865 gebenin 34 (%0.4)'ünde anti-HCV pozitif, 8803 gebenin 12 (%0.1)'sinde anti-HIV1/2 pozitif olarak saptandı.Sonuç: Gebelik dönemi, HBV taşıyıcısı kişilerin saptanması ve yenidoğan infeksiyonlarının önlenmesi açısından çok önemlidir. Yine anneden bebeğe HIV bulaşında en önemli korunma, annedeki HIV infeksiyonunun erken saptanması ve etkin önlemlerin alınmasıdır. Diğer yandan, etkili önleyici yöntemlerin olmaması gebelerde HCV infeksiyonu açısından taramanın gereksiz olduğunu düşündürmekle birlikte gebenin HCV pozitif olduğunun bilinmesi kontamine kan ile bebeğin temasına neden olabilecek invaziv obstetrik girişimlerden kaçınmak açısından yararlı olabilir. Bu infeksiyon etkenlerinin gebelik döneminde taranması anne ve bebek sağlığı açısından yararlıdırIntroduction: Vertical transmission is an important route for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections in children. Determination of these viral infectious agents during pregnancy is important for both maternal and infant health. In this study, the prevalances of hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV) and human immunodeficiency virus antibody (anti-HIV1/2) were determined in pregnant women admitted to Ege University Medical Faculty Hospital outpatient pregnancy clinic. Materials and Methods: Test records of pregnant women, aged between 16-49 years (mean 30.3 ± 5.9), who applied to Ege University Medical Faculty Hospital Obstetrics Outpatient Clinic between January 2014 and July 2017 were tested for HBsAg, anti-HCV and anti-HIV in the Virology Laboratory, and were evaluated. Samples were screened for viral markers using Architect i2000SR (Abbott, USA). Results: ELISA results demonstrated the existence of HBsAg in 127 (1.4%) among 8967; anti-HCV in 34 (0.4%) among 8865 and anti-HIV 1/2 in 12 (0.1%) among 8803 pregnant women. Conclusion: Since perinatal exposure is an important mode of HBV transmission resulting in chronic disease in infected infants and is preventable with immunoprophylaxis, it is important to determine the HBV infected mother. The same is true for HIV infection which can be prevented if it is detected during pregnancy. For HCV infection, even though definite effective preventive measures are lacking, invasive obstetric procedures favoring the contact with contaminated maternal blood could be avoided. Screening of these viral infectious agents during pregnancy is important for both maternal and infant healt

Ege Üniversitesi Tıp Fakültesi Hastanesinde Gebelerde HBsAg, Anti-HIV1/2 ve Anti-HCV Seroprevalansı

Introduction: Vertical transmission is an important route for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections in children. Determination of these viral infectious agents during pregnancy is important for both maternal and infant health. In this study, the prevalances of hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV) and human immunodeficiency virus antibody (anti-HIV1/2) were determined in pregnant women admitted to Ege University Medical Faculty Hospital outpatient pregnancy clinic. Materials and Methods: Test records of pregnant women, aged between 16-49 years (mean 30.3 ± 5.9), who applied to Ege University Medical Faculty Hospital Obstetrics Outpatient Clinic between January 2014 and July 2017 were tested for HBsAg, anti-HCV and anti-HIV in the Virology Laboratory, and were evaluated. Samples were screened for viral markers using Architect i2000SR (Abbott, USA). Results: ELISA results demonstrated the existence of HBsAg in 127 (1.4%) among 8967; anti-HCV in 34 (0.4%) among 8865 and anti-HIV 1/2 in 12 (0.1%) among 8803 pregnant women. Conclusion: Since perinatal exposure is an important mode of HBV transmission resulting in chronic disease in infected infants and is preventable with immunoprophylaxis, it is important to determine the HBV infected mother. The same is true for HIV infection which can be prevented if it is detected during pregnancy. For HCV infection, even though definite effective preventive measures are lacking, invasive obstetric procedures favoring the contact with contaminated maternal blood could be avoided. Screening of these viral infectious agents during pregnancy is important for both maternal and infant healthGiriş: Hepatit B virüsü (HBV), hepatit C virüsü (HCV) ve insan immünyetmezlik virüsü (HIV) infeksiyonlarında vertikal geçiş önemli bir bulaşma yoludur. Bu viral infeksiyon etkenlerinin gebelik döneminde belirlenmesi, anne ve bebek sağlığı açısından önemlidir. Bu çalışmada Ege Üniversitesi Tıp Fakültesi Hastanesine başvuran gebelerde, hepatit B yüzey antijeni (HBsAg), hepatit C antikoru (anti-HCV) ve HIV antikoru (anti-HIV1/2) pozitifliğinin araştırılması amaçlandı.Materyal ve Metod: Ocak 2014-Temmuz 2017 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Gebe Polikliniğine başvuran ve Tıbbi Mikrobiyoloji Anabilim Dalı Viroloji Laboratuvarında HBsAg, anti-HCV ve anti-HIV testleri Architect i2000SR (Abbott, ABD) sistemi ile çalışılan, yaşları 16-49 yıl arasında (yaş ortalaması 30.3 ± 5.9) olan gebelerin sonuçları değerlendirmeye alındı. Bulgular: Çalışmaya alınan 8967 gebenin 127 (%1.4)'sinde HBsAg pozitif, 8865 gebenin 34 (%0.4)'ünde anti-HCV pozitif, 8803 gebenin 12 (%0.1)'sinde anti-HIV1/2 pozitif olarak saptandı.Sonuç: Gebelik dönemi, HBV taşıyıcısı kişilerin saptanması ve yenidoğan infeksiyonlarının önlenmesi açısından çok önemlidir. Yine anneden bebeğe HIV bulaşında en önemli korunma, annedeki HIV infeksiyonunun erken saptanması ve etkin önlemlerin alınmasıdır. Diğer yandan, etkili önleyici yöntemlerin olmaması gebelerde HCV infeksiyonu açısından taramanın gereksiz olduğunu düşündürmekle birlikte gebenin HCV pozitif olduğunun bilinmesi kontamine kan ile bebeğin temasına neden olabilecek invaziv obstetrik girişimlerden kaçınmak açısından yararlı olabilir. Bu infeksiyon etkenlerinin gebelik döneminde taranması anne ve bebek sağlığı açısından yararlıdı