Does Providing Clinical Care for Trauma Patients have a Positive Effect on Physicians’ Perspective on Child Passenger Safety?

Introduction: Motor vehicle crashes are the most common cause of the mortality in the pediatric population. Preventive strategies are the best approach to reduce mortality and morbidity due to motor vehicle crashes. Since parents mostly refer to them for guidance, doctors should have a high level of knowledge and awareness to increase the usage of car safety seats. We thought that providing care for trauma patients could have a positive effect on the physicians’ awareness and knowledge level. Based on this, we aimed to assess the awareness and knowledge of pediatricians and emergency physicians and trauma doctors. Methods: An electronic survey consisting of 23 questions was prepared. Demographic features, awareness and knowledge level of the physicians were assessed on three sections. Five suggestions in the guideline of the American Academy of Pediatrics were used to assess physicians’ knowledge level. The respondents were grouped as those providing clinical care for trauma patients and those do not. Results: The questionnaires were sent to 641 physicians and 323 who completed the questionnaire were included in the study. One hundred and fourteen (35.3%) of the respondents were providing clinical care for trauma patients. One hundred ninety (59.2%) respondents had children. Majority of the physicians had a satisfactory level of knowledge about car safety seat (CSS). The number of respondents reported having adequate self-awareness was found statistically significantly higher in the groups of doctors who have children and provide clinical care for trauma patients (p0.05). Interestingly, the knowledge level in physicians who had children was statistically significantly lower than in those with no children (p<0.01). Conclusion: Our survey revealed that physicians who provide clinical care for trauma patients think they have a high level of knowledge about CSS. Unfortunately, their knowledge level was low as other physicians in the study group

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Analyzing the relationship between the conscious consumerism levels of the 8th grade students and their environmental attitudes: Sample of Denizli province

Bu çalışmanın amacı, sekizinci sınıf öğrencilerinin bilinçli tüketicilik düzeyleri ve çevreye yönelik tutumları arasındaki ilişkiyi incelemektir. İlişkisel tarama modelinin kullanıldığı araştırmanın örneklemi, Denizli merkez ilçelerdeki (Pamukkale ve Merkezefendi) devlet ortaokullarında bulunan ve küme örnekleme yöntemiyle seçilen 825 öğrenciden oluşmaktadır. Araştırmanın verileri Bilinçli Tüketicilik Düzeyi Ölçeği, Çevresel Tutum Ölçeği ve Kişisel Bilgi Formu aracılığıyla toplanmıştır. Araştırmanın alt problemlerinin çözümlenmesinde Bağımsız Örneklemler t-Testi, Tek Faktörlü Varyans Analizi (One-Way ANOVA) ve Basit Doğrusal Regresyon Analizi tekniklerinden yararlanılmıştır. Araştırmanın sonuçlarına bakıldığında, öğrencilerin bilinçli tüketicilik düzeyleri ve çevreye yönelik tutumları iyi düzeydedir. Öğrencilerin bilinçli tüketicilik düzeyleri ve çevreye yönelik tutumlarının; harçlık biriktirme, akademik başarı, televizyon izleme süresi ve okulların bulunduğu sosyo-ekonomik çevre değişkenlerine göre anlamlı bir fark gösterdiği saptanmıştır. Ancak öğrencilerin bilinçli tüketicilik düzeyleri ve çevreye yönelik tutumları; cinsiyet, anne eğitim durumu baba eğitim durumu, düzenli harçlık alma ve sosyal medya kullanma değişkenlerine göre anlamlı bir fark göstermemiştir. Araştırmanın son alt problemine göre, sekizinci sınıf öğrencilerinin çevreye yönelik tutumlarının bilinçli tüketicilik düzeylerini anlamlı şekilde yordadığı saptanmıştır. Bilinçli tüketicilik düzeylerine yönelik toplam varyansın %12’sinin çevresel tutum ile açıklandığı sonucuna varılmıştır.The purpose of this study is to analyze the relationship between the conscious consumption levels of the 8th grade students and their attitudes towards the environment. The sample of the study, in which the correlational survey model and quantitative methods are used, is composed of 825 students selected from the public schools in Denizli central districts (Pamukkale and Merkezefendi) with the method of cluster sampling. The data of the study are collected by means of Conscious Consumption Level Scale, Environmental Attitude Scale and Personal Information Form. Unpaired t-Test, One Way Analysis of Variance (One- Way ANOVA) and Simple Linear Regression Analysis technics are used in the analysis of the sub-problems of the research. When the results of the research are examined, the conscious consumption levels and environmental attitudes of the students are seen to be at good level. It is observed that the conscious consumption levels and environmental attitudes of the students show a significant difference in accordance with the variables of pocket money saving, academic success, time spared for watching television and the socio- economic environmental variables of the related schools. However, the students’ conscious consumption levels and their environmental attitudes do not show a significant difference according to gender, educational background of the parents, receiving pocket money regularly and using social media variables. With regard to the last sub-problem of the research, it is determined that the environmental attitudes of the eighth grade students predict their conscious consumption tendencies. It is concluded that 12% of the total variance regarding conscious consumption tendencies are explained with the environmental attitudes

Pott Puffy Tumor in Children: A Rare Emergency Clinical Entity

Objectives: Pott puffy tumor (PPT) is defined as soft tissue swelling of the forehead due to subperiosteal edema, accumulation of pus, or granulation tissue. It is associated with osteomyelitis of frontal bone secondary to frontal sinusitis. Pott puffy tumor can be complicated by preseptal and orbital cellulitis and intracranial infection

Mediterranean spotted fever due to contact with dog-tick

Akdeniz benekli ateşi (ABA), Rickettsia conorii'nin etken olduğu kene ile bulaşan riketsiya enfeksiyonlarından biridir. Etken insanlara genellikle enfekte kahverengi köpek keneleri (Rhipicephalus sanguineus) aracılığıyla bulaşır. Bu yazıda Bartın ilinde köpek kenesi ile temas sonrasında ABA gelişen 16 yaşında bir erkek hasta sunulmaktadır. 2007 yılı Haziran ayında hastanemize başvuran olgunun öyküsünden, beş gün önce köpeğinin kenelerini temizlediği, bundan yaklaşık 12 saat sonra bacağına bir kenenin yapıştığını fark ettiği ve keneyi bacağından cımbızla uzaklaştırdığı öğrenilmiştir. Yaklaşık üç gün sonra, olguda yüksek ateş, baş ağrısı, el ve ayak tabanları da dahil olmak üzere tüm vücutta yaygın döküntü ve bacakta kenenin ısırdığı bölgede siyah renkli bir lezyon ortaya çıkmıştır. Fizik incelemede sağ bacak ön yüzünde kenenin ısırdığı alanda saptanan ortası siyah ve çevresinde mor bir halka bulunan lezyon, ABA'ya özgül olan "tache noire" ile uyumlu bulunmuştur. Olgunun ilk başvurusunda ve başvurudan 10 gün sonra alınan serum örneklerinde çalışılan Rickettsia indirekt immünofloresan antikor (İFA) testi ilk serumda negatif, ikinci serumda ise 1/512 dilüsyonda pozitif olarak saptanmıştır. Olgu, 10 günlük doksisiklin tedavisi ile herhangi bir komplikasyon olmaksızın iyileşmiştir. Bu olgu ile, özellikle son yıllarda kene ile ilişkili enfeksiyon insidansının artış gösterdiği ülkemizde, yaz mevsiminde yüksek ateş, makülopapüler döküntü, baş ağrısı, miyalji, artralji şikayetleri ve kene ısırığı öyküsü olan, özellikle ısırık bölgesinde siyah renkli es-kar gelişen olguların ayırıcı tanısında ABA'nın düşünülmesi gerektiğinin vurgulanması amaçlanmıştır.Mediterranean spotted fever (MSF) is one of the tick-borne rickettsial infections caused by Rickettsia conorii. It is transmitted to humans by brown dog ticks (Rhipicephalus sanguineus). In this case report, a 16-years-old male patient who was diagnosed as MSF after an exposure to dog-tick in Bartin province (located at middle Black Sea region of Turkey) has been presented. His history revealed that, five days before admission to the hospital (on June, 2007) he had cleaned dog-ticks from his dog, and after 12 hours he found a stucked tick on his leg and he took it out right away with a tweezer. High fever, headache and generalized maculopapular rash including soles and palms and a black-colored lesion at the tick bite site developed three days later. In clinical examination, there was a black escar circled with a red-purple colored halo in front of the right tibia at the site of the tick bite showing high similarity to &quot;tache noire&quot; which was specific to MSF. Indirect immunofluorescence assay (IFA) for Rickettsia yielded negative result in the serum sample collected on admission day, however, it was found positive at 1/512 titer in the serum sample collected 10 days after admission. The patient has recovered completely without any complication after 10 days of doxycycline therapy. The aim of this presentation is to point out that MSF should be considered for the differential diagnosis of a patient with a history of tick bite, fever, maculopapular rash, headache, myalgia, arthralgia and especially with black escar during summer months in our country where the incidence of tick-borne infections has been increasing since recent years

Retrospective Analysis of Childhood Poisoning

Amaç: Zehirlenmeler çocuk yaş grubunda sık görülen, hızlı tanı ve tedavi gerektiren, önlenebilir çevresel acillerdendir. Bu çalışmada zehirlenme nedeniyle başvuran hastaların epidemiyolojik ve klinik özellikleri incelenmiştir.Yöntemler: Haziran 2010-Ocak 2015 yılları arasında çocuk acil servisine zehirlenme nedeniyle başvuran hastaların hastane kayıtları geriye dönük olarak değerlendirilmiştir.Bulgular: Çalışmaya alınan 997 zehirlenme olgusunun, %55’inin kız olduğu görülmüştür. Hastaların ortanca yaşının 43 ay [çeyrekler arası aralık: 24-166], %58,1’inin 5 yaş altında, %30,7’sinin 12 yaş üstünde olduğu bulunmuştur. Zehirlenmelerin, beş yaş altında çoğunlukla erkeklerde (%57,5) ve tamamının kaza sonucu, 12 yaş üstünde ise kızlarda (%81) ve özkıyım amaçlı (%76,1) olduğu saptanmıştır. Olguların %84,7’si tek etkenle, %15,3’ü ise birden fazla etkenle zehirlenmiştir. En sık ilaçlarla (%56,7), ikinci sırada ise kostik/korozif maddelerle (%27,8) olan zehirlenmeler saptanmıştır. İlaçlar ile olan zehirlenmelerin en sık analjezikler (%26,9) ve santral sinir sistemi ilaçları (%24) ile olduğu görülmüştür. Hastaların %71,3’ünün asemptomatik olduğu, semptomatik hastalarda ise en sık gastrointestinal sistem bulguları olduğu bulunmuştur. İlaçlarla zehirlenen olguların %21’ine mide lavajı; %28’ine aktif kömür uygulanmış, %2’sine antidot tedavisi verilmiştir. Hastaların %92’si çocuk acil servisinden taburcu edilirken, 14 olgu (%1,4) yoğun bakımda tedavi edilmiştir. Beş yıl süresince zehirlenmeye bağlı mortalite gözlenmemiştir.Sonuç: Zehirlenmeler çocuk yaş grubunda morbiditenin önemli ve önlenebilir bir nedenidir. Beş yaş altı grupta kaza sonucu, adölesan yaş grubunda özkıyım amaçlı zehirlenmelerin sık olduğu, ilaçlar ve kostik/korozif maddelerle olan zehirlenmelerin en önemli neden olduğu bulunmuştur. Yaş gruplarına göre bu epidemiyolojik ve klinik özelliklerin bilinmesi, nedene yönelik hızlı tanı ve tedavi yapılmasını sağlayacak; gerekli önlemler alınarak zehirlenmelerin azaltılmasına katkı sağlayacaktır.Introduction: Poisonings are common and preventable environmental emergencies requirin rapid diagnosis and treatment in the pediatric age group. The epidemiological and clinical characteristics of poisoning patients were investigated in this study.Methods: Hospital records of patients admitted to the pediatric emergency department due to poisoning between June 2010 and January 2015 were evaluated retrospectively.Results: Fifty-five percent of 997 poisoning cases were girls. The median age of the patients was 43 months [Interquartile range: 24-166], 58.1% of patients were under age five and 30.7% were older than 12 years of age. Poisoning under age of 5 was observed predominantly in males as a result of an accident (57.5%) and in above 12 years of age in girls (81%) and due to suicidal purposes (76.1%). In 84.7% of cases, single-drug poisoning was detected. The most common toxicity agents were drugs and caustic/corrosive substances (56.7% and 27.8%, respectively). Analgesics (26.9%) and central nervous system drugs (24%) were the most commonly used drugs. 71.3% of patients were asymptomatic and gastrointestinal findings were found to be the most common symptom in symptomatic patients. Gastric lavage, activated charcoal and antidote treatment were performed in 21%, 28% vad 2% of cases of drug-related poisonings, respectively. 92% of patients were discharged from the emergency department, while 14 patients (1.4%) were treated in the intensive care unit. Mortality due to poisoning was not observed during the five years.Conclusion: Poisoning is an important and preventable cause of morbidity in the pediatric age group. Accidental poisoning is frequently observed in children younger than five years of age while suicidal poisoning is common in adolescence. Drugs and caustic/corrosive substances were found to be the most important cause of poisoning. Recognition of these epidemiologic and clinical features according to age groups will contribute to rapid diagnosis and treatment as well as reduction in incidence of poisoning by taking the necessary precautions.</p