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Introduction: This study aimed to demonstrate the validity of the Ask Suicide-Screening Questions (ASQ) in a clinical sample consisting of adolescents admitted to child and adolescent psychiatry (CAP), and then to confirm its validation in those presenting to the pediatric emergency department (PED), which was the main target group for the study. Method: This cross-sectional study evaluated the compatibility of the ASQ with the suicide probability scale, which is a standardized measure, to identify cases with suicide risk in 248 adolescents aged 10-18 years. To demonstrate the clinical validity of the scale, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), Kappa, and area under the curve (AUC) performance metrics and 95% confidence interval (CI) values were calculated. Results: Positive screening rate, sensitivity, specificity, PPV and NPV for the CAP patients were calculated as 31.8%, 100% (95% CI: 100.0-100.0), 70.9% (95% CI: 63.4-78.4), 12.8% (95% CI: 3.2-22.3) and 100% (95% CI: 100.0-100.0), respectively. The PLR and AUC were calculated as 3.4% (95% CI: 2.7-4.5) and 0.855 (95% CI: 0.817-0.892), respectively. Positive screening rate, sensitivity, specificity, PPV and NPV for the PED patients were calculated as 28%, 100% (95% CI: 100.0-100.0), 75.3% (95% CI: 66.3-84.2), 21.4% (95% CI: 6.2-36.6) and 100% (95% CI: 100.0-100.0), respectively. The PLR, Kappa and AUC were 4.05% (95% CI: 2.82-5.81), 0.278 and 0.876 (95% CI: 0.832-0.921), respectively. Conclusion: This study showed the first evidence that Turkish adaptation of the ASQ is a valid screening tool for identifying those at risk of suicide among adolescents who applied to the CAP and PED.
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BACKGROUND: Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. METHODS: The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. RESULTS: A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. CONCLUSION: This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region.
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Antibacterianos , Pacientes Ambulatorios , Niño , Humanos , Estudios Prospectivos , Antibacterianos/efectos adversos , Combinación Amoxicilina-Clavulanato de Potasio/efectos adversos , Cefalosporinas/efectos adversos , Diarrea/inducido químicamente , Diarrea/epidemiología , Diarrea/tratamiento farmacológicoRESUMEN
BACKGROUND: Type 1 pseudohypoaldosteronism (PHA1) is a rare condition characterized by the resistance of the kidney to the effect of aldosterone. Secondary PHA1 is a syndrome that is most often related to urinary tract anomalies (UTAs) and/or urinary tract infections (UTIs). A similar pattern of electrolyte impairment is seen in congenital adrenal hyperplasia (CAH) and secondary PHA1, and CAH is a condition that requires urgent treatment. In our study, eight patients aged between 15 days and 8 months (seven males and one female) were included in the evaluation. It was aimed to evaluate cases of secondary PHA1 in our clinic and to identify the problems encountered in diagnosis and follow-up. METHODS: The records of the patients who presented to our hospital between February 2010 and 2021 were retrieved and retrospectively scanned. RESULTS: In all cases, hyponatremia, hyperkalemia, hyperaldosteronism, and hyperreninemia were detected. Other biochemical and hormonal tests were normal. Leukocytosis was detected in urine analysis, and urine cultures were productive. UTA was detected in five cases. Nine episodes of PHA1 occurred in eight patients and fungal infections were responsible for causing two episodes. Four episodes of PHA1 needed mineralocorticoid treatment. On the third day, serum electrolytes normalized. Fludrocortisone treatment was continued for 1 week. In one case, UTIs were repeated with PHA1, but in the follow-up, there were no additional problems. CONCLUSIONS: Secondary PHA1 should be kept in mind when hyponatremia and hyperkalemia are seen, especially in infants aged under 3 months or older, up to 8 months, who present with non-specific symptoms. Fungal infections should not be forgotten in UTI etiology because PHA1 episodes can be initiated. If CAH is suspected, mineralocorticoid treatment should be rapidly initiated.
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Hiperplasia Suprarrenal Congénita , Hiperpotasemia , Hiponatremia , Seudohipoaldosteronismo , Infecciones Urinarias , Hiperplasia Suprarrenal Congénita/complicaciones , Hiperplasia Suprarrenal Congénita/diagnóstico , Femenino , Humanos , Hiperpotasemia/complicaciones , Hiponatremia/etiología , Lactante , Masculino , Mineralocorticoides , Seudohipoaldosteronismo/diagnóstico , Seudohipoaldosteronismo/etiología , Seudohipoaldosteronismo/terapia , Estudios Retrospectivos , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnósticoRESUMEN
Background: The health impact of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) spans across all age groups including mothers and their newly born infants; and breastfeeding women during this pandemic deserves special attention due to its short and long-term health implications. When planning the current study, our hypothesis was that the anxiety of transmitting the COVID-19 disease to the baby through breastfeeding would increase among breastfeeding women and it would predominantly be state anxiety. The current study aims to investigate the relationship between the knowledge levels of breastfeeding mothers about COVID-19 and their anxiety levels. Materials and Methods: This is a cross-sectional study and we aimed to reach all mothers with babies between 0 and 24 months of age who applied to the Healthy Child Care Policlinic of Ankara University Faculty of Medicine Hospital between July 1 and August 31, 2020 Questionnaires measuring the level of knowledge about COVID-19 disease and breast milk and questionnaires measuring anxiety levels were administered to mothers. The state-trait anxiety levels and knowledge levels of breastfeeding mothers about COVID-19 disease, as well as their knowledge levels about breast milk and sociodemographic characteristics were compared. Results: A total of 145 breastfeeding mothers were included in the study. The trait anxiety was found to be either absent or mild in 89 (61.4%), moderate in 28 (19.3%), and advanced in 28 (19.3%) mothers. The state anxiety level, however, was found to be either absent or mild in 51 (35.2%), moderate in 42 (29%), and advanced in 52 (35.9%) mothers. When mothers' trait and state anxiety levels and their knowledge levels about breast milk, their knowledge levels about COVID-19 disease and their sociodemographic characteristics were compared, it was determined that mothers with 0-6 months old infants had lower state anxiety levels compared to mothers with older infants. However, the anxiety levels of mothers whose children were >12 months old were mostly moderate (p < 0.05). There was no statistically significant difference in terms of other variables (p < 0.05). A positive correlation was found between the child age and state anxiety level (p = 0.027). Conclusion: Moderate and advanced level of state anxiety was found to be higher than level of trait anxiety parallel to our hypothesis. Among breastfeeding mothers, those with the lowest state anxiety scores were those who had babies between 0 and 6 months. It is important to support breastfeeding mothers in promoting breastfeeding, especially after 6 months of birth. Policymakers, obstetricians and especially the family physicians should be aware that adverse life events may put a higher burden on the emotional wellbeing of breastfeeding women especially after 6 months of birth of the babies. So, breastfeeding promotion, protection and support strategies should be reconsidered specially after 6 months.
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Lactancia Materna , COVID-19 , Ansiedad/epidemiología , COVID-19/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: The diagnosis of cows milk protein allergy (CMPA) is not always easy. Cow's Milk-related Symptom Score (CoMiSS) has been developed to raise the awareness of CMPA among the primary health-care providers. In this study, we aimed to evaluate the validity of CoMiSS as a diagnostic approach of CMPA in infants in our country. METHODS: Infants with a CoMiSS of more than 12 points were included. An elimination diet was implemented in these infants for 4 weeks, and CoMiSS was reapplied. Infants with a reduction of ≥3 points in CoMiSS were considered responsive to the elimination diet, and an open oral challenge test was performed. Infants with symptom recurrence were diagnosed with CMPA. RESULTS: The study included 168 infants. When they were included in the study, the first CoMiSS score was 13.6 ± 1.9. After the elimination diet, the number of responsive infants was 154 (91.7%). Of the infants, 91 (54.2%) were diagnosed with CMPA with positive challenge. The majority of the patients diagnosed with CMPA presented with gastrointestinal and/or dermatological symptoms (80.3%). Positive family history of allergy was more prevalent in CMPA(+) infants (P < 0.001). The mean atopic dermatitis score was higher in CMPA(+) infants (P = 0.001). Eosinophilia and cows milk-specific IgE (CM-sIgE) positivity were more prevalent in infants with CMPA (P = 0.01 and P < 0.001, respectively). CONCLUSIONS: CoMiSS is a valuable tool to evaluate CMPA in primary care. The presence of multiple symptoms, especially skin involvement, helps to recognise infants with CMPA. Family history and eosinophilia also support the diagnosis of CMPA.
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Hipersensibilidad a la Leche , Leche , Alérgenos , Animales , Bovinos , Niño , Femenino , Humanos , Inmunoglobulina E , Lactante , Hipersensibilidad a la Leche/diagnóstico , Proteínas de la Leche , RecurrenciaRESUMEN
Tobacco or tobacco products (TTP) are harmful because they contain nicotine and some heavy metals. In this study, it was aimed to evaluate whether the responses of parents to questionnaires were compatible with the hair cotinine levels of their children, and to investigate whether exposure to environmental tobacco smoke (ETS) and living conditions increased the levels of cotinine, lead (Pb), arsenic (As), and cadmium (Cd) in the hair samples of the children. Questionnaires were administered to the parents questioning household consumption of TTP and living conditions. Children were grouped as "exposed to ETS" (E-ETS) and "not exposed to ETS" (NE-ETS). This grouping was performed through a questionnaire-based evaluation, and a hair cotinine cut-off value-based evaluation. According to the questionnaire-based evaluation, there were no significant differences in hair Pb, As, and Cd levels between the groups (P-values: .337, .994, and .825, respectively). The hair cotinine of the E-ETS group was higher (0.24 ± 0.21 vs 0.22 ± 0.15 ng/mg), but the difference was not statistically significant (P = .317). According to the cotinine evaluation, cotinine, Pb, and As levels were statistically higher in the E-ETS group (P < .001, <.001, and .036, respectively), but there was no statistical difference between the groups in terms of Cd levels (P = .238). Our results showed that exposure to ETS increased the levels of cotinine, Pb, and As in the hair samples of children, and the questionnaire responses of the parents about their smoking habits might not be compatible with the hair cotinine levels of the children.
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Cotinina/análisis , Cabello/química , Metales/análisis , Contaminación por Humo de Tabaco , Niño , Cotinina/metabolismo , Femenino , Cabello/metabolismo , Humanos , Masculino , Metales/metabolismo , Nicotina/análisis , Padres , Fumar , Encuestas y Cuestionarios , NicotianaRESUMEN
BACKGROUND: The aim of this study is to determine whether pentraxin 3 (PTX3) levels can be used in the diagnosis of appendicitis in children. METHODS: Fifteen children under 18 years old, who gave blood samples for reasons other than inflammatory conditions, and 40 children who were proved to have appendicitis (non-perforated or perforated) between August 2017 and January 2018, were enrolled in the study. Patients were classified into subgroups: group 1 (healthy children without any sign of inflammation, n = 15), group 2 (non-perforated appendicitis, n = 25), and group 3 (perforated appendicitis, n = 15). RESULTS: The median PTX3 value was 1.01 ng/mL (minimum value: 0.82, maximum: 1.28) in the control group. The median PTX3 values prior to surgery were 20.68 ng/mL (minimum: 1.02, maximum: 28.471) and 1.46 (minimum: 1.05, maximum: 23.421) ng/mL for non-perforated appendicitis and perforated appendicitis respectively. The PTX3 levels were significantly higher in groups 2 and 3 than in group 1 (P < 0.01). According to receiver operating characteristics analysis the cut-off value of PTX3 levels at admission for appendicitis was 1.30 ng/mL with a sensitivity of 75% and a specificity of 100% (area under the curve, 0.939; P = 0.000). CONCLUSIONS: Pentraxin 3 levels were significantly higher in children with appendicitis than in healthy children. Children with high PTX3 levels complaining of right lower quadrant pain may support a diagnosis of appendicitis. Future studies should be conducted to evaluate changes in PTX3 levels by comparing children with appendicitis versus acute abdominal pain in larger populations to further determine the value of PTX3 in the diagnosis of appendicitis in children.
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Apendicitis/diagnóstico , Proteína C-Reactiva/análisis , Componente Amiloide P Sérico/análisis , Dolor Abdominal/diagnóstico , Apendicitis/sangre , Biomarcadores/sangre , Niño , Femenino , Humanos , Inflamación/diagnóstico , Leucocitos/metabolismo , Recuento de Linfocitos , Masculino , Neutrófilos/metabolismo , Curva ROCRESUMEN
OBJECTIVES: We aimed to call attention to respiratory system manifestations which occur in the course of many inherited metabolic diseases (IMD), and present as the leading cause of death. MATERIALS AND METHODS: We retrospectively reviewed the diagnosis, treatment, and outcome of patients evaluated at our hospital between June 2012 and June 2018 with a diagnosis of IMD and accompanying respiratory manifestations. RESULTS: A total of 50 children (29 [58%] male, 21 [42%] female) with IMD and respiratory manifestations were defined. Disorders of intracellular metabolism (n = 33, 66%) formed the majority, followed by intoxication type metabolic disorders (n = 9, 18%) and energy metabolism disorders (n = 8, 16%). The most frequent respiratory symptoms were snoring (20, 40%), tachypnea (16, 32%) and wheezing (14, 28%). Physical examination findings were signs of respiratory distress (n = 28, 56%), crackles (n = 24, 48%), thoracic deformity (n = 23, 46%), decreased breath sounds (n = 17, 34%), rhonchus (n = 17, 34%), wheezing (n = 17, 34%) and stridor (n = 10, 20%). Major respiratory manifestations were chronic airway aspiration (n = 23, 46%), upper airway obstruction (n = 23, 46%), and recurrent pneumonia (n = 18, 36%). Twenty-three 23 patients (46%) experienced endotracheal intubation, 9 patients (18%) required whole-house mechanical ventilation and tonsilloadenoidectomy was performed in 7 patients (14%). Overall survival rate was 70% (n = 35) in a median follow-up period of 2.36 (0.05-5.86) years. CONCLUSIONS: Respiratory system manifestations of IMD strongly relate with increased morbidity and mortality. Therefore, prompt diagnosis and correct intervention of respiratory complications with a multidisciplinary team including pediatric metabolic diseases specialists, pulmonologists, otorhinolaryngologists, physiotherapists, and anesthesiologists are crucial to prevent progression and irreversible damage.
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Enfermedades Metabólicas/complicaciones , Enfermedades Respiratorias/complicaciones , Adenoidectomía , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Intubación Intratraqueal , Masculino , Respiración Artificial , Estudios Retrospectivos , TonsilectomíaRESUMEN
Subaponeurotic (subgaleal) fluid collection (DSFC) is a rare clinical entity of unknown etiology. We aimed to present our series of infants who were diagnosed with DSCF at Ankara University Children's Hospital. We retrospectively reviewed clinical findings, imaging studies, laboratory tests, management, and clinical courses of infants diagnosed with DSCF between June 2014 and June 2018. Five infants (4 males, 1 female), aged 5-14 weeks, were identified during the study period. All deliveries were non-progressive (3 normal deliveries, 2 cesarean sections) while instrumentation (vacuum extraction or forceps) was used in 2. History of recent trauma, concern for child abuse, and family or personal history of coagulopathy were negative for all patients. Conservative management with the spontaneous resolution was observed in 2 to 12 weeks in all infants. Although rare, DSFC should always be kept in mind in the differential diagnosis of scalp swelling in young infants. The diagnosis is primarily clinical, and current treatment is conservative.
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Edema/diagnóstico por imagen , Edema/terapia , Cuero Cabelludo/diagnóstico por imagen , Tratamiento Conservador/métodos , Femenino , Humanos , Lactante , MasculinoRESUMEN
Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38-65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms. What is known? ⢠Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential. ⢠Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough. What is new? ⢠We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores. ⢠We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.
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Tos/etiología , Apnea Obstructiva del Sueño/diagnóstico , Adolescente , Algoritmos , Niño , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Tos/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Polisomnografía , Estudios Prospectivos , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/terapia , Encuestas y CuestionariosRESUMEN
Çullas-Ilarslan NE, Günay F, Ileri DT, Elhan AH, Ertem M, Arsan S. Investigation of the frequency of iron insufficiency among infants in a population in which routine iron supplementation is implemented. Turk J Pediatr 2018; 60: 22-31. Iron deficiency anemia (IDA) represents the most common cause of anemia worldwide. Because of potential irreversible neurodevelopmental impairment, its prevention during infancy is essential. We aimed to investigate the frequency of iron insufficiency among infants in a population which routine iron supplementation is implemented; and to examine related risks. A total of 501 infants, aged 9-15 months, were screened with complete blood count and serum ferritin. Infants were divided into two groups. [Group 1 (iron insufficient), [Group 1a: Iron deficiency (ID), Group 1b: IDA (IDA)], Group 2 (Iron sufficient (IS)]. Anemia was recognized in 122 (24.3%) infants. Microcytosis was observed in 110 (90.2%) of anemic infants. Group 2 accounted for 49.5% (n=248) whereas 152 (30.3%) and 101 (20.2%) infants belonged to Groups 1a and 1b, respectively. Multiple logistic regression analysis showed that male gender (OR=1.53; 95%CI 1.07 and 2.17), receiving > 500 ml/day cow`s milk (OR=2.77; 95%CI 0.87 and 8.83) and incompliance to iron supplementation (OR=2.51; 95%CI 1.75 and 3.60) were distinctive characteristics of Group 1 while prevalence of iron insufficiency was higher in infants consuming less formula (OR=3.10; 95%CI 2.00 and 4.80). The most frequent reasons for incompliance were consideration of supplementation as unnecessary (n=69, 31.1%) and neglection (n= 59, 26.6%). Our study demonstrated a high frequency of iron insufficiency among infants in a setting utilizing national iron supplementation and `incompliance` to iron as the most evident risk factor for iron insufficiency. Effective counseling of families by health care providers concerning importance of compliance to iron prophylaxis is essential for prevention of iron insufficiency. We also suggest screening of infants for ID as well as IDA in settings with high frequency of iron insufficiency.
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Anemia Ferropénica/epidemiología , Hierro/uso terapéutico , Análisis de Varianza , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/prevención & control , Recuento de Células Sanguíneas , Estudios Transversales , Femenino , Ferritinas/sangre , Humanos , Lactante , Alimentos Infantiles , Deficiencias de Hierro , Masculino , Tamizaje Masivo , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Turquía/epidemiologíaRESUMEN
OBJECTIVES: Otitis media with effusion (OME) is an important clinical entity because of its high prevalence, difficulties in diagnosis, complications and diversities in management. Herein, we aimed to evaluate current physician approaches on OME and determine clinical adherence to current guidelines. METHODS AND MATERIALS: A total of 370 physicians [Group 1: pediatricians (nâ¯=â¯256, 69.2%), Group 2: otorhinolarynologists (nâ¯=â¯114, 30.8%)] completed a survey instrument addressing demographic data and clinical practice parameters on OME in children. We also compared clinical approaches of Group 1 and Group 2. In addition, multiple logistic regression analysis was performed to evaluate factors which may effect correct approaches. RESULTS: The mean period of clinical experience was 9.30⯱â¯8.35 [median 6 (1-40)] years. A total of 311 (84%) respondents reported satisfactory level of self-confidence as regards of clinical approaches to OME. Reduced mobility of the tympanic membrane and preference of pneumatic otoscopy was signified by 107 (28.9%) and 64 (17.3%) respondents, respectively. Fifty-six (15.1%) physicians identified "watchful waiting" for 3 months for children who are not at risk while 314 (84.9%) reported preference of medications, with antibiotics the most preferred prescription (nâ¯=â¯223, 63%). Comparison of Group 1 and Group 2 indicated similar results except better, yet insufficient, characterization of physical examination findings of OME by Group 2 (pâ¯<â¯0.001, for each parameter). Group 2 preferred tympanometry more in uncertain cases (pâ¯<â¯0.001) and handled chronic cases better (pâ¯<â¯0.001). Multiple logistic regression analysis revealed lower signification of reduced mobility of the tympanic membrane for respondents who denoted depending on personal experience ([OR]â¯=â¯3.077 [95% CI 1.042-9.09]) or following clinical guidelines ([OR]â¯=â¯3.365 [95% CI 1.38-8.20]) rather than combining them both. Rate of antibiotic avoidance was lowest in physicians with a period of clinical experience<5 years ([OR]â¯=â¯2.14 [95% CI 1.32-3.48]). CONCLUSIONS: Despite notifying high self-confidence and adherence to current guidelines on OME, both pediatricians and otorhinolaryngologists lacked to exhibit proper approaches. Further research is warranted to evaluate the causes of poor adherence to current guidelines and bring suggestions for the maintenance of consistent and correct clinical approaches to OME.
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Pruebas de Impedancia Acústica , Adhesión a Directriz/estadística & datos numéricos , Otitis Media con Derrame/diagnóstico , Otorrinolaringólogos/estadística & datos numéricos , Otoscopía , Pediatras/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Espera Vigilante , Enfermedad Aguda , Antibacterianos/uso terapéutico , Niño , Preescolar , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Lactante , Modelos Logísticos , Masculino , Otitis Media/diagnóstico , Otitis Media/terapia , Otitis Media con Derrame/terapia , Médicos , Investigación , Riesgo , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: Today no method of topical anesthesia for intravitreal injection administration has been proven to make the patient comfortable yet. We compared the efficacy of topical levobupivacaine 0.75% and proparacaine 0.5% in patients undergoing intravitreal injections. MATERIALS AND METHODS: A prospective, randomized study comparing two agents for topical anesthesia in intravitreal injections. Ninety-six consecutive patients were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=48) or proparacaine 0.5% (n=48). Patients were asked to score their pain using a visual analog scale (VAS) immediately following the injection. The average of these scores was used as the primary outcome. The surgeon performing the procedure scored his perception of the patients' pain using the Wong-Baker FACES scale. RESULTS: Mean VAS pain scores for two groups were found to be 44.77 ± 16.42 and 34.18 ± 14.83, respectively. Mean VAS pain score in the proparacaine group was significantly lower than that in the levobupivacaine group (P= 0.003). Mean Wong-Baker FACES scores for the two groups were 1.08 ± 0.49 and 1.10 ± 0.30, respectively. There was no statistically significant difference between levobupivacaine and proparacaine groups (P=0.824). CONCLUSIONS: Topical proparacaine 0.5% was more effective in preventing pain during intravitreal injections.
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UNLABELLED: Late-preterm birth is associated with higher rates of neonatal morbidity and mortality and higher health care utilization, but its impact on later life is not well known. In this study, we aimed to evaluate whether late-preterm birth affects blood pressure, renal function, and urinary protein excretion in children later in life. Sixty-five children aged 4 to 13 years born as late-preterm and 65 age- and sex-matched children born full term were evaluated with 24-h ambulatory blood pressure monitoring (ABPM), urinary microalbumin excretion (UAE), and glomerular filtration rate (GFR). All subjects underwent ABPM prospectively. For each gender, daytime, nighttime, and 24-h systolic and diastolic and mean blood pressures (SBP, DBP, and MAP) were transformed to standard deviation scores (SDS). Blood pressure profiles (SBP DBP, and MAP) were considered abnormal when the corresponding SDS values exceeded 1.63. Urinary microalbumin excretion was expressed as milligrams per day, and the value between 30 and 300 mg/day was defined as microalbuminuria (MA). There was no significant difference in the mean GFR and MA levels between late-preterm and term children. 24-h systolic BP SDS, daytime systolic BP SDS, nighttime systolic BP SDS, 24-h diastolic BP SDS, nighttime diastolic BP SDS, 24-h MAP BP SDS, daytime MAP BP SDS, and nighttime MAP BP SDS were found to be significantly higher in late-preterm children compared to term children. CONCLUSION: We conclude that late-preterm children have higher BP levels, so those children should be followed up carefully by the pediatrician regarding probable hypertension in their future life.
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Hipertensión/etiología , Nacimiento Prematuro , Adolescente , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial , Niño , Preescolar , Femenino , Tasa de Filtración Glomerular , Humanos , Recién Nacido , Masculino , Embarazo , Proteinuria/metabolismo , Factores de RiesgoRESUMEN
The purpose of this work is to study the effectiveness of silicone oil, heavy silicone oil and perfluorodecaline against Bacillus cereus. For this we tested the antimicrobial activities of three intraocularly used liquids--silicone oil (Siluron 1000), heavy silicone oil (Densiron-68) and perfluorodecaline (F-Decalin)--against B. cereus (NCTC 9946). The antimicrobial effects of silicone oil, heavy silicone oil and perfluorodecaline were determined by the growing capability of the microorganism. We found that the number of B. cereus decreased in all three concentrations of silicone oil. The bacteria grew for approximately 2 weeks in heavy silicone oil and declined after 17 days. Perfluorodecaline significantly reduced B. cereus colonies and was the most effective of the liquids. In conclusion, silicone oil and perfluorodecaline seem to be effective against B. cereus.