Short-term azithromycin use is associated with QTc interval prolongation in children with cystic fibrosis.

BACKGROUND: Azithromycin is used for children with cystic fibrosis (CF) for its immunomodulatory and anti-inflammatory action. This study investigated the short-term alterations in QTc interval associated with azithromycin prophylaxis in pediatric patients with CF. METHODS: This study included 121 patients with mild CF, of whom 76 received azithromycin (patient group) and 45 did not receive azithromycin (control group). The patient and control groups were categorized according to age as under 12 years of age and over 12 years of age. The first presentation measured all the patient and control groups at basic QTc time intervals. The QTc intervals of all patients were then remeasured systemically at 1, 3, and 6 months. Age categories and QTc intervals that were calculated at each month in the patient and control groups were compared statistically. RESULTS: A statistically significant difference was detected in the patient group between the initial QTc interval time and the electrocardiogram (ECG) findings in the first and third months after prophylaxis treatment (p < 0.001; p = 0.01). However, no statistically significant difference was detected in the sixth month (p > 0.05) in all groups. Almost all of the children's QTc intervals were within normal range and within the safety zone (under 0.44 s). No statistically significant difference was detected in the control group between the initial ECG and the QTc intervals measured at 1, 3, and 6 months. CONCLUSION: Short-term use of azithromycin prophylaxis in pediatric patients with mild CF slightly increased the QTc interval in the first and third months of follow-up. Nevertheless, all QTc interval changes fell within the safety zone. Notably, 1 month of follow-up treatment should be performed to check for any alteration in the QTc interval. If increased QTc interval duration is not detected in the first month, azithromycin prophylaxis can be safely prescribed.

Diagnostic role of gray-scale and shear-wave elastography in pediatric patients with undescended testes: a prospective controlled study.

Aim: Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes. Material and methods: Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10-118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys' testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group. Results: Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group's echogenicity was normal (p <0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70-0.85, sensitivity 83.7%, specificity 68.7%, p <0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes. Conclusion: The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.

Determining Self-Efficacy of Nurses Who Graduated From Distance Education Because of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study.

BACKGROUND: The current literature states that distance education has caused a lack of professional skills, regression of existing professional skills (Kaya & Akin Isik, 2021; Kürtüncü & Kurt, 2020), a lack of self-confidence, and feelings of inadequacy among nursing students (George et al., 2020). The current study examined the professional self-efficacy of nurses who graduated from distance education because of the coronavirus disease 2019 pandemic. METHOD: This multicenter cross-sectional study was conducted between November 2020 and June 2022 with 164 nurses who graduated from distance education in 2020-2021 from three faculties of health sciences. RESULTS: Professional self-efficacy of the nurses was found to be above average. Male nurses and nurses who believed distance education had a negative impact on their professional skills had significantly higher professional self-efficacy. Some nurses reported that their professional theoretical knowledge was insufficient and defined the effect of distance education on their professional skills as relatively negative. CONCLUSION: Most of the nurses expressed that distance education had a negative effect on their professional self-efficacy and working life. [J Contin Educ Nurs. 2023;54(10):480-488.].

A qualitative case study about overuse of digital play at home.

The prevalence of digital play devices, including tablets and smartphones, has led to overuse among some young children. The purpose of this research is to examine the overuse cases among young children. Participants of this qualitative case study were five children aged five to seven years, their parents, and a psychiatrist. The data were mainly obtained through semi-structured interviews. Interviews were further supported by close observations, a collection of digital play diaries, as well as an interview with a psychiatrist who specializes in childhood gaming addiction. Then data analyzed using content analysis techniques. The results are presented in five themes: practices, reasons, feelings about overuse, restricting playtime, and content. The first three themes described the nature of the overuse, while the last two themes described the parents' efforts to restrict their children's digital play. Findings revealed that the joint effects of different factors triggered children's overuse, that parents and children felt a range of emotions from happiness to aggression, and that parents' restrictive mediation strategies were mostly infective.

Role of derived neutrophil-to-lymphocyte ratio, uric acid-to-creatinine ratio and Delta neutrophil index for predicting neonatal outcomes in pregnancies with preeclampsia.

We aimed to compare the maternal and neonatal systemic inflammatory markers, platelet indices and new indices in biochemical parameters in women with preeclampsia and healthy controls. The secondary aim was to investigate whether there was a relationship between maternal hematological markers and neonatal outcomes. A retrospective case control study was conducted in a tertiary hospital. Maternal demographic and birth characteristics, complete blood count indices, derived neutrophil to lymphocyte ratio (dNLR), Delta neutrophil index (DNI), uric acid-to-creatinine (Cre) ratio and uric acid-to-alanine transaminase ratio, neonatal hematological parameters were compared between the preeclamptic group and control group. The study consisted of 170 cases (84 preeclampsia and 86 control). Neutrophil-to-lymphocyte ratio (NLR), dNLR, blood urea nitrogen (BUN), creatinine (Cre), uric acid, LDH, aspartate transaminase (AST) and alanine aminotransferase (ALT), uric acid-to-Cre ratio and uric acid-to-ALT ratio were higher and statistically significant in the preeclamptic group than in control ones (p: 0.000 - BUN, Cre, uric acid, LDH, p: 0.001 - AST, p: 0.004 - ALT, p: 0.000 - uric acid-to-Cre ratio, p: 0.009 - uric acid-to-ALT ratio, respectively). NLR and platelet-to-lymphocyte (PLR) ratio were significantly higher in newborns of preeclamptic mothers (p: 0.039; p: 0.004, respectively). A low-moderate correlation between maternal uric acid-to-Cre ratio and neonatal PLR was detected (r: 0.193; p: 0.013). Moreover, moderate negative correlations between maternal PLR (r:-0.231, p: 0.002), uric acid (r: 0.332, p:0.000) and adverse neonatal outcomes were found. Uric acid and PLR, which can be easily calculated clinically may predict adverse neonatal outcomes.IMPACT STATEMENTWhat is already known about this topic? Preeclampsia is known as a significant cause of maternal morbidity and mortality. Haematological indices have been evaluated for the prognosis of many kinds of disease.What do the results of this study add? This study has focussed on new combined haematological-biochemical indices and its relationship with neonatal outcomes. Both higher NLR, derived NLR, DNI and lower PLR were recorded as useful markers for preeclampsia.What are the implications of these findings for clinical practice and/or further research? Some indices that were calculated by assessing basic and simple blood parameters may help clinicians to predict clinical outcomes of preeclampsia.

Differentiating children with familial Mediterranean fever from other recurrent fever syndromes: The utility of new Eurofever/PRINTO classification criteria.

Objectives: In this study, we aimed to investigate the performance of Eurofever Registry and the Paediatric Rheumatology International Trials Organisation (PRINTO) classification criteria in pediatric patients with familial Mediterranean fever (FMF). Patients and methods: This retrospective, cross-sectional study included a total of 130 pediatric FMF patients (67 males, 63 females; mean age: 12.4±3.6 years; range, 2.5 to 17.7 years) with at least one M694V mutation in MEFV gene between July 2010 and July 2019. Demographic features and disease characteristics were recorded. The control group was consisted of 41 patients (19 males, 22 females; mean age: 7.8±4.0 years; range, 2.1 to 17.8 years) with other hereditary autoinflammatory diseases (AIDs), including periodic fevers with aphthous stomatitis, pharyngitis, and adenitis syndrome (n=30), mevalonate kinase deficiency (n=9), and tumor necrosis factor receptor-associated periodic syndrome (n=2). Sensitivity and specificity of the Eurofever/PRINTO classification criteria were calculated. Results: The sensitivity and specificity were 97.7% and 56.1% for Yalcinkaya-Ozen criteria, respectively and 93.1% and 90.2% for Tel Hashomer criteria, respectively. The Eurofever/PRINTO classification criteria reached a sensitivity and specificity of 94.6% and 82.9% and 93.1% and 80.5%, respectively, when genetic plus clinical criteria and clinical-only criteria were applied. Conclusion: The Eurofever/PRINTO classification criteria have a comparable sensitivity for avoidance of FMF underdiagnosis in childhood. The Yalcinkaya-Ozen criteria have the highest sensitivity without a significant specificity. The Tel Hashomer criteria and Eurofever/PRINTO classification criteria were superior to Yalcinkaya-Ozen criteria to differentiate FMF from other AIDs, thus leading to less complications relevant to underdiagnosis of other AIDs.

Seroprevalence of Toxoplasma gondii infections in Syrian pregnant refugee women in Turkey.

OBJECTIVE: Congenital infections in refugee women have been very rarely studied. The purpose of this study is to investigate the Toxoplasma gondii (T. gondii) seroprevalence in Syrian pregnant refugee women living in Turkey and to discuss the differences with Turkish pregnant women. STUDY DESIGN: This is a retrospective cohort study including 752 pregnant refugee women and is based on the nine-year data of a reference public hospital in Ankara. RESULTS: In the study group, T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) seropositivity rates were 47 % and 0.4 %, respectively. Compared with a recent study conducted in the same center on Turkish native pregnant women, there was a significant difference in IgG seropositivity and no significant difference in IgM seropositivity. CONCLUSION: Due to the seroprevalence difference between the indigenous and refugee groups, the Syrian refugee women has to be specifically considered in the prevention of congenital toxoplasmosis infections in Turkey.

Evaluation of different classification criteria in children with Behcet disease: results from a single referral center.

OBJECTIVES: Behcet Disease (BD) is a systemic vasculitis, first described with a triad of oral aphthous ulcers, genital ulcers, and uveitis. The authors aimed to share the clinical properties and utilities of three distinct classification criteria for BD in this study. METHODS: This case-control study was conducted in pediatric BD patients, diagnosed between January 2012 and July 2019. The control group included 53 children with other rheumatic disorders. Sensitivity and specificity for International Study Group (ISG), International Criteria for BD (ICBD), and pediatric criteria for BD (PEDBD) criteria were tested. RESULTS: The mean age at symptom onset and diagnosis of the 16 BD patients (6 females, 10 males) were 11.2 ± 3.6 and 13 ± 3.1 years, respectively. The sensitivity and specificity of ISG criteria were 87.5% and 100%. Furthermore, ICBD criteria had a sensitivity and specificity of 93.7% and 98.1%, whereas the authors found sensitivity and specificity as 93.7% and 96.2% for PEDBD. CONCLUSION: ICBD and PEDBD reached higher sensitivity for pediatric BD diagnosis and ICBD had the highest specificity. The authors speculate that the utilization of ICBD may provide early diagnosis of BD in childhood, prevent related morbidities and misdiagnosis.

An Exploration of Nursing Students' Clinical Decision-Making Process.

PURPOSE: This study was carried out descriptively and retrospectively with the purpose of determining nursing diagnoses used by intern students in their clinical practice. METHODS: The study data were obtained by checking the care plans of the internship files of 248 students studying at a nursing faculty. FINDINGS: The students determined 77 different nursing diagnoses in 13 domains of North American Nursing Diagnosis Association (NANDA)-I taxonomy II. The total number of nursing diagnosis used in the care plans was 1,469. CONCLUSION: Most of the diagnoses determined by the students were in the "safety/ protection" domain; however, they determined no diagnoses in the "life principles" domain.

Teacher ratings of resilience and peer relationships of preschoolers whose fathers died unexpectedly.

This study endeavors to compare resilience and peer relationships of children who lost their fathers in a major mining accident in Soma with those who did not. Teachers rated 51 preschoolers whose fathers died, and 53 preschoolers whose fathers were alive. On the negative side, bereaved children had lower resilience and higher exclusion; on the positive side, bereaved children had lower peer victimization and higher prosocial behavior. Death of fathers is associated with lower resilience and more exclusion among young children, but others treat them better as well.

Laparoscopic management of primary abdominal pregnancy: a case report.

This is a case report of a primary abdominal pregnancy managed by laparoscopic intervention. A 22 year old, gravida 1, woman was admitted to our emergency room with vaginal bleeding and pain in lower abdomen. She was 4 weeks pregnant according to her last menstrual period. She had undergone right salpingoophorectomy previously. Pelvic examination revealed cervical motion tenderness, bilateral adnexal tenderness and rebound tenderness. Her vital signs were normal. Beta hCG was 15826 IU/ml and hemoglobin was 10.0 g/dl. Transvaginal sonography showed an endometrium of 3 mm thickness and free fluid in the pelvis. Upon admission to the Early Pregnancy Clinic, abdominal pain became worse and hemoglobin decreased to 8.0 g/dL. Therefore, we performed a laparoscopy which showed that the uterus, left tube and ovary were completely normal with absence of the right ovary and tube. Approximately 500 cc blood was aspirated from the pelvis. Between the right sacrouterine ligament and rectum, there was a bleeding area 2 cm in width which was removed with forceps and sent for frozen pathological examination,which revealed 'placental tissue fragments'. Endometrial sampling was reported to be 'secretory endometrium'. A rapid decrease in the beta HCG post operative titer confirmed the resolution of the pregnancy. Primary abdominal pregnancy is extremely rare. The diagnosis is confirmed according to Studdiford's criteria. In the literature, there only a few cases of abdominal pregnancy in which laparoscopic procedure has been used effectively as treatment. However, laparoscopic procedure is usually successful in treatment of abdominal pregnancy if the gestational age is early enough.