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This study aimed to assess the therapeutic effects of implementing the BioFire® Blood Culture Identification 2 (BCID2) Panel (bioMérieux, Marcy l'Etoile, France) in the clinical practice of children with sepsis. This retrospective cross-sectional study included children from 15 days of age to 18 years old with sepsis and of whom the BCID2 Panel was studied from the positive blood culture. If the antimicrobial treatment was changed according to the results of BCID2 Panel, it was recorded and re-grouped as targeted antimicrobial therapy, de-escalation of the antimicrobial treatment and shifting to another antimicrobial drug if any antimicrobial resistance was detected. Seven-days and thirty-days mortality rate was recorded. Thirty-two patients with 36 septic episodes with positive BCID2 Panel results were included. The median age was 10 months 15 days (ranging from 15 days to 16.5 years). The mean difference between having positive results by the BCID2 Panel and conventional culture methods was 82.2 ± 45.4 h (ranging from 12.3 to 207 h). Effect of the BCID2 Panel on the antimicrobial treatment was detected in 69.4% of the episodes (n = 25). Glycopeptides were ceased at 6 patients, piperacillin/tazobactam was ceased at 6 patients, and cefotaxime was ceased at one patient and de-escalation was achieved in 13 episodes which formed the 36.1% of the initial antimicrobial treatment. Conclusion: The BCID2 Panel had an important impact on the patients care and optimization according to the principles of antimicrobial stewardship. The BCID2 Panel may be one of the key items for rapid and accurate diagnosis in children with sepsis. Blood culture is still the mainstay for especially detection of antimicrobial drug resistance, while BCID2 tests had several advantages such as speed and diagnostic accuracy as good as blood culture. What is Known: ⢠The BioFire® Blood Culture Identification 2 (BCID2) Panel (bioMérieux, Marcy l'Etoile, France) is a well-validated assay that allows for the simultaneous identification of 43 nucleic acid targets associated with bloodstream infections within about 1 h. What is New: ⢠BCID2 Panel had a direct impact on the patient's treatment decision at the 69.4% of the sepsis episodes. ⢠The clinicians received the microbiological results 82.2 h earlier with BCID2 panel compared to blood culture methods with antimicrobial resistance and de-escalation of the antimicrobial drugs was achieved at 13 episodes which formed the 36.1% of the initial treatment.
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Anti-Infecciosos , Bacteriemia , Sepse , Criança , Humanos , Lactente , Bacteriemia/diagnóstico , Hemocultura , Estudos Retrospectivos , Estudos Transversais , Sepse/diagnóstico , Sepse/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Antibacterianos/uso terapêuticoRESUMO
PURPOSE: We aimed to evaluate the demographic characteristics of children with perianal abscess, distribution of microbiological etiology, antibiotic susceptibility, and identify the effectiveness and coverage of antibiotics due to culture results. METHODS: A retrospective study was designed to evaluate pediatric patients with perianal abscesses between January 2013 and December 2022. RESULTS: A total of 197 episodes in 135 patients were evaluated. The median age of the patients was 10 months (22 days-17 years). The isolated microorganisms were Gram-positive bacteria in 56 (28.4%) patients and Gram-negative bacteria in 141 (71.6%) patients. The most common isolated species was Escherichia coli (n = 70, 35.5%), followed by Klebsiella spp. (n = 48, 24.4%), Staphylococcus aureus (n = 37, 18.9%), and Enterobacter spp. (n = 9, 4.5%). Forthy-two percent (n = 58) of isolates were positive for extended-spectrum beta-lactamase, 8% (n = 11) were carbapenem-resistant in Gram-negative bacteria, and 37.5% (n = 21) were methicillin-resistant, 7.1% (n = 4) were vancomycin-resistant in Gram-positive bacteria. According to bacterial culture results, ertapenem plus glycopeptide had the highest antimicrobial coverage rate (92.3%), followed by ertapenem plus clindamycin (89.8%), ertapenem (81.7%), third-generation cephalosporin plus glycopeptide (82.2%), third-generation cephalosporin plus clindamycin (69.5%). CONCLUSION: Ertapenem can be a good choice in the empirical treatment of perianal abscesses in children due to its high coverage rate.
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Abscesso , Antibacterianos , Bactérias Gram-Positivas , Infecções por Bactérias Gram-Positivas , Humanos , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Doenças do Ânus , Antibacterianos/uso terapêutico , Bactérias Gram-Positivas/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Estudos RetrospectivosRESUMO
The aim of the current study was to investigate the ratio and predictors of probable Prolonged Grief Disorder (PGD) among bereaved survivors eight years after the 2011 Van earthquake. Among a sample of 495 survivors who experienced loss as a result of this earthquake, 8.9% met the criteria of probable PGD. In the binary logistic regression analysis, being woman, being aged 40 or over, personal injury, property damage, losing family members, and the psychological impact of the earthquake predicted probable PGD. The current study highlights the importance of considering PGD among bereaved survivors after earthquakes.
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Luto , Terremotos , Transtornos de Estresse Pós-Traumáticos , Feminino , Pesar , Humanos , Transtorno do Luto Prolongado , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , TurquiaRESUMO
BACKGROUND: Tuberculosis (TB) infection is transmitted by sharing the same airway with people with active TB. Children are often not considered the source of TB bacilli, and index case investigation is carried out after diagnosis. Here, we describe the impact of the presence of a household index case on childhood TB disease. METHODS: The data of patients aged between 1 month and 18 years who were diagnosed with TB were collected. We compared patients according to whether they had an index case in the household or not. RESULTS: A total of 202 TB patients were enrolled, of whom 62 (30.7%) had a household index case. There was no significant difference in having a household index case between TB patients under the age of five (23.3%) and older children (33.8%) (p = .140). Pulmonary TB was present in 61.4% of the cases, and extrapulmonary TB was present in 38.6% of the cases. The rate of patients who had a household index case was significantly higher in pulmonary TB (46.8%) compared to extrapulmonary TB (5.1%) (p < .001). Pulmonary TB patients with a history of household contact were more likely to have diagnostic radiological findings (93.1%) compared to those without (75.8%) (p = .009). However, pulmonary TB patients without household contact history had a higher rate of diagnostic microbiological findings (59.1%) and constitutional symptoms (63.6%) (p = .019 and p = .013, respectively). CONCLUSION: Household contact research is an important epidemiological tool. However, considering the contact rates in the household, new and more comprehensive public health programs are required to prevent the spread of childhood tuberculosis.
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Background Vaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents ≥12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP. Methods A retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP. Results During the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval [CI]: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID-19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio [OR]: 0.347 [95% CI: 0.184-0.654]). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 [95% CI: 2.920-11.200]), and PICU admission was less frequently required (p = 0.011, OR: 0.188 [95% CI: 0.045-0.793]). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%). Conclusions This study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS-C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents' decisions may be changed, particularly those who hesitate to or refuse vaccination.
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Objective: Posttraumatic growth (PTG), defined as a positive change after a traumatic event, has become the subject of various studies, and its relationship with posttraumatic stress symptoms (PTSS) has been extensively investigated. However, studies have indicated differences in the relationship between PTG and PTSS. Therefore, this study aimed to investigate the mediating role of PTSS in the relationship between the number of traumatic losses and PTG among the 2011 Van earthquake survivors. Methods: The sample of this study consisted of 917 participants who experienced the 2011 Van earthquake. A personal information form, impact of event scale-revised (IES-R), and posttraumatic growth inventory (PTGI) were used as data collection tools. Results: Survivors with traumatic loss were found to have higher PTSS and PTG than survivors without traumatic loss. The mean scores of the PTGI subscales were higher among survivors with traumatic loss except for changes in self-perception. A positive correlation was found between IES-R and PTGI total scores. In the regression analysis, it was found that PTSS played a mediating role in the relationship between the number of traumatic losses and PTG. Conclusion: This study revealed that PTG is possible with the presence of PTSS. Mental health professionals assisting survivors with traumatic loss should take the enhancement of PTG into consideration in addition to their efforts to reduce PTSS.
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This study examines the stocks of clay brick in Toronto's single detached housing, to provide parameters for city scale material reuse and recycling. Based on consensus from the literature and statistics on Toronto's single detached housing stocks, city scale reusable and recyclable stocks were estimated to provide an understanding of what volume could be saved from landfill and reintroduced into the urban fabric. On average 2523-4542 m(3) of brick was determined to be available annually for reuse, which would account for 20-36% of the volume of virgin brick consumed in new house construction in 2012. A higher volume, 6187 m(3) of brick, was determined to be available annually for recycling because more of the prevalence of cement-based mortar, which creates challenges for brick reuse in Toronto. The results demonstrated that older housing containing reusable brick were being mostly landfilled and replaced with housing that contained only recyclable brick.
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Materiais de Construção/análise , Habitação , Mineração/métodos , Reciclagem , Gerenciamento de Resíduos , Silicatos de Alumínio/análise , Cidades , Argila , OntárioRESUMO
During the 1963-1964 ethnic conflict and 1974 war in Cyprus, many Turkish Cypriots were displaced by Greek Cypriot forces. The psychological condition of Turkish Cypriots after these conflicts has not been studied to the present day. At the time of the Annan Plan Referendum on April 24th 2004, when people on both sides were to decide whether to reunite or not, and when old traumatic events where being discussed in vivid detail, the psychological responses of the internally displaced and non-displaced Turkish Cypriots were investigated. The sample of the study derived from a sample of a larger household survey study conducted on 408 adult people taken randomly from three different districts. People who settled down in Cyprus after 1974 or who had never experienced a war in Cyprus were not included in the study. 129 Turkish Cypriots who experienced either 1963-64 conflict or the 1974 war were included in the present study. 86 of these had been displaced. The first part of the questionnaire that was administered to the subjects included demographic characteristics, war-related traumatic experiences, the level of seriousness, and traumatic incidents resulting from other circumstances. In the second part of the questionnaire, the Traumatic Stress Symptom Checklist (TSSC) and Brief Symptom Inventory (BSI) were used to investigate the symptoms of the post-traumatic process. The outcomes indicates that the internally displaced persons (IDPs) where subjected to traumatic incidents at a higher degree due to killing, displacement, captivity, or killing of family members and relatives. The rate of posttraumatic stress disorder (PTSD) of IDPs is 20%, and is significantly higher than for non-displaced persons. The comparison of BSI subscales show that IDPs had a higher level of depression scores than the non-displaced persons. The somatization subscale scores are higher in non-displaced persons. The study reveals a higher frequency of war-related traumatic events in IDPs than in non-displaced people, greater suffering from posttraumatic stress and more negative beliefs about future reunion.