Parental beliefs and practices regarding childhood fever in Turkish primary care.

BACKGROUND: Fever is a very common problem in pediatric age and is one of the most common reasons parents seek medical attention. We aimed to investigate beliefs, habits, and concerns of Turkish parents regarding their children's fever. MATERIALS AND METHODS: We performed a cross-sectional survey which was conducted as face-to-face interviews by family physicians from April to June 2014 in family healthcare centers in nine different cities in Turkey. Parents with a child with fever aged between 0 and 14 years were interviewed. The participants were asked questions about sociodemographic data, the definition and measurement of fever, antipyretics, and other interventions used to reduce fever before presenting to the primary care center. RESULTS: A total of 205 parents participated in this study. Ninety-four parents (45.8%) measured fever with a thermometer prior to presentation. Only 36 parents (38%) used the thermometer correctly. Thirty-eight parents (18.5%) knew the correct temperature definition of fever for the measured site. A mercury-in-glass thermometer was the choice for most parents (78%) and preferred site for measurement was axillary region (85%). The fever was treated prior to arrival by 171 parents (83.4%). Paracetamol was the most frequently used antipyretic. Fifty-four parents (31.5%) failed to administer the correct antipyretic dose, and 73 parents (42.6%) failed to give the antipyretics at proper intervals. One hundred and fifty-three parents (67%) believed that if not treated fever could cause convulsions. CONCLUSION: We conclude that parents share important misconceptions about definition, treatment, and consequences of childhood fever and tend to treat fever before seeking medical care with a substantial rate of wrong doses and wrong intervals.

Drugs with anticholinergic side-effects in primary care.

BACKGROUND: Anticholinergic drugs in elderly people have been associated with some serious side-effects. Patients in Turkey tend to attend primary care centers to have prescriptions of the drugs they chronically use. However, very little are known about how frequent that these drugs are prescribed and their side-effects in Turkish population. We aimed to investigate the usage and side-effects of drugs with anticholinergic properties in patients over 65 years of age attending to primary care centers. MATERIALS AND METHODS: Five hundred and sixty-three subjects were interviewed with a questionnaire of 16 questions inquiring their medication and possible side-effects. Timed up and go test (TUGT) and standardized mini-mental test (SMMT) were also performed. RESULTS: Medical records of 563 individuals were screened to detect anticholinergic medication. Twenty-eight patients were using anticholinergic medication. Mean duration of anticholinergic medication usage was 3.17 years. Mean number of falls occurred in the previous year was 1.14 ± 1.17. Mean SMMT score was 27.20 ± 1.13. Mean TUGT scores mean was 12.4 ± 1.25. Drowsiness in 18 patients (65%), dry mouth in 15 patients (53%), dry eyes in 15 patients (53%), constipation in 11 patients (39%), blurred vision in 11 patients (%39), urinary hesitancy in eight patients (28%), confusion in six patients (21%) were reported. We found that none of the subjects were evaluated in terms of fall risk or mental status by their doctors before the prescription of drugs with anticholinergic effects. CONCLUSIONS: A suggested approach to improve drug safety was reported as to reduce the use of anticholinergic drugs when it is possible. Psychiatrists and family physicians should select less anticholinergic drugs for medication and have to evaluate their patients' fall risk and their cognitive status before prescribing drugs with anticholinergic side effects.

Penetrating shrapnel injuries of the posterior fossa.

BACKGROUND: Gunshot injuries of the posterior fossa are rare and may follow a fatal course. In posterior fossa gunshot injuries, cerebellar hematoma, contusion, obstruction of cerebrospinal fluid (CSF) circulation by the shrapnel, and intracranial hypertension caused by autoregulation loss lead to mortality in the early stage. METHODS: In this study, four cases of patients who underwent surgical intervention after penetrating shrapnel injuries of the pure posterior fossa were evaluated. RESULTS: All of the patients were male; their mean age was 26.5 ± 5 years. The lowest and highest Glasgow Coma Scale scores were 4 and 12, respectively. Neural injury was detected by computed tomography performed after systemic and neurological examination following admission to the emergency service. The shrapnel was found in the cerebellar tissue in three cases and in the fourth ventricle in one case. Following preoperative procedures, surgery was performed with the patient in the prone position. Postoperative monitoring revealed no CSF fistula, meningitis, or hydrocephalus. None of the patients required revision surgery. There were no postoperative mortalities. CONCLUSION: Due to the small volume of the posterior fossa, acute pathologies may lead to rapid neurological deterioration and death. Early surgical intervention and close postoperative follow-up after penetrating shrapnel injuries of the posterior fossa play a significant role in reducing mortality and morbidity.

Trace minerals in experimental subarachnoid haemorrhage: zinc, copper and manganese levels in rat brain tissue, blood and urine.

BACKGROUND: Zinc (Zn), copper (Cu) and manganese (Mn) are involved in regulatory systems in the cell. Their role in neuromodulator activities and redox reactions has been implicated in the pathogenesis of neurological disorders. The aim of this study was to determine changes of Zn, Cu and Mn levels in brain tissue, blood and urine after experimental subarachnoid haemorrhage (SAH). The possible importance of these trace minerals on the pathogenesis of SAH was also discussed. METHOD: Rats were divided into three groups; namely a SAH group, a control group and a normal group. Blood samples in the SAH group and normal saline in the control group were injected into the cisterna magna. No surgical procedures were performed on the normal group. Brain tissue, blood and urine samples were measured for trace minerals by atomic absorption spectrophotometry. Measurements were taken on days 3, 7 and 10 after the onset in the control and SAH groups, and on the first day in the normal group. FINDINGS: The reduced blood Zn levels and increased Zn urine loss observed in the SAH group were conspicuously significant. Furthermore, significant changes in Mn levels were also seen at different stages of the trial in the SAH group. However, differences found in the Cu levels between the groups were not significant enough to explain the results. INTERPRETATION: These results suggest that the low blood Zn levels seen throughout the stages, the low brain tissue Mn levels seen during the latter part of the trial, and the low blood Mn levels observed during the early stages, may all be related to an increased risk in experimental SAH in rats. These differences may have possible role in the pathogenesis of SAH, and further investigations into the reduced blood Mn levels observed during the study may lead to new insight into the treatment of SAH.