Ali Bulent Cengiz

Effect of aluminum adjuvants on safety and immunogenicity of Haemophilus influenzae type b-CRM197 conjugate vaccine

Abstract Objective : The present study was carried out to evaluate the safety and immunogenicity of the Haemophilus influenzae type b‐CRM197 (Hib‐CRM197) conjugate vaccine in relation to the change of adjuvant from aluminum hydroxide to aluminum phosphate (AlPO4).

Measurement Accuracy of Fever by Tympanic and Axillary Thermometry

As the basic sciences develop, temperature measurement methods and devices were improved. For hundreds of years both in clinics and home, mercury-in-glass thermometer was the standard of human temperature measurements. In this study, we aimed to compare tympanic infrared thermometers with the conventional temperature option, mercury-in-glass thermometer, which is historical standard in the clinical conditions. Methods: A total of 102 randomly selected pediatric patients who admitted to our hospital were enrolled, and simultaneous temperature measurements were performed via axilla and external auditory canal with 3 different techniques. For external auditory recordings, infrared tympanic First Temp Genius for clinical use and Microlife IR 1DA1 for home usage were used. Classic mercury-in-glass thermometers were used for axillary recording. For each method, 886 measurements were performed. Results: The mean results of the axillary mercury-in-glass thermometers, infrared tympanic First Temp Genius, and Microlife IR 1DA1 were 36.8 ± 0.7, 37.5 ± 0.9, 36.9 ± 0.8, respectively. The Bland-Altman plot of differences suggests that 95% of the infrared tympanic clinical use thermometer readings were within the limits of agreement, which is +0.27 and −1.75°C range of mercury-in-glass thermometer. The Bland-Altman plot of differences suggests that 95% of the tympanic home-use thermometer readings were within the limits of agreement, which is +0.98 and −1.27°C range of mercury-in-glass thermometer. In our group, 15% of the patients were misdiagnosed as febrile with home-use tympanic thermometer, whereas this percentage was 4% with clinical tympanic thermometer. Also, 5% and 31% of febrile patients were misdiagnosed as afebrile with clinical tympanic and home-use tympanic thermometer, if axillary mercury-in-glass thermometer recording defines fever. Discussion: Our results showed that there is a significant difference in each recording with different thermometers, and this variance was present in both higher and lower readings. We recommend thathome-use infrared tympanic thermometer could be used for screening but must not be considered as a tool to decide patients follow-up.

A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses

OBJECTIVES The aim of the study is to assess the effect of ring wearing and ring types on hand contamination and efficacy of alcohol-based hand disinfection among nurses working in intensive care settings. METHODS Hand cultures were obtained from 84 nurses providing direct patient care in intensive care units of a pediatric hospital. Colony counts were compared depending on ring wearing and the type of ring worn. Twenty-eight nurses were asked to a wear plain wedding ring, 28 to wear rings with stones and 28 not to wear any rings, starting 15 days before and continuing throughout the study. Cultures were obtained by using sterile gloves containing phosphate-buffered-saline solution (PBS) after an alcohol-based hand disinfectant was used and bacteria were identified with standard laboratory tests. RESULTS The nurses wearing rings had more Gram-positive, Gram-negative and total bacterial colonization on their hands than the nurses without rings despite using an alcohol-based rub (p=0.001). When comparing the two groups with rings (plain wedding rings and rings with stones), colony counts of Gram-positive, Gram-negative and total bacteria did not differ (p>0.05). CONCLUSIONS Ring wearing increases the bacterial colonization of hands and alcohol-based hand disinfection might not significantly reduce contamination of the ring-wearing hands. The type of ring did not cause any significant difference on the bacterial load. Wearing rings could increase the frequency of transmission of potential nosocomial pathogens.

Cytomegalovirus-related congenital nephrotic syndrome with diffuse mesangial sclerosis

This case report describes congenital nephrotic syndrome in a 2-month-old girl associated with cytomegalovirus infection. Histological examination on renal biopsy showed diffuse mesangial sclerosis and cytomegalic inclusion bodies in the tubular cells and in some glomeruli. Cytomegalovirus (CMV) polymerase chain reaction (PCR) titer in serum was high. Remission of pulmonary and renal symptoms was achieved with ganciclovir in 3 weeks. No recurrence of proteinuria was observed during the follow-up period of 14 months. These finding suggested a causal relationship between congenital nephrotic syndrome and cytomegalovirus infection.

PIPERACILLIN/TAZOBACTAM PLUS AMIKACIN VERSUS CARBAPENEM MONOTHERAPY AS EMPIRICAL TREATMENT OF FEBRILE NEUTROPENIA IN CHILDHOOD HEMATOLOGICAL MALIGNANCIES

A prospective, randomized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia. Patients aged 2–16 years with hematological malignancies who had febrile neutropenia were randomly assigned to receive piperacillin/tazobactam (80 mg/kg piperacillin/10 mg/kg tazobactam, q6h) combined with amikacin (PTA) (7.5 mg/kg, q12h) or meropenem or imipenem (20 mg/kg, q8h) (C). Response to antimicrobial therapy, evaluated for etiological agents, was measured. Duration of fever, neutropenia, and hospitalization, mortality, and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Out of 87 febrile neutropenic episodes that were evaluable for comparison, 46 patients received PTA and 41 patients were treated with carbapenems (imipenem or meropenem). Overall, the microbiologically documented infection rate was 21.9%, with Staphylococcus epidermidis as the most common cause of bacteremia. The rate of treatment modification was 56.5% in the PTA group and 53.6% in the carbapenem group with no statistical difference (p >. 05). There was no infection-related mortality during the study period.There was no difference between the two regimens for durations of fever, neutropenia, and hospitalization (p >. 05 for all categories). PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies.

Mumps meningoencephalitis effect on hearing.

Sensorineural hearing loss is an important complication of mumps. Audiologic tests of 26 children with mumps meningoencephalitis, 25 uncomplicated mumps cases and 20 control cases were performed, and hearing level thresholds at speech and high frequencies were determined. The mean hearing level thresholds in the mumps meningoencephalitis group were higher than those of mumps cases at frequencies from 6,000 to 18,000 Hz in the right ear and at 250 and from 4,000 to 18,000 Hz in the left ear (P < 0.05). Mumps meningoencephalitis cases had higher mean hearing thresholds than did control groups at all frequencies other than 125 and 250 Hz in the right ear and 10,000 Hz in the left ear. The mean hearing thresholds of mumps cases were higher than those of control group at frequencies of 1,000 and 4,000 Hz in the right ear and 1,000 and 10,000 Hz in the left ear (P < 0.05). These results show that mumps meningoencephalitis causes a higher risk of hearing loss than does mumps.

The value of mean platelet volume in the determination of community acquired pneumonia in children

BackgroundMean platelet volume (MPV) is a reflection of platelet size, which has been shown to correlate with platelet function and activation. The aim of this study was to evaluate whether MPV could be used for the diagnostic tool of community-acquired pneumonia (CAP) and for making the decision for hospitalization.MethodsThe computerized records of children aged 1 to 18 years who were diagnosed with CAP based on WHO criteria were evaluated. A standard protocol was followed, and patients with severe CAP were hospitalized. CAP patients were divided into two groups based on disease severity. The control group consisted of age and gender matched healthy children during the study period. Values for hemoglobin, white blood cell count (WBC), platelet count, MPV and C-reactive protein (CRP) obtained on first presentation were recorded for each patient.ResultsA total of 196 patients were diagnosed with CAP during the study period, 108 (55.1%) of which had severe disease, which required hospitalization (Group 1a), while the remaining 88 (44.9%) were followed-up as outpatients (Group 1b). The control group consisted of 100 healthy children (Group 2). Patients with CAP had lower MPV values than their healthy counterparts (7.1±0.68 vs. 8.31±1.2 fL; p<0.001). MPV value was significantly higher in hospitalized CAP patients compared to outpatients (7.32±0.71 vs. 6.83±0.5 fL; p=0.012). ROC curve analysis suggested that MPV level cut-off point for making a diagnosis of CAP was 8.1 fL, with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 91%, 51%, 80.8% and 70.5%, respectively.ConclusionsOur findings suggest that MPV may be a useful predictor for diagnosed CAP but low specificity and NPV rates may lead to the false-negative diagnosis.

Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination.

Background : Mumps vaccine has not yet been included in the routine vaccination programme, for this reason mumps is still one of the most common infections for children in Turkey. One of the major complication of mumps is meningoencephalitis, which although usually heals spontaneously, it may cause neurologic complications.

Long-term beneficial effects of dexamethasone on intellectual and neuropsychological outcome of children with pneumococcal meningitis

A Substantial ratio of bacterial meningitis survivors suffers mild or serious intellectual and neuropsychological handicaps. We organized eighty subjects into three groups: 1) Pneumococcal meningitis (PM) who did not receive dexamethasone, 2) PM who received dexamethasone, 3) Other bacterial meningitis with different etiology. All subjects underwent Bender Visual Motor Gestalt test and age-appropriate Intelligence qutient (IQ) tests. The mean full-scale IQ scoring fell within normal range (90±17) in the post-meningitic cohort. There was no statistical difference between two pneumococcal groups regarding full scale IQ testing (88±16 and 91±18) and Bender-Gestalt scoring (4.0±3.3 and 3.8±2.6), respectively. However, the subjects with full scale IQ score <85 (below the average) were statistically less in the group with steroid therapy. PM patients who received dexamethasone therapy had statistically better academic performance. As a result, adjuvant steroid therapy has no significant impact on overall intellectual tests in PM subjects. However, dexamethasone seems to diminish development of below the average IQ scoring in PM cases. In addition, PM subjects who received steroids showed better academic achievement. These findings may support the idea of dexamethasone administration prior to first antibiotic dose in PM subjects.

Acute kidney injury due to acyclovir

Acyclovir is an antiviral agent widely used in herpetic infections in children. Although acyclovir is generally well tolerated, severe nephrotoxicity has been reported in some cases. In this report, we present a 16-year-old girl who developed acute renal failure due to acyclovir treatment and who needed repetitive hemodialysis. Renal biopsy was performed in order to confirm the diagnosis. A diagnosis of drug-related acute tubulointerstitial nephritis with focal tubular necrosis was made.