Anil Tapisiz

A current analysis of caregivers’ approaches to fever and antipyretic usage

INTRODUCTION The aim of this survey was to investigate the current knowledge, attitudes, and practices of febrile childrens caregivers about fever, antipyretic usage, and temperature measurement methods in a tertiary care hospital. METHODOLOGY A 41-item questionnaire was administered to a convenience sample of febrile childrens caregivers in face-to-face interviews by two research assistants from January 2012 through June 2012 in an urban region of Turkey. RESULTS A total of 1,032 caregivers completed the interview. Approximately one-third of caregivers considered a temperature of less than 37.8°C (100°F) to be a fever, and 13% of all respondents would give antipyretics for a body temperature ≤ 37.8°C. Furthermore, 76% of parents would wake their children from sleep to administer antipyretics. Although a high proportion (89.5%) of respondents believed that fever had harmful effects, 10.5% considered fever to be beneficial. Alternating use of acetaminophen and ibuprofen (44%) and giving antipyretics routinely (71%) before and after immunizations were common parental practices and generally advised by pediatricians. Parents with higher levels of education were more likely to consider fever to be beneficial and to treat fever with antipyretics, and less likely to seek medical attention for mild fever. Most caregivers stated that they were unsure about the right site (90%) and thermometer type (95%) for temperature measurement. CONCLUSIONS Persistent fever anxiety and excessive antipyretic usage may be heightened by the lack of knowledge regarding accurate temperature measurement methods with digital thermometers in our population. Parental education may positively affect the approach to fever and antipyretic usage.

Clinical and epidemiological features of Turkish children with 2009 pandemic influenza A (H1N1) infection: Experience from multiple tertiary paediatric centres in Turkey

Abstract Background: In April 2009 a novel strain of human influenza A, identified as H1N1 virus, rapidly spread worldwide, and in early June 2009 the World Health Organization raised the pandemic alert level to phase 6. Herein we present the largest series of children who were hospitalized due to pandemic H1N1 infection in Turkey. Methods: We conducted a retrospective multicentre analysis of case records involving children hospitalized with influenza-like illness, in whom 2009 H1N1 influenza was diagnosed by reverse-transcriptase polymerase chain reaction assay, at 17 different tertiary hospitals. Results: A total of 821 children with 2009 pandemic H1N1 were hospitalized. The majority of admitted children (56.9%) were younger than 5 y of age. Three hundred and seventy-six children (45.8%) had 1 or more pre-existing conditions. Respiratory complications including wheezing, pneumonia, pneumothorax, pneumomediastinum, and hypoxemia were seen in 272 (33.2%) children. Ninety of the patients (11.0%) were admitted or transferred to the paediatric intensive care units (PICU) and 52 (6.3%) received mechanical ventilation. Thirty-five children (4.3%) died. The mortality rate did not differ between age groups. Of the patients who died, 25.7% were healthy before the H1N1 virus infection. However, the death rate was significantly higher in patients with malignancy, chronic neurological disease, immunosuppressive therapy, at least 1 pre-existing condition, and respiratory complications. The most common causes of mortality were pneumonia and sepsis. Conclusions: In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.

Acremonium spp. peritonitis in an infant

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis. Clinical presentation of fungal peritonitis is similar to bacterial peritonitis and Candida spp. are the most common agent. Fungal peritonitis has been usually associated with high morbidity, mortality and its treatment is difficult. In this report, we present an infant with Acremonium spp. peritonitis. A 7‐month‐old boy with Down syndrome, congenital heart disease, pulmonary hypertension and congestive heart failure required peritoneal dialysis for his persistent pulmonary oedema and symptomatic hyponatremia. Acremonium spp. peritonitis developed while he was on extended spectrum antibiotics and fluconazole. The patient was successfully treated with peritoneal dialysis catheter removal and liposomal amphotericin B. The case was presented to draw attention to a rare cause of peritonitis –Acremonium spp. – in a paediatric patient.

Successful treatment of Paecilomyces variotii peritonitis in a liver transplant patient.

Paecilomyces variotii has previously been reported as a causative pathogen for peritonitis in patients on continuous ambulatory peritoneal dialysis and shown to be usually sensitive to amphotericin B and resistant to voriconazole. We report the first case, to our knowledge, of P. variotii peritonitis in a liver transplant patient, which was unresponsive to initial liposomal amphotericin B (L-AmB) treatment and resolved dramatically after the addition of voriconazole. The present case provides evidence for the clinical and microbiological effectiveness of voriconazole combined with L-AmB in treating P. variotii peritonitis refractory to initial L-AmB treatment.

Prevention of measles spread on a paediatric ward

Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.

Alteration of thiol-disulphide homeostasis in acute tonsillopharyngitis.

Objective: Thiol-disulphide homeostasis (TDH) has a critical role in various clinical disorders. We aimed to assess the association of TDH with acute tonsillopharyngitis (AT) in children. Methods: This study included 94 (73 viral and 21 bacterial) tonsillopharyngitis patients and 88 control children. Their native thiol, total thiol, and disulphide levels were measured. Results: Viral and bacterial tonsillopharyngitis patients had lower native thiol levels compared with healthy children (P < 0.001 and P = 0.008, respectively). Both groups had lower total thiol levels compared with control children (P = 0.002 for viral, P = 0.011 for bacterial). The disulphide levels were lower in bacterial than in viral tonsillopharyngitis patients (P = 0.04), and there was a significant difference between viral tonsillopharyngitis patients and the control group (P < 0.001). The native/total thiol ratio in each patient group was lower than in the control group (P < 0.001 for viral, P = 0.017 for bacterial). The disulphide/native thiol and disulphide/total thiol ratios were significantly higher in viral (P < 0.001 for both) and bacterial tonsillopharyngitis patients (P = 0.017 for both) than in healthy children. In all patients, a correlation was found between the levels of C-reactive protein (CRP) and native thiol (r = −0.211, P = 0.04), CRP and total thiol (r = −0.217, P = 0.036), white blood cell (WBC) and native thiol (r = −0.228, P = 0.002), WBC and total thiol (r = −0.191, P = 0.01), and WBC and disulphide (r = 0.160, P = 0.03). Discussion: TDH is altered in AT in children. The alteration is more prominent in viral than in bacterial tonsillopharyngitis.

Tularemia in Children, Turkey, September 2009-November 2012

Clinical course in children differs from that in adults.

Anidulafungin: is it a promising option in the treatment of pediatric invasive fungal infections?

Cases of invasive fungal infections are increasing globally due to an increase in the immunosuppressed population, the use of broad-spectrum antibiotics and the invasive instrumentation of patients in intensive care units. Ongoing emergence of resistance and problems with toxicity have resulted in the need for the development of new antifungal agents. Anidulafungin, the most recently developed echinocandin, is approved by the US FDA for treatment of candidemia, other forms of Candida infection and esophageal candidiasis in non-neutropenic adult patients, but it is not currently licensed for pediatric usage. The drug is projected to be distinctive owing to its unique pharmacokinetics and is already listed in adult antifungal treatment guidelines. In this article, anidulafungin will be reviewed with a focus on pediatric patients.

C1 inhibitor level on neonatal sepsis and its relations with clinical findings

Background:  Generalised oedema is a frequent finding during neonatal sepsis, but its aetiology remains uncertain.

Association between deep neck space abscesses and internal carotid artery narrowing in pediatric patients

Background/aim: Our aim was to interpret the effects of deep neck space abscesses on the adjacent carotid artery according to abscess location, as well as to determine narrowing by calculating the mean stenosis ratios.Materials and methods: Neck computed tomography scans and clinical data of 45 children with neck abscesses were evaluated retrospectively for abscess location and internal carotid artery narrowing. The lumen areas of the carotid arteries were measured from standard levels, and stenosis ratios were calculated with two different techniques. The mean stenosis ratios of each group according to abscess location were then compared with the control group.Results: Among the 45 abscesses included in the study, 51.1% (n = 23/45) were located in the peritonsillar region, 37.8% (n = 17/45) were located in the parapharyngeal-lateral retropharyngeal space, and 11.1% (n = 5/45) were in the midline retropharyngeal space. We found a statistically significant difference between the mean stenosis ratios of the ipsilateral side of the parapharyngeal-lateral retropharyngeal abscesses and the control group (P < 0.01).Conclusion: The children with parapharyngeal-lateral retropharyngeal abscesses all had narrowing in the adjacent carotid lumen to some degree. Although most of the patients had no clinical symptoms, radiologists have to be aware of this arterial complication to prevent further progress and fatal complications.