Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 5 Articles
Background and objective: The noncompliance of treatment guidelines by healthcare\nprofessionals, along with physiological variations, makes the pediatric population more prone to\nantibiotic prescribing errors. The present study aims to evaluate the prescribing practices and errors\nof the most frequently prescribed antibiotics among pediatric patients suffering from acute\nrespiratory tract infections who had different lengths of stay (LOS) in public hospitals.\nMethods: A retrospective, cross-sectional study was conducted in five tertiary-care public hospitals\nof Lahore, Pakistan, between 1 January 2017 and 30 June 2017. The study population consisted of\npediatric inpatients aged 0 to 9 years. Results: Among the 11,892 pediatric inpatients, 82.8% were\nsuffering from lower acute respiratory tract infections and had long LOS (53.1%) in hospital.\nPenicillins (52.4%), cephalosporins (16.8%), and macrolides (8.9%) were the most frequently\nprescribed antibiotics. Overall, 40.8% of the cases had antibiotic prescribing errors related to wrong\ndose (19.9%), wrong frequency (18.9%), and duplicate therapy (18.1%). Most of these errors were\nfound in the records of patients who had long LOS in hospital (53.1%). Logistic regression analysis\nrevealed that the odds of prescribing errors were lower in female patients (OR = 0.6, 95% CI = 0.1-\n0.9, p-value = 0.012). Patients who were prescribed with less than equal to 3 antibiotics per prescription (OR = 1.724,\n95% CI = 1.1-2.1, p-value = 0.020), had long LOS\n(OR = 12.5, 95% CI = 10.1-17.6, p-value < 0.001), and were suffering from upper respiratory tract\ninfections (URTI) (OR = 2.8, 95% CI = 1.7-3.9, p-value < 0.001) were more likely to experience\nprescribing errors. Conclusion: Antibiotics were commonly prescribed to patients who had long LOS.\nPrescribing errors (wrong dose, wrong frequency, and duplicate therapy) were commonly found in\ncases of lower respiratory tract infections (LRTIs), especially among those who had prolonged stay\nin hospital....
Background: Pediatric head trauma management varies between emergency departments globally. Here we aim\nto compare the pediatric minor head trauma management between a US and Italian hospital.\nMethods: We conducted a retrospective chart review of children 0-18 years old presenting after minor head\ntrauma (Glasgow Coma Scale 14-15) from two emergency departments, in Boston, Massachusetts, United States\nand Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management\ncharacteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed\ntomography (CT) scans between the two populations.\nResults: There were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston\nhad more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered\non the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7%\nvs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%)\nthan in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had\nCTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and\ndefinitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar\npopulations presenting to the two hospitals, and thus, differences in the management of these children.\nConclusion: The population of head trauma patients and the management of pediatric minor head trauma\ndiffers between Boston and Trieste, with a preference for CT scans in Boston and a preference for\nhospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care\ninfluenced by the different patient populations and institutional resources....
Fetal/neonatal allo-immune thrombocytopenia (FNAIT) results from maternal\nimmunization against fetal platelet-specific antigens (HPA) inherited from the father. Most cases\ninvolve HPA located on glycoproteins (GP) IbIX, IaIIa and IIbIIIa. Iso-immunizations can also occur\nin the absence of expression of membrane proteins, such as GPIIb or GPIIIa in Glanzmann patients.\nCD36 (also called glycoprotein GPIV) deficiency is observed in 3 to 5% of Asian and African\npopulations. We report here the case of a 41-year-old Canadian woman originated from Africa, who\ndelivered a male dead new-born at 39 weeks of gestation. A massive intracranial haemorrhage was\nidentified as being the obvious cause of death. No platelet antibody against GPIbIX, IaIIa, and IIbIIIa\nwas identified by the gold-standard Monoclonal Antibody-specific Immobilization of Platelet\nAntigens (MAIPA) assay. Surprisingly, anti CD36 iso-antibodies were identified in the maternal\nserum with a new bead-based multiplex assay. The CD36 gene was sequenced for both parents, and\na mutation was identified on Exon 10 of the motherâ??s CD36 gene, which was absent for the father:\nNM_000072.3:c.975T>G inducing a STOP codon at position 325 of the mature protein. The absence\nof CD36 expression on the motherâ??s platelets was confirmed by flow cytometry....
Background: Meningococcal meningitis (MM) is known to be responsible of high cost for the Public Health\nAdministration. Aim of the work is to calculate the costs for the hospitalization of pediatric patients affected\nby MM.\nMethods: We calculate the costs for the hospitalization of pediatric patients affected by MM in the acute\nphase (HAP) over a nine year period. We performed a MEDLINE search to verify the cost of MM HAP\nreported in other studies.\nResults: At Bambino Gesu Children Hospital, the median cost of HAP was of 12,604 euro (range from 9203 to\n35,050 euro). Comparing our data with the previous studies, we find out similar results of approximately\n16,750 euro (range 12,000â??20,000 euro).\nDiscussion: Despite the relative rarety of the disease, MM is associated to direct high cost of HAP.\nConclusions: Hospital costs are an important end-point in health economic evaluation of the disease and\nmay be useful to policy makers and health economists to understand the potential benefit of improving\nmeningococcal vaccination programmes....
Ensuring that the entire Australian population is Vitamin D sufficient is challenging, given\nthe wide range of latitudes spanned by the country, its multicultural population and highly urbanised\nlifestyle of the majority of its population. Specific issues related to the unique aspects of vitamin D\nmetabolism during pregnancy and infancy further complicate how best to develop a universally safe\nand effective public health policy to ensure vitamin D adequacy for all. Furthermore, as Australia is\nconsidered a â??sunny countryâ?, it does not yet have a national vitamin D food supplementation policy.\nRickets remains very uncommon in Australian infants and children, however it has been recognised\nfor decades that infants of newly arrived immigrants remain particularly at risk. Yet vitamin D\ndeficiency rickets is entirely preventable, with the caveat that when rickets occurs in the absence of\npreexisting risk factors and/or is poorly responsive to adequate treatment, consideration needs to be\ngiven to genetic forms of rickets....
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