Outpatient Children Research Articles

The effect of antenatal steroid administration on mortality and morbidity in newborns that 34 weeks and older

Objective: The effects of antenatal steroid (AS) administration on mothers during pregnancy were investigated on mortality and morbidity in newborns that 34 weeks' gestations and older. Material and Method: Between January 2016 and June 2018, pregnant women who were followed-up from our hospital's gynecology and obstetrics outpatient clinic and children born from these pregnancies were included in the study. This study was conducted as prospective and retrospective. Patients included in the study were divided into three groups according to AS application: full cure, incomplete cure, and non-taking. Results: A total of 727 pregnant women were included in the study, but 56 pregnant women were excluded from the study because they went to another hospitals to give birth. AS application on mothers; 251 (37.4%) complete dose, 176 (26.2%) incomplete cure and 244 (36.4%) was not applied at all. Newborn included in the study are 379 (56.5%) male, 292 (43.5%) female, 317 (47.2%) were between 34-36 weeks and 354 (52.7%) were between 37-39 weeks. There was also a statistically significant difference in the rate of hospitalization in the neonatal intensive care unit, intubation time, oxygen requirement period, maximum FiO2, 5th minute Apgar score in children of women that AS not applied. Conclusion: We may conclude that AS application will decrease respiratory problems especially in newborns over 34 weeks and thus affect the mortality and morbidity in the newborn. A single cure of AS may reduce the duration of intensive care unit and oxygen demand

Study on the correlation between the proportion of outpatient children with asthma and PM2.5 and temperature in Hangzhou

Study on the correlation between the proportion of outpatient children with asthma and PM2.5 and temperature in Hangzhou

THE MAIN ASPECTS OF INVASIVE DISEASES TREATMENT AND PREVENTION IN TEENAGERS

In Ukraine, about 100,000 cases of geohelminthiasis are registered annually, 80%of which are children under 17 years of age. Symptoms of helminthiasis are mild orcompletely absent, but harmful to the body, however, infection of the child's body isespecially dangerous.Objective - to conduct a marketing study of drugs, used for treatment, and identify themain problems of this pathology prevention.Material and methods. A marketing research and analysis of the trade names’ market,analysis of 52 medical records of inpatients and outpatients (children aged 12 to 17years) for worm infestations and medical records of medical institutions in Chernivtsihave been carried out.Results. At the first stage of the research, a statistical study of invasive diseases state wasconducted and the main risk factors for infection were identified. We studied the rangeof antiparasitic drugs available on the domestic pharmaceutical market. Albendazole ismost often used as an active anthelmintic agent, 75% of which are domestic and 25% ofimported production. Preparations with the active substance pyrantel pamoate accountfor 42.8% of domestic production, all others are imported. According to the results of theprocessed medical records of patients several of the most common treatment regimens,which include anthelmintic therapy, the use of enterosorbents and the appointment ofa 5-day course prescription of H1-histamine receptor blockers were chosen. Havinganalyzed the average cost of the day treatment of nematode infestations, we came to theconclusion that the most available complex of group II drugs, the main antihelmintic drugis Zentel.One of the measures to prevent helminthiasis is the use of phytopreparations anddietary supplements based on medicinal plant materials, which, unlike chemicals, arecharacterized by milder properties and less toxicity, the ability not only to affect thepathogen directly, but also to restore the functional state of the organs and systemsaffected by worm infestation.Conclusions. From the offered schemes of pharmacotherapy the most accessible is theuse of a complex which structure includes Сarbowhite, Rolinoz, Zentel. It is promising tostudy the use of phytomedicines both during medical therapy and for prevention.

رهاب علاج الأسنان وعلاقته بالمزاج لدى الأطفال

The aim of this study was to identify the percentage of dental phobia among children, and its relartionship with temperament of children. The analytical descriptive methodology was used with two instruments: Dental phobia questionnaire and child temperament scale. The sample included (393) outpatient children in dental clinics of Aleppo University in the academic year of 2017-2018. The children aged between 6-13 years. The findings indicated that the mean of dental phobia was 31.5 while high level of dental phobia was 49.11. The dental phobia was significantly higher among females than among males. On the other hand, there were significantly positive correlation between dental phobia and the following factors: Activity, resistance, mood quality, distractibility, and negative correlation between dental phobia and the following factors: regular-ity, first reaction (approach), and adaptability.

Correspondence: early identification of COVID-19 positive outpatient children, is it useful?

The differential diagnosis between COVID-19 and the common cold, or allergic cough, or mild respiratory symptoms with or without fever is not easy for Primary Care Pediatricians (PCPs).According to the official Italian report “Rapporto ISS COVID-19 n. 58/2020” of August 21st, 2020, all children with COVID-19 common symptoms and/or a corporal temperature higher than 37.5°C, are considered as suspected cases and have to be tested with a nasopharyngeal swab. We have identified risk factors that could be useful in PCPs' clinical practice to define priorities in addressing children to the proper diagnostic procedure. For the physical and mental health of the children and their families and to allow the PCPs to fulfill their duty, it is important to look for less invasive tools to perform the proper diagnosis. This should also allow children to go to school and to go on with their daily life.

Outcomes, evidence-based treatments, and disparities in a statewide outpatient children’s behavioral health system

Abstract Purpose Many questions remain about the effectiveness of behavioral health treatments for children in large systems of care, including the use of evidence-based treatments (EBTs). The goals of this study were to 1) describe outcomes of children receiving treatment in a statewide system, overall and separately for demographic groups; 2) describe penetration rates of EBTs and examine outcomes by treatment type and 3) examine moderation of treatment type by demographic group. Methods Participants were 46,399 children receiving behavioral health services at one of 25 outpatient clinics in a state system between 2013 and 2017. Administrative data included child demographic characteristics, treatment type, and problem severity based on the Ohio Scales. Propensity score methods were used to analyze EBT effects compared to no EBT conditions, and interactions with demographic groups. Results The overall pre- to post-treatment effect size across all treatment types was medium (Cohen’s d = 0.49 to 0.51) and similar to prior research. White children showed greater improvements than Black or Hispanic children, 7 to 12-year olds improved more than younger and older children, and females improved more than males. Almost half (47%) of children received cognitive behavioral therapy, and an additional 12.4% received another EBT. Children receiving EBTs showed greater improvement than those not receiving an EBT. The relative benefits of EBTs were mostly consistent across sex, age, and race/ethnicity, but EBTs were associated with some reductions in disparities by race/ethnicity (particularly for Hispanic youth and more modestly for Black youth) and age. Conclusions Outcomes for children receiving behavioral health treatment in a statewide system were modest. EBTs can be disseminated within large systems and have potential for improving overall outcomes for children from diverse backgrounds.

High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014-2017.

Little is known about the extent and serotypes of dengue viruses circulating in Africa. We evaluated the presence of dengue viremia during 4 years of surveillance (2014–2017) among children with febrile illness in Kenya. Acutely ill febrile children were recruited from 4 clinical sites in western and coastal Kenya, and 1,022 participant samples were tested by using a highly sensitive real-time reverse transcription PCR. A complete case analysis with genomic sequencing and phylogenetic analyses was conducted to characterize the presence of dengue viremia among participants during 2014–2017. Dengue viremia was detected in 41.9% (361/862) of outpatient children who had undifferentiated febrile illness in Kenya. Of children with confirmed dengue viremia, 51.5% (150/291) had malaria parasitemia. All 4 dengue virus serotypes were detected, and phylogenetic analyses showed several viruses from novel lineages. Our results suggests high levels of dengue virus infection among children with undifferentiated febrile illness in Kenya.

Comparison of Bacterial Contamination in a Children’s Outpatient Clinic: General Medicine Versus Pulmonary Units

Background: The bacteria that inhabit outpatient healthcare facilities influence patient outcomes and recovery, although the diversity and quantity of these bacterial communities is largely unknown. Whether differences in bacterial presence exist in individual medical specialty units of an outpatient clinic is also largely unknown. The purpose of this study was to compare bacterial species found in the general medicine and pulmonary units of an outpatient children’s clinic associated with a teaching hospital. Methods: In total, 6 locations (4 floor sites, counters, air ducts) were sampled in 3 rooms in the pulmonary (PUL) unit and 3 rooms in the general medicine (GM) unit on 13 days over a 6-month period. Sterile double transport swabs were utilized, transported on ice to a microbiology lab, and used to inoculate Hardy Diagnostics Cdiff Banana Broth (for Clostridium difficile), CHROM MRSA agar (for methicillin-resistant Staphylococcus aureus [MRSA]), eosin methylene blue (Levine-type, for Lac+ gram negatives [GN]), and Pseudomonas isolation agar (for Pseudomonas spp and P. aeruginosa [PS and PSA]). Media were incubated for 48 hours at 37°C and were scored for bacterial presence based on colonial observation. Results: The presence of bacteria isolated from GM and PUL units differed by species and location. Based on the percentage of positive swabs, the presence of GN was widespread in both units (Fig 1). Additionally, bacterial presence was greatest on the floors (GN ranged from 72% to 85% on floors in the 2 units), whereas counters had fewer positive swabs (GN ranged from 23% to 38% on counters), and swabs from return air ducts rarely led to bacterial growth. The 1 case in which swabs from the PUL unit resulted in higher levels of bacterial growth than for the GM unit was for PSA (GM, 8%; PUL, 13%). C. difficile detection was the same on both units (ie, 35% of floor samples showed contamination). Conclusions: The levels of environmental bacterial presence observed for these clinic units differed in some cases by unit and ranged from not detectable to very high levels. Detection of C. difficile on 35% of floor samples in both units could be problematic. Additionally, for the PUL unit, contamination of 13% of floor samples by PSA should raise concerns because many patients in this clinic have cystic fibrosis (CF). Although many CF patients are colonized by PSA, others may potentially contract an infection by this pathogen from the clinical environment. This observation supports current infection control recommendations for CF patients in outpatient settings.Funding: NoneDisclosures: None

Determination of Red Cell Indices Cut-off for Identifying Iron Deficiency Anaemia among Pre-school Children with Sickle Cell Anaemia

Nigerian pre-school children have a high risk of developing iron deficiency and there is no consistent evidence that patients with sickle cell anaemia are protected from iron deficiency anaemia. The objective is to explore red cell indices cut-off values useful as surrogate for detecting iron deficiency in children with sickle cell anaemia. Ninety-seven children with sickle cell anaemia were recruited from Children Outpatient. Reference intervals were developed using the 2.5th – 97.5th, 3.0rd – 97.0th, 5 – 95th, and 10th – 90th percentile intervals for MCV and MCH. The discriminatory performance of the proposed red cell indices criterion was assessed by use of sensitivity, specificity, accuracy, likelihood ratio and predictive values. The 2.5th, 3rd, 5th, 10th, 90th, 95th, 97th, and 97.5th percentile values were: MCV (62.7, 63.6, 66.5, 69.6, 86.3, 87.7, 89.5, and 90.1fl), and MCH (19.0, 19.5, 20.8, 21.4, 28.2, 29.1, 29.5 and 29.7pg). The various calculated cut-off points for the MCV and MCH had lower sensitivity but a higher specificity for detecting iron deficiency than the standard reference values for the general population. The calculated cut-off point for the study subjects below the 10th percentiles had the best discriminatory performance. The cut-off for iron deficiency was 69.6fl for MCV and 21.4pg for MCH either use singly or in combination. In conclusion, standard reference cut-offs of MCV and MCH based on results from western individuals without sickle cell anaemia of the same age are not in agreement with the estimated values for children with sickle cell anaemia in Nigeria.

Epidemiology of Enterococcal Infections in Enugu State, Nigeria

Enterococci despite being a normal commensal is of great health concern since it can become virulent. Hence the study investigated the prevalence of Enterococci infection and two tertiary health institutions (Enugu State University of Technology (ESUT) Teaching Hospital, Parklane and University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla in Enugu State) were used. Isolation and identification were based on standard procedures and biochemical tests. The results showed that age ranges of 21-25years 10(14.7%) and 26-30 years 8(11.8%) had the highest prevalence. Also, more females were infected by the organism than males though the difference was not statistically significant (p= 0.371).The possible predisposing factor showed that 16(23.5%) were unknown while 10(14.7%), 6(8.8%), 14(20.6%), 9(13.2%), 8(11.8%) and 5(7.6%) were catheterization, surgery, pregnancy, Diabetes, HIV/AIDS and previous history of enterococcal infection, respectively. The frequency of enterococcal isolates from different specimens showed that 24(35.3%) of the isolates were from urine samples, 12(17.6%) were from high vaginal swab, 7(10.2%) were from ear swab and wound swab respectively, 4(5.9%) were from urethral swab and aspirates respectively and 2(2.9%) were from sputum samples. Furthermore, departmental sources of enterococcus sp. isolated showed that 21(30.9%) were from Surgery department followed by general out-patients department 14(20.6%), Urology 8(10.3%), Gynaecology 7(10.3), Medicine 6(8.8%), Antenatal, Children out-patients, Neurology and Children Emergency Department had 3(4.4%) each. Also, 41(60.3%) out of the 68 isolates were nosocomially acquired and 27(39.7%) isolates were community acquired. There was no significant difference (p= 0.486) when nosocomially acquired enterococcal isolates were compared with community acquired enterococcal isolates. Monthly frequencies of the isolates showed that July had the highest frequency 10(14.7%) followed by the month of May 7(10.3%). April, August and October had 6(8.8%) respectively. February, March November and December had 5(7.4) respectively; January and September had 4(5.9%) respectively while June had 3(4.4%). Seasonal comparison (rainy and dry season) of the distribution of the isolates within the years of the study showed that rainy season had 38 number of isolates while dry season had 30 number of isolates and there was no significant difference between the frequencies of occurrence in the two seasons (p= 0.271). Therefore, there is an increasing prevalence of Enterococci and can be hospital acquired, screening for this organism is important in hospital setting.

Medically Attended Outpatient Coronavirus Infections in Ecuadorean Children During the 20 Months Preceding Countrywide Lockdown Related to the SARS-CoV-2 Pandemic of 2020.

Human coronaviruses (HCoVs) cause respiratory tract infections during childhood manifesting as common colds, bronchiolitis, croup and pneumonia. In temperate geographies, HCoV activity peaks between December and March. The epidemiology and manifestations of HCoV infections have not been previously reported from Ecuador. Children <5 years who presented with ≥2 symptoms consistent with an acute respiratory tract infection were eligible for enrollment. After obtaining informed consent, demographic data and details regarding the acute illness were recorded. Secretions collected with a nasopharyngeal swab underwent diagnostic testing using multiplex polymerase chain reaction. A total of 850 subjects were enrolled. A total of 677 (80%) tested positive for at least 1 pathogen, including 49 (7.2%) who tested positive for ≥1 HCoV type. HCoV-NL63 was the most frequent type detected (39%), followed by HCoV-OC43 (27%), 229E (22%) and HKU1 (12%). Nearly all subjects who tested positive for HCoV had nasal congestion or secretions (47/49; 96%). The most frequent syndromic diagnosis was common cold (41%), followed by bronchiolitis (27%). We found no association between the infecting HCoV type and subject's syndromic diagnosis (P > 0.05) or anatomic location of infection (upper vs. lower respiratory tract; P > 0.05). The 2018-2019 peak HCoV activity occurred from October to November; the 2019-2020 peak occurred from January to February. HCoVs were detected in ~7% of outpatient Ecuadorean children <5 years of age with symptoms of acute respiratory tract infection. The most frequently detected HCoV types, and the period of peak HCoV activity differed for the 2018-2019 and 2019-2020 seasons.

Coronavirus Disease 2019 versus Influenza A in Children: An Observational Control Study in China

This study aimed to understand the differences in clinical, epidemiological, and laboratory features between the new coronavirus disease 2019 (COVID-2019) and influenza A in children. Data of 23 hospitalized children with COVID-19 (9 boys, 5.7 ± 3.8 years old) were compared with age- and sex-matched 69 hospitalized and 69 outpatient children with influenza A from a hospital in China. The participants' epidemiological history, family cluster, clinical manifestations, and blood test results were assessed. Compared with either inpatients or outpatients with influenza A, children with COVID-19 showed significantly more frequent family infections and higher ratio of low fever (< 37.3 °C), but shorter cough and fever duration, lower body temperature, and lower rates of cough, fever, high fever (> 39 °C), nasal congestion, rhinorrhea, sore throat, vomiting, myalgia or arthralgia, and febrile seizures. They also showed higher counts of lymphocytes, T lymphocyte CD8, and platelets and levels of cholinesterase, aspartate aminotransferase, lactate dehydrogenase, and lactic acid, but lower serum amyloid, C-reactive protein, and fibrinogen levels and erythrocyte sedimentation rate, and shorter prothrombin time. The level of alanine aminotransferase in children with COVID-19 is lower than that in inpatients but higher than that in outpatients with influenza A. Pediatric COVID-19 is associated with more frequent family infection, milder symptoms, and milder immune responses relative to pediatric influenza A.

Colonization of Environmental Methicillin-Resistant Staphylococcus Aureus in a Newly Constructed Children's Outpatient Clinic

<h3>Background</h3> The purpose of this study was to examine prevalence of environmental methicillin-resistant Staphylococcus aureus (MRSA) in a newly constructed children's outpatient clinic. Viable MRSA on floors and select surfaces in waiting areas and two medical units were compared for the last 3 months of construction through the first 6 months of occupation. <h3>Methods</h3> A total of 52 locations were swabbed weekly, including common areas (floors at check-in desks, waiting rooms, and on children's toys), and on patient room floors, counters, and return air ducts in pulmonary and general medicine units (3 rooms tested in each). Testing was performed during the last 3 months of construction (October-December 2018), and the first 6 months after opening (January - June 2019). HardyCHROM MRSA selective and differential agar media was used to identify viable MRSA. <h3>Results</h3> In common areas, during construction we observed 4/80 (5%) positive swabs for MRSA. After occupation, 72 /208 (35%) positive swabs for MRSA were found in the common areas. In pulmonary unit rooms during construction we observed 3/60 (5%) positive samples for MRSA, and 52/234 (22%) positive samples for MRSA after occupation (p < 0.01). In general medicine rooms during construction we observed 10/60 (17%) positive MRSA samples and 75/234 (32%) positive samples for MRSA after occupation (p < 0.01). Significant differences in the presence of viable MRSA between construction and occupation phases were found in the the common area as well (p < 0.01). <h3>Conclusions</h3> This study shows the rapid colonization of the clinical environment with MRSA within the first 6 months of opening of a children's outpatient clinic. The potential link between environmental bacteria and healthcare-associated infections is an important area of research in infectious disease, particularly for outpatient clinics, requiring monitoring studies such as this.

Comparison of Viable Environmental Bacterial Prevalence and Species in Outpatient General Medicine and Pulmonary Patient Units

<h3>Background</h3> Environmental bacteria in outpatient healthcare facilities likely influence patient outcomes and recovery. The diversity and quantity of these bacterial communities are largely unknown. The purpose of this study was to compare viable bacteria found in general medicine (GenM) and pulmonary (PUL) units of an outpatient children's clinic. <h3>Methods</h3> Six locations (4 floor sites, counters, and air ducts) were sampled in rooms in the GenM and PUL units over a 6-month period. Sterile transport swabs were used to sample clinic sites, and then to inoculate selective and differential media for the detection of Clostridium difficile (Cdiff), methicillin-resistant Staphylococcus aureus (MRSA), Lac+ Gram negatives (GN), and Pseudomonas sp. and P. aeruginosa (PS & PSA). <h3>Results</h3> Bacterial presence in GenM and PUL units differed by species and location. GN bacteria were widespread in both units. Bacterial presence was greatest on the floors (GN, 72% to 85% of swabs in GenM and PUL, respectively), while counters had fewer positive swabs (GN, 23% to 38%), and swabs from return air ducts had little growth. Swabs from the PUL unit yielded higher levels of PSA growth than GenM unit swabs (13 % vs. 8%, respectively). MRSA was significantly higher on floors in GenM vs PUL (p < 0.05), but not on counters (p = 0.83). There was no significant difference for Cdiff or PS in GenM vs PUL on floors or counters (p > 0.05), and GN was slightly higher on floors in GenM vs. PUL (p < 0.08). <h3>Conclusions</h3> Viable environmental bacterial species detected in these clinic units differed by unit and surface, ranging from not detectable to very high. Detection of Cdiff on 35% of floors in both units is concerning. Additionally, a 13% PSA rate on PUL unit floors may have implications for cystic fibrosis patients treated there.

IMPACT OF PREVENTIVE PRACTICES ON ANAEMIA DUE TO MALARIA AMONG CHILDREN ATTENDING OUT-PATIENT CLINIC IN SPECIALIST HOSPITAL YOLA, ADAMAWA STATE, NIGERIA

The study focused on the impact of preventive practices on anaemia due to malaria among children. The study considered Out-Patients children who came to laboratory for malaria diagnostic test. Blood sample was examined using Giemsa stain for parasite detection and speciation. Informed consent was obtained and structured questionnaire were administered. Pack Cell Volume was used to screened for anaemia. A total of 310 children were sampled. Malaria anaemia in relation to types of net used, children that were anaemic with malaria used damage insecticide nets recorded highest and least among those using untreated insecticide net with 57.1% and 38.0% respectively (p˃0.05). Malaria anaemia based on insecticide application, those used cover cloth (50.0%) against mosquito vector and are anaemic with malaria recorded highest while those applied house spray (25.0%) had the least. Malaria anaemia with regard to sleeping habit of the child at night, high proportion were seen in children that were anaemic with malaria sleeping outdoor (56.5%) while those sleeping indoor (36.9%) recorded least (p˃0.05). Subjects that were anaemic with malaria and previously used Sulphonamides (51.4%) had highest prevalence (p˃0.05). Children that were anaemic with malaria and period of last treatment of four months (58.2%) recorded highest while period of last treatment of one month (24.1%) had the least (p˃0.05). Therefore, insecticide application using house spray, stayed indoor at night using mosquito nets had an impact on reducing the risk of anaemia due to malaria.

Indicator of early kidney injury in adolescents with polycystic ovary syndrome: Can urine NGAL level be?

Introduction and Purpose The Urinary Neutrophil-gelatinase associated lipocalin (NGAL) levels which are a biomarker for early diagnosis of kidney damage that may develop in patients with Polycystic Ovary Syndrome (PCOS) were investigated in the study. Material and Methods The 30 patients diagnosed with Polycystic Ovarian Syndrome between the ages of 13 and 18 who applied to the Yuzuncu Yil University General Children's Outpatient Clinic were included in the PCOS group and 30 healthy adolescents without any known acute or chronic illness and drug use were included in the control group. Findings Urine NGAL value was 842.204 ± 21.561 in PCOS group and 775.379 ± 23.98 in control group. NGAL level in PCOS group was statistically significantly higher than control group (p: .045). When we examine the relationship between dyslipidemia and PCOS; While dyslipidemia was positive in 10 (33.7%) patients in the PCOS group, it was negative in 20 (66.7%) patients. While 1 patient had dyslipidemia, 29 patients did not have dyslipidemia in the control group. A significant relationship was found between dyslipidemia and PCOS (p: .005). Conclusion We found that subclinical kidney dysfunction started in early stage patients in PCOS in our study. The urine NGAL level was thought to increase in response to increased oxidative stress in PCOS. We found no relationship between, insulin resistance and urea, BUN, creatinine and NGAL levels. However, we found a negative correlation between NGAL level and LDL. In addition, dyslipidemia, insulin resistance and ALT elevation were detected in the PCOS group.

Verification of the Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) reference values in Croatian children and adolescents.

IntroductionThe aim of this study was to examine whether the Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) could be applied to Croatian children and adolescents.Materials and methodsA total of 295 outpatient healthy children and adolescents of age 1 to 18 were selected using the direct a posteriori sampling method. According to current guidelines, 20 samples were tested for each of a total of 51 reference intervals for ferritin, cortisol, dehydroepiandrosterone sulfate, follicle stimulating hormone, lutein stimulating hormone, prolactin, progesterone, sex hormone binding globulin, thyroid stimulating hormone, total testosterone, total thyroxine and total triiodothyronine. Serum samples were analysed on the Beckman Coulter DxI600 immunoassay analyser by chemiluminescence immunoassay method. A reference interval was adopted if < 10% of the results fall outside CALIPER reference interval range. For analytes in which this criterion is not met in the first set of samples, a new set of 20 samples were collected.ResultsAfter the first set of measurements, 96% of all tested reference intervals were adopted for use. The additional sets of 20 reference subjects were tested for only two reference intervals; follicle stimulating hormone for female aged 1 to 9 years, and irrespective of the gender, sex hormone binding globulin for children aged 8 to 11 years. All results of additional samples were within the specified interval limits.ConclusionsCALIPER reference intervals for ferritin and 11 hormones defined for Beckman Coulter DxI600 immunoassay analyser can be implemented into the Croatian laboratories and clinical practice.

Potential Drug-drug Interactions Analysis in Children Out-patients with Bronchopneumonia Medication Prescriptions

Drug-drug interactions (DDIs) is defined as the alteration of efficacy and toxicity of some drugs in the presence of other drugs. In the treatments of bronchopneumonia in outpatient settings, there is a lack of documentation of DDIs. This study was aimed to observe the potential DDIs on the prescriptions of children with bronchopneumonia. An observational and cross-sectional study was conducted on outpatient children with bronchopneumonia prescriptions during 2017. Potential for DDI was identified by online drug interaction checkers. The potential DDI then classified based on its severity (minor, moderate, and major) and mechanism (pharmacokinetic and pharmacodynamic). Among 86 prescriptions analyzed, potential DDIs observed at 48.84% of it. Of that, there were 67 potential DDIs where 72.34% of it were categorized as moderate. The majority of potential DDIs was pharmacodynamic interaction (76.12%) with the most frequently involved drug pair was Ephedrine-Salbutamol (29.85%). Children outpatients with bronchopneumonia are at risk of potential DDIs, especially to minor and moderate potential DDIs. Prescriptions screening for potential DDIs followed by monitoring of therapeutical effects and associated adverse drug events will optimize patient safety.

Molecular characteristics of Clostridium difficile in children with acute gastroenteritis from Zhejiang

BackgroundClostridium difficile infection (CDI) has an increasing pediatric prevalence worldwide. However, molecular characteristics of C. difficile in Chinese children with acute gastroenteritis have not been reported.MethodsA five-year cross-sectional study was conducted in a tertiary children’s hospital in Zhejiang. Consecutive stool specimens from outpatient children with acute gastroenteritis were cultured for C. difficile, and isolates then were analyzed for toxin genes, multi-locus sequence type and antimicrobial resistance. Diarrhea-related viruses were detected, and demographic data were collected.ResultsA total of 115 CDI cases (14.3%), and 69 co-infected cases with both viruses and toxigenic C. difficile, were found in the 804 stool samples. The 186 C. difficile isolates included 6 of toxin A-positive/toxin B-positive/binary toxin-positive (A+B+CDT+), 139 of A+B+CDT−, 3 of A−B+CDT+, 36 of A−B+CDT− and 2 of A−B−CDT−. Sequence types 26 (17.7%), 35 (11.3%), 39 (12.4%), 54 (16.7%), and 152 (11.3%) were major genotypes with significant differences among different antimicrobial resistances (Fisher's exact test, P < 0.001). The A−B+ isolates had significantly higher resistance, compared to erythromycin, rifampin, moxifloxacin, and gatifloxacin, than that of the A+B+ (χ2 = 7.78 to 29.26, P < 0.01). The positive CDI rate in infants (16.2%) was significantly higher than that of children over 1 year old (10.8%) (χ2 = 4.39, P = 0.036).ConclusionsCDI has been revealed as a major cause of acute gastroenteritis in children with various genotypes. The role of toxigenic C. difficile and risk factors of CDI should be emphatically considered in subsequent diarrhea surveillance in children from China.

Clinical Recommendations for Managing the Impact of Insulin Adsorptive Loss in Hospital and Diabetes Care.

Adsorption of insulin to infusion sets impacts patient therapeutic outcomes and, unaccounted for, may exacerbate persistent hyperglycemia or result in therapy-induced hypoglycemia. This article aims to provide recommendations for clinicians involved in intensive care and/or outpatient pump therapy contexts. A dynamic adsorption model is used to evaluate time-varying insulin concentration in the infusion set outflow. Hourly and daily percentage insulin loss to adsorption is examined for neonatal, pediatric, and adult intensive care patients, as well as outpatient children and adults weighing 30, 50, and 80 kg. A short review of preconditioning methods is included. Insulin adsorption in outpatient pump therapy is most pronounced in the first hour, where as much as 80% of the intended insulin dose may be lost to adsorption. Subsequently, insulin adsorptive loss is typically negligible. Overall, extra care should be taken in the first 1-6 h of a new infusion set, particularly in children or teenagers. Typically, insulin adsorption in the adult intensive care unit is negligible unless infused at low flow rates (<2 mL/h). Insulin adsorption is significant in pediatric and neonatal intensive care, resulting in delivery concentrations as low as 5%-50% of that intended. Thus, it is recommended that preconditioning of insulin delivery lines be carried out prior to infusion initiation in this context. However, no preconditioning method completely removes adsorption, and care should still be taken in the first 1-6 h of insulin dosing. Recommendations made in this article are dependent on the insulin concentration and flow rate used in each clinical context.