Cost-effectiveness of rotavirus vaccination in Turkey.

BACKGROUND/PURPOSE: Cost-effectiveness studies about rotavirus (RV) vaccination programs were performed in many countries due to the severe economic burden of RV infections. This study is an economic evaluation performed to assess the potential for introducing the RV vaccine to the Turkish National Immunization Program. METHODS: In this retrospective clinical study, the records and laboratory findings of a total of 4126 patients admitted to Turgut Ozal University Hospital, Ankara, Turkey with acute gastroenteritis were analyzed. A model described by Parashar et al. was used to obtain the annual episodes of diarrhea, hospitalization and outpatients visits in Turkey. Monovalent and pentavalent vaccination was assumed to protect in average 85% of RV acute gastroenteritis. All costs are expressed in 2012 United States (US) $, where US$1 equals 1.8 Turkish Liras (TL). Losses of labor costs were not taken into consideration. RESULTS: The vaccination program with 85% coverage was cost effective and cost saving compared to no vaccination. A projected birth cohort of 1.25 million children was followed until 5 years of age; a routine vaccination could potentially avert 210,994 cases of diarrhea treated in outpatient hospital facilities and 42,715 hospitalizations. The RV associated economic burden was obtained as US$17,909 million per year (US$14.33 per birth annually) in medical direct costs by using the national level of RV diarrhea disease burden estimates. For monovalent and pentavalent vaccination, assuming a cost of US$31.5 and US$38 per vaccine course, the cost of the vaccination program was estimated to be approximately US$37,878 million and US$45,475 million, respectively. CONCLUSION: At a cost per vaccine course of US$31.5 for monovalent and US$38 for pentavalent vaccine, routine RV vaccination could be potentially cost effective and also cost saving in Turkey. National RV vaccinations will play a significant role in preventing RV infections.

Evaluación de 200 pacientes pediátricos expuestos al riesgo de contraer rabia / Assessment of 200 pediatric patients exposed to rabies risk

Antecedentes/Objetivo: La rabia continúa siendo un grave problema de salud pública, especialmente en los países subdesarrollados o en vías de desarrollo. El objetivo de este estudio fue investigar las características demográficas y los programas de vacunación de los pacientes ingresados con diagnóstico presuntivo de rabia al Centro de Emergencias Pediátricas de nuestro hospital, que funciona como uno de los centros de vacunación antirrábica de nuestra provincia. Métodos: En este estudio, se analizaron retrospectivamente las historias clínicas de 200 pacientes ingresados al Centro de Emergencias Pediátricas con presunta exposición al virus de la rabia. Resultados: Entre los 200 casos, se halló que el riesgo de contraer rabia era mayor en el grupo de 5 a 9 años. El 68,5% de los casos tenían antecedentes de haber sido mordidos por un perro; el 29,5%, de haber sido rasguñados por un gato; y el 2%, de haber tenido contacto con otros animales. En el 76% de los casos se trataba de animales callejeros, solamente el 11% tenían dueño y habían sido vacunados, y estaban bajo supervisión. Se administró solamente la vacuna antirrábica al 42,5% de los pacientes ingresados, la vacuna antirrábica y la vacuna antitetánica al 51,5%, y la vacuna antirrábica, la vacuna antitetánica y concentrado de inmunoglobulinas antirrábicas al 6%. Se detectó que la profilaxis postexposición se había realizado según las recomendaciones en el 83,5% de los casos. Conclusión: La rabia continúa siendo un problema de salud pública grave en los países en vías de desarrollo, como el nuestro. Consideramos que es necesario sensibilizar a la sociedad; las autoridades locales deben esforzarse por luchar contra los animales callejeros y supervisar los servicios; el personal de la salud involucrado debe actualizarse mediante capacitaciones para reducir los casos de rabia.

Background/Purpose: Rabies is still an important health problem particularly in underdeveloped or developing countries. In this study, the aim was to investigate demographic characteristics and vaccination schedules of cases suspected of having rabies and admitted to the Pediatric Emergency Clinic of our hospital, which serves as one of the Rabies Vaccination Centers in our province. Methods: In our study, medical records of 200 patients admitted to the Pediatric Emergency Clinic with suspicion of risk of contact with the rabies virus were retrospectively analyzed. Results: Of those 200 cases, rabies risk was found to be greater in the 5-9 year old group. There was a history of having been bitten by dogs in 68.5% of cases, cat scratch in 29.5%, and contact with other animals in 2%. While 76% of animals were stray animals, only 11% of them had an owner and had been vaccinated, and were under supervision. Rabies vaccination only had been administered to 42.5% of admitted patients, tetanus and rabies vaccination to 51.5%, tetanus; rabies vaccination and human rabies immune globulin were administered to 6%. Post-exposure prophylaxis was found to have been given as recommended to 83.5% of cases. Conclusion: Rabies remains an important public health problem in developing countries Like ours. We consider that public awareness should be raised; local authorities should devote efforts to control stray animals and supervise such services, and updated guidance and training should be provided to the concerned health staff to reduce the risk of rabies.

Evaluación de 200 pacientes pediátricos expuestos al riesgo de contraer rabia / Assessment of 200 pediatric patients exposed to rabies risk

Antecedentes/Objetivo: La rabia continúa siendo un grave problema de salud pública, especialmente en los países subdesarrollados o en vías de desarrollo. El objetivo de este estudio fue investigar las características demográficas y los programas de vacunación de los pacientes ingresados con diagnóstico presuntivo de rabia al Centro de Emergencias Pediátricas de nuestro hospital, que funciona como uno de los centros de vacunación antirrábica de nuestra provincia. Métodos: En este estudio, se analizaron retrospectivamente las historias clínicas de 200 pacientes ingresados al Centro de Emergencias Pediátricas con presunta exposición al virus de la rabia. Resultados: Entre los 200 casos, se halló que el riesgo de contraer rabia era mayor en el grupo de 5 a 9 años. El 68,5% de los casos tenían antecedentes de haber sido mordidos por un perro; el 29,5%, de haber sido rasguñados por un gato; y el 2%, de haber tenido contacto con otros animales. En el 76% de los casos se trataba de animales callejeros, solamente el 11% tenían dueño y habían sido vacunados, y estaban bajo supervisión. Se administró solamente la vacuna antirrábica al 42,5% de los pacientes ingresados, la vacuna antirrábica y la vacuna antitetánica al 51,5%, y la vacuna antirrábica, la vacuna antitetánica y concentrado de inmunoglobulinas antirrábicas al 6%. Se detectó que la profilaxis postexposición se había realizado según las recomendaciones en el 83,5% de los casos. Conclusión: La rabia continúa siendo un problema de salud pública grave en los países en vías de desarrollo, como el nuestro. Consideramos que es necesario sensibilizar a la sociedad; las autoridades locales deben esforzarse por luchar contra los animales callejeros y supervisar los servicios; el personal de la salud involucrado debe actualizarse mediante capacitaciones para reducir los casos de rabia.(AU)

Background/Purpose: Rabies is still an important health problem particularly in underdeveloped or developing countries. In this study, the aim was to investigate demographic characteristics and vaccination schedules of cases suspected of having rabies and admitted to the Pediatric Emergency Clinic of our hospital, which serves as one of the Rabies Vaccination Centers in our province. Methods: In our study, medical records of 200 patients admitted to the Pediatric Emergency Clinic with suspicion of risk of contact with the rabies virus were retrospectively analyzed. Results: Of those 200 cases, rabies risk was found to be greater in the 5-9 year old group. There was a history of having been bitten by dogs in 68.5% of cases, cat scratch in 29.5%, and contact with other animals in 2%. While 76% of animals were stray animals, only 11% of them had an owner and had been vaccinated, and were under supervision. Rabies vaccination only had been administered to 42.5% of admitted patients, tetanus and rabies vaccination to 51.5%, tetanus; rabies vaccination and human rabies immune globulin were administered to 6%. Post-exposure prophylaxis was found to have been given as recommended to 83.5% of cases. Conclusion: Rabies remains an important public health problem in developing countries Like ours. We consider that public awareness should be raised; local authorities should devote efforts to control stray animals and supervise such services, and updated guidance and training should be provided to the concerned health staff to reduce the risk of rabies.(AU)

Assessment of 200 pediatric patients exposed to rabies risk.

BACKGROUND/PURPOSE: Rabies is still an important health problem particularly in underdeveloped or developing countries. In this study, the aim was to investigate demographic characteristics and vaccination schedules of cases suspected of having rabies and admitted to the Pediatric Emergency Clinic of our hospital, which serves as one of the Rabies Vaccination Centers in our province. METHODS: In our study, medical records of 200 patients admitted to the Pediatric Emergency Clinic with suspicion of risk of contact with the rabies virus were retrospectively analyzed. RESULTS: Of those 200 cases, rabies risk was found to be greater in the 5-9 year old group. There was a history of having been bitten by dogs in 68.5% of cases, cat scratch in 29.5%, and contact with other animals in 2%. While 76% of animals were stray animals, only 11% of them had an owner and had been vaccinated, and were under supervision. Rabies vaccination only had been administered to 42.5% of admitted patients, tetanus and rabies vaccination to 51.5%, tetanus; rabies vaccination and human rabies immune globulin were administered to 6%. Post-exposure prophylaxis was found to have been given as recommended to 83.5% of cases. CONCLUSION: Rabies remains an important public health problem in developing countries Like ours. We consider that public awareness should be raised; local authorities should devote efforts to control stray animals and supervise such services, and updated guidance and training should be provided to the concerned health staff to reduce the risk of rabies.

Evaluation of children presenting to the emergency room after electrical injury.

BACKGROUND/AIM: To evaluate children who presented to the Pediatric Emergency Department with electrical injury and to discuss the follow-up of these cases and potential precautions that can be taken. MATERIALS AND METHODS: A total of 36 patients presented to the Pediatric Emergency Department with electrical injury between May 2010 and May 2013, and these cases were investigated retrospectively. The patients' age and sex, location and form of exposure to electric current, seasonal distribution, length of hospital stay, musculoskeletal and cardiovascular system complications, renal damage, and treatments were recorded. RESULTS: The majority of the patients were exposed to low-voltage electrical current at home. When the patients were evaluated based on the type of electric current, alanine transaminase, aspartate transaminase, creatine kinase, and creatine kinase-myocardial isoenzyme levels were found to be significantly higher among patients who were exposed to high-voltage electric current. None of the patients died, and the mean length of hospital stay was 2.50 ± 1.06 days. CONCLUSION: Electrical injuries can present with a wide variety of problems, ranging from a simple injury to life-threatening severe multiple organ injury. Even simple precautions can prevent possible morbidity and mortality. We think that the public level of knowledge and awareness should be increased.

Accuracy of Internet guidance on pediatric otolaryngology procedures.

OBJECTIVES: To evaluate the reliability and accuracy of the most visited Internet websites for the frequently performed surgical pediatric otorhinolaryngology procedures. STUDY: A google.com search was used to determine the top 20 Internet sites for the terms 'adenoidectomy', 'tonsillectomy' and 'ventilation tube surgery'. The DISCERN plus questionnaire was used to score each website. Furthermore, a 'hit list' of reliable and accurate websites was created depending on the most clicked healthcare organizations with corporate identities and the personal websites of the otolaryngologists with academic titles who were members of the Turkish Society of Otolaryngology Head and Neck Surgery. The pages were also investigated as if they were in this list of accurate websites. RESULTS: Of the 60 websites viewed for the terms 'adenoidectomy', 'tonsillectomy' and 'ventilation tube surgery', only 23.3% were matching the list of accurate websites. The mean DISCERN plus score was 35.70 (16-58), 38.02 (16-80) and 39.08 (16-58) for adenoidectomy, tonsillectomy and ventilation tube surgery respectively. There was no significant difference between the three groups (p>0.05). The mean DISCERN plus score for all the websites was 37.37 out of the maximum score of 80. CONCLUSIONS: In the light of our results we can conclude that the quality of data on the Internet is not adequate enough to obtain information about the most frequent surgical procedures in pediatric otorhinolaryngology. Clinicians must be aware about this fact and warn the parents about the disinformation which may lead to wrong decisions.

Method of the diagnosis of adenoid hypertrophy for physicians: adenoid-nasopharynx ratio.

OBJECTIVE: We aimed to describe the feasibility of a prediction of adenoid hypertrophy by pediatricians for diagnostic accuracy of nasopharyngeal x-ray in a pediatric unit. METHODS: Forty-six patients with a history of probable adenoid hypertrophy between January 2013 and August 2013 were included in the study. Participants were excluded from the study if they had previous adenoidectomy; anatomic anomaly in the nose, palate, or nasopharynx; and acute infection. Nasal endoscopy was performed and evaluated adenoid size (choanal obstruction ratio) in all patients by an otorhinolaryngologist who was blinded to the information of other data. Lateral nasopharyngeal x-ray graphs of all patients were evaluated by pediatricians with adenoid-nasopharynx (A-N) ratio, who were blinded to the information of other data. The A-N ratio was calculated by Fujioka method. The A-N ratio of each patient was compared with the choanal obstruction ratio that was determined in the nasal endoscopic examination. Spearman correlation test was used for statistical analysis, and P < 0.05 was described as significant. RESULTS: Forty-six patients were included in this study. The study sample consisted of 25 male (54.3%) and 21 female (45.7%) patients. The mean age of the patients was 6.17 years (range, 2-14 y). In the nasal endoscopic examination, the mean (SD) choanal obstruction ratio was 64.6% (19.5%) (range, 12.5%-90%). Mean (SD) A-N ratio was found to be 16.7 (14.4). The A-N ratio correlated with nasal endoscopic examination findings (r = 0.334, P = 0.023) CONCLUSIONS: The A-N ratio was found to be a useful, tolerable, and confident diagnostic method in pediatric patients for adenoid hypertrophy. Pediatricians can confidently use this method for decision after follow-up or operation.