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The design of the powertrain components by considering inertial properties is important for sustainability and lightness. The highest shock impulses cause the instant negative transient torque proportional to the system inertia and acceleration. In this study, the vehicle having the Double Mass Flywheel (DMF) system subjected to a specific curb obstacle is investigated experimentally in an urban driving profile. The LTI (Linear-Time-Invariant) system of the crash mechanism in vehicle systems is presented as one-dimensional and three-dimensional models. The free-body-diagram (FBD) is presented in the curb crash condition, and the obtained equation of motion is then correlated via curb crash analysis and experimental test results. The analysis is performed firstly in curb crash explicit analysis, then the system modeling with the mathematical powertrain model approach is obtained via one-dimensional modeling to find the effective impact torque on the timing ring. Then, the component-based design is analyzed and correlated with real experimental test results. The experimental Timing ring removal test is then correlated with the curb crash explicit model representing the full vehicle. Thus, the obtained minimum Timing Ring slipping torque presents the required urban safety DMF production process needs. The impulse shock analysis of DMF timing ring due to curb crashes is presented, and preventive methods are indicated by considering urban driving profile conditions.

Clutch components rotating at high speed remain under the influence of high centrifugal forces. Therefore at the high rotational speeds flywheel is subjected to extreme forces that may cause severe cracks and breakages. Burst test validates the mechanical robustness of the flywheel under various rotational speeds. In this study comparative analysis have been performed experimentally and numerically in order to confirm correlation of the results. Centrifugal endurance test called burst have been performed in addition to finite element analysis which has been used for calculating stress values of flywheel. Additionally design of experiment method has been used for obtaining the response surface that approximates the stress behavior of automobile flywheel. This provides strong correlation between FEA results and data fittings calculation that gives extra contribution to reduce the design process. This study gives ideas for the stress improvement of flywheel by making experimental and numerical comparison. Experimental and numerical correlations results taken from this study can be used on the estimation of design robustness instead of prototypes production which causes time and money consumption during flywheel design and production process.

This paper presents an automated calibration method for industrial robots, based on the use of (1) a novel, low-cost, wireless, 3D measuring device mounted on the robot end-effector and (2) a portable 3D ball artifact fixed with respect to the robot base. The new device, called TriCal, is essentially a fixture holding three digital indicators (plunger style), the axes of which are orthogonal and intersect at one point, considered to be the robot tool center point (TCP). The artifact contains four 1-inch datum balls, each mounted on a stem, with precisely known relative positions measured on a Coordinate Measuring Machine (CMM). The measurement procedure with the TriCal is fully automated and consists of the robot moving its end-effector in such as a way as to perfectly align its TCP with the center of each of the four datum balls, with multiple end-effector orientations. The calibration method and hardware were tested on a six-axis industrial robot (KUKA KR6 R700 sixx). The calibration model included all kinematic and joint stiffness parameters, which were identified using the least-squares method. The efficiency of the new calibration system was validated by measuring the accuracy of the robot after calibration in 500 nearly random end-effector poses using a laser tracker. The same validation was performed after the robot was calibrated using measurements from the laser tracker only. Results show that both measurement methods lead to similar accuracy improvements, with the TriCal yielding maximum position errors of 0.624 mm and mean position errors of 0.326 mm.

Abstract Purpose Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. Patients and Methods In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. Results Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). Conclusion We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.

In this study, natural radioactivity levels ( 226 Ra, 232 Th, and 4  K) of some medicinal plant samples with known anti-oxidative properties, which are frequently consumed by animals and humans, were obtained from Ankara province and its surroundings (Mamak, Kızılcahamam, Beypazarı, Kahramankazan, and Polatlı districts) were determined using a thallium-doped sodium iodide NaI(Tl) gamma spectrometry. By using the determined natural radioactivity concentrations in the collected plant samples, the number of radiological doses that people could be exposed by consuming these plants was calculated. As a result of the study, 226 Ra, 232 Th, and 4  K radioactivity concentration ranges of the plant samples were found be 14.69 ± 1.27-59.08 ± 3.12 Bq kg -1 , 1.78 ± 0.04-50.05 ± 2.76 Bq kg -1 and 207.24 ± 34.09-826.13 ± 25.40 Bq kg -1 , respectively. The highest 226 Ra, 232 Th, and 4  K activity concentrations were measured in Astragalus densifolius subsp. ayashensis (Kahramankazan), Astragalus kochakii (Kahramankazan) and Rumex patientia (Patience Dock) (Kahramankazan) plants, respectively. The lowest 226 Ra, 232 Th and, 4  K activity concentration plants were determined respectively as Rumex patientia (Mamak), Lavandula angustifolia (Kızılcahamam), and Astragalus acikirensis (Polatlı). The establishment and routine repetition of environmental radioactivity monitoring programs in each region are important for human and animal health, and the results of this study gain importance for Ankara and its surroundings in terms of environmental health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region., Methods: The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre., Results: A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect., Conclusion: This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region., (© 2023. The Author(s).)

Background: Human metapneumovirus (hMPV) is one of the leading causes of acute respiratory infections and bronchiolitis in infants. A history of prematurity and chronic diseases such as congenital heart disease or asthma/reactive airway disease (RAD) increases the risk of severe lower respiratory tract infection (LRTI) due to hMPV. In this cross-sectional study, we aimed to analyze the clinical outcome and risk factors for severe disease in children with LRTI due to hMPV., Methods: The current cross-sectional study included children between 28 days and 18 years of age with the diagnosis of hMPV-associated LRTI hospitalizations, over two years from January 2016 to September 2018 in Health Science University Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital. hMPV virus was detected by the multiplex polymerase chain test (PCR) (Commercial Multiplex Real-Time PCR: FTD Respiratory 21 plus, Fast Track Diagnostics, Luxembourg) from a nasopharyngeal swab. Patients who had positive results in multiplex PCR tests with other viral agents simultaneously were not included in the study. Data were retrospectively collected from the computerized hospital system., Results: In this cross-sectional study, 62 patients who were hospitalized with the diagnosis of LRTI due to hMPV infection were included. Thirty-five (55.7%) of the patients were male. The median age was one year (2 months-15 years). Fifty-one (82.2%) patients were younger than two years. The median hospital length of stay was found to be 10 days (2-33 days) in patients with an underlying disease and 7,5 days (ranging from 2 to 20 days) in the patients without an underlying disease, this difference was significant (p=0.031)., Conclusions: Clinicians should consider hMPV as an important pathogen of LRTI even in healthy children, although we expect a poor course of disease in children with an underlying disease.

Background: Amphotericin B is a broad-spectrum antifungal agent and is the backbone of the treatment for medically important opportunistic fungal pathogens in children. This study aimed to compare the nephrotoxicity associated with L-AmB in children with acute lymphoblastic leukemia and acute myeloid leukemia., Materials and Methods: A total of 112 pediatric acute lymphoblastic leukemia or acute myeloid leukemia patients who received treatment with L-AmB (Ambisome®) at the University of Health Sciences Dr Behcet Uz Children's Hospital over 7 years were included. The incidence of hypokalemia, decreased estimated glomerular filtration rate and presence of acute kidney injury was recorded., Results: The average L-AmB treatment duration was 17.1±15.0 days. Five patients (4.4%) of the patients had grade I acute renal injury according to KDIGO criteria and 16 patients (14.2%) had increased risk for kidney injury according to RIFLE criteria. There were no patients with eGFR decrease above 50% and no renal injury and failure were observed during L-AmB treatment. The rate of patients with hypokalemia in the pre-treatment was 17.9% and the post-L-AmB group was 50.0%. The rate of hypokalemia was higher in the post-treatment group (P=0.0015). Among the 112 patients, only two patients (1.7%) required cessation of L-AmB treatment due to resistant hypokalemia despite supplementation., Conclusions: Hypokalemia was more common compared to glomerulotoxicity and acute renal injury (according to KDIGO and RIFLE criteria) in pediatric leukemia patients treated with L-AmB. Hypokalemia developed in nearly half of the patients and the study shows the need for randomized controlled trials and strategies for hypokalemia associated with L-AmB treatment., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Statement of Problem: Dental prosthetic materials can cause artifacts in cone beam computed tomography (CBCT) images, adversely affecting diagnostic quality, although the problem may be less with polyetheretherketone (PEEK). Studies evaluating the artifacts caused by frequently used prosthetic materials are lacking., Purpose: The purpose of this in vitro study was to compare the artifacts in CBCT images caused by PEEK, zirconia, cobalt-chromium (Co-Cr) alloy, and titanium (Ti)., Material and Methods: A polymethylmethacrylate phantom (Ø4.0×4.0 cm) with a central cylindrical aperture (Ø0.5×0.5 cm) was produced. Co-Cr, Ti, zirconia, and PEEK cylinders (0.5×0.5 cm) were manufactured, and CBCT images of the empty phantom (control group) with the test cylinders inside were made 3 times. In all images, the axial sections passing through the middle of the materials were evaluated. Eight regions of interest (ROI) area were determined around the materials (0.5×0.5 cm). The presence of artifacts was evaluated by making gray value standard deviation (SD) calculations in these ROI areas. The average SD values of 8 ROI fields from the 3 CBCT scans were made, and the materials were compared with each other in terms of the presence of artifacts by using 1-way analysis of variance (α=.05)., Results: The difference between the SD values of the control and the PEEK cylinder was not statistically significant (P>.05). The SD values of both the control and PEEK groups were significantly lower than those of the zirconia, Co-Cr, and Ti groups (P<.05)., Conclusions: Zirconia, Ti, and Co-Cr caused artifacts in CBCT images, but the artifacts with PEEK were similar to those in the control group, suggesting it was the optimal choice in terms of achieving diagnostic quality., (Copyright © 2021 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study is to provide a basis for the development of appropriate screening strategies and evaluate the indications of the interferon-gamma release assay (IGRA) in Bacillus Calmette-Guérin (BCG)-vaccinated children., Methods: Children who were examined with both IGRA (QuantiFERON®-TB Gold Plus) and tuberculin skin test (TST) for tuberculosis infection were included in the study. Underlying medical conditions of the patients were recorded. Cohen's κ was run to determine if there was an agreement between TST and IGRA., Results: A total of 220 patients with a mean age of 11.05 ± 4.43 years (2.5-18 years) were analyzed. Ninety-nine patients were immunocompromised and 121 patients were immunocompetent. TSTs and IGRA showed none to the slight agreement in both of the immunocompromised and immunocompetent patients. In the immunocompromised group, 43/99 (43.4%) and the immunocompetent group 35/121 (28.9%) of the tests did not show any correlation., Conclusion: In a high-risk setting where the BCG vaccine is mandatory, it may be beneficial to use IGRA primarily in immunocompetent patients. In immunocompromised patients, the use of both the TST and IGRA could increase the efficacy of screening for latent tuberculosis infection., (© 2020 Wiley Periodicals LLC.)

Background: The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and its resistance to multiple antibiotics has become a serious challenge since the early 2000s. Especially, community-acquired MRSA (CA-MRSA) infections that appear mainly as skin and soft tissue infections (SSTIs) tend to increase worldwide. The objective of this cross-sectional study was to evaluate the trends in the frequency of SSTIs due to community-acquired S. aureus among children., Methods: All children with SSTIs caused by culture positive community-acquired S. aureus during the period from 2013 to 2018 were included in this study. Data of the outpatients were collected from medical records. Annual alteration in frequencies of CA-MRSA and community-acquired methicillin-sensitive S. aureus (CAMSSA) were evaluated., Results: A total of 112 cases was evaluated. Of these, 35 (31.25%) were CA-MRSA. The rates of CA-MRSA had emerged from an increasing annual frequency of 9.5 cases per 10,000 SSTIs as of 2014 to 96.8 cases per 10,000 SSTIs in 2018. The ratio of cases with CA-MRSA to cases with CA-MSSA was 0 - 0.09 in two years of the study period and increased to a maximum ratio of 0.6 - 0.72 in the last two years. Consequently, the frequency of S. aureus in cases with SSTIs was significantly higher in 2016 - 2018 compared to the initial study period within the years of 2013-2015 [p < 0.001, relative risk increase: 7 (2.6-28.7) for CA-MRSA and p=0.002, relative risk increase: 2.1 (1.2-3.5)]. Cases with CA-MRSA increased approximately eight-fold during the six-year-study period., Conclusions: The rates of CA-MRSA in SSTIs among children increased significantly compared to CA-MSSA. The clinical impact of this increase should be evaluated, especially in patients with SSTI who are unresponsive to empirical treatment.

Background: The influenza virus is a significant cause of acute lower respiratory tract infections (LRTI) requiring hospitalization in childhood and leads to severe morbidity and mortality, especially in certain risk groups., Objectives: The study aims to evaluate acute LRTI due to influenza in a tertiary care hospital and the risk factors for hospitalization among Turkish children., Study Design: Children between 1 month and 18 years of age who were hospitalized at Dr. Behçet Uz Children's Hospital between January 2016 and March 2018 with lower respiratory tract infection that tested positive for influenza by PCR were included. Children with viral coinfections were excluded. Patient files were retrospectively scanned from the hospital computerized system in terms of age, underlying diseases, whether antiviral therapy was used, and length of hospital stay. Statistical analysis was performed using SPSS statistical software., Results: The study included 131 patients with a median age of 2 years (1 month-15 years). Sixty-seven (51,1%) patients were younger than two years. Influenza A was isolated in 129 patients and B in 2 patients. Fifty-two patients (39,7%) had underlying medical conditions, and the most common one was malignancies (12/52, 23%). This was followed by neurodevelopmental diseases (9/52, 17,3%), prematurity (9/52 patients, 17,3%), primary immunodeficiency (8/52, 15,4%), asthma (7/52, 13,4%), Down syndrome (4/52, 7,7%), chronic renal disease (2/52, 3,8%) and congenital heart diseases (1/52, 1,9%). The mean length of stay (LOS) was 12,3 ± 9,5 days (2-60 days). The LOS was found to be statistically longer (15,2 ± 12,1 days, 3-60 days) in patients with an underlying disease compared to previously healthy patients (10,4 ± 6,7 days, 2-35 days) (p = 0.01)., Conclusions: Hospitalization due to influenza-related acute LRTI is not an issue only for patients with an underlying medical condition. Vaccination should be considered not only for those with underlying medical conditions but also for healthy children., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The aim of this study was to evaluate the diagnostic utility of serum galactomannan (GM) positivity for invasive aspergillosis (IA) in children. Positive GM results between January 2015 and August 2017 were reviewed retrospectively in children with hematologic malignancies. Single and consecutive positive GM results were evaluated according to the different galactomannan index (GMI) (>0.5, >0.7, >1.0 and >1.5) values. There were 104 positive GM results of 70 patients. IA was identified in 29 patients (41.4%) (2 proven and 27 probable). For a single positive GMI of >0.5, >0.7, >1.0, and >1.5, the numbers were 104, 76, 57, and 32 and the positive predictive values (PPVs) were 39.4%, 43.2%, 47.2%, and 50.0%, respectively. The single GM positivity at different thresholds showed no difference between the IA and non-IA group (P>0.05). For 2 consecutive positive GMI values of >0.5, >0.7, >1.0, and >1.5, the numbers were 34, 20, 13, and 4, and the PPVs were 58.8%, 65.0%, 84.6%, and 100.0%, respectively. In the IA group, positivity was higher at all thresholds (P<0.05). According to our findings, consecutive GM positivity has higher PPVs independently from the cutoff value chosen. In pediatric patients with high risk, consecutive sampling should be preferred.

An amendment to this paper has been published and can be accessed via the original article.

Background: Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports. However, cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited, and most available data are from intensive care unit or adult studies., Methods: In this cross-sectional study spanning 6 years, comprehensive assessment of total health care costs attributable to CLABSI's associated with ports between two periods., Results: This cross-sectional study was carried out in the pediatric hematology-oncology ward of Dr. Behçet Uz Children's Hospital from 1 August November 2011 to 31 July 2017. The CLABSI rates decreased significantly from 8.31 CLABSIs to 3.04 per 1000 central line days (p < 0.001). In the pre-bundle period, total attributable costs spent for of patients with CLABSI were $130,661, and in the bundle period, total attributable costs spent for patients with CLABSI were $116,579. Within bundle implantation, 71 potential CLABSI were prevented, which saved an additional $208,977., Conclusion: Our study shows that central line bundles decreases not only the CLABSI rate but also decreases attributable costs due to CLABSI. Expenses spent for bundle elements, were covered by savings by preventing CLABSI with higher costs.

Purpose: The optimal scrubbing time for the disinfection of the surface of needleless connectors has not been determined. The evidence for successful needleless connector decontamination with 70% isopropyl alcohol ranges from 5 to 60 s. The aim of this prospective study was to identify colonization on the external surface of needleless connectors on central venous catheters and measure the efficiency of 15 s of scrubbing with 70% alcohol., Method: A total of 31 patients were included. Samples were collected adhering to aseptic no-touch technique policies. Two samples were collected from the injectable surface of the needleless connector with sterile sodium chloride 0.9% moistened and a dry swab from the same site. Then the surface was scrubbed with alcohol 70% for 15 s for disinfection and second couples of samples for the cultures were taken after disinfection., Findings: A total of 420 swabs were obtained. The number of colonization (equal or higher than 15 CFU/plate) was present on 21 of the needleless connectors (20.0%). Coagulase-negative staphylococci was responsible for all the colonization. After disinfection for 15 s, no isolation exceeding 1 CFU/plate was present., Conclusion: Scrubbing for 15 s with 70% alcohol was found to be successful at elimination of colonization of the surface of needleless connector even in high microorganism counts.

Objective: Smartphones and associated messaging applications have become the most common means of communication among health care workers and the general population. The aim of this study was to evaluate the reliability and accuracy of smartphones for the diagnosis of rash in children admitted to emergency departments during the night shift., Methods: The images of the children who were admitted to the paediatric emergency department with rash were included in this study, and at least two images taken with smartphones by residents or paediatric infectious disease fellows were re-directed to the chief consultant of the Paediatric-Infectious Department via smartphone. Initial diagnosis by the consultant was recorded, and the patient's physical examination was performed by another clinician on the first working day; diagnostic tests were planned by this clinician. The definitive diagnosis was recorded and compared with the initial diagnosis., Results: Among the 194 patients, the most common final diagnoses were chickenpox (varicella-zoster infections) in 33 patients (17.0%) and skin infections (including impetigo, ecthyma, erysipelas and cellulitis) in 33 patients (17.0%). The initial diagnosis, which was performed via WhatsApp on a smartphone, was identical to the final diagnosis in 96.3% of the cases. Incompatible initial diagnoses included 4 measles cases, 1 staphylococcal scalded skin syndrome case, 1 cutaneous leishmaniasis case and 1 petechial rash case., Conclusions: Our study has shown that the use of a smartphone-based instant messaging application for transmitting images of paediatric rash is accurate and useful for diagnosis. However, physical examination and medical history are still the primary methods. Consultation via smartphones in emergency departments for paediatric rashes during nightshifts would help both clinicians and patients.

Kara A, Devrim İ, Çağlar İ, Bayram N, Kundak S, Apa H, Altan EV. Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of six cases. Turk J Pediatr 2019; 61: 538-543. Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous adverse reactions commonly caused by exposure to drugs and can end up with significant morbidity and mortality. We reported our experience with six patients who were diagnosed with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis with a different clinical presentation. In patients, drugs and Mycoplasma pneumoniae infection were implicated as a trigger. Intravenous Immunoglobulin treatment was given to all patients, and intensive treatment was applied for skin and mucosal lesions. The median period of stay in hospital was 13.5 days. The most common long-term complication was ocular involvement. Among six patients, corneal epithelial defects occurred in one patient. Consequently, ophthalmological evaluation should be performed both at the time of diagnosis and before hospital discharge.

Çağlar İ, Topal S, Çokboz M, Düzgöl M, Kara A, Bayram SN, Apa H, Devrim İ. Clinical features and laboratory findings in children hospitalized with acute Epstein-Barr virus infection: a cross-sectional study in a tertiary care hospital. Turk J Pediatr 2019; 61: 368-373. Epstein-Barr virus (EBV) is widespread all over the world. It causes infectious mononucleosis (IM) mostly in adolescents and adults. Although IM is considered to be rare in younger children and infants, acute EBV infection may have various manifestations in this age group. We aimed to describe the clinical features and laboratory findings of children hospitalized with acute EBV infection. All children hospitalized at Dr. Behçet Uz Children`s Hospital, between January 2010 and January 2017, who tested positive by presence of EBV-specific antibodies and had the diagnosis of acute EBV infection, were included (n=66). Thirty four of the patients (51.5%) were under 6 years of age, and 23 (34.8%) children were below 3 years of age. The most common physical finding was fever (92.4%) followed by cervical lymphadenopathy and tonsillopharyngitis. Leukocytosis (65.1%) and lymphocytosis (42.4%) were the most common laboratory findings. Reactive and atypical lymphocytes were present in 77.2% of the patients. Fifty-three (80.3%) of the patients had a doctor visit before hospitalization, and the ratio of patients using antibiotics was 77.3%. Skin rash was observed in 14 (27.4%) of the patients who used antibiotic treatment and in 2 (13.3%) of the patients who did not (p > 0.05). EBV infection resulting in admission to hospital is common in younger children, even in pre-school period. Serological tests for EBV specific antibody responses and peripheral blood smear evaluation are important diagnostic tools. In addition, rapid streptococcal antigen test and throat culture should be performed in patients presenting with tonsillopharyngitis in order to exclude Group A beta-hemolytic streptococci and reduce unnecessary antibiotic consumption.

Objectives: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey., Methods: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed., Results: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies., Conclusion: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital., (Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

Background: Healthcare-associated infections results in increased health care costs and mortality. There are limited studies concerning the distribution of the etiologic agents and the resistance patterns of the microorganisms causing healthcare-associated urinary tract infections (HA-UTI) in pediatric settings., Objectives: The aim of this study was to evaluate the distribution and antibiotic susceptibility patterns of pathogens causing HA-UTI in children., Material and Methods: Isolates from 138 children with UTI who were hospitalized in pediatric, neonatal and pediatric surgery intensive care units were reviewed., Results: Most common isolated organism was Klebsiella pneumoniae (34.1%) and Escherichia coli (26.8%). Among the Pseudomonas aeruginosa, Meropenem and imipenem resistance rates were 46.2% and 38.5%. Extended-spectrum beta-lactamase (ESBL) production was present in 48 Klebsiella species (82.8%). Among ESBL positive Klebsiella species, the rate of meropenem and imipenem resistance was 18.8%, and ertapenem resistance was 45.9%. Extended spectrum beta-lactamase production was present in 27 (72.9%) Escherichia coli species. Among ESBL positive E. coli, the rate of meropenem and imipenem resistance was 7.4%, and ertapenem resistance was 14.8., Conclusions: Emerging meropenem resistance in P. aeruginosa, higher rates of ertapenem resistance in ESBL positive ones in E. coli and Klebsiella species in pediatric nosocomial UTI are important notifying signs for superbug infections., Competing Interests: Competing interests: The authors have declared that no competing interests exist.

Objective: Hospitalization of the children with preseptal cellulitis creates a burden on healthcare costs. This study aimed to analyze the hospital costs for preseptal cellulitis and determine the factors contributing., Methods: Children, between 1 and 18 years old, who were admitted to hospital for preseptal cellulitis from May 2013 to December 2016 were included in the study. Patients were divided into groups by age (under or equal to five years and older than five years) and by the presence of sinusitis. Demographics, length of stay and total and categorical hospital costs were evaluated retrospectively., Results: The study included 54 patients with a mean age of 5 years. Thirty one of the patients were under five years of age. The most common symptoms were swelling (94.4%) and redness (83.3%) around eye. Among the predisposing factors, sinusitis was the most common one (37%). The average length of stay was 4.5 days. Total hospital cost of all patients was $11,841. Antibiotic costs (37%) and inpatient floor costs (36%) were the greatest expenditures. Between age groups, length of stay was longer, and inpatient floor and antibiotic costs were significantly higher in the group of >5 years (p = 0.007, p = 0.004 and p = 0.001, respectively). In the group with sinusitis, length of stay was longer, and all hospital costs were significantly higher compared to the group without sinusitis (p < 0.001). There was a strong, positive correlation between length of stay and hospital costs (r = 0.854, n = 53, p < 0.001). Sinusitis was a significant factor (p < 0.001) for longer length of stay, but age was not (p = 0.841)., Conclusion: Sinusitis was found to be an important factor contributing to longer length of stay and higher hospital costs for preseptal cellulitis. Oral or ambulatory intravenous antimicrobial treatment strategies might decrease the hospital expenditure in these patients; however care should be taken in the presence of sinusitis., (Copyright © 2018. Published by Elsevier B.V.)

The aim of this study was to evaluate the effect of Er:YAG laser irradiation on the micro-shear bond strength of self-etch adhesives to the superficial dentin and the deep dentin before and after thermocycling. Superficial dentin and deep dentin surfaces were prepared by flattening of the occlusal surfaces of extracted human third molars. The deep or superficial dentin specimens were randomized into three groups according to the following surface treatments: group I (control group), group II (Er:YAG laser; 1.2 W), and group III (Er:YAG laser; 0.5 W). Clearfil SE Bond or Clearfil S 3 Bond was applied to each group's dentin surfaces. After construction of the composite blocks on the dentin surface, the micro-shear bond testing of each adhesive was performed at 24 h or after 15,000 thermal cycles. The data were analyzed using a univariate analysis of variance and Tukey's test (p < 0.05). Laser irradiation in superficial dentin did not significantly affect bond strength after thermocycling (p > 0.05). However, deep-dentin specimens irradiated with laser showed significantly higher bond strengths than did control specimens after thermocycling (p < 0.05). Thermocycling led to significant deterioration in the bond strengths of all deep-dentin groups. The stable bond strength after thermocycling was measured for all of the superficial-dentin groups. No significant difference was found between the 0.5 and 1.2 W output power settings. In conclusion, the effect of laser irradiation on the bond strength of self-etch adhesives may be altered by the dentin depth. Regardless of the applied surface treatment, deep dentin showed significant bond degradation.

Objective: The purpose of this study was to evaluate the effect of surface and heat treatments on the mechanical properties and phase transformation of yttria-stabilized tetragonal zirconia (Y-TZP) materials., Background Data: Zirconia is exposed to several treatments during dental application process. Knowing the effect of applied treatments on zirconia is essential for clinical success., Material and Methods: Forty disk specimens of Zirkonzahn (Z) and DC-Zirkon (DC) materials were fabricated. The specimens were randomly divided into four groups according to surface [control, sandblasting, Erbium: Yttrium Aluminum Garnet (Er:YAG) laser irradiation] and heat (firing) treatments. The surface roughness (Ra, μm) was measured using a surface profilometer. The relative amount of the transformed monoclinic (m) phase was analyzed by X-ray diffractometry (XRD). Biaxial flexural strength was tested using piston-on-three-ball technique. The data were analyzed with the Kruskal-Wallis H test with Bonferroni correction, and the Mann-Whitney U test was used for pairwise comparisons., Results: There were no significant differences in surface roughness among the treated groups (p > 0.05), whereas sandblasting showed higher surface roughness than other treatments for both materials. Scanning electron microscopic (SEM) analyses revealed changes in surface morphology after surface treatments, especially in laser groups with the formation of cracks, and in sandblasting groups with the formation of microretentive grooves. The greatest amount of the monoclinic phase was measured after sandblasting (8.13%) for Z and (19.8%) for DC. The monoclinic phase reverted to the tetragonal phase after heat treatment. Heat treatment groups showed significantly lower flexural strength than other treatments (p < 0.05)., Conclusions: Heat and surface treatments influenced the mechanical properties of zirconia ceramic. The biaxial flexural strength and crystalline phase of materials decreased after heat treatments.