Background: Hand hygiene is a cheap, simple, and an effective method that is necessarily implemented in crowded areas such as schools where infectious diseases can spread easily. Objective: To improve hand hygiene of students from grade 6 to 8 in a primary school from Canakkale, Turkey. Materials and Methods: This research was conducted in the educational year of 2012-2013 in a primary school, Kepez, Canakkale, Turkey. The subjects consisted of 185 primary school students from grade 6 to 8. Of these, 161 (participation rate = 87%) students participated. It was an educational study devoted to improve skills about hand hygiene. This study was carried out in three steps. First, a self-answered questionnaire and a standard checklist were used before hand hygiene training. Second, after 1 week from this first step, students were trained for improving hand-washing skills. Immediately afterward the training course, researchers observed each student for the assessment of their hand-washing habits and then filled the skill checklist. The last evaluation was made in the third step after 3 months from the training course. Students' hand-washing skill scores before and after the training were compared. Statistical analyses were performed using the SPSS software, version 19.0. A p-value of less than 0.05 was considered to be statistically significant. Results: Of 161 participants, 50.1% were boys and 49.0% were girls with the mean age of 12.6 ± 0.9 (min 11; max 14) years. Of these participants, 32.3% were from grade 6, 32.3% from grade 7, and 35.4% from grade 8; 98.1% students were living in Kepez and 1.9% were living in village. A statistically significant difference was detected between the first practice, which was made before training, and the second and third practices, which were made after training, in terms of handwashing skill development (p o 0.001). After the training, hand-washing skill scores showed a significant increase than before-training skill scores in both female and male students (p o 0.001). Conclusion: In this study, hand-washing skill training was found to be effective. In addition, students were found to be successful on implementing hand-washing skills in the last practice that was done after 3 months from the training course. However, it should be considered that newly acquired behaviors must be followed once in 6 months or in a year with continuity for these behaviors to be permanent and long standing.

Proton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249 714.29/µl, 197 314.29/µl, 193 941.18/µl, 183 500/µl, respectively). The platelet count decrease was statistically significant (p < 0.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69 000/µl, 97 000/µl and 49 000/µl respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.

BackgroundDrugs represent one of the etiologic causes of acute rhabdomyolysis (AR) with drug-induced rhabdomyolysis most commonly associated with HMG-CoA reductase inhibitors. AR etiology can also result from the use of diclofenac, a non-steroidal anti-inflammatory drug, and omeprazole, a proton pump inhibitor. Cases of AR triggered by pantoprazole have never before been reported, although it has been observed that its inclusion in multiple drug therapies can result in muscle events.Case presentationA 45-year-old man presenting with complaints of fatigue and extensive body pain was diagnosed with acute rhabdomyolysis. His symptoms started on the fourth day of the concomitant use of diclofenac and pantoprazole. The patient was using diclofenac 50-mg tablets once daily for 1 month and pantoprazole 40-mg tablets once daily during the previous week for headaches and pyrosis, resulting in an increase in his creatinine kinase levels to 3114 IU/L (reference range 24–190 IU/L) on the fifth day of concomitant use. His creatinine kinase levels returned to normal and his complaints disappeared after the seventh day of discontinuation of both treatments.DiscussionA third case of diclofenac-induced rhabdomyolysis was defined in which, different from previous cases, AR was detected during the concomitant use of diclofenac and pantoprazole. The timing of the symptom development and the limited number of AR cases induced by diclofenac and pantoprazole suggested a drug interaction.ConclusionThe close relationship between diclofenac and pantoprazole, and the cytochrome P450 and P-glycoprotein systems offers a strong indication that a drug interaction may be occurring. While evaluating the side effects of drugs in patients undergoing monotherapy, clinicians should also consider the mechanisms that play a part in drug absorption and distribution.

When clinicians assess medication adherence of patients, they should benefit from objective BP measurements and scales. Subjective and objective findings are important while making clinical decision.

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