Rapid diagnosis of influenza in the paediatric emergency department may allow a significant reduction in the over-prescription of antibiotics.

Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

Children under three years of age with recurrent wheeze run a high risk of incomplete immunisation. Efforts should be therefore made to insure that such children receive adequate vaccination.

Objective:To determine the influence of rapid diagnosis of influenza on patient management and laboratory tests as well as the length of the stay in the emergency department of children presenting with influenza-like illness (ILI) without signs of focal infection. Material and Method: A cross-sectional study was conducted in the pediatric emergency department of Vakif Gureba Hospital, Istanbul, between December 2008 and March 2009, including patients aged 8 months to 11 years presenting with fever and cough, coryza, myalgias,and /or malaise. After obtaining informed consent, patients were allocated into two groups. Group 1: physician informed about the rapid influenza test result; or Group 2; physician not informed of the rapid influenza test result. Nasopharyngeal swabs obtained from all patients were immediately tested with Influenza A/B Rapid Test ® for influenza A and B. Laboratory tests ordered and length of stay in the emergency department were compared between the resultant influenza-positive groups (informed and not informed). After initial presentation, a control visit check was carried out 1 month later. Results: One hundred and fifty children were enrolled, (mean age 4.2±3.8 years years, male/female ratio1.2) among whom 72 (48%) tested positive for influenza. Comparison of the groups revealed that the number of tests ordered and length of stay in the emergency department were significantly lower in the first group (12 versus 35 cases, and 62 versus 145 minutes respectively, (p<.0001). Clinical presentation symptoms were not significantly different between two groups. Conclusion: During the influenza season, rapid diagnosis of influenza may allow a reduction of additional laboratory tests and decreased length of time to discharge in a pediatric emergency department. (Çocuk Enf Derg 2010; 4: 60-4)

ÖzetAmaç: Bu çalışmada, term bebeklerde 6-12. saat ve 24. saatteki bilirübin değerlerinin oluşabilecek belirgin hiperbilirü-bineminin göstergesi olup olmadığı değerlendirildi. Gereç ve Yöntem:Çalışmaya sağlıklı, term hiperbilirübine-mi tanısı alan yenidoğanlar alındı. Serum total bilirubin öl-çümleri yaşamın ilk 6-12. saatleri arasında yapıldı. Takip eden günlerde 24, 48, 72 ve 96. saatlerde tekrarlandı. Olguların 6-12. saatler arasındaki ve 24. saatteki bilirubin değerleri ROC analizi ile belirgin hiperbilirubineminin göstergesi olup olmadığı açısından değerlendirildi. Bulgular: Çalışmada 134'ü (%48.5) erkek, 142'si (%51.5) kız 276 yenidoğan değerlendirildi. Klinik sarılık 240 (%86) olguda görüldü. Otuz yedi (%13.4) olguda belirgin hiperbilirubinemi gelişti. 6.-12. saatler arasındaki 3.9 mg/dl'nin üzerin-deki bilirubin değerleri %67.6 duyarlılık, %64.9 özgüllük ile (p<0.002) anlamlı bulundu. Pozitif prediktif değer %22.9, negatif prediktif değer %92.8 idi. 24. saatteki 7.7 mg/dl'nin üze-rindeki bilirubin değerleri %78.4 duyarlılık, %77.8 özgüllük ile (p<0.001) anlamlı bulundu. Pozitif prediktif değer %35.4, negatif prediktif değer %95.9 idi. 24. saatteki bilirubin değerlerinin 6-12. saatler arasındaki bilirubin değerlerine göre belirgin hiperbilirubineminin göstergesi olmak açısından daha anlamlı olduğu tespit edildi.Sonuç: Erken taburcu edilen yenidoğanlarda 24. saatteki bilirubin değerleri ileriki günlerde gelişebilecek belirgin hiperbilirubineminin göstergesi olarak anlamlı bir ölçüttür.Anahtar sözcükler: Hiperbilirubinemi; total bilirübin düzeyi; yenidoğan. Summary Background:The predictive value of 6-12th and 24th hour bilirubin levels in determining significant hyperbilirubinemia among healthy term neonates was evaluated in this study.