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Ademhan Tural D, Emiralioglu N, Akin S, Alboga D, Ozsezen B, Nayir Buyuksahin H, Guzelkas I, Kasikci M, Sunman B, Gungor I, Yalcin E, Dogru D, Kiper N, Demirel AH, Ozcelik U. Galectin-3 levels in children with cystic fibrosis. Eur J Pediatr 2024; 183:2333-2342. [PMID: 38430280 DOI: 10.1007/s00431-024-05479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
Cystic fibrosis (CF) is a multisystemic disease in which airway obstruction, infection, and inflammation play a critical role in the pathogenesis and progression of CF lung disease. The carbohydrate-binding protein Galectin-3 is increased in several inflammatory and fibrotic diseases and has recently been forwarded as a biomarker in these diseases. We aimed to define the role of serum Galectin-3 in children with CF by comparison with healthy subjects. This is a cross-sectional, case-control study. 143 CF and 30 healthy subjects were enrolled in the study. Peripheral blood and sputum concentrations of Galectins-3, interleukin (IL)-17A, IL-8, and neutrophil elastase (NE) were determined with commercial ELISA kits. There was no significant difference between the groups in age and gender (p = 0.592, p = 0.613, respectively). Serum Galectin-3 and NE concentrations were higher in the patient group than in healthy controls (p = 0.002, p < 0.001, respectively). There were no significant differences between groups according to IL-17A and IL-8 concentrations. Serum Galectin-3 was correlated with age (r = 0.289, p < 0.001) and body mass index (BMI) (r = 0.493, p < 0.001) in children with CF. Sputum Galectin-3 levels are negatively correlated with percent predictive forced expiratory volume in 1 s (FEV1) (r = - 0.297, p = 0.029), FEV1 z-score, (r = - 0.316, p = 0.020), percent predictive forced vital capacity (FVC) (r = - 0.347, p = 0.010), and FVC z-score (r = - 0.373, p = 0.006). Conclusion: The study shows that serum Galectin-3 levels increased in clinically stable CF patients, and serum Galectin-3 response may depend on age, gender, and BMI. The sputum Galectin-3 was found to be negatively correlated with patients' lung functions. What is known: • Galectin-3 is a key regulator of chronic inflammation in the lung, liver, kidney, and tumor microenvironment. What is new: • Children with cystic fibrosis (CF) have higher serum Galectin-3 concentrations than healthy children. • Serum Galectin-3 expression influenced by age, BMI, and gender in children with CF.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Senay Akin
- Department of Sport Medicine, Hacettepe University, Ankara, Turkey
| | - Didem Alboga
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Merve Kasikci
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Irem Gungor
- Department of Sport Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | | | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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Lam YT, Papon JF, Alexandru M, Anagiotos A, Armengot M, Boon M, Burgess A, Calmes D, Crowley S, Dheyauldeen SAD, Emiralioglu N, Erdem Eralp E, van Gogh C, Gokdemir Y, Haarman EG, Harris A, Hayn I, Ismail-Koch H, Karadag B, Kempeneers C, Kieninger E, Kim S, Lorent N, Ozcelik U, Pioch C, Raidt J, Reula A, Roehmel J, Sperstad Kennelly S, Yiallouros P, Goutaki M. Association between upper and lower respiratory disease among patients with primary ciliary dyskinesia: an international study. ERJ Open Res 2024; 10:00932-2023. [PMID: 38444659 PMCID: PMC10910353 DOI: 10.1183/23120541.00932-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/03/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Nearly all patients with primary ciliary dyskinesia (PCD) report ear-nose-throat (ENT) symptoms. However, scarce evidence exists about how ENT symptoms relate to pulmonary disease in PCD. We explored possible associations between upper and lower respiratory disease among patients with PCD in a multicentre study. Methods We included patients from the ENT Prospective International Cohort (EPIC-PCD). We studied associations of several reported ENT symptoms and chronic rhinosinusitis (defined using patient-reported information and examination findings) with reported sputum production and shortness of breath, using ordinal logistic regression. In a subgroup with available lung function results, we used linear regression to study associations of chronic rhinosinusitis and forced expiratory volume in 1 s (FEV1) accounting for relevant factors. Results We included 457 patients (median age 15 years, interquartile range 10-24 years; 54% males). Shortness of breath associated with reported nasal symptoms and ear pain of any frequency, often or daily hearing problems, headache when bending down (OR 2.1, 95% CI 1.29-3.54) and chronic rhinosinusitis (OR 2.3, 95% CI 1.57-3.38) regardless of polyp presence. Sputum production associated with daily reported nasal (OR 2.2, 95% CI 1.20-4.09) and hearing (OR 2.0, 95% CI 1.10-3.64) problems and chronic rhinosinusitis (OR 2.1, 95% CI 1.48-3.07). We did not find any association between chronic rhinosinusitis and FEV1. Conclusion Reported upper airway symptoms and signs of chronic rhinosinusitis associated with reported pulmonary symptoms, but not with lung function. Our results emphasise the assessment and management of upper and lower respiratory disease as a common, interdependent entity among patients with PCD.
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Affiliation(s)
- Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jean-François Papon
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mihaela Alexandru
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- AP-HP Département de Génétique médicale, Sorbonne Université, Inserm UMR_S933 Maladies génétiques d'expression pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Andreas Anagiotos
- Department of Otorhinolaryngology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miguel Armengot
- Department of Otorhinolaryngology, and Primary Ciliary Dyskinesia Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medical School, Valencia University, Valencia, Spain
- Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
| | - Mieke Boon
- Department of Paediatrics, University Hospital Leuven, Leuven, Belgium
| | - Andrea Burgess
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Doriane Calmes
- Department of Pneumology, University Hospital Liège, Liège, Belgium
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Sinan Ahmed D. Dheyauldeen
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ela Erdem Eralp
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Christine van Gogh
- Department of Otorhinolaryngology – Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Yasemin Gokdemir
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Eric G. Haarman
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Amanda Harris
- Southampton Children's Hospital, University of Southampton, Southampton, UK
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Isolde Hayn
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hasnaa Ismail-Koch
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Bülent Karadag
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Céline Kempeneers
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sookyung Kim
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Department Chrometa, Laboratory of Respiratory and Thoracic Diseases, KU Leuven, Leuven, Belgium
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Charlotte Pioch
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanna Raidt
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Ana Reula
- Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
- Biomedical Sciences Department, CEU-Cardenal Herrera University, Castellón, Spain
| | - Jobst Roehmel
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Lung Research (DZL), Associated Partner Site, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Panayiotis Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
- Pediatric Pulmonology Unit, Hospital “Archbishop Makarios III”, Nicosia, Cyprus
| | | | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ademhan Tural D, Kasikci M, Eryilmaz Polat S, Ozsezen B, Hizal M, Sunman B, Nayir Büyüksahin H, Guzelkas I, Altay O, Dolgun TY, Emiralioglu N, Yalcin E, Dogru D, Kiper N, Hascelik G, Diker KS, Ozcelik U. The airway microbiota in siblings with primary ciliary dyskinesia: Related factors and correlation with clinical characteristics. Pediatr Pulmonol 2024; 59:695-706. [PMID: 38088243 DOI: 10.1002/ppul.26816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/22/2023] [Accepted: 12/03/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVES-AIM We aimed to show the composition and structure of and explore affecting factors on airway microbiota in primary ciliary dyskinesia (PCD) patients using culture-independent techniques. METHOD A cross-sectional observational study was performed. We recruited 14 PCD patients (seven pairs of siblings) and nine parents. Bacterial rDNA was extracted from sputum and nasal samples. Sputum samples were also inoculated on suitable bacteriological media. RESULTS Thirty-three separate genera were detected in sputum samples of PCD patients, and 41 were in nasal samples of parents. The detected genera were dominated by phyla Proteobacteria in PCD patients and their parents. Culture-dependent analyses could not detect many of the bacterial species detected with culture-independent analyses. There were no significant differences in alpha diversity between the siblings' pairs, and siblings' samples did not cluster together nearly as strongly as nonsiblings' samples. Patients who had no new complaints and no bacterial growth with the culture-dependent method at the time of study and patients who had no Haemophilus influenzae growth in the previous year had a significantly greater diversity (p < .05). Microbiota communities tended to cluster together by age, pulmonary exacerbation status, the existence of at least one H. influenzae growth with culture-dependent analyses in the previous year, and forced expiratory volume in 1 sec z and FEF25-75 z-scores. CONCLUSION The airway microbiota of patients with PCD have presented more diverse bacterial communities than had been indicated with culture-dependent methods. The study identifies relationships between bacterial airway microbiota composition and the clinical measures of patients. Sibling pairs have no more community similarities than nonsibling PCD patients. Our results may indicate that the patients' clinical characteristics, which determine the disease severity, might affect the PCD microbiome.
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Affiliation(s)
| | - Merve Kasikci
- Department of Statistics, Hacettepe University, Ankara, Türkiye
| | | | - Beste Ozsezen
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | - Mina Hizal
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | - Birce Sunman
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | | | - Ismail Guzelkas
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | - Ozlem Altay
- Department of Protein Science, Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden
| | | | | | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
| | - Gulsen Hascelik
- Department of Microbiology, Hacettepe University, Ankara, Türkiye
| | | | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University, Ankara, Türkiye
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4
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Hizal M, Gunel IE, Ozcan HN, Oguz B, Emiralioglu N, Yalcin E, Dogru D, Ozcelik U, Haliloglu M, Kiper N. Comparison of lung ultrasonography and magnetic resonance imaging versus computed tomography in pulmonary alveolar microlithiasis. Pediatr Pulmonol 2024. [PMID: 38214437 DOI: 10.1002/ppul.26862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Mina Hizal
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ilkin E Gunel
- Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hatice N Ozcan
- Department of Radiology, Pediatric Radiology Division, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Pediatric Radiology Division, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology, Pediatric Radiology Division, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
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Lam YT, Papon JF, Alexandru M, Anagiotos A, Armengot M, Boon M, Burgess A, Caversaccio N, Crowley S, Dheyauldeen SAD, Emiralioglu N, Erdem E, Gogh CV, Gokdemir Y, Gunaydın O, Haarman EG, Harris A, Hayn I, Ismail-Koch H, Karadag B, Kempeneers C, Kim S, Lorent N, Ozcelik U, Pioch C, Poirrier ALM, Reula A, Roehmel J, Yiallouros P, Goutaki M. Lack of Correlation of Sinonasal and Otologic Reported Symptoms With Objective Measurements Among Patients With Primary Ciliary Dyskinesia: An International Study. Clin Exp Otorhinolaryngol 2023; 16:407-412. [PMID: 38056830 DOI: 10.21053/ceo.2023.01130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/25/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Jean-François Papon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Service d'ORL, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mihaela Alexandru
- Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Service d'ORL, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Département de Génétique Médicale, Sorbonne Université, Inserm UMR_S933, Maladies Génétiques D'expression Pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Andreas Anagiotos
- Department of Otolaryngology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miguel Armengot
- Department of Otorhinolaryngology, and Primary Ciliary Dyskinesia Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medical School, Valencia University, Valencia, Spain
- Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
| | - Mieke Boon
- Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Burgess
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Nathalie Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Sinan Ahmed D Dheyauldeen
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ela Erdem
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Christine van Gogh
- Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Yasemin Gokdemir
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Onder Gunaydın
- Department of Otorhinolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Eric G Haarman
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Amanda Harris
- Southampton Children's Hospital, University of Southampton, Southampton, UK
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Isolde Hayn
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hasnaa Ismail-Koch
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Céline Kempeneers
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Sookyung Kim
- Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Service d'ORL, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Charlotte Pioch
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ana Reula
- Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
- Biomedical Sciences Department, CEU-Cardenal Herrera University, Castellón, Spain
| | - Jobst Roehmel
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Panayiotis Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
- Pediatric Pulmonology Unit, Hospital 'Archbishop Makarios III', Nicosia, Cyprus
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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Nayır Büyükşahin H, Emiralioglu N, Simşek Kiper PÖ, Sunman B, Güzelkaş I, Alboğa D, Akgül Erdal M, Boduroglu K, Utine GE, Yalcın E, Doğru D, Kiper N, Ozcelik U. Evaluation of polysomnography findings in children with genetic skeletal disorders. J Sleep Res 2023; 32:e13914. [PMID: 37128177 DOI: 10.1111/jsr.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Children with genetic skeletal disorders have variable conditions that can lead to sleep-disordered breathing, and polysomnography is the gold standard for diagnosing this condition. We aimed to review polysomnography findings, to assess the severity of sleep apnea, and to investigate the clinical variables predictive of sleep-disordered breathing in these patients. We retrospectively collected the medical records of patients with genetic skeletal disorders who underwent polysomnography for 5 years. Twenty-seven children with various genetic skeletal disorders, including achondroplasia (14), Crouzon syndrome (3), acromesomelic dysplasia Maroteaux type (3), Apert syndrome (2), osteopetrosis (1), Jeune dysplasia (1), Desbuquois dysplasia (1), acrodysostosis (1), and spondyloepiphyseal dysplasia (1) were enrolled. The median age at the first polysomnography was 58 (1st-3rd quartile: 31-113) months. The overall sleep-disordered breathing results were: 19 (70.3%) had obstructive sleep apneas (OSA) (4 mild, 6 moderate, 9 severe), 2 (7.4%) had central apneas, 4 (14.8%) had nocturnal hypoventilation. There was a significant correlation between non-ambulatory status with both total AHI and OSA (p < 0.001, rho: -0.66/p = 0.04, rho: 0.38, respectively). Nine patients received positive airway pressure titration, and the oAHI values of all returned to the normal range. These patients were started with positive airway pressure treatment. Our cohort showed that the majority of the patients with skeletal dysplasia had sleep apnea syndrome characterised mainly by OSA, highlighting the importance of polysomnography screening for sleep disorders. Positive airway pressure therapy represents an effective treatment for sleep-disordered breathing in those patients.
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Affiliation(s)
- Halime Nayır Büyükşahin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Özlem Simşek Kiper
- Division of Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Güzelkaş
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Akgül Erdal
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Koray Boduroglu
- Division of Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülen Eda Utine
- Division of Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcın
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Nayir Buyuksahin H, Dogru D, Gözmen O, Ozon A, Portakal O, Emiralioglu N, Haliloglu M, Kılıc K, Vardar Yaglı N, Yıldırım D, Dag O, Guzelkas I, Yalcın E, Ozcelik U, Kiper N. Cystic fibrosis related bone disease in children: Can it be predicted? Clin Nutr 2023; 42:1631-1636. [PMID: 37487275 DOI: 10.1016/j.clnu.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/09/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND&AIMS Cystic fibrosis (CF) -related bone disease (CFBD) is an important complication of CF, and low BMD in childhood is a precursor of CFBD. Here, we aimed to investigate bone turnover biomarkers, including osteocalcin (OC), receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in relation to low BMD in children with CF (cwCF). We also evaluated factors which could affect bone turnover with particular emphasis on fat-free mass (FFM), forced expiratory volume in 1 s (FEV1), hand grip strength (HGS), and functional capacity and physical activity. METHODS Sixteen cwCF aged 8-18 years with moderate low BMD (group1) and 64 cwCF with normal BMD (group2) were enrolled. Serum RANKL, OC, and OPG were determined by immunoenzymatic assays. Multiple parameters including pancreatic status, lung functions, body mass index (BMI), FFM measured by bioelectric impedance analysis (BIA), 6-minute walk test, vitamin D, nutritional intake, HGS, functional capacity and physical activity, serum and urine biomarkers were compared between the two groups. RESULTS We found similar serum levels of RANKL (p = 0.501), OC (p = 0.445), OPG (p = 0.380), and RANKL/OPG ratio (p = 0.449) between group1 and group2 in cwCF. BMI z-score (p < 0.001), FFMI z-score (p < 0.001), FEV1 z-score (p = 0.007), and right-HGS (%pred) (p = 0.009) significantly differed between the two groups. Multivariate linear regression revealed that the only factors that predicted BMD were FFMI z-score and HGS %pred. CONCLUSION Serum OC, OPG, RANKL and RANKL/OPG ratio did not predict BMD in cwCF. FFMI z-score and HGS %pred measured by non-invasive and practical methods were the best predictors of BMD.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Deniz Dogru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Onur Gözmen
- Division of Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alev Ozon
- Division of Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oytun Portakal
- Department of Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kübra Kılıc
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar Yaglı
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Damla Yıldırım
- Department of Nutrition and Dietetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Osman Dag
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ismail Guzelkas
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcın
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Nayır Büyükşahin H, Emiralioglu N, Sekerel BE, Soyer T, Oguz B, Güzelkaş I, Sunman B, Alboğa D, Akgül Erdal M, Yalcın E, Doğru D, Ozcelik U, Kiper N. Plastic bronchitis during childhood: Diversity of presentation, etiology, treatment, and outcomes. Pediatr Pulmonol 2023; 58:2559-2567. [PMID: 37278540 DOI: 10.1002/ppul.26548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/11/2023] [Accepted: 05/27/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Plastic bronchitis (PB) is a rare disease in children, and reliable data are scarce. Here, we aimed to analyze the clinical features, management, and outcomes in children with PB. METHODS The medical data of patients who were followed up with a diagnosis of PB between January 2010 and March 2022 were retrospectively analyzed. RESULTS The median age of 15 patients was 9 (interquartile range: 4-10) years with a male/female ratio of 12/3. Initial symptoms included recurrent pneumonia (33.3%), persistent atelectasis (33.3%), cast expectoration (26.6%), and intense, persistent cough (6.6%). The most common underlying diagnosis was asthma (n = 12, 80%), and six of the patients were newly diagnosed. The most common radiological findings were atelectasis as a consequence of major airway obstruction on chest X-ray or computed tomography. Five patients, all diagnosed as having asthma, had recurrent PB and required multiple airway procedures for treatment and diagnosis. During a median 7-year follow-up of five patients, occasionally cast expectoration was observed in one patient with asthma who had poor compliance with inhaled corticosteroids. CONCLUSION PB is a common reflection of the different underlying etiologies in the pediatric age group, and treatment and outcomes are closely related to these. It should be kept in mind that asthma can be a predisposing factor for the development of PB.
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Affiliation(s)
- Halime Nayır Büyükşahin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bulent E Sekerel
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Güzelkaş
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Akgül Erdal
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcın
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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9
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Eren E, Tokac M, Ozcelik U, Sahin T, Tellioglu G, Peksen C, Dinckan A. Comparison of Bipolar vascular sealing and conventional back-table dissection in terms of post-renal transplant drainage and back-table preparation times. Eur Rev Med Pharmacol Sci 2023; 27:6223-6228. [PMID: 37458629 DOI: 10.26355/eurrev_202307_32981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The usage of vessel sealing devices has been gaining popularity in all surgical specialties. Post-renal transplant drain placement is a common practice among transplant surgeons. However, prolonged drainage accompanied by surgical wound complications and perirenal fluid collections is a frequent complication experienced by the recipients. This study aimed to compare Bipolar vascular sealing with conventional back-table dissection in terms of post-renal transplant drainage duration, amount, surgical wound complication, and back-table preparation time. PATIENTS AND METHODS A double-blind clinical study randomizes recipients into 2 groups, using Bipolar vascular sealing (Group 1) and conventional ligation (Group 2) back-table dissection. Variables such as recipient age, gender, body mass index (BMI), cause of end-stage renal disease, amount and duration of surgical drainage, back-table time, and cold ischemia time (CIT) were collected prospectively. RESULTS Ninety-eight consecutive living donor (M/F: 69/29) renal transplant recipients were enrolled in this prospective randomized clinical trial. There were 49 patients in each group. The mean BMI was 26.76±4.57. There was no difference among the groups regarding recipient age, BMI, total drainage, and surgical drainage duration. The surgical site infection rate was not different between the two groups. Group 1 had significantly shorter back-table time, with mean back-table time being 15.26±2.51 minutes in Group 1 and 28.83±6.27 minutes in Group 2 (p<0.001). The CIT was also significantly different between the 2 groups (p<0.001). In Group 1, the recorded CIT was 43.3±11.4, and in Group 2, 57.1±13.3 minutes. CONCLUSIONS The use of Bipolar vascular sealing to seal lymphatic vessels at the back-table is feasible, safe, and easy to perform. It also expedites the dissection and shortens the time required for back-table graft preparation.
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Affiliation(s)
- E Eren
- Department of General Surgery, Istinye University Hospital, Istanbul, Turkey.
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10
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Goutaki M, Lam YT, Alexandru M, Anagiotos A, Armengot M, Boon M, Burgess A, Caversaccio N, Crowley S, Dheyauldeen SAD, Emiralioglu N, Erdem E, van Gogh C, Gunaydin O, Haarman EG, Harris A, Hayn I, Ismail-Koch H, Karadag B, Kempeneers C, Kim S, Lorent N, Ozcelik U, Pioch C, Poirrier ALML, Reula A, Roehmel J, Yiallouros P, Yumusakhuylu AC, Papon JF. Characteristics of Otologic Disease Among Patients With Primary Ciliary Dyskinesia. JAMA Otolaryngol Head Neck Surg 2023; 149:587-596. [PMID: 37166807 PMCID: PMC10176184 DOI: 10.1001/jamaoto.2023.0841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 05/12/2023]
Abstract
Importance Otologic disease is common among people with primary ciliary dyskinesia (PCD), yet little is known about its spectrum and severity. Objective To characterize otologic disease among participants with PCD using data from the Ear-Nose-Throat Prospective International Cohort. Design, Setting, and Participants This cross-sectional analysis of baseline cohort data from February 2020 through July 2022 included participants from 12 specialized centers in 10 countries. Children and adults with PCD diagnoses; routine ear, nose, and throat examinations; and completed symptom questionnaires at the same visit or within 2 weeks were prospectively included. Exposures Potential risk factors associated with increased risk of ear disease. Main Outcomes and Measures The prevalence and characteristics of patient-reported otologic symptoms and findings from otologic examinations, including potential factors associated with increased risk of ear inflammation and hearing impairment. Results A total of 397 individuals were eligible to participate in this study (median [range] age, 15.2 [0.2-72.4] years; 186 (47%) female). Of the included participants, 204 (51%) reported ear pain, 110 (28%) reported ear discharge, and 183 (46%) reported hearing problems. Adults reported ear pain and hearing problems more frequently when compared with children. Otitis media with effusion-usually bilateral-was the most common otoscopic finding among 121 of 384 (32%) participants. Retracted tympanic membrane and tympanic sclerosis were more commonly seen among adults. Tympanometry was performed for 216 participants and showed pathologic type B results for 114 (53%). Audiometry was performed for 273 participants and showed hearing impairment in at least 1 ear, most commonly mild. Season of visit was the strongest risk factor for problems associated with ear inflammation (autumn vs spring: odds ratio, 2.40; 95% CI, 1.51-3.81) and age 30 years and older for hearing impairment (41-50 years vs ≤10 years: odds ratio, 3.33; 95% CI, 1.12-9.91). Conclusion and Relevance In this cross-sectional study, many people with PCD experienced ear problems, yet frequency varied, highlighting disease expression differences and possible clinical phenotypes. Understanding differences in otologic disease expression and progression during lifetime may inform clinical decisions about follow-up and medical care. Multidisciplinary PCD management should be recommended, including regular otologic assessments for all ages, even without specific complaints.
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Affiliation(s)
- Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mihaela Alexandru
- Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital Bicêtre, Service d’ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Andreas Anagiotos
- Department of Otorhinolaryngology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miguel Armengot
- Department of Otorhinolaryngology and Primary Ciliary Dyskinesia Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- University of Valencia Medical School, Valencia, Spain
| | - Mieke Boon
- Department of Paediatrics, University Hospital, Leuven, Belgium
| | - Andrea Burgess
- Primary Ciliary Dyskinesia Centre, Southampton Children’s Hospital, Southampton NHS Foundation Trust, Southampton, England, United Kingdom
| | - Nathalie Caversaccio
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Sinan Ahmed D. Dheyauldeen
- Department of Otorhinolaryngology–Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ela Erdem
- Department of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Christine van Gogh
- Department of Otorhinolaryngology–Head and Neck Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Onder Gunaydin
- Department of Otorhinolaryngology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Eric G. Haarman
- Department of Pediatric Pulmonology, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Amanda Harris
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, England, United Kingdom
| | - Isolde Hayn
- Department of Otorhinolaryngology–Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hasnaa Ismail-Koch
- Primary Ciliary Dyskinesia Centre, Southampton Children’s Hospital, Southampton NHS Foundation Trust, Southampton, England, United Kingdom
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Céline Kempeneers
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Sookyung Kim
- Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital Bicêtre, Service d’ORL, Le Kremlin-Bicêtre, France
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospital, Leuven, Belgium
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Charlotte Pioch
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ana Reula
- Biomedical Sciences Department, CEU-Cardenal Herrera University, Castellón, Spain
- Molecular, Cellular and Genomic Biomedicine Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Jobst Roehmel
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Panayiotis Yiallouros
- University of Cyprus Medical School, Nicosia, Cyprus
- Pediatric Pulmonology Unit, Archbishop Makarios III Hospital, Nicosia, Cyprus
| | | | - Jean-François Papon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Saclay, Hôpital Bicêtre, Service d’ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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11
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Lam YT, Papon JF, Alexandru M, Anagiotos A, Armengot M, Boon M, Burgess A, Crowley S, Dheyauldeen SAD, Emiralioglu N, Erdem Eralp E, van Gogh C, Gokdemir Y, Gunaydın O, Haarman EG, Harris A, Hayn I, Ismail-Koch H, Karadag B, Kempeneers C, Kim S, Latzin P, Lorent N, Ozcelik U, Pioch C, Poirrier ALM, Reula A, Roehmel J, Yiallouros P, Goutaki M. Sinonasal disease among patients with primary ciliary dyskinesia: an international study. ERJ Open Res 2023; 9:00701-2022. [PMID: 37228283 PMCID: PMC10204851 DOI: 10.1183/23120541.00701-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/21/2023] [Indexed: 05/27/2023] Open
Abstract
Background Sinonasal symptoms are a common feature of primary ciliary dyskinesia (PCD); however, literature about their severity and frequency, particularly during the life course, is scarce. Using baseline data from the Ear, nose and throat (ENT) Prospective International Cohort of PCD patients, we describe sinonasal disease in PCD. Methods We included participants who had a routine sinonasal examination during which they completed a symptoms questionnaire. We compared frequency of reported symptoms and examination findings among children and adults, and identified characteristics potentially associated with higher risk of sinonasal disease using ordinal regression. Results 12 centres contributed 384 participants; median age was 16 years (IQR 9-22), and 54% were male. Chronic nasal problems were the most common feature, reported by 341 (89%). More adults (33; 24%) than children (10; 4%) described hyposmia. Quality of life was moderately affected by rhinosinusitis among 136 participants with completed SNOT-22 questionnaires (median score 31; IQR 23-45). Examinations revealed nasal polyps among 51 of 345 participants (15%) and hypertrophic inferior nasal turbinates among 127 of 341 participants (37%). Facial pain was detected in 50 of 342 participants (15%). Nasal polyps, hypertrophic turbinates, deviated septum and facial pain were found more commonly in adults than children. The only characteristic associated with higher risk of sinonasal disease was age 10 years and older. Conclusions Based on our findings, regular sinonasal examinations are relevant for patients with PCD of all ages. There is a need for improved management of sinonasal disease supported by evidence-based guidelines.
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Affiliation(s)
- Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Jean-François Papon
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mihaela Alexandru
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Andreas Anagiotos
- Department of Otorhinolaryngology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miguel Armengot
- Department of Otorhinolaryngology, and Primary Ciliary Dyskinesia Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medical School, Valencia University, Valencia, Spain
| | - Mieke Boon
- Department of Paediatrics, University Hospital, Leuven, Belgium
| | - Andrea Burgess
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo, Norway
| | - Sinan Ahmed D. Dheyauldeen
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ela Erdem Eralp
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Christine van Gogh
- Department of Otorhinolaryngology – Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Yasemin Gokdemir
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Onder Gunaydın
- Department of Otorhinolaryngology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Eric G. Haarman
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Amanda Harris
- Southampton Children's Hospital, University of Southampton, Southampton, UK
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Isolde Hayn
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hasnaa Ismail-Koch
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Bülent Karadag
- Department of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Céline Kempeneers
- Division of Respirology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Sookyung Kim
- Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Hôpital Bicêtre, Service d'ORL, Le Kremlin-Bicêtre, France
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospital, Leuven, Belgium
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Charlotte Pioch
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ana Reula
- Biomedical Sciences Department, CEU-Cardenal Herrera University, Castellón, Spain
- Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
| | - Jobst Roehmel
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Panayiotis Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
- Pediatric Pulmonology Unit, Hospital “Archbishop Makarios III”, Nicosia, Cyprus
| | | | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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12
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Nayir Buyuksahin H, Dogru D, Emiralioglu N, Ademhan Tural D, Özsezen B, Sunman B, Guzelkaş I, Alboğa D, Arikan-Akdagli S, Sarıbaş Z, Gulmez D, Alp A, Hazırolan G, Soyer Ö, Şekerel BE, İnam G, Irmak İ, Damadoğlu E, Kalyoncu F, Yalçın E, Ozcelik U, Kiper N. A case-control study of the effects of Aspergillus clinical phenotypes on pulmonary functions in patients with cystic fibrosis. Pediatr Pulmonol 2023; 58:1185-1193. [PMID: 36651101 DOI: 10.1002/ppul.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION There are no precise data about the effect of Aspergillus infection on lung function other than allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (pwCF). Here, we aimed to determine clinical phenotypes caused by Aspergillus spp. using laboratory and immunologic parameters and to compare Aspergillus phenotypes in terms of pulmonary function tests (PFT) prospectively. METHODS Twenty-three pwCF who had Aspergillus isolation from respiratory cultures in the last year (case group) and 20 pwCF without Aspergillus isolation in sputum (control group) were included. Aspergillus immunoglobulin (Ig)-G, Aspergillus IgE, Aspergillus polymerase chain reaction (PCR), galactomannan, total IgE from blood samples, and Aspergillus PCR and galactomannan from sputum, and skin prick test reactivity to Aspergillus antigen were used to distinguish different Aspergillus phenotypes. Pulmonary functions and frequency of pulmonary exacerbations were evaluated during a 1-year follow-up. RESULTS Of 23 pwCF, 11 (47.8%) had Aspergillus colonization, nine (39.1%) had Aspergillus bronchitis, and three (13%) had ABPA. Aspergillus infection was not associated with worse z-scores of forced expiratory volume in the first second (FEV1) (p = 0.612), forced vital capacity (p = 0.939), and the median FEV 1% decline (0.0%/year vs. -4.7%/year, p = 0.626). The frequency of pulmonary exacerbations in the Aspergillus infected and noninfected groups was similar. CONCLUSION Although Aspergillus spp. Isolation in pwCF was not associated with decreased lung function, a further decline was seen in the ABPA subgroup, and frequent pulmonary exacerbations during the 1-year follow-up.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Beste Özsezen
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Guzelkaş
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Sarıbaş
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dolunay Gulmez
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Soyer
- Department of Pediatrics, Division of Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatrics, Division of Allergy and Asthma, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gözde İnam
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlim Irmak
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Damadoğlu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fuat Kalyoncu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Nayir Buyuksahin H, Emiralioglu N, Ademhan Tural D, Ozsezen B, Sunman B, Guzelkas I, Alboğa D, Akgül Erdal M, Yalçın E, Dogru D, Tokatlı A, Ozcelik U, Sivri S, Kiper N. Coexistence of cystic fibrosis with other genetic disorders: A case series. Pediatr Pulmonol 2023; 58:345-347. [PMID: 36193028 DOI: 10.1002/ppul.26182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/23/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Akgül Erdal
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayşegül Tokatlı
- Department of Pediatrics, Division of Pediatric Metabolism, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serap Sivri
- Department of Pediatrics, Division of Pediatric Metabolism, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Hızal M, Eryilmaz Polat S, Emiralioğlu N, Cinel G, Yalcin E, Dogru D, Ozcelik U, Kiper N. The role of bronchoscopy in eosinophilia and pulmonary involvement. Pediatr Int 2022; 65:e15421. [PMID: 36413116 DOI: 10.1111/ped.15421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/16/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many possible underlying causes can be seen in children with unexplained peripheral eosinophilia (UPE) with suspected pulmonary involvement. We aimed to demonstrate the clinical characteristics and diagnoses of children evaluated for UPE who underwent diagnostic bronchoscopy. METHODS Thirty-one children who underwent diagnostic bronchoscopy for UPE between 2006- 2018 were included. Demographic characteristics, bronchoscopy findings and final diagnosis, and treatments were evaluated. RESULTS The median age at the time of diagnosis was 5 (0.25-17.5) years. The final diagnoses of 26 patients were as follows: immunodeficiency (n=6); hyper IgE syndromes (n=4), DOCK8 deficiency + HES (idiopathic hypereosinophilic syndrome) (n=1), and severe combined immunodeficiency (n=1), HES (n=3), idiopathic chronic eosinophilic pneumonia (ICEP) (n=3), idiopathic pulmonary hemosiderosis (n=1), B cell lymphoma (n=1). In one child, an integrin α3 mutation + CMV pneumonia was detected. Congenital pneumonia was found in one patient, and parasitic infection in another. In two, eosinophilia was attributed to underlying asthma and atopy. In four, the underlying reasons could not be elucidated. Two children with HES and one with ICEP were lost to follow-up. There was no significant relationship between the peripheral eosinophil count at the time of diagnosis and the percentage of bronchoalveolar lavage eosinophils (BAL). Bronchoscopy contributed to the management of 14 (53.9%) patients. CONCLUSIONS Bronchoscopy has potential diagnostic contribution in patients with UPE suspected of having pulmonary involvement. Numerous various underlying causes may be present in this patient group. There is no relation between peripheral eosinophil count and BAL eosinophil percentage.
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Affiliation(s)
- Mina Hızal
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
| | - Nagehan Emiralioğlu
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
| | - Guzin Cinel
- Ministry of Health Ankara City Hospital, Pediatric Pulmonology, Ankara, Turkey
| | - Ebru Yalcin
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
| | - Deniz Dogru
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
| | - Ugur Ozcelik
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
| | - Nural Kiper
- Hacettepe University Faculty of Medicine- Pediatric Pulmonology-, Ankara, Turkey
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Raidt J, Maitre B, Pennekamp P, Altenburg J, Anagnostopoulou P, Armengot M, Bloemsma LD, Boon M, Borrelli M, Brinkmann F, Carr SB, Carroll MP, Castillo-Corullón S, Coste A, Cutrera R, Dehlink E, Destouches DMS, Di Cicco ME, Dixon L, Emiralioglu N, Erdem Eralp E, Haarman EG, Hogg C, Karadag B, Kobbernagel HE, Lorent N, Mall MA, Marthin JK, Martinu V, Narayanan M, Ozcelik U, Peckham D, Pifferi M, Pohunek P, Polverino E, Range S, Ringshausen FC, Robson E, Roehmel J, Rovira-Amigo S, Santamaria F, Schlegtendal A, Szépfalusi Z, Tempels P, Thouvenin G, Ullmann N, Walker WT, Wetzke M, Yiallouros P, Omran H, Nielsen KG. The disease-specific clinical trial network for Primary Ciliary Dyskinesia (PCD-CTN). ERJ Open Res 2022; 8:00139-2022. [PMID: 35983540 PMCID: PMC9379353 DOI: 10.1183/23120541.00139-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/12/2022] [Indexed: 11/12/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients. The disease-specific clinical trial network for primary ciliary dyskinesia (PCD-CTN) was built under the framework of the European Reference Network (ERN)-LUNG PCD Core, and operates to establish evidence-based and new personalised treatment for PCDhttps://bit.ly/3sLtC8o
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16
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Asfuroglu P, Sismanlar Eyuboglu T, Aslan AT, Gursoy TR, Emiralioglu N, Yalcin E, Kiper N, Sen V, Sen HS, Altintas DU, Ozcan D, Kilinc AA, Cokugras H, Baskan AK, Yazan H, Erenberk U, Dogan G, Unal G, Yilmaz AI, Keskin O, Arik E, Kucukosmanoglu E, Irmak I, Damadoglu E, Ozturk GK, Gulen F, Basaran AE, Bingol A, Cekic S, Sapan N, Kilic G, Harmanci K, Kose M, Ozdemir A, Tugcu GD, Polat SE, Hangul M, Ozcan G, Aydin ZGG, Yuksel H, Topal E, Ozdogan S, Caltepe G, Suleyman A, Can D, Ekren PK, Bal CM, Kilic M, Cinel G, Cobanoglu N, Pekcan S, Cakir E, Ozcelik U, Dogru D. The success of the Cystic Fibrosis Registry of Turkey for improvement of patient care. Pediatr Pulmonol 2022; 57:1245-1252. [PMID: 35102722 DOI: 10.1002/ppul.25852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) registries play an essential role in improving disease outcomes of people with CF. This study aimed to evaluate the association of newly established CF registry system in Turkey on follow-up, clinical, growth, treatment, and complications of people with this disease. METHODS Age at diagnosis, current age, sex, z-scores of weight, height and body mass index (BMI), neonatal screening results, pulmonary function tests, history of meconium ileus, medications, presence of microorganisms, and follow-up were evaluated and compared to data of people with CF represented in both 2017 and 2019 registry data. RESULTS There were 1170 people with CF in 2017 and 1637 in 2019 CF registry. Eight hundred and fourteen people were registered in both 2017 and 2019 of whom z-scores of heights and BMI were significantly higher in 2019 (p = 0.002, p =0.039, respectively). Inhaled hypertonic saline, bronchodilator, and azithromycin usages were significantly higher in 2019 (p =0.001, p = 0.001, p = 0.003, respectively). The percent predicted of forced expiratory volume in 1 sec and forced vital capacity were similar in 2017 and 2019 (88% and 89.5%, p = 0.248 and 84.5% and 87%, p =0.332, respectively). Liver diseases and osteoporosis were significantly higher, and pseudo-Bartter syndrome (PBS) was significantly lower in 2019 (p = 0.011, p = 0.001, p = 0.001, respectively). CONCLUSIONS The z-scores of height and BMI were higher, the use of medications that protect and improve lung functions was higher and incidence of PBS was lower in 2019. It was predicted that registry system increased the care of people with CF regarding their follow-up. The widespread use of national CF registry system across the country may be beneficial for the follow-up of people with CF.
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Affiliation(s)
- Pelin Asfuroglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tugba Ramasli Gursoy
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Sen
- Department of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Hadice Selimoglu Sen
- Department of Chest Diseases, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Derya Ufuk Altintas
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Dilek Ozcan
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Pulmonology, Cerrahpasa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Azer Kilic Baskan
- Department of Pediatric Pulmonology, Cerrahpasa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Ufuk Erenberk
- Department of Pediatrics, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Guzide Dogan
- Department of Pediatric Gastroenterology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Gokcen Unal
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Asli Imran Yilmaz
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ozlem Keskin
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Elif Arik
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ercan Kucukosmanoglu
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ilim Irmak
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoglu
- Department of Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokcen Kartal Ozturk
- Department of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Gulen
- Department of Pediatric Pulmonology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Abdurrahman Erdem Basaran
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Aysen Bingol
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sukru Cekic
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Nihat Sapan
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Gonca Kilic
- Department of Pediatric Metabolism and Nutrition, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Koray Harmanci
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Ozdemir
- Department of Pediatric Pulmonology, Ministry of Health Mersin City Hospital, Mersin, Turkey
| | - Gokcen Dilsa Tugcu
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Melih Hangul
- Department of Pediatric Pulmonology, Gaziantep Cengiz Gokcek Maternity and Children's Hospital, Gaziantep, Turkey
| | - Gizem Ozcan
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zeynep Gokce Gayretli Aydin
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hasan Yuksel
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Sebnem Ozdogan
- Department of Pediatric Pulmonology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Gonul Caltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ayse Suleyman
- Department of Pediatric Allergy and Immunology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Demet Can
- Department of Pediatric Pulmonology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Pervin Korkmaz Ekren
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Cem Murat Bal
- Department of Pediatric Pulmonology, Doctor Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kilic
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Guzin Cinel
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Nazan Cobanoglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Nayir Buyuksahin H, Emiralioglu N, Ozsezen B, Ademhan Tural D, Sunman B, Guzelkas I, Tezel B, Dayangaç Erden D, Yalçın E, Dogru D, Ozcelik U, Kiper N. Cystic fibrosis newborn screening: Five-year experience from a tertiary care center. Pediatr Pulmonol 2022; 57:403-410. [PMID: 34842364 DOI: 10.1002/ppul.25778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/20/2021] [Accepted: 11/20/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Newborn screening (NBS) for cystic fibrosis (CF) was implemented in our country on January 1, 2015, based on immunoreactive trypsinogen tests (IRT/IRT). Here, we aimed to evaluate the diagnoses of patients and follow-up process within the first 5 years of NBS from a tertiary care center. METHODS This retrospective cohort study was conducted on patients who were admitted to our pediatric pulmonology department for sweat test (ST) via NBS. Patients with CF with negative NBS results and those with CF with positive NBS and joined our follow-up were also investigated. Clinical outcome measures were compared between patients with CF with positive and negative NBS. RESULTS Six hundred sixty infants who were referred for ST via NBS were included. Across the entire study population (n = 683), 11.4% of patients had CF (14.1% of had negative NBS in this CF group). The sensitivity of NBS was found as 84.9% and the positive predictive value (PPV) was 9.4%. The median age at diagnosis was older (p < 0.001), reluctance for feeding and Pseudobartter syndrome (PBS) were significantly higher at presentation in the negative NBS group. There was no statistically significant difference between the groups regarding weight-for-age (p = 0.899) and height-for-age (p = 0.491) in the first 2 years' follow-ups. CONCLUSIONS Our findings showed the low sensitivity and PPV of NBS; therefore, further studies based on all patients in our country are necessary for new cut-off values. PBS and reluctance for feeding should be alarm symptoms for CF even if the infants had negative NBS. Additionally, later diagnosis of patients who had negative NBS did not affect the nutritional outcomes; we need large-scale prospective studies to optimize nutritional benefits for all infants diagnosed via NBS.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Basak Tezel
- General Directorate of Public Health, Ministry of Health, Ankara, Turkey
| | - Didem Dayangaç Erden
- Department of Medical Biology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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Tugcu GD, Emiralioglu N, Yalcin E, Sahiner UM, Dogru D, Sekerel BE, Ozcelik U, Kiper N, Soyer O. The controversy of drug hypersensitivity in patients with cystic fibrosis and review of the literature. Pediatr Allergy Immunol 2022; 33:e13719. [PMID: 34907613 DOI: 10.1111/pai.13719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there are conflicting data about true prevalence of drug hypersensitivity in children with CF. METHODS The suspicious drug hypersensitivity reactions (DHRs) of children with CF were enquired by the European Network for Drug Allergy (ENDA) questionnaire, and skin tests and/or drug provocation tests were performed according to the established guidelines. RESULTS Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4 years [4.8-12.4 years]) with cystic fibrosis were included in the study, among which 22 patients with 24 suspected DHRs were evaluated. Most of the suspected DHRs were of non-immediate (n = 16, 66.6%) type, and the offending drugs were amoxicillin-clavulanic acid (n = 7), macrolides (n = 4), trimethoprim-sulfamethoxazole (TMP/SMX) (n = 2), piperacillin-tazobactam (n = 1), pancrelipase (n = 1), and ursodeoxycholic acid (n = 1). Eight (33.3%) of the DHRs were classified as immediate (ceftriaxone [n = 2], ceftazidime [n = 2], meropenem [n = 1], AmBisome [n = 2], and vancomycin [n = 1]). The main clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%), and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed, and none of the skin tests revealed a positive result; however, 2 DPTs with TMP/SMX were positive. CONCLUSION Actual drug hypersensitivity was demonstrated in 2 of 219 patients (0.9%) with non-beta-lactam antibiotics. These results conflict with previous researches that showed higher drug hypersensitivity rates but are consistent with some recent studies. Allergological diagnostic workup is mandatory in patients with cystic fibrosis in case of a suspicious DHR.
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Affiliation(s)
- Gokcen Dilsa Tugcu
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Umit Murat Sahiner
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Bulent Enis Sekerel
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey
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19
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Sonbahar-Ulu H, Cakmak A, Inal-Ince D, Vardar-Yagli N, Yatar I, Calik-Kutukcu E, Saglam M, Tekerlek H, Bozdemir-Ozel C, Arikan H, Emiralioglu N, Ozcelik U. Physical fitness and activities of daily living in primary ciliary dyskinesia: A retrospective study. Pediatr Int 2022; 64:e14979. [PMID: 34459071 DOI: 10.1111/ped.14979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/27/2021] [Accepted: 08/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare, hereditary, autosomal recessive disorder characterized by recurrent upper and lower respiratory tract infections. This study aimed to compare pulmonary function, respiratory muscle strength, exercise capacity, physical fitness, and activities of daily living (ADLs) retrospectively between patients with PCD and healthy controls. METHODS Data from 20 patients with PCD and 20 matched, healthy counterparts recorded between July 2015 and January 2017 were analyzed. The data evaluated and recorded included pulmonary function using a portable spirometer, respiratory muscle strength (using a mouth pressure device, exercise capacity using the incremental shuttle walk test,), physical fitness (using the Munich Fitness Test), and ADLs (using the Glittre ADL test). RESULTS Pulmonary function, respiratory muscle strength, incremental shuttle walk test scores (all parameters), and total Munich Fitness Test scores were lower in the PCD group relative to controls (P < 0.05). The duration to complete the Glittre ADL test was higher in PCD patients than in healthy subjects (P < 0.05). CONCLUSIONS Pulmonary function, respiratory muscle strength, exercise capacity, physical fitness, and ADL were affected by PCD. Thus, pulmonary rehabilitation regimens should be tailored according to these impacts.
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Affiliation(s)
- Hazal Sonbahar-Ulu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ilker Yatar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Cyprus
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Haluk Tekerlek
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hulya Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Atilim University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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20
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Ramasli Gursoy T, Aslan AT, Asfuroglu P, Sismanlar Eyuboglu T, Cakir E, Cobanoglu N, Pekcan S, Cinel G, Dogru D, Ozcelik U, Yalcin E, Sen V, Ercan O, Kilinc AA, Yazan H, Altintas DU, Kartal Ozturk G, Bingol A, Sapan N, Celebioglu E, Tugcu GD, Ozdemir A, Harmanci K, Kose M, Emiralioglu N, Tamay Z, Yuksel H, Ozcan G, Topal E, Can D, Korkmaz Ekren P, Caltepe G, Kilic M, Ozdogan S. Clinical findings of patients with cystic fibrosis according to newborn screening results. Pediatr Int 2022; 64:e14888. [PMID: 34131975 DOI: 10.1111/ped.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a lethal recessive genetic disease caused by loss of function associated with mutations in the CF trans-membrane conductance regulator. It is highly prevalent (approximately 1 in 3,500) in Caucasians. The aim of this study was to compare demographic and clinical features, diagnostic tests, treatments, and complications of patients with CF whose newborn screening (NBS) with twice-repeated immune reactive trypsinogen testing was positive, normal, and not performed. METHODS In this study, 359 of all 1,488 CF patients recorded in the CF Registry of Turkey in 2018, who had been born through the process of NBS, were evaluated. Demographic and clinical features were compared in patients diagnosed with positive NBS (Group 1), normal (Group 2), or without NBS (Group 3). RESULTS In Group 1, there were 299 patients, in Group 2, there were 40 patients, and in Group 3, there were 20 patients. Among all patients, the median age at diagnosis was 0.17 years. The median age at diagnosis was higher in Groups 2 and 3 than in Group 1 (P = 0.001). Fecal elastase results were higher in Group 2 (P = 0.033). The weight z-score was lower and chronic Staphylococcus aureus infection was more common in Group 3 (P = 0.017, P = 0.004, respectively). CONCLUSIONS Frequency of growth retardation and chronic S. aureus infection can be reduced with an early diagnosis using NBS. In the presence of clinical suspicion in patients with normal NBS, further analyses such as genetic testing should be performed, especially to prevent missing patients with severe mutations.
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Affiliation(s)
- Tugba Ramasli Gursoy
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pelin Asfuroglu
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Nazan Cobanoglu
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Guzin Cinel
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Velat Sen
- Department of Pediatric Pulmonology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Omur Ercan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Istanbul University Cerrahpasa Medicine Faculty, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Derya Ufuk Altintas
- Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Gokcen Kartal Ozturk
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Aysen Bingol
- Department of Pediatric Allergy and Immunology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nihat Sapan
- Department of Pediatric Allergy and Immunology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ebru Celebioglu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gokcen Dilsa Tugcu
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ali Ozdemir
- Department of Pediatric Pulmonology, Ministry of Health Mersin City Hospital, Mersin, Turkey
| | - Koray Harmanci
- Department of Pediatric Allergy and Immunology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Tamay
- Department of Pediatric Allergy, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Yuksel
- Department of Pediatric Allergy and Immunology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Gizem Ozcan
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Demet Can
- Department of Pediatric Pulmonology, Balikesir University Faculty of Medicine, Balikesir, Turkey
| | | | - Gonul Caltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Mehmet Kilic
- Department of Pediatric Allergy and Immunology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Sebnem Ozdogan
- Department of Pediatric Pulmonology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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21
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Nayir Buyuksahin H, Yalçın E, Emiralioglu N, Hazırolan G, Ademhan Tural D, Ozsezen B, Sunman B, Guzelkas I, Dogru D, Ozcelik U, Kiper N. The effect of Pseudomonas aeruginosa eradication regimens on chronic colonization and clinical outcomes in pediatric patients with cystic fibrosis. Pediatr Int 2022; 64:e15249. [PMID: 36321341 DOI: 10.1111/ped.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic Pseudomonas aeruginosa colonization (Pa-CC) affects cystic fibrosis (CF) progression, including pulmonary exacerbations and pulmonary function tests. There are few studies of the effects of eradication protocols on colonization time. Here, we aimed to evaluate the effect of eradication regimens on chronic colonization and assess the impact of Pa-CC on body mass index, lung functions, and pulmonary exacerbations. METHODS A retrospective review was conducted of medical records, over a period of 11 years, of children aged under 18 years with CF who had Pa-CC in our tertiary care pediatric hospital. RESULTS Pseudomonas aeruginosa was detected in 215 of our patients with CF during the study period. Forty-four patients with Pa-CC were recruited for the study. The eradication treatment for the initial acquisition of P. aeruginosa was inhaled antibiotics in 27 (61.4%) patients; the remainder were given intravenous antibiotics. It was observed that eradication treatment with either IV or inhaled antibiotics did not affect the time between the P. aeruginosa and the time of Pa-CC(P = 0.791). There was a non-significant decrease in the body mass index z-score from the Pa-IA to the last visit(P = 0.27), a significant decline in forced expiratory volume in 1 s (FEV1%) (P = 0.01) over time, and the annual number of exacerbations after colonization was significantly higher than before colonization (P = 0.03). CONCLUSIONS There was no difference between eradication regimens in delaying the age at Pa-CC. Pseudomonas aeruginosa colonization in patients with CF was also associated with poorer lung functions, lower body mass index, and more pulmonary exacerbation regardless of mucoid type. Consequently, to slow the progression of lung disease, we must prevent Pa-CC, which we can achieve with early eradication. Despite conventional eradication protocols, future studies need to evaluate those who fail to clear P. aeruginosa.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Gulsen Hazırolan
- Department of Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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22
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Ademhan Tural D, Yalçın E, Emiralioglu N, Ozsezen B, Sunman B, Nayir Buyuksahin H, Guzelkas I, Dogru D, Ozcelik U, Kiper N. Comparison of inhaled mannitol/dornase alfa combination and daily dornase alfa alone in children with cystic fibrosis. Pediatr Pulmonol 2022; 57:142-151. [PMID: 34687284 DOI: 10.1002/ppul.25740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Inhaled recombinant human deoxyribonuclease (dornase alfa) and osmotic agents such as inhaled mannitol are used for improving the clearance of secretions of cystic fibrosis (CF) patients. We aimed to evaluate the long-term clinical effects of adding dry powder inhaled (DPI) mannitol in subjects with CF who are taking daily dornase alfa. METHOD We conducted a retrospective case-control study on subjects with CF. The effect of DPI mannitol was assessed by comparing DPI mannitol and dornase alfa combination with daily dornase alfa alone in children with CF during a 12-month period. The primary outcome measures of the study were absolute changes in percent predicted forced expiratory volume in 1 s (FEV1) and FEV1 z-scores and the secondary outcomes included other spirometry indices, body mass index, frequency of pulmonary exacerbations, SPO2 , and sputum microbiology. RESULT Of a total of 28 patients who committed to use DPI mannitol treatments during the study period, five had a positive challenge with DPI mannitol and two were aged over 18 years. Therefore, the mannitol treatment group consisted of 21 patients. However, the effect of DPI mannitol was analyzed using 15 patients in the mannitol treatment group who received DPI mannitol for at least 12 months, and 18 patients who only used dornase alfa constituted the control group. The median absolute change in FEV1 between baseline and the third month; and baseline and the 12th month were significantly higher in the mannitol treatment group (p = 0.038, p = 0.004, respectively). When the groups are compared with respect to absolute z-score changes, all spirometry indices, except FVC at the end of 3 months, showed statistically significant improvements in the mannitol treatment group. Some secondary outcomes like pulmonary exacerbation frequency during the study year and median absolute body mass index z-score changes from baseline to the end of the study showed no significant differences between the groups (p = 0.735, p = 0.161, respectively). No colonization changes were observed in the treatment group. CONCLUSIONS This study showed that in those patients who tolerated long-term (12 months) treatment with DPI mannitol and dornase alfa made greater improvements in FEV1, FVC, FEV1/FVC, FEF25-75 z-scores than treatment with dornase alfa alone in children with CF.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, School of Medicine, Hacettepe University, Ankara, Turkey
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23
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Ademhan Tural D, Yalcin E, Emiralioglu N, Ozsezen B, Alp A, Sunman B, Gozmen O, Dogru D, Ozcelik U, Kiper N. Human bocavirus and human metapneumovirus in children with lower respiratory tract infections: Effects on clinical, microbiological features and disease severity . Pediatr Int 2022; 64:e15102. [PMID: 35616205 DOI: 10.1111/ped.15102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/10/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to compare the clinical findings of human bocavirus (HBoV) and human metapneumovirus (HMPV) infections, and to analyze the effects of coinfections on clinical features and disease severity in children with HBoV and HMPV infections. METHODS Data were collected from 125 children with lower respiratory tract infections due to HBoV or HMPV, detected from nasal swap by real-time polymerase chain reaction (PCR) during the period from January, 2013 to December, 2017. In total, there were 101 HBoV (group 1) and 23 HMPV (group 2) infections in our data. The patients were further divided into four subgroups according to the coinfection status: HoBV only (subgroup 1, n = 41), HMPV only (subgroup 2, n = 19), HBoV and coinfection with other respiratory viruses (subgroup 3, n = 60), and HMPV and coinfection with other respiratory viruses (subgroup 4, n = 4). RESULTS The majority (88.8%) of the patients were aged 5 years or younger. Coinfections with other respiratory viruses were significantly more common in group 1 (P = 0.001). Among patients who had nosocomial pneumonia, patients with HBoV infections had significantly longer mean length of hospital stay (LOS) than those with HMPV infections (P = 0.032). The hospitalization and antibiotic requirements were significantly higher in subgroup 1 than subgroup 3 (P = 0.005, 0.039, resp.) According to the logistic regression analyses, the LOS increased by 21.7 times with HBoV infections (P = 0.006). CONCLUSIONS Human bocavirus and HMPV infections are serious pathogens mostly seen in children and usually requiring hospitalization regardless of co-infection status. The HBoV infections caused longer LOS than the HMPV infections in patients with nosocomial infections.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Onur Gozmen
- Department of Pediatrics, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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24
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Hizal M, Satırer O, Polat SE, Tural DA, Ozsezen B, Sunman B, Karahan S, Emiralioglu N, Simsek-Kiper PO, Utine GE, Boduroglu K, Yalcin E, Dogru D, Kiper N, Ozcelik U. Obstructive sleep apnea in children with Down syndrome: is it possible to predict severe apnea? Eur J Pediatr 2022; 181:735-743. [PMID: 34562164 PMCID: PMC8475480 DOI: 10.1007/s00431-021-04267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022]
Abstract
The objectives are to explore the demographic and polysomnographic features of children with Down syndrome and to determine the predictive factors associated with severe sleep apnea. A total of 81 children with Down syndrome referred for full-night polysomnography were analyzed. In addition, parental interviews were performed for each child. Data were available for 81 children, with a mean age of 4.8 years. Severe obstructive sleep apnea was determined in 53.1%. Age, sex, exposure to second-hand smoke, clinical findings, anthropometric features, and the presence of comorbidities were not predictors of severe obstructive sleep apnea. Children who were exposed to second-hand smoke had more sleep-related symptoms. Even in children without symptoms, the prevalence of severe obstructive sleep apnea was 40%. Moreover, 86% of parents had no previous information regarding possible sleep breathing disorders in their children. Clinically significant central apnea was present in 10 patients (12.3%).Conclusion: Our results demonstrate that severe obstructive sleep apnea is common in children with Down syndrome, even in children without a history of symptoms of sleep apnea. It is not possible to predict patients with severe apnea; thus, screening of children with Down syndrome beginning from young ages is very important. Central apneas could be a part of the spectrum of sleep abnormalities in Down syndrome.
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Affiliation(s)
- Mina Hizal
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children's Hospital, Sihiye, Ankara, Turkey.
| | - Ozlem Satırer
- Department of Pediatrics, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistic, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Pelin Ozlem Simsek-Kiper
- Department of Pediatric Genetics, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
| | - Gulen Eda Utine
- Department of Pediatric Genetics, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
| | - Koray Boduroglu
- Department of Pediatric Genetics, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University School of Medicine Ihsan Dogramacı Children’s Hospital, Sihiye Ankara, Turkey
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25
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Soyak Aytekin E, Keskin A, Tan C, Yalçın E, Dogru D, Ozcelik U, Kiper N, Tezcan I, Cagdas D. Differential diagnosis of primary immunodeficiency in patients with BCGitis and BCGosis: A single-centre study. Scand J Immunol 2021; 94:e13084. [PMID: 34780073 DOI: 10.1111/sji.13084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/26/2021] [Indexed: 01/05/2023]
Abstract
BCG infections occur more frequently in patients with underlying primary immunodeficiency disease (PIDD). In this study, we aimed to evaluate the ratio of PIDD in the patients with BCG infections. Patients with BCG infections were analyzed in a tertiary referral centre in the 2015-2020 period. Forty-seven patients with BCGitis/BCGosis were evaluated; thirty-four (72.3%) had BCGitis, and 13 (27.7%) had BCGosis. Common tissue and organs affected are lymph nodes (57.4%), skin and subcutaneous tissue (48.9%), lungs (23.4%) and liver (17%). PIDD was shown in 26 patients (55.3%), including 92.3% of patients with BCGosis and 41.2% of patients with BCGitis. Ten patients had Mendelian susceptibility to Mycobacterial disease (MSMD) (21.2%), six had predominantly antibody deficiency (PAD) (12.7%), five had severe combined immunodeficiency (SCID) (10.6%), three had CGD (6.3%), and two had CID (4.2%). Mortality was reported in two patients (4.2%) with CID (ZAP70 deficiency (n = 1) and PIK3R1 deficiency (n = 1)). Parental consanguinity (84%), axillary lymphadenopathy (65%), mycobacterial lung disease (42%), hepatomegaly (30%) and growth retardation (19%) were significantly high in patients with PIDD diagnosis. Isolated vaccination site infection was also recorded in patients with PIDD (CID (n = 1), SCID (n = 1), PAD (n = 5)). BCG vaccination should be planned with caution for the cases with suspected PIDD. This study indicates that almost all patients (92.3%) with BCGosis and one in every two patients (41.2%) with BCGitis have an underlying PIDD. Parental consanguinity, axillary lymphadenopathy, mycobacterial lung disease, hepatomegaly and growth retardation (19%) are important clinical features in the differential diagnosis of PIDD.
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Affiliation(s)
- Elif Soyak Aytekin
- Divisions of Pediatric Immunology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Armagan Keskin
- Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Cagman Tan
- Institute of Child Health, Immunology, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçın
- Division of Pediatric Pulmonology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Deniz Dogru
- Division of Pediatric Pulmonology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pediatric Pulmonology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Nural Kiper
- Division of Pediatric Pulmonology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Ilhan Tezcan
- Divisions of Pediatric Immunology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
| | - Deniz Cagdas
- Divisions of Pediatric Immunology, Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey
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Ademhan Tural D, Emiralioglu N, Ozsezen B, Saribas Z, Ozcan N, Alp A, Sunman B, Hizal M, Eryilmaz Polat S, Yalcin E, Dogru D, Ozcelik U, Kiper N. The frequency and related factors of non-tuberculosis mycobacteria infections among patients with cystic fibrosis. Pediatr Int 2021; 63:1369-1375. [PMID: 33682254 DOI: 10.1111/ped.14688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) can cause chronic lung infection particularly in patients who have structural lung disease such as cystic fibrosis (CF). We evaluated the incidence and management of NTM infections in patients with CF in our center. METHODS A retrospective cohort study was carried out on CF patients having at least one positive NTM isolate between 2012 and 2020. RESULTS Ten patients (2.1%) had at least one positive NTM culture from respiratory samples. All of them were vaccinated with Bacille Calmette-Guérin (BCG) vaccine, which is in the national vaccination program in our country. Eight patients had the Mycobacterium abscessus complex, one had Mycobacterium avium, and one had Mycobacterium szulgai growth in their respiratory samples. Three patients had transient NTM infection, two had persistent, and five had active NTM infection (NTM pulmonary disease). Patients with NTM pulmonary disease received antibiogram-directed antimycobacterial therapy. In patients with NTM pulmonary disease, the median ppFEV1 and BMI decreased by 17% and 1%, respectively, at the time of the first NTM isolation when compared with the values one year before the first NTM isolation. Culture conversion was not seen in any patient infected with Mycobacteriunm abscessus complex. CONCLUSIONS The NTM infection incidence is lower in our country than in those countries where the BCG vaccine is not routinely applied. The BCG vaccine may be a protective factor for NTM infection. Further studies are needed about the prevalence of NTM infections, facilitating and protective factors, and appropriate management of NTM infections in patients with CF.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Zeynep Saribas
- Department of Medical Microbiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Nursun Ozcan
- Department of Radiology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Mina Hizal
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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Goutaki M, Lam YT, Alexandru M, Anagiotos A, Armengot M, Bequignon E, Boon M, Burgess A, Coste A, Emiralioglu N, Erdem E, Haarman EG, Harris A, Hool SL, Karadag B, Kim S, Latzin P, Lorent N, Ozcelik U, Reula A, Roehmel J, van Gogh C, Yiallouros P, Zappe SM, Papon JF. Study protocol: the ear-nose-throat (ENT) prospective international cohort of patients with primary ciliary dyskinesia (EPIC-PCD). BMJ Open 2021; 11:e051433. [PMID: 34635525 PMCID: PMC8506890 DOI: 10.1136/bmjopen-2021-051433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a rare, genetic, multiorgan disease with an estimated prevalence of 1 in 10 000. It affects mainly the upper and lower airways due to impaired mucociliary clearance. Almost all patients have sinonasal or otologic (ear-nose-throat, ENT) problems, although the ENT clinical phenotype may present great variability. Despite that, data on PCD ENT manifestations are scarce and based on small single-centre studies. To date, we know little about the spectrum and severity of PCD ENT disease, its association with lung disease, its course over life and its determinants of prognosis.This study protocol describes the aims and methods of the first prospective, observational, multinational cohort study focusing on ENT disease in patients with PCD. METHODS AND ANALYSIS The ENT prospective international cohort of patients with PCD (EPIC-PCD) is a prospective standardised observational clinical cohort set up as a multinational multicentre study, embedded into routine patient care. It aims to longitudinally characterise ENT disease in patients with PCD and its association with lung disease, and to identify determinants of its prognosis. Patients of all ages, diagnosed with PCD who undergo an ENT clinical assessment at least once a year at one of the participating centres will be invited to participate. Collected data include diagnostic test results, results of ENT examinations, lung function measurements, information on management of ENT disease and patient-reported data on clinical symptoms and health-related quality of life (QoL). Data are collected using the standardised PCD-specific FOLLOW-PCD form and the validated QoL-PCD questionnaire. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committees at all participating centres, based on local legislation. The results of the study will be published in scientific journals, presented at scientific conferences and disseminated to participants and national patient organisations. TRIAL REGISTRATION NCT04611516.
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Affiliation(s)
- Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Yin Ting Lam
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mihaela Alexandru
- Hôpital Kremlin-Bicetre, Service d'ORL et de Chirurgie Cervico-Faciale, AP-HP, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - Andreas Anagiotos
- Department of Otorhinolaryngology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miguel Armengot
- Department of Otorhinolaryngology, and Primary Ciliary Dyskinesia Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- Medical School, University of Valencia, Valencia, Spain
| | - Emilie Bequignon
- Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, AP-HP, Creteil, France
| | - Mieke Boon
- Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Burgess
- Primary Ciliary Dyskinesia Centre, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK
| | - Andre Coste
- Hôpital Henri Mondor et Centre Hospitalier Intercommunal de Créteil, Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, AP-HP, Creteil, France
- Faculté de médecine, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne, Creteil, France
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ela Erdem
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Eric G Haarman
- Department of Paediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Amanda Harris
- Primary Ciliary Dyskinesia Centre, NIHR Respiratory Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Sara-Lynn Hool
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Bulent Karadag
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sookyung Kim
- Hôpital Kremlin-Bicetre, Service d'ORL et de Chirurgie Cervico-Faciale, AP-HP, Paris, France
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ana Reula
- Biomedical Sciences Department, CEU Cardenal Herrera University, Castellón, Spain
- Molecular, Cellular and Genomic Biomedicine Group, IIS La Fe, Valencia, Spain
| | - Jobst Roehmel
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christine van Gogh
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Panayiotis Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
- Pediatric Pulmonology Unit, Hospital 'Archbishop Makarios III', Nicosia, Cyprus
| | - Soeren Marian Zappe
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jean Francois Papon
- Hôpital Kremlin-Bicetre, Service d'ORL et de Chirurgie Cervico-Faciale, AP-HP, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
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Nayir Buyuksahin H, Emiralioglu N, Ademhan Tural D, Ozsezen B, Sunman B, Guzelkas I, Yalcin E, Dogru D, Ozcelik U, Kiper N. Impact of COVID-19 on pediatric pulmonology healthcare practice. Pediatr Pulmonol 2021; 56:2811-2817. [PMID: 34265185 PMCID: PMC8441731 DOI: 10.1002/ppul.25557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/16/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Coronavirus 2019 (COVID-19) is typically spread by droplets and has had a remarkable effect on pediatric pulmonology healthcare practice. Here, we aimed to evaluate the effect of the COVID-19 pandemic on the clinical follow-up and hospital visits of patients followed up at a pediatric pulmonology unit at a tertiary care center. METHODS This study was an observational descriptive study performed at a tertiary care center pediatric pulmonology unit between January 2019 and December 2020. We analyzed the outpatient visits, laboratory procedures which including pulmonary function tests (PFTs), diffusion capacity assessment, plethysmography, and lung clearance index (LCI), high-speed video microscopy, gastric aspirate sampling, and Flexible fiberoptic bronchoscopy (FFB) during clinical follow-up, and hospitalization numbers of patients with chronic lung diseases during the COVID-19 pandemic and compared them with the previous year before the pandemic started. RESULTS In 2020, compared with 2019, outpatient visits decreased by 42.2%; from 8324 patients to 4804 patients and other laboratory procedures decreased after the pandemic started; PFTs including spirometry by 87.2%; from 2990 to 380 tests, diffusion capacity assessment from 172 to 55 tests, plethysmography from 172 to 53 and LCI from 70 to 9 tests, also high-speed video microscopy analyses by 64.3% from 300 to 107 patients, and gastric aspirate sampling by 75.5% from 42 to 9 patients. FFB procedures also decreased by 59.1%, from 142 to 58 patients, and only 15 were after the first reported case of COVID-19 in our country, and they were all for urgent indications. None of these patients was positive pretesting for COVID-19 who underwent the FFB. There was no significant decrease in patients' hospitalization due to pulmonary exacerbation in cystic fibrosis, interstitial lung disease, and primary ciliary dyskinesia.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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Ademhan Tural D, Emiralioglu N, Ozsezen B, Sunman B, Nayir Buyuksahin H, Guzelkas I, Oguz B, Bilginer Y, Orhan D, Yalcin E, Dogru D, Ozcelik U, Ozen S, Kiper N. Clinical spectrum of children with interstitial pneumonia with autoimmune features. Respir Med 2021; 187:106566. [PMID: 34416614 DOI: 10.1016/j.rmed.2021.106566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Interstitial pneumonia with autoimmune features (IPAF) is a term used to describe adult patients with interstitial lung disease (ILD) who display some clinical or serological features of autoimmune diseases and who do not meet the full criteria for a specific connective tissue disease (CTD). The aim of this study was to define the demographic, clinical, radiologic, serologic and histopathologic features and assess treatment in children with IPAF. METHODS This retrospective cohort study was conducted at a tertiary referral pediatric pulmonology center between January 2010 and August 2020. Children with proven interstitial pneumonia with no known etiologies were evaluated for IPAF according to European Respiratory Society/American Thoracic Society research statement of IPAF. RESULTS Among 132 children with ILD, 17 patients were evaluated in detail for IPAF criteria and six patients were further diagnosed as having IPAF. The incidence of IPAF in our patients with ILD was 4.5%. Four of these patients were female. The median age at the time of ILD diagnosis was 10.5 years. The most common initial symptom was shortness of breath, and the most common physical examination sign was crackles in both lungs. Steroid therapy was given to all patients and four patients received other immunosuppressive agents for steroid sparing. Two of those patients died because of respiratory insufficiency during the follow-up. CONCLUSION Children with interstitial pneumonia and certain clinical, serologic, and/or morphologic features should raise suspicion for the presence of an underlying systemic autoimmune disease. IPAF is also seen in children and should be categorized in chILD classifications.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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Ademhan Tural D, Emiralioglu N, Dogru D, Ozsezen B, Ipek OF, Sunman B, Nayir Buyuksahin H, Guzelkas I, Ciki K, Kilic K, Vardar Yagli N, Yalcin E, Kiper N, Sivri S, Ozcelik U. Evaluation of sleep-disordered breathing and its relationship with respiratory parameters in children with mucopolysaccharidosis Type IVA and VI. Am J Med Genet A 2021; 185:2306-2314. [PMID: 33960649 DOI: 10.1002/ajmg.a.62229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 11/08/2022]
Abstract
The aims of the study were to evaluate the prevalence of sleep-disordered breathing (SDB) by using polysomnography (PSG) in children with MPS IVA and MPS VI who underwent enzyme replacement therapy (ERT) and to analyze the effect on SDB of having upper airway surgery, pulmonary functions, and exercise capacity. A retrospective cross-sectional study was conducted on patients with MPS IVA (n:17) and MPS VI (n:11) aged under 19 years who underwent polysomnography. Descriptive and nonparametric analyses were performed for demographic, PSG, pulmonary function and exercise capacity variables. The frequency of sleep apnea in the study sample was 85.7% (24/28). Four patients (14.3%) had no sleep apnea, 15 (53.6%) had mild, and nine (32.1%) had moderate-to-severe sleep apnea. Two patients (7.1%) had central sleep apnea and 22 had obstructive sleep apnea (OSA) (78.6%). Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were negatively correlated to apnea-hypopnea index (AHI) (r = -0.594, p = .009; r = -0.636, p = .005, respectively). Despite ERT and previous upper airway surgery, the prevalence of OSA was high in patients with MPS IVA-MPS IV, emphasizing the importance of PSG screening for sleep disorders. Pulmonary function tests may be useful for predicting sleep apnea in patients with MPS IVA and MPS VI.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Omer Faruk Ipek
- Department of Pediatrics, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Kismet Ciki
- Department of Pediatric Metabolism, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kubra Kilic
- Department of Physical Therapy and Rehabilitation, Faculty of Medical Sciences, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar Yagli
- Department of Physical Therapy and Rehabilitation, Faculty of Medical Sciences, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Serap Sivri
- Department of Pediatric Metabolism, Ihsan Dogramaci Children's Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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Hizal M, Eryilmaz Polat S, Ramasli Gursoy T, Ozsezen B, Ademhan Tural D, Karakaya J, Emiralioglu N, Pekcan S, Tana Aslan A, Yalcin E, Dogru D, Ozcelik U, Kiper N. Risk factors for recurrent pulmonary exacerbation in idiopathic pulmonary hemosiderosis. Pediatr Pulmonol 2021; 56:1060-1068. [PMID: 33247613 DOI: 10.1002/ppul.25189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the risk factors of recurrent pulmonary exacerbation and poor prognosis in children with idiopathic pulmonary hemosiderosis (IPH). METHODS In this multicenter study, 54 patients with a diagnosis of IPH were included. Medical records were retrospectively reviewed from three tertiary care hospitals between 1979 and 2019. Also, current information and the long-term progress of patients was determined by contacting the families by telephone. RESULTS A total of 54 children were included. The median age of onset of symptoms was 4.5 years (3 months to 15.8 years). The median time from onset to diagnosis was 0.9 years (0.25 months to 12 years). The mean number of recurrent episodes per child in the recurrence-positive group was 3.55 (1-15). Univariate analysis demonstrated that patients presenting with hypoxia or requiring transfusion at the time of presentation had significantly more recurrence episodes (p = .002). Multivariate analysis showed that the presence of hypoxia at the time of initial presentation was a significant independent predictor of recurrent episodes (p = .027). The median follow-up was 3.3 years (0.75 months to 27 years). There was a significant relationship between the presence of hypoxia, transfusion history, antinuclear antibody positivity, and elevated transaminases at the time of initial evaluation and treatment response. CONCLUSIONS The present study provides substantial information regarding factors that may affect recurrent exacerbations and prognosis in children with IPH. Demonstrating hypoxia as an independent risk factor in recurrence episodes could guide physicians in the planning of treatment strategies.
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Affiliation(s)
- Mina Hizal
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | - Beste Ozsezen
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Jale Karakaya
- Department of Biostatistic, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Pekcan
- Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Tana Aslan
- Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Tekerlek H, Mutlu A, Inal-Ince D, Livanelioglu A, Kahraman A, Eryilmaz-Polat S, Karakaya J, Ozcelik U. Motor repertoire is age-inadequate in infants with cystic fibrosis. Pediatr Res 2021; 89:1291-1296. [PMID: 32717740 DOI: 10.1038/s41390-020-1082-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND General movements (GMs) in infants occur as fidgety movements (FMs) between postterm 9 and 20 weeks. We aimed to evaluate FMs and motor repertoire in infants with cystic fibrosis (CF) and their relation with clinical findings. METHODS Demographic and clinical characteristics were recorded. FMs and motor repertoire were analyzed from a 5-min video recording of each infant. Videos were rated based on the Prechtl General Movement Assessment and motor optimality score (MOS) was calculated. RESULTS The analysis included 18 infants with CF and 20 healthy infants at postterm age of 3-5 months. MOS was significantly lower in the infants with CF compared to controls (p < 0.05). Fifty percent of the infants with CF had abnormal or absent/sporadic FMs. MOS was negatively associated with hospitalization duration (r = -0.378, p = 0.036); and positively associated with vitamin A level in CF infants (r = 0.665, p = 0.026). CONCLUSIONS Infants with genetically anticipated severe CF phenotype tended to have lower MOS. MOS may be used in addition to genetic testing to predict disease severity in infants with CF. Infants with CF, absent/sporadic FMs, and lower MOS could be considered for planning specific age-adequate early intervention programs. IMPACT Motor repertoire was age-inadequate in infants with cystic fibrosis (CF). 50% of infants with CF had abnormal or absent/sporadic fidgety movements (FMs). Motor optimality score (MOS) was positively associated with vitamin A level and negatively correlated with hospitalization duration in infants with CF. MOS tended to decrease as genetically anticipated disease severity increased; thus, MOS might enable us to predict disease severity in CF. The relationship between motor repertoire and phenotype and genotype is unclear and warrants further study. CF infants with absent/sporadic FMs, and lower MOS could be considered for planning early intervention.
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Affiliation(s)
- Haluk Tekerlek
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Akmer Mutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayse Livanelioglu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aysu Kahraman
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz-Polat
- Department of Pediatric Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Chest Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ozcelik U, Aytac S, Kuskonmaz B, Yalcin E, Dogru D, Okur V, Kara A, Hizal M, Polat SE, Emiralioglu N, Kiper N, Çetinkaya DU. Nonmyeloablative hematopoietic stem cell transplantation in a patient with hereditary pulmonary alveolar proteinosis. Pediatr Pulmonol 2021; 56:341-343. [PMID: 33232559 DOI: 10.1002/ppul.25174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Ugur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selin Aytac
- Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Baris Kuskonmaz
- Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Bone Marrow Transplantation Unit, Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Visal Okur
- Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Bone Marrow Transplantation Unit, Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ateş Kara
- Department of Pediatric Infectious Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mina Hizal
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sanem Eryılmaz Polat
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Duygu Uckan Çetinkaya
- Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Bone Marrow Transplantation Unit, Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ozsezen B, Dogru D, Emiralioglu N, Ademhan Tural D, Sunman B, Nayir Buyuksahin H, Guzelkas İ, Yalcın E, Ozcelik U, Kiper N. P152 Clinical findings and long-term effect of methicillin-resistant Staphylococcus aureus isolation in patients with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Iyigun I, Alikasifoglu A, Gonc N, Ozon A, Eryilmaz Polat S, Hizal M, Kiper N, Ozcelik U. Obstructive sleep apnea in children with hypothalamic obesity: Evaluation of possible related factors. Pediatr Pulmonol 2020; 55:3532-3540. [PMID: 32986303 DOI: 10.1002/ppul.25097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/10/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Hypothalamic obesity (HO) is a type of obesity that is caused by hypothalamic damage. HO can be complicated by obstructive sleep apnea syndrome (OSAS) due to anatomical narrowing of the upper airway and hypothalamic damage-induced dysfunction of the sleep control mechanisms. We aimed to explore the presence and severity of OSAS in children with HO and hypothesized that OSAS is more severe and frequent in HO than exogenous obesity (EO). METHODS This cross-sectional study was conducted among children aged 6.6-17.9 years. Subjects with HO (n = 14) and controls with EO (n = 19) were consecutively recruited through an endocrinology clinic. All patients underwent full-night polysomnography. The primary outcomes were obstructive apnea-hypopnea index (OAHI) and the severity of OSAS. We analyzed the polysomnography findings, biochemical parameters, Brodsky and modified Mallampati scores, and blood pressure compared with the controls. We explored the different obesity types and these variables in association with OAHI using multiple linear regression (MLR). RESULTS Age and body mass index z scores (BMI-z) were similar between the EO and HO groups. The OAHI of HO (5.8) was higher than that of EO (2.2). In MLR, the predicted OAHI was formulated as an equation using regression coefficients of obesity type (HO), age, and BMI-z (R2 = .41). In the logistic regression analysis, the odds ratio of moderate/severe OSA was 5.6 for HO. CONCLUSIONS Children with HO have a higher risk of moderate/severe OSAS than children with EO. Polysomnography should be considered in all patients with HO.
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Affiliation(s)
- Irem Iyigun
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayfer Alikasifoglu
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nazlı Gonc
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alev Ozon
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mina Hizal
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Ademhan Tural D, Emiralioglu N, Tural Hesapcioglu S, Karahan S, Ozsezen B, Sunman B, Nayir Buyuksahin H, Yalcin E, Dogru D, Ozcelik U, Kiper N. Psychiatric and general health effects of COVID-19 pandemic on children with chronic lung disease and parents' coping styles. Pediatr Pulmonol 2020; 55:3579-3586. [PMID: 32946202 PMCID: PMC7537125 DOI: 10.1002/ppul.25082] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND We aim to assess the anxiety and depressive symptoms related to the COVID-19 pandemic in children with chronic lung disease and their parents and also to evaluate parents' coping strategies. METHODS Parents of children aged 4-18 years, with chronic lung disease (study group n = 113) and healthy control (n = 108) were enrolled in the study. General Health Questionnaire-12, specific COVID-19 related anxiety questions, The Coping Orientation to Problems Experienced inventory, coronavirus-related psychiatric symptom scale in children-parental form were used to analyze the psychiatric effects of COVID-19. Parents were also asked about how online education affected their family life and children. All data were compared between children/parents in the study and control groups. Risk factors related with anxiety scores of children were also analyzed. RESULTS Talking about the pandemic, concern about coronavirus transmission, taking precaution to prevent coronavirus transmission, making pressure to protect from COVID-19 were significantly higher in parents within the study group (p < .05). Parents in the study group used more problem-focused coping than parents in the control group (p = .003). Anxiety symptoms score was higher in children of the study group (p = .007). Parents in the study group found online education more useful than parents in the control group. CONCLUSION Children with chronic lung diseases and their parents have more anxiety due to COVID-19 pandemic and these parents use more mature coping strategies to manage the stress of the pandemic. Longitudinal and larger studies should be done in all aspects of online education in children with chronic lung diseases.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Selma Tural Hesapcioglu
- Department of Child and Adolescent Psychiatry, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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Ozsezen B, Emiralioglu N, Tural DA, Sunman B, Buyuksahin HN, Yalcin E, Dogru D, Ozcelik U, Kiper N. Telephone surveillance during 2019 novel coronavirus disease: Is it a helpful diagnostic tool for detecting acute pulmonary exacerbations in children with chronic lung disease? J Telemed Telecare 2020; 28:694-702. [PMID: 33183128 DOI: 10.1177/1357633x20972008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The global burden of the 2019 novel coronavirus disease pandemic on the healthcare system, as well as the high transmission risk of coronavirus disease has led to the use of alternative strategies for evaluation of children with chronic conditions. In this context, telemedicine has become the effective and affordable choice. In this study we aimed to evaluate the efficiency of telephone visits to determine pulmonary exacerbations and hospitalization rates of children with cystic fibrosis and interstitial lung disease. METHODS A total of 119 children with cystic fibrosis or interstitial lung disease were enrolled and provided cases in which telephone visits were applied during the peak time of the coronavirus disease pandemic in our country. The recordings of respiratory, gastrointestinal and other symptoms, nutrition status, rate of acute pulmonary exacerbation, treatments initiated by telephone visits, referral to hospital and hospitalization were established from the electronic health reports of the patients. RESULTS Thirteen patients (10.9%) were symptomatic, 12 of them (10%) were diagnosed with acute pulmonary exacerbation. One patient was diagnosed with peripheral facial paralysis. Nine patients were recalled to the hospital and seven patients (5.8%) were hospitalised. DISCUSSION Using telemedicine the health status of patients can be defined, and patients can be guided on proper healthcare that they need, especially during the times of pandemics which we are facing. Communication with patients while minimising the risk of exposure to coronavirus disease is an important advantage of telemedicine. Telemedicine will have to be implemented on our daily medical practice in the near future.
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Affiliation(s)
- Beste Ozsezen
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
| | | | - Dilber A Tural
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
| | | | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University, Turkey
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Hizal M, Yalcin E, Alp A, Ozden M, Karakaya J, Eryilmaz Polat S, Tugcu G, Dogru D, Ozcelik U, Kiper N. Respiratory viruses: What is their role in acute exacerbations in children with cystic fibrosis? Pediatr Pulmonol 2020; 55:1646-1652. [PMID: 32227679 DOI: 10.1002/ppul.24750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 02/02/2020] [Accepted: 02/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Respiratory viruses (RVs) are frequently present in the airways of patients with cystic fibrosis (CF) during pulmonary exacerbations (PEx). METHOD AND OBJECTIVES This prospective, longitudinal study was performed to examine the role of RVs in acute exacerbations in children with CF. Sputum samples or additional midturbinate swabs were tested from all children using a polymerase chain reaction panel. The primary aims of the study were to determine the prevalence and etiologic role of RVs in exacerbations of CF and to compare changes with RV-positive and RV-negative infections. The secondary aims were to determine the predictive factors for RV-related exacerbations. RESULTS From 50 patients with PEx, 23 (48.9%) sputum samples were virus-positive. With a combination of sputum and swab, viral positivity increased to 56%. The virus-positive group presented more frequently with hypoxia (oxygen saturation <93%) than the virus-negative group (P = .048). Virus-positive exacerbations were not associated with an increase in colonization rates or greater lung function decline over 12 months. CONCLUSIONS RVs frequently present during PEx of CF. However, predicting viral infections is difficult in this group. Only the presence of hypoxia may raise the suspicion of an accompanying viral agent. The combination of sputum and nasal swab samples increases the diagnostic yield in viral infections of CF. Despite their high frequency, the presence of RVs had no impact on clinical outcomes, such as a decline in lung function and increased colonization rates.
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Affiliation(s)
- Mina Hizal
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alpaslan Alp
- Department of Microbiology, Hacettepe University, Ankara, Turkey
| | - Meltem Ozden
- Department of Microbiology, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokcen Tugcu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Onay Z, Gursoy TR, Aslan A, Eyuboglu TS, Cakir E, Cobanoglu N, Pekcan S, Cinel G, Dogru D, Ozcelik U, Yalcin E, Sen V, Ercan O, Kilinc A, Yazan H, Altintas D, Demir E, Bingol A, Sapan N, Celebi E, Tugcu G, Ozdemir A, Harmanci K, Kose M, Emiralioglu N, Tamay Z, Yuksel H, Ozcan G, Topal E, Can D, Korkmaz P, Caltepe G, Kilic M, Ozdogan S. P060 Indications and contraindications for lung transplantation of cystic fibrosis patients in Turkey. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gursoy TR, Onay ZR, Aslan AT, Eyuboglu TS, Cakir E, Cobanoglu N, Pekcan S, Cinel G, Dogru D, Ozcelik U, Yalcin E, Sen V, Ercan O, Kilinç A, Yazan H, Altintas D, Esen D, Bingol A, Sapan N, Celebi E, Tugcu G, Ozdemir A, Harmanci K, Kose M, Emiralioglu N, Tamay Z, Yuksel H, Ozcan G, Topal E, Can D, Korkmaz P, Caltepe G, Kiliç M, Ozdogan S. P035 Comparison of clinical findings of the patients with cystic fibrosis in terms of diagnosed with and without neonatal screening. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ozipek M, Arikan H, Calik-Kutukcu E, Kerem-Gunel M, Saglam M, Inal-Ince D, Vardar-Yagli N, Livanelioglu A, Bozdemir-Ozel C, Cakmak A, Sonbahar-Ulu H, Emiralioglu N, Ozcelik U. Deviations of body functions and structure, activity limitations, and participation restrictions of the International Classification of Functioning, Disability, and Health model in children with cystic fibrosis and non-cystic fibrosis bronchiectasis. Pediatr Pulmonol 2020; 55:1207-1216. [PMID: 32109001 DOI: 10.1002/ppul.24708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To the best of our knowledge, there is no study in the literature investigating the extrapulmonary outcomes of children with non-cystic fibrosis (CF) bronchiectasis and CF under the framework of the International Classification of Functioning, Disability, and Health (ICF) model. The purpose of the present study is to evaluate the children with CF and non-CF bronchiectasis using the ICF model. MATERIALS AND METHODS Children with CF, non-CF bronchiectasis, and healthy counterparts were evaluated (20 participants in each group) according to the ICF items in domain b (body functions), domain s (body structures), and domain d (activities and participation). The pulmonary functions, respiratory and peripheral muscle strength tests, and posture analysis were carried out for domain b. For domain d, however, the Glittre-activities of daily living test and Pediatric Outcome Data Collection were used. RESULTS Muscle strength of shoulder abductors and hip extensors in children with CF was significantly lower than healthy children and adolescents (P < .05). The severity of lateral and posterior postural abnormalities in children with CF and non-CF bronchiectasis was higher than those of healthy children (P < .05). Among the patient groups, global function, sports/physical function, expectations, transfers/basic mobility, and pain/comfort were the most affected participation dimensions (P < .05). CONCLUSIONS This study highlights the need for comprehensive up-to-date evaluation methods according to the ICF model for understanding rehabilitation requirements in CF and non-CF bronchiectasis in different age groups.
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Affiliation(s)
- Melike Ozipek
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Atilim University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem-Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayse Livanelioglu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aslihan Cakmak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hazal Sonbahar-Ulu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Child Health and Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Mete Yesil A, Yalcin E, Ademhan Turhal D, Emiralioglu N, Dogru D, Ozcelik U, Kiper N. From Diagnosis to Treatment of Pediatric Tuberculosis: Ten Years Experience in a Single Institution. Clin Pediatr (Phila) 2020; 59:476-482. [PMID: 32088989 DOI: 10.1177/0009922820906488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim and Objectives. To describe the patient characteristics, clinical-epidemiologic-microbiologic profile, and treatment outcomes, and to draw attention to tuberculosis (TB) in Turkey. Methods. A retrospective, descriptive study was undertaken of 93 children aged 0 to 18 years who were admitted to Hacettepe University Pediatric Pulmonology Department for treatment from January 2005 to December 2015. Review of hospital records was performed for all children diagnosed as having TB. Results. Pulmonary TB was detected in 51.6% of the patients, extrapulmonary involvement in 33.3%, and pulmonary TB with extrapulmonary involvement in 15.1%. The history of contact with an adult with TB was found in 29% of cases. The most common extrapulmonary TB was TB lymphadenitis. The most common symptom was cough followed by fever and night sweats. One fifth of the patients had normal physical examinations at the time of diagnosis. One fifth (20.4%) of the patients had culture, 17.2% had polymerase chain reaction, and 15% had acid-resistant bacillus positivity. In 21.4% of patients with culture growth, at least one anti-TB drug resistance was found. The mean duration of treatment of patients treated according to the national guideline was 8.6 months (range = 6-36 months). Recovery was seen in 91.4% of patients. Conclusion. The most important way to prevent childhood TB is to fight adult TB through early diagnosis and effective treatment. The presence of contact history must direct us to search for TB. While evaluating children with persisted nonspecific symptoms, TB must be kept in mind even if physical examinations are normal.
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Affiliation(s)
- Ayse Mete Yesil
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilber Ademhan Turhal
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Bal Topçu D, Tugcu G, Ozcan F, Aslan M, Yalcinkaya A, Polat SE, Hizal M, Yalcin EE, Ersoz DD, Ozcelik U, Kiper N, Lay I, Oztas Y. Plasma Ceramides and Sphingomyelins of Pediatric Patients Increase in Primary Ciliary Dyskinesia but Decrease in Cystic Fibrosis. Lipids 2020; 55:213-223. [PMID: 32120452 DOI: 10.1002/lipd.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
We investigated plasma sphingomyelin (CerPCho) and ceramide (Cer) levels in pediatric patients with cystic fibrosis (CF) and primary ciliary dyskinesia (PCD). Plasma samples were obtained from CF (n = 19) and PCD (n = 7) patients at exacerbation, discharge, and stable periods. Healthy children (n = 17) of similar age served as control. Levels of 16-24 CerPCho and 16-24 Cer were measured by LC-MS/MS. Concentrations of all CerPCho and Cer species measured at exacerbation were significantly lower in patients with CF than PCD. 16, 18, 24 CerPCho, and 22, 24 Cer in exacerbation; 18, 24 CerPCho, and 18, 20, 22, 24 Cer at discharge; 18, 24 CerPCho and 24 Cer at stable period were significantly lower in CF patients than healthy children (p < 0.001 and p < 0.05). All CerPCho and Cer levels of PCD patients were significantly higher except 24 CerPCho and 24 Cer during exacerbation, 24 CerPCho at discharge, and 18, 22 CerPCho levels at stable period (p < 0.001 and p < 0.05) compared with healthy children. There was no significant difference among exacerbation, discharge, and stable periods in each group for Cer and CerPCho levels. This is the first study measuring plasma Cer and CerPCho levels in PCD and third study in CF patients. The dramatic difference in plasma levels of most CerPCho and Cer species found between two diseases suggest that cilia pathology in PCD and CFTR mutation in CF seem to alter sphingolipid metabolism possibly in opposite directions.
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Affiliation(s)
- Dilara Bal Topçu
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Gokcen Tugcu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Filiz Ozcan
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Konyaaltı, 07070, Turkey
| | - Mutay Aslan
- Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Konyaaltı, 07070, Turkey
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Sanem Eryilmaz Polat
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Mina Hizal
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Ebru Elmas Yalcin
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Deniz Dogru Ersoz
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Incilay Lay
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
| | - Yesim Oztas
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Sıhhıye, 06100, Turkey
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Eroglu-Ertugrul NG, Yalcin E, Oguz B, Ocal T, Kuskonmaz B, Emiralioglu N, Dogru-Ersoz D, Ozcelik U, Tezcan I, Kiper N. The value of flexible bronchoscopy in pulmonary infections of immunosuppressed children. Clin Respir J 2019; 14:78-84. [PMID: 31710418 PMCID: PMC7162225 DOI: 10.1111/crj.13103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/30/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
Objectives To demonstrate the value of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) when determining causes of lung infection in immunocompromised children; to investigate differences in causes and radiological features of lung infections following bone marrow transplantation (BMT) compared to other immunosuppressive conditions; to evaluate the reliability of radiological findings when predicting the pathogen. Methods We retrospectively evaluated 132 immunosuppressed children who underwent FB and BAL because pulmonary complications between January 1999 and May 2014 at the Hacettepe University Hospital Pediatric Pulmonology Unit. Two groups, Group I (n = 106) and Group II (n = 26), consisted of patients who had primary or secondary immunodeficiency and those who were immunosuppressed because BMT, respectively. Radiological findings before FB and macroscopic and microscopic findings of the procedure were evaluated. Results FB and BAL were diagnostic in 86/132 patients (65.1%) and the antimicrobial treatment changed for 75/132 patients (56.8%). The most common pathogen was bacteria (Streptococcus pneumoniae was the leading one). Bacteria were more frequent in Group I than Group II (P = .008). No significant difference in radiological findings between Groups I and II was found. Considering all patients, a significant association was detected between viral pathogens and radiologically interstitial infiltration and a ground‐glass appearance (P = .003). However, no significant association was detected between bacterial and fungal pathogens and the radiological findings. Conclusion In immunosuppressed patients, FB and BAL should be evaluated early for clarifying the causative agents. Then, appropriate treatments can be utilised and the side effects and high cost of unnecessary treatment may be mitigated.
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Affiliation(s)
| | - Ebru Yalcin
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Turgay Ocal
- Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Baris Kuskonmaz
- Division of Pediatric Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru-Ersoz
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ilhan Tezcan
- Division of Pediatric Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Hizal MG, Eryilmaz Polat S, Ademhan D, Emiralioglu N, Kiper O, Utuni E, Yalcin E, Dogru Ersoz D, Kiper N, Ozcelik U. Evaluation of Sleep Disorders in Children with Down Syndrome. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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46
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Saglam M, Uge B, Vardar Yagli N, Inal Ince D, Sonbahar Ulu H, Calik Kutukcu E, Bayrakci Tunay V, Ozcelik U. The Effects of Weighted Exercise Training on Lean Body Weight, Balance and Functional Capacity in Individuals with Cystic Fibrosis: A Pilot Study. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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47
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Yalcin E, Emiralioglu N, Tugcu GD, Eryilmaz S, Hizal MG, Mete Yesil A, Gonc N, Dogru D, Ozcelik U, Kiper N. Vitamin D and LL-37 Levels in Childhood Tuberculosis Disease and Latent Tuberculosis Infection. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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48
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Hizal MG, Yalcin E, Alp A, Ozden M, Eryilmaz Polat S, Tugcu GD, Dogru Ersoz D, Ozcelik U, Kiper N. The Effects of Respiratory Viruses on the Acute Pulmonary Exacerbations in Cystic Fibrosis Patients. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Emiralioglu N, Taskiran E, Kosukcu C, Bilgic E, Atilla P, Kaya B, Gunaydin O, Yuzbasioglu A, Ademhan D, Eryilmaz Polat S, Hizal MG, Yalcin E, Dogru D, Kiper N, Ozcelik U. Current Diagnostic Methods in Primary Ciliary Dyskinesia: Hacettepe University Experience. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cakmak A, Inal-Ince D, Sonbahar-Ulu H, Bozdemir-Ozel C, Tekerlek H, Saglam M, Calik-Kutukcu E, Vardar-Yagli N, Yalcin EE, Ozcelik U, Arikan H. Aerobic exercise training in Kartagener's syndrome: case report. J Exerc Rehabil 2019; 15:468-471. [PMID: 31316943 PMCID: PMC6614767 DOI: 10.12965/jer.1938144.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 11/22/2022] Open
Abstract
Kartagener’s syndrome is a rare, autosomal recessive inherited disease, which is characterized by a triad of chronic sinusitis, bronchiectasis, and situs inversus. In this report, we aimed to represent the effect of aerobic exercise training in addition to chest physiotherapy in an outpatient with Kartagener’s syndrome. An 18-year-old female diagnosed with Kartagener’s syndrome applied with the complaints of productive cough and dyspnea with exertion and attended pulmonary rehabilitation program comprising exercise training in addition to standard treatment. Aerobic exercise training was performed three times weekly at 80% of the peak heart rate, for 8 weeks as supervised sessions. Respiratory physiotherapy and postural exercises were taught to the patient to be performed at home each day of the week. Before and after pulmonary rehabilitation program, incremental shuttle walk test (ISWT) was performed; dyspnea and fatigue were assessed using Borg Scale. Pulmonary function test was evaluated using spirometer. The patient wore activity monitor for 7 consecutive days before and after training. After pulmonary rehabilitation program, 90-m increase in ISWT was observed. We recommend exercise training in patients with Kartagener’s syndrome to increase exercise capacity. Further randomized control trial is needed to clarify the effects.
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Affiliation(s)
- Aslihan Cakmak
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hazal Sonbahar-Ulu
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemile Bozdemir-Ozel
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Haluk Tekerlek
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Melda Saglam
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Naciye Vardar-Yagli
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Elmas Ebru Yalcin
- Department of Pediatric Chest Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Chest Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hulya Arikan
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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