1
|
Bilgin G, Unal F, Yanaz M, Baskan AKILIC, Uzuner S, Ayhan Y, Onay ZR, Kalyoncu M, Tortop DMAVI, Arslan H, Oksay SCAN, Kostereli E, Yazan H, Atag E, Ergenekon AP, Ekizoglu NBAS, Yegit CYILMAZ, Gokdemir Y, Uyan ZS, Kilinc AA, Cokugras H, Eralp EERDEM, Cakir E, Karadag B, Oktem S, Karakoc F, Girit S. Long-term outcomes of standardized training for caregivers of children with tracheostomies: The IStanbul PAediatric Tracheostomy (ISPAT) project. Pediatr Pulmonol 2024; 59:331-341. [PMID: 37983721 DOI: 10.1002/ppul.26749] [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: 01/14/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND AND OBJECTIVES: Children with tracheostomies are at increased risk of tracheostomy-related complications and require extra care. Standardized training programs for caregivers can improve tracheostomy care and reduce complications. In this study, we compared caregiver knowledge and skill scores after a standardized theoretical and practical training program on tracheostomy care (IStanbul PAediatric Tracheostomy (ISPAT) project) immediately and 1 year post-training and evaluated how this training affected the children's clinical outcomes. MATERIALS AND METHODS We included 32 caregivers (31 children) who had received standardized training a year ago and administered the same theoretical and practical tests 1 year after training completion. We recorded tracheostomy-related complications and the number and reasons for admission to the healthcare centers. All data just before the training and 1 year after training completion were compared. RESULTS After 1 year of training completion, the median number of correct answers on the theoretical test increased to 16.5 from 12 at pretest (p < 0.001). Compared with pretest, at 1-year post-training practical skills assessment scores, including cannula exchange and aspiration, were significantly higher (both p < 0.001) and mucus plug, bleeding, and stoma infection reduced significantly (p = 0.002, 0.022, and 0.004, respectively). Hands-on-training scores were better than pretest but declined slightly at 1 year compared to testing immediately after training. Emergency admission decreased from 64.5% to 32.3% (p = 0.013). Hospitalization decreased from 61.3% to 35.5% (p = 0.039). CONCLUSION Our findings indicate that caregiver training can lead to a persistent increase in knowledge and skill for as long as 1 year, as well as improvements in several measurable outcomes, although a slight decrease in scores warrants annual repetitions of the training program.
Collapse
Affiliation(s)
- Gulay Bilgin
- Faculty of Medicine, Division of Pediatric Pulmonology, Medeniyet University, Istanbul, Turkey
| | - Fusun Unal
- Faculty of Medicine, Division of Pediatric Pulmonology, Medipol University, Istanbul, Turkey
| | - Muruvvet Yanaz
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Azer K I L I C Baskan
- Cerrahpasa Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul University, Istanbul, Turkey
| | - Selcuk Uzuner
- Faculty of Medicine, Istanbul Bezmialem University, Istanbul, Turkey
| | - Yetkin Ayhan
- Faculty of Medicine, Division of Pediatric Pulmonology, Medeniyet University, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Faculty of Medicine, Division of Pediatric Pulmonology, Medeniyet University, Istanbul, Turkey
| | - Mine Kalyoncu
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Deniz M A V I Tortop
- Faculty of Medicine, Division of Pediatric Pulmonology, Medeniyet University, Istanbul, Turkey
| | - Huseyin Arslan
- Cerrahpasa Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul University, Istanbul, Turkey
| | - Sinem C A N Oksay
- Faculty of Medicine, Division of Pediatric Pulmonology, Medeniyet University, Istanbul, Turkey
| | - Ebru Kostereli
- Faculty of Medicine, Division of Pediatric Pulmonology, Koc University, Istanbul, Turkey
| | - Hakan Yazan
- Health Sciences University, Umraniye Training and Research Hospital, Division of Pediatric Pulmonology, Istanbul, Turkey
| | - Emine Atag
- Faculty of Medicine, Division of Pediatric Pulmonology, Medipol University, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Nilay B A S Ekizoglu
- Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Division of Pediatric Pulmonology, Istanbul, Turkey
| | - Cansu Y I L M A Z Yegit
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Faculty of Medicine, Division of Pediatric Pulmonology, Koc University, Istanbul, Turkey
| | - Ayse Ayzıt Kilinc
- Cerrahpasa Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul University, Istanbul, Turkey
| | - Haluk Cokugras
- Cerrahpasa Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul University, Istanbul, Turkey
| | - Ela E R D E M Eralp
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Faculty of Medicine, Division of Pediatric Pulmonology, Istinye University, Istanbul, Turkey
| | - Bulent Karadag
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Faculty of Medicine, Division of Pediatric Pulmonology, Medipol University, Istanbul, Turkey
| | - Fazilet Karakoc
- Faculty of Medicine, Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Saniye Girit
- Faculty of Medicine, Division of Pediatric Pulmonology, Medeniyet University, Istanbul, Turkey
| |
Collapse
|
2
|
Bas Ikizoglu N, Atag E, Ergenekon P, Gokdemir Y, Uyan ZS, Girit S, Kilinc Sakalli AA, Erdem Eralp E, Cakir E, Guven F, Aksoy ME, Karadag B, Karakoc F, Oktem S. Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team. Front Pediatr 2024; 12:1325582. [PMID: 38362002 PMCID: PMC10867101 DOI: 10.3389/fped.2024.1325582] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. Methods A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Results Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. Conclusion The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.
Collapse
Affiliation(s)
- Nilay Bas Ikizoglu
- Division of Pediatric Pulmonology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Emine Atag
- Division of Pediatric Pulmonology, School of Medicine, Maltepe University, Istanbul, Turkiye
| | - Pinar Ergenekon
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, School of Medicine, Koc University, Istanbul, Turkiye
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkiye
| | - Ayse Ayzit Kilinc Sakalli
- Division of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul-Cerrahpasa University, Istanbul, Turkiye
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Istinye University, Istanbul, Turkiye
| | - Feray Guven
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Bulent Karadag
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Sedat Oktem
- Division of Pediatric Pulmonology, School of Medicine, Medipol University, Istanbul, Turkiye
| |
Collapse
|
3
|
Temur HO, Alkan A, Yozgat CY, Cakir E, Yazan H, Yabul FC, Cesme DH, Yozgat Y. MRI evaluation of right heart functions in children with mild cystic fibrosis. Cardiol Young 2023; 33:1828-1833. [PMID: 36226672 DOI: 10.1017/s1047951122003249] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to assess the ventricular anatomy, function of the right ventricle, and the haemodynamic findings of pulmonary artery in children with cystic fibrosis using cardiac MRI. PATIENTS This prospective study consisted of 32 children with mild cystic fibrosis and 30 age-matched healthy control participants. METHODS Cardiac MRI was used to assess right ventricular volumes, anatomy, and function and to assessment of haemodynamic findings of pulmonary artery in the control and study groups. Haemodynamic findings of pulmonary arteries were determined using pulmonary arteries peak velocity (cm/s), and pulmonary arteries time-to-peak velocity (ms) and pulmonary artery systolic pressure. All data of children with mild cystic fibrosis were compared with those of 30 age-matched healthy control group participants. RESULTS Our patients and their age-matched controls were aged from 6 to 17 years and from 7 to 15 years, respectively. We found that ejection fraction (%), cardiac output (L/ml), cardiac output (L/ml/m2), and systolic volume (ml/m2) were significantly lower in children with cystic fibrosis (p < 0.01). Right ventricular anterior wall thickness (mm) was significantly higher in children with cystic fibrosis (p = 0.01). No significant difference was observed between the haemodynamic parameters of pulmonary artery in the patient group. CONCLUSION In our study, cardiac MRI was used to investigate whether the right ventricle was affected functionally and anatomically in children with mild cystic fibrosis. We detected a significant decrease in right ventricular systolic functions and notable alterations in the right ventricular geometry of children with mild cystic fibrosis. These alterations usually manifest themselves as hypertrophy of the right ventricle. Our study's results demonstrate no relationship between the development of pulmonary hypertension in mild cystic fibrosis children.
Collapse
Affiliation(s)
- Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Celik Yabul
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Dilek Hacer Cesme
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Uyan ZS, Atag E, Ergenekon AP, Gokdemir Y, Gokler O, Ay P, Bas İkizoglu N, Cenk M, Erdem Eralp E, Sivrikaya GU, Girit S, Cakir E, Kilic AA, Yazan H, Can Oksay S, Hepkaya E, Kiyan G, Karadag B, Karakoc F, Oktem S. Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team. Pediatr Pulmonol 2022; 57:418-426. [PMID: 34821480 DOI: 10.1002/ppul.25772] [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: 06/28/2021] [Revised: 10/30/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Tracheostomy care in children may be challenging, due to lack of knowledge of healthcare providers (HCPs). The aim of this study was to determine the level of knowledge of HCP who follow patients with tracheostomy and to increase this level with theoretical training and training in a simulation laboratory. MATERIALS AND METHODS ISPAT (IStanbul PAediatric Tracheostomy), a multidisciplinary team for tracheostomy care was established and a training program was prepared. Participants were subjected to theoretical and practical pretests which evaluated their knowledge levels and skills for care, follow-up, and treatment of a patient with tracheostomy. After the theoretical and practical training given to the participants with a simulation model, theoretical and practical posttests were applied. RESULTS Fifty-one HCP from nine tertiary pediatric clinics in Istanbul were enrolled in the training program. Only six (11.8%) of them had received standardized training programs previously. Regarding the theoretical tests, seven of the 33 questions were indicated as essential. The knowledge level of the participants based on the essential questions significantly increased after the training (p < 0.05 for all of the essential questions). The total number of correct answers and correct answers of three subheadings also significantly increased after the practical training (p < 0.001 for all). Ninety-five percent of the participants assessed the course as good or excellent in general. CONCLUSION Training in a simulation laboratory in combination with theoretical education can improve the knowledge and skills of the HCP enabling improved care of children with a tracheostomy.
Collapse
Affiliation(s)
- Zeynep S Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Almala P Ergenekon
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ozan Gokler
- Department of Otorhinolaryngology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nilay Bas İkizoglu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muruvvet Cenk
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - G Ulufer Sivrikaya
- Rahmi M. Koc Academy of Interventional Medicine, Education and Simulation (RMK AIMES), Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse A Kilic
- Division of Pediatric Pulmonology, Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Evrim Hepkaya
- Division of Pediatric Pulmonology, Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| |
Collapse
|
6
|
Dogan Demir A, Kut A, Ozaydin E, Nursoy M, Cakir FB, Ustabas Kahraman F, Erenberk U, Uzuner S, Collak A, Cakin ZE, Cakir E. Evaluation of diagnostic components and management of childhood pulmonary tuberculosis: a prospective study from Istanbul, Turkey. J Infect Dev Ctries 2022; 16:112-119. [PMID: 35192528 DOI: 10.3855/jidc.14505] [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] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/25/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The diagnosis of childhood tuberculosis is difficult and most of the patients are diagnosed clinically. The objective of this study is to reveal the diagnostic and therapeutic components of childhood pulmonary tuberculosis and to analyze the changes that occurred in our country over the years. METHODOLOGY All patients diagnosed with tuberculosis between 2006 and 2016 were included. Demographic characteristics, diagnostic and treatment outcomes were recorded and patients were followed up prospectively. RESULTS A total of 492 patients were included in the study. 97% had Bacillus Calmette-Guerin vaccine, 36% were diagnosed with microbiologically-confirmed tuberculosis and 64% were diagnosed with clinically-proven tuberculosis. 94% of the patients had symptoms consistent with tuberculosis, all patients had radiologic findings, 74% had a history of tuberculosis contact and 63% had tuberculin skin test positivity. The diagnoses included primary tuberculosis in 62%, secondary tuberculosis in 21%, progressive primary tuberculosis in 13% and miliary tuberculosis in 4%. 48% of the patients received a treatment regimen containing three drugs as the initial treatment, and drug-related side effects developed in 12%. Isoniazid resistance was detected in 13% of the patients and rifampicin resistance was detected in 8%. None of the patients died due to tuberculosis. In the last 50 years in Turkey, the rates of Bacillus Calmette-Guerin vaccination and diagnosis of tuberculosis cases have increased and the mortality rates have decreased over the years. CONCLUSIONS Our study is one of the few prospective studies and revealed the differences between the recent data and the past 50 years in childhood tuberculosis in Turkey.
Collapse
Affiliation(s)
| | - Arif Kut
- Division of Pediatric Pulmonology, Maltepe University, Istanbul, Turkey
| | - Erhan Ozaydin
- Sureyyapasa Chest Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Nursoy
- Division of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Betul Cakir
- Division of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Ufuk Erenberk
- Division of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Selcuk Uzuner
- Division of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Abdulhamit Collak
- Division of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Ebru Cakin
- Division of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Yilmaz Yegit C, Kilinc AA, Can Oksay S, Unal F, Yazan H, Köstereli E, Gulieva A, Arslan H, Uzuner S, Onay ZR, Kilic Baskan A, Collak A, Atag E, Ergenekon AP, Bas Ikizoğlu N, Ay P, Oktem S, Gokdemir Y, Girit S, Cakir E, Uyan ZS, Cokugras H, Karadag B, Karakoc F, Erdem Eralp E. The ISPAT project: Implementation of a standardized training program for caregivers of children with tracheostomy. Pediatr Pulmonol 2022; 57:176-184. [PMID: 34562057 DOI: 10.1002/ppul.25704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/15/2021] [Revised: 08/15/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). OBJECTIVE Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. MATERIALS AND METHODS Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. RESULTS A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). CONCLUSION Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.
Collapse
Affiliation(s)
- Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Fusun Unal
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Ebru Köstereli
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Hüseyin Arslan
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Azer Kilic Baskan
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Abdulhamit Collak
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nilay Bas Ikizoğlu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital
| | - Pinar Ay
- Division of Public Health, Marmara University, School of Medicine, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
9
|
Gokdemir Y, Eyuboglu TS, Emiralioglu N, Er B, Sen V, Pekcan S, Ergenekon AP, Hizal MG, Eryilmaz S, Kose M, Hangul M, Cakir E, Cokugras H, Kılınc AA, Sasıhuseyinoglu AS, Altintas DU, Gulen F, Eski A, Bingol A, Ozdemir A, Topal E, Gursoy TR, Girit S, Ay P, Yılmaz O. Geographical barriers to timely diagnosis of cystic fibrosis and anxiety level of parents during newborn screening in Turkey. Pediatr Pulmonol 2021; 56:3223-3231. [PMID: 34273142 DOI: 10.1002/ppul.25586] [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: 01/05/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the availability of cystic fibrosis (CF) screening countrywide, diagnostic delay is still a crucial issue. The objectives of this study were to explore the stages of the NBS process, determine the risk factors associated with diagnostic delay and evaluate parent anxiety and experience throughout the process. METHODS This is a multicenter cross-sectional study. A questionnaire was completed by parents of newborns diagnosed with CF via NBS in 17 centers. Socio-demographic characteristics, parent knowledge and experiences related to NBS, sweat test availability in the region of residence, and time to the definitive CF diagnosis were assessed through this questionnaire. Parents' anxiety levels were evaluated through the State-Trait Anxiety Inventory scales 1 and 2. Delayed diagnosis (DD) was defined as a definite CF diagnosis beyond the 8th week of life. Predictors of delayed CF diagnosis were evaluated by univariate and multivariate analysis. RESULTS A total of 220 CF patients diagnosed via NBS were enrolled; 82 (37.3%) babies had DD. Multivariable analysis indicated that residence in the Southeast Anatolia region of Turkey (OR = 10.79, 95% CI = 2.37-49.2) was associated with a higher incidence of DD compared with other regions in Turkey. Of the total, 216 (98.1%) of the caregivers regarded the NBS program as useful and 180 (82%) reported high anxiety levels. CONCLUSION The organization of newborn screening should take into account regional and socio-cultural characteristics to improve the early diagnosis of CF and also reduce the anxiety level of parents.
Collapse
Affiliation(s)
- Yasemin Gokdemir
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Nagehan Emiralioglu
- Division of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Berrin Er
- Department of Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Sen
- Division of Pediatric Pulmonology, School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mina Gharibzadeh Hizal
- Division of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Sanem Eryilmaz
- Division of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Kose
- Division of Pediatric Pulmonology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Melih Hangul
- Division of Pediatric Pulmonology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, School of Medicine, Bezmi Alem Vakıf University, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Pulmonology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzıt Kılınc
- Division of Pediatric Pulmonology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Derya Ufuk Altintas
- Division of Pediatric Allergy and Immunology, School of Medicine, Cukurova University, Adana, Turkey
| | - Figen Gulen
- Division of Pediatric Pulmonology, School of Medicine, Ege University, Istanbul, Turkey
| | - Aykut Eski
- Division of Pediatric Pulmonology, School of Medicine, Ege University, Istanbul, Turkey
| | - Aysen Bingol
- Division of Pediatric Pulmonology, School of Medicine, Akdeniz University, Istanbul, Turkey
| | | | - Erdem Topal
- Division of Pediatric Allergy and Immunology, School of Medicine, İnonu University, Malatya, Turkey
| | - Tugba Ramaslı Gursoy
- Division of Pediatric Pulmonology, School of Medicine, Gazi University, Ankara, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Pınar Ay
- Department of Public Health, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ozge Yılmaz
- Division of Pediatric Pulmonology, School of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
10
|
Atag E, Unal F, Yazan H, Girit S, Uyan ZS, Ergenekon AP, Yayla E, Merttürk E, Telhan L, Meral Ö, Kucuk HB, Gunduz M, Gokdemir Y, Erdem Eralp E, Kiyan G, Cakir E, Ersu R, Karakoc F, Oktem S. Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study. Pediatr Pulmonol 2021; 56:2925-2931. [PMID: 34236776 DOI: 10.1002/ppul.25566] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/10/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population. METHODS Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed. RESULTS One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease. Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. CONCLUSION Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.
Collapse
Affiliation(s)
- Emine Atag
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Fusun Unal
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Esra Yayla
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Edanur Merttürk
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Leyla Telhan
- Department of Pediatrics, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Özge Meral
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Hanife Busra Kucuk
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Gunduz
- Division of Neonatalogy, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Faculty of Medicine Istanbul, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| |
Collapse
|
11
|
Yazan H, Khalif F, Shadfaan LA, Bilgin S, Nursoy M, Cakir FB, Cakin ZE, Uzuner S, Cakir E. Post-infectious bronchiolitis obliterans in children: Clinical and radiological evaluation and long-term results. Heart Lung 2021; 50:660-666. [PMID: 34098236 DOI: 10.1016/j.hrtlng.2021.05.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aims to evaluate clinical and radiological findings and treatment outcomes of the patients with PIBO. METHODS One hundred fourteen children were enrolled. Initial demographic and clinical findings were evaluated. Pre- and post-treatment clinical and radiological findings were compared. RESULTS The median age of the patients at initial pulmonary injury was 7,2 months, the median age at diagnosis was 17.5 months. Persistent wheezing was the most common complaint. Thirty-five patients had mechanical ventilation history. 82,5% of patients had clinical improvement. Bronchiectasis, atelectasis, hyperinflation and air trapping in HRCT improved significantly with treatment. Post-treatment Bhalla scores decreased from 8.3 to 6.5 (p= 0,001). Improvement was observed in radiological and clinical findings after treatment. CONCLUSIONS This study is one of the largest studies in the literature and one of the few studies that evaluate clinical and radiological outcomes of patients with PIBO.
Collapse
Affiliation(s)
- Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey.
| | - Fathouma Khalif
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Lina Al Shadfaan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Sennur Bilgin
- Department of Radiology, Faculty of Medicine, Münster University
| | - Mustafa Nursoy
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Fatma Betül Cakir
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Zeynep Ebru Cakin
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Selcuk Uzuner
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| |
Collapse
|
12
|
Yazan H, Kilinc AA, Dogan R, Gedik O, Al Shadfan LM, Basoz M, Ozturan O, Cakir E. Effects of long-term azithromycin therapy on auditory functions in children with chronic respiratory diseases. Int J Pediatr Otorhinolaryngol 2021; 147:110808. [PMID: 34186301 DOI: 10.1016/j.ijporl.2021.110808] [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: 02/10/2021] [Revised: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES In recent years, long-term azithromycin (AZT) use has been increased in pediatric patients with chronic respiratory tract problems. In this study, we aimed to assess auditory functions in children on long-term AZT therapy. METHOD The study included 43 patients who received long-term AZT treatment and 27 age-matched, healthy controls. In the study and control groups, ear-nose-throat examination, pure tone audiometry, speech recognition threshold (SRT), speech discrimination score (SDS), uncomfortable loudness level (UCL), acoustic reflex tests, and otoacoustic emission tests were performed. The test results were statistically compared between groups. RESULTS Mean age was 11.3 ± 0.56 years in the study group and 9.3 ± 3.07 years in the control group. The medain hearing examination was 8 months after end of AZT treatment (Ranged: 1-12 months). No significant difference was found in normal- and high-frequency audiogram tests at any frequency between study and control groups. Also, no significant difference was found in distortion product otoacoustic emissions (DPOAE) and transient evoked otoacoustic emissions (TEOAE) tests between groups. Also, there was no significant difference in acoustic reflex, SRT, SDS, and UCL test results between study and control groups. CONCLUSION This is the first study assessing auditory functions comprehensively in pediatric patients who received long-term AZT therapy. In this study, it was shown that long-term AZT use had no deleterious effect on auditory function tests.
Collapse
Affiliation(s)
- Hakan Yazan
- Bezmilalem Vakif University, Department of Pediatric Pulmonology, Istanbul, Turkey.
| | - Ayse Ayzit Kilinc
- İstanbul University-Cerrahpasa, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Remzi Dogan
- Bezmialem Vakif University, Department of Otorhinolayngology, Istanbul, Turkey
| | - Ozge Gedik
- Bezmialem Vakif University, Faculty of Health Sciences, Audiology Department, Istanbul, Turkey
| | | | - Meliha Basoz
- Bezmialem Vakif University, Faculty of Health Sciences, Audiology Department, Istanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Department of Otorhinolayngology, Istanbul, Turkey
| | - Erkan Cakir
- Bezmilalem Vakif University, Department of Pediatric Pulmonology, Istanbul, Turkey
| |
Collapse
|
13
|
Aslanhan U, Cakir E, Pur Ozyigit L, Kucuksezer UC, Gelmez YM, Yuksel M, Deniz G, Cetin Aktas E. Pseudomonas aeruginosa colonization in cystic fibrosis: Impact on neutrophil functions and cytokine secretion capacity. Pediatr Pulmonol 2021; 56:1504-1513. [PMID: 33512090 DOI: 10.1002/ppul.25294] [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: 04/08/2020] [Revised: 01/03/2021] [Accepted: 01/22/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Chronic colonization with Pseudomonas (P.) aeruginosa worsens the prognosis of cystic fibrosis (CF) patients. This study aims to analyze the functional properties of neutrophils in CF patients with P. aeruginosa colonization. METHODS Patients with CF (n = 16) were grouped by positivity of P. aeruginosa in sputum culture, as positive (P.+) or negative (P.-), then compared with age and sex matched healthy controls (n = 8). Adhesion molecules, apoptotic index, intracellular CAP-18, interleukin 8 (IL-8), and tumor necrosis factor α (TNF-α) levels of neutrophils, following P. aeruginosa and lipopolysaccharides (LPS) stimulation, were analyzed by flow cytometry. IL-1β, IL-6, TNF-α, and IL-17 plasma levels were determined by Luminex. RESULTS Patients with CF had increased phagocytosis of Escherichia coli and P. aeruginosa, upregulated oxidative burst and chemotaxis. Increased neutrophil apoptosis was noted in CF patients. In unstimulated conditions, higher levels of CD16+ TNF-α+ and CD16+ IL-8+ neutrophils were determined, whereas bacteria and LPS stimulation significantly decreased secretion of CAP-18 from CD16+ neutrophils of CF patients. Plasma levels of IL-1β, TNF-α and IL-17 in P.+ patients were higher than in P.- group. CONCLUSION Our findings confirm inadequate neutrophil defense towards pathogens in CF. A significant difference in migration, phagocytosis, oxidative burst, percentage of IL-8 producing neutrophils, IL-1β, TNF-α, and IL-17 secretions were noted among CF patients according to their colonization status, which might induce a further destructive effect on airways, resulting in an unfavorable prognosis for children with CF who also have colonization.
Collapse
Affiliation(s)
- Umit Aslanhan
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Department of Immunology, Institute of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Leyla Pur Ozyigit
- Department of Allergy and Immunology, University Hospitals of Leicester, Leicester, UK
| | - Umut Can Kucuksezer
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Yusuf Metin Gelmez
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Mine Yuksel
- Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Esin Cetin Aktas
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
14
|
Nursoy MA, Kilinc AA, Abdillahi FK, Ustabas Kahraman F, Al Shadfan LM, Sumbul B, Sennur Bilgin S, Cakir FB, Daskaya H, Cakir E. Relationships Between Bronchoscopy, Microbiology, and Radiology in Noncystic Fibrosis Bronchiectasis. Pediatr Allergy Immunol Pulmonol 2021; 34:46-52. [PMID: 33989070 DOI: 10.1089/ped.2020.1319] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Published data on the correlations of bronchoscopy findings with microbiological, radiological, and pulmonary function test results in children with noncystic fibrosis (CF) bronchiectasis (BE) are unavailable. The aims of this study were to evaluate relationships between Bronchoscopic appearance and secretion scoring, microbiological growth, radiological severity level, and pulmonary function tests in patients with non-CF BE. Methods: Children with non-CF BE were identified and collected over a 6-year period. Their medical charts and radiologic and bronchoscopic notes were retrospectively reviewed. Results: The study population consisted of 54 female and 49 male patients with a mean age of 11.7 ± 3.4 years. In the classification according to the bronchoscopic secretion score, Grade I was found in 2, Grade II in 4, Grade III in 9, Grade IV in 17, Grade V in 25, and Grade VI in 46 patients. When evaluated according to the Bhalla scoring system, 45 patients had mild BE, 37 had moderate BE, and 21 had severe BE. Microbial growth was detected in bronchoalveolar lavage fluid from 50 of the patients. Forced expiratory volume in 1 s (FEV1) and functional vital capacity decreased with increasing bronchoscopic secretion grade (P = 0.048 and P = 0.04), respectively. The degree of radiological severity increased in parallel with the bronchoscopic secretion score (P = 0.007). However, no relationship was detected between microbiological growth rate and radiological findings (P = 0.403). Conclusions: This study showed that bronchoscopic evaluation and especially scoring of secretions correlate with severe clinical condition, decrease in pulmonary function test, worsening in radiology scores, and increase in microbiological bacterial load in patients. Flexible endoscopic bronchoscopy should be kept in mind in the initial evaluation of non-CF BE patients.
Collapse
Affiliation(s)
- Mustafa Atilla Nursoy
- Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Istanbul Cerrahpasa University Medical Faculty, Istanbul, Turkey
| | | | | | | | - Bilge Sumbul
- Department of Microbiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | | | - Fatma Betul Cakir
- Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anaesthesiology, and Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonolgy, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| |
Collapse
|
15
|
Duztas DT, Al-Shadfan L, Ozturk H, Yazan H, Cakir E, Ekinci NUO, Dalgic B, Rohlfs M, Jeske T, Klein C, Kotlarz D, Gurkan OE. New Findings of Immunodysregulation, Polyendocrinopathy, and Enteropathy X-linked Syndrome (IPEX); Granulomas in Lung and Duodenum. Pediatr Dev Pathol 2021; 24:252-257. [PMID: 33683986 DOI: 10.1177/1093526621998868] [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] [Indexed: 11/15/2022]
Abstract
Immune dysregulation, polyendocrinopathy and enteropathy, X-linked (IPEX) syndrome is a rare disorder caused by loss-of-function mutations in the gene forkhead box protein 3 (FOXP3). IPEX patients frequently show chronic diarrhea (enteropathy) associated with villous atrophies in the small intestine. Our case is different from this classical information in the literature, since he presented with neonatal onset inflammatory bowel disease within the first months of life accompanied by deep ulcers throughout colonic mucosa. Moreover, he developed chronic lung disease during follow-up and histopathological examinations showed granulomas in both gastrointestinal tract and lung parenchyma. Genetic analysis revealed the diagnosis of IPEX syndrome with a germline mutation in FOXP3. Thus, our study provides an unusual presentation of IPEX syndrome with colitis and granulomas presence in histopathological examinations.
Collapse
Affiliation(s)
- Demet Teker Duztas
- Department of Pediatric Gastroenterology and Hepatology, Gazi University, Ankara, Turkey
| | - Lina Al-Shadfan
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Ozturk
- Department of Pediatric Gastroenterology and Hepatology, Gazi University, Ankara, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Buket Dalgic
- Department of Pediatric Gastroenterology and Hepatology, Gazi University, Ankara, Turkey
| | - Meino Rohlfs
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Tim Jeske
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Daniel Kotlarz
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Odul Egritas Gurkan
- Department of Pediatric Gastroenterology and Hepatology, Gazi University, Ankara, Turkey
| |
Collapse
|
16
|
Guliyeva A, Cakir E, Yazan H, AlShadfan L, Sharifov R, Temur HO, Karaarslan U, Yozgat CY, Erenberk U, Yakut K, Yozgat Y. Assessment of Right Heart Functions in Children with Mild Cystic Fibrosis. Klin Padiatr 2021; 233:231-236. [PMID: 33601431 DOI: 10.1055/a-1341-1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a multisystemic disease that prevalently involves the lungs. Hypoxemia occurs due to the existing of progressive damage to the pulmonary parenchyma and pulmonary vessels. The condition may cause systolic and diastolic dysfunction to the right ventricle due to the effects of high pulmonary artery systolic pressure (PASP). The study aimed to determine echocardiographic alterations in PASP, right ventricle (RV) anatomy, and functions in mild CF children. MATERIALS AND METHODS RV anatomy, systolic, and diastolic functions were evaluated with conventional echocardiographic measurements. Estimated PASP was used measured with new echocardiographic modalities, including pulmonary artery acceleration time (PAAT), right ventricular ejection time (RVET), and their ratio (PAAT/RVET). The obtained echocardiographic data were statistically compared between the patient group and the control group. RESULTS The study consisted of 30 pediatric patients with mild CF and 30 healthy children with similar demographics. In patient group, conventional parameters disclosed differences in RV anatomy, both systolic and diastolic functions of RV compared with the healthy group. We did not compare the patient group with published standard data because of the wide range variability. However, new echocardiographic parameters showed notable increase in pulmonary artery pressure compared with values of control group and published standard data (p<0.001). CONCLUSION Elevated PASP, RV failure, and Cor pulmonale usually begin early in children with mild CF. In addition to routine echocardiographic measurements to evaluate RV, we recommend the use of new echocardiographic modalities for routine examinations and in the follow up of children with mild CF.
Collapse
Affiliation(s)
- Aynur Guliyeva
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Yazan
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Lina AlShadfan
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Utku Karaarslan
- Pediatric Intensive Care Unit, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | | | - Ufuk Erenberk
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Kahraman Yakut
- Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
17
|
Denizoglu Kulli H, Gurses HN, Zeren M, Ucgun H, Cakir E. Do pulmonary and extrapulmonary features differ among cystic fibrosis, primary ciliary dyskinesia, and healthy children? Pediatr Pulmonol 2020; 55:3067-3073. [PMID: 32877003 DOI: 10.1002/ppul.25052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/09/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is generally likened to cystic fibrosis (CF) due to similarities in impaired mucociliary clearance and some other symptoms. The aim of our study was to investigate pulmonary and extrapulmonary characteristics of children with CF and PCD since no studies have addressed respiratory muscle strength in children with PCD and to compare the results to those obtained from healthy age-matched controls. METHODS Pulmonary and extrapulmonary characteristics were assessed by 6-min walk test, spirometry, maximum inspiratory and expiratory pressure measurements, and knee extensor strength test in the children with CF, PCD, and healthy controls. RESULTS Children with PCD and CF had similar PFT results, except forced expiratory flow between 25% and 75% of vital capacity (FEF25-75 ) which was lower in PCD (p = .04). Maximum inspiratory pressure (MIP) value was lower in the children with CF compared with the healthy controls (p = .016), MEP value of the children with PCD was worse than those with CF and healthy controls (p = .013 and p = .013), respectively. 6-min walk test (6MWT) distance of the children with CF was lower than their healthy counterparts (p = .003). Knee extensor muscle strength differed among the children with PCD, CF, and healthy control groups, but post hoc test failed to show statistical significance (p = .010). CONCLUSION Children with CF and PCD had some impairments in pulmonary functions, respiratory muscle strength, functional capacity, and peripheral muscle strength compared with healthy children. However, the unique characteristics of each disease should be considered during physiotherapy assessment and treatment. The clinicians may especially focus on the respiratory and peripheral muscle strength of the children with PCD.
Collapse
Affiliation(s)
- Hilal Denizoglu Kulli
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Hulya Nilgun Gurses
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hikmet Ucgun
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| |
Collapse
|
18
|
Zeren M, Gurses HN, Denizoglu Kulli H, Ucgun H, Cakir E. Sit-to-stand test in children with bronchiectasis: Does it measure functional exercise capacity? Heart Lung 2020; 49:796-802. [PMID: 33010517 DOI: 10.1016/j.hrtlng.2020.09.017] [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] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Similar to six-minute walk test (6MWT), sit-to-stand test (STST) is a self-paced test which elicits sub-maximal effort; therefore, it is suggested as an alternative measurement for functional exercise capacity in various pulmonary conditions including COPD and cystic fibrosis. We aimed to investigate the association between 30-second STST (30s-STST) and 6MWT in both children with bronchiectasis (BE) and their healthy counterparts, as well as exploring cardiorespiratory burden and discriminative properties of both tests. METHODS Sixty children (6 to 18-year-old) diagnosed with non-cystic fibrosis BE and 20 age-matched healthy controls were included. Both groups performed 30s-STST and 6MWT. Test results, and heart rate, SpO2 and dyspnea responses to tests were recorded. RESULTS Univariate analysis revealed that 30s-STST was able to explain 52% of variance in 6MWT (r = 0.718, p<0.001) in BE group, whereas 20% of variance in healthy controls (r = 0.453, p = 0.045). 6MWT elicited higher changes in heart rate and dyspnea level compared to 30s-STST, indicating it was more physically demanding. Both 30s-STST (21.65±5.28 vs 26.55±3.56 repetitions) and 6MWT (538±85 vs 596±54 m) were significantly lower in BE group compared to healthy controls (p<0.01). Receiver operating characteristic (ROC) curve analysis revealed an area under the ROC curve (UAC) of 0.765 for 30s-STST and 0.693 for 6MWT in identifying the individuals with or without BE (p<0.05). Comparison between AUCs of 30s-STST and 6MWT yielded no significant difference (p = 0.466), indicating both tests had similar discriminative properties. CONCLUSIONS 30s-STST is found to be a valid alternative measurement for functional exercise capacity in children with BE.
Collapse
Affiliation(s)
- Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey.
| | - Hilal Denizoglu Kulli
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Silahtaraga St. No: 189, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Chest Diseases, Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
19
|
Temur HO, Yozgat CY, Uzuner S, Ugurlucan M, Yazan H, Cakir E, Yozgat Y. Balanced Double Aortic Arch Causing Persistent Respiratory Symptoms Mimicking Asthma in an Infant. J Pediatr Intensive Care 2020; 10:162-166. [PMID: 33884220 DOI: 10.1055/s-0040-1712959] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022] Open
Abstract
Double aortic arch (DAA) is a common form of complete vascular ring. The condition leads to airway obstruction and compression of the esophagus. A balanced type of DAA is an extremely rare anomaly. The anatomical aberration cannot be easily distinguished by transthoracic echocardiography when an infant has chronic respiratory distress. Herein we presented a case of an 11-month-old infant who had chronic respiratory distress and a balanced type of DAA.
Collapse
Affiliation(s)
- Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Selcuk Uzuner
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
20
|
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]
|
21
|
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]
|
22
|
Zubarioglu T, Bayraktar B, Dalgic N, Sancar M, Cakir E, Togay A, Gencer H, Bulut E, Yalciner A. Evaluation of QuantiFERON tuberculosis Gold In-Tube assay for diagnosis of active tuberculosis in children. J Paediatr Child Health 2020; 56:581-585. [PMID: 31714643 DOI: 10.1111/jpc.14687] [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: 05/31/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 11/29/2022]
Abstract
AIM Tuberculin skin test (TST) is still used in diagnostic algorithms of childhood tuberculosis (TB). QuantiFERON TB Gold In-Tube assay (QFT-GIT) is an alternative test to TST based on the detection of interferon-gamma release upon in vitro induction of peripheral mononuclear cells by TB antigens. In this study, we aimed to determine the diagnostic value and performance of QFT-GIT for active childhood TB. METHODS This retrospective study was conducted between January 2005 and December 2011 in three referral hospitals in Turkey with 124 children who were diagnosed with definite active TB. Sensitivity values of TST and QFT-GIT were determined by accepting the microbiological confirmation as the gold standard of diagnosis of TB. RESULTS In our study, sensitivity of QFT-GIT and TST was found to be 65 and 66% respectively. However, combined usage of QFT-GIT and TST was found to be more sensitive (85%) than TST or QFT-GIT alone (P < 0.0001). Although negative results of QFT-GIT or TST did not exclude the diagnosis of active TB in children, their positivity supported the diagnosis. Specificity could not be measured as only microbiologically confirmed cases of Mycobacterium tuberculosis disease were enrolled in the study. CONCLUSION Although sensitivities of TST and QFT-GIT are too low to exclude active TB, their positivity supports diagnosis of active TB in children concomitant with signs and symptoms. QFT-GIT and TST should be used together to enhance diagnostic sensitivity and could help exclude a diagnosis of TB if the pretest probability is low.
Collapse
Affiliation(s)
- Tanyel Zubarioglu
- Department of Pediatrics, Sisli Etfal Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Banu Bayraktar
- Department of Clinical Microbiology, Sisli Etfal Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Nazan Dalgic
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Sisli Etfal Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Mesut Sancar
- Division of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Bezmi Alem Vakıf University, Istanbul, Turkey
| | - Alper Togay
- Department of Clinical Microbiology, Sisli Etfal Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Hasim Gencer
- Department of Pediatrics, Sisli Etfal Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Emin Bulut
- Department of Clinical Microbiology, Sisli Etfal Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Altan Yalciner
- Duzen Laboratories Group, Department of Microbiology, Division of Tuberculosis Laboratory, Istanbul, Turkey
| |
Collapse
|
23
|
Cakir E, Atabek AA, Calim OF, Uzuner S, AlShadfan L, Yazan H, Ozturan O, Cakir FB. Post-intubation subglottic stenosis in children: Analysis of clinical features and risk factors. Pediatr Int 2020; 62:386-389. [PMID: 31883152 DOI: 10.1111/ped.14122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/12/2018] [Revised: 10/02/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subglottic stenosis (SGS) is a complication that develops after intubation and is characterized by respiratory distress. The aim was to evaluate patients with post-intubation SGS and to discover the factors contributing to its development. METHODS A total of 112 patients who had a history of intubation were included. The case group consisted of 50 patients with post-extubation persistent respiratory symptoms for which flexible bronchoscopy (FOB) was conducted and showed SGS. The control group consisted of 62 patient with no post-extubation persistent respiratory symptoms, for whom FOB was not done (n = 54), and who had post-extubation persistent respiratory symptoms and underwent FOB, which did not show subglottic stenosis (n = 8). RESULTS No significant differences were detected related to age, gender, and gestational age. The median number of recurrent intubations was 2.5 and 3 in the case group and in control group, respectively (P = 0.14). The median duration of intubation was 20.5 days in the case group, and 6 days in the control group (P < 0.001). The Myer-Cotton classification indicated a degree of obstruction of grade 1 (mild) in 30% (n = 15), grade 2 in 16% (n = 8), grade 3 in 48% (n = 24), and grade 4 in 6% (n = 3) of the case group. CONCLUSION The duration of intubation was found to be a significant risk factor for SGS development. Age at intubation, gender, gestational age, indication of intubation, and the number of recurrent intubations were found to have no significant association. Patients with post-extubation persistent respiratory problems, especially those with prolonged intubations, should be evaluated for SGS.
Collapse
Affiliation(s)
- Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse Ayzit Atabek
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Omer Faruk Calim
- Faculty of Medicine, Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Selcuk Uzuner
- Division of Pediatric Intensive Care Unit, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lina AlShadfan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Orhan Ozturan
- Faculty of Medicine, Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatma Betul Cakir
- Division of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
24
|
Yesilbas O, Kus HD, Şik G, Citak A, Temur B, Yozgat CY, Temur HO, Cakir E, Yozgat Y. Double Aortic Arch Mimics the Clinical Characteristics of Severe Reactive Airway Disease in a Pediatric Patient. J Pediatr Intensive Care 2020; 9:141-144. [PMID: 32351771 DOI: 10.1055/s-0039-1700952] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022] Open
Abstract
Reactive airway disease is a prevalent condition that can be detected in the early infancy period. The condition might also deteriorate into asthma in some cases. If infants do not respond to the treatment of persistent wheeze and coughing, other rare causes should be investigated. The complete form of vascular ring is an extremely uncommon congenital cardiovascular abnormality. Double aortic arch constitutes the most significant portion of the complete vascular ring anomalies. Clinical manifestations of the anomaly are mainly respiratory due to the tracheal compression and mimicking the conditions of asthma. There have not been many reports about the clinical presentations of double aortic arch being remarkably similar to the same clinical manifestations of asthma in the literature. As far as we can be sure, there have not been any reported cases about severe reactive airway disease that caused a patient to have a life-threatening condition in the pediatric intensive care unit. Herein, we present a 5-month-old girl who had double aortic arch. Her anatomical aberration was diagnosed by three-dimensional computed tomography angiography of thorax, and the anomaly mimicked the clinical characteristics of life-threatening severe reactive airway disease.
Collapse
Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Hazar Dogus Kus
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Güntülü Şik
- Department of Pediatric Critical Care Medicine, Mehmet Ali Aydınlar University, Faculty of Medicine, Atakent Acıbadem Hospital, Istanbul, Turkey
| | - Agop Citak
- Department of Pediatric Critical Care Medicine, Mehmet Ali Aydınlar University, Faculty of Medicine, Atakent Acıbadem Hospital, Istanbul, Turkey
| | - Bahar Temur
- Department of Cardiovascular Surgery, Mehmet Ali Aydınlar University, Faculty of Medicine, Atakent Acıbadem Hospital, Istanbul, Turkey
| | | | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
25
|
Zeren M, Cakir E, Gurses HN. Effects of Inspiratory Muscle Training on Postural Stability, Pulmonary Function and Functional Capacity in Children with Cystic Fibrosis: A Randomised Controlled Trial. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
26
|
Sismanlar Eyuboglu T, Dogru Ersoz D, Cakir E, Cobanoglu N, Pekcan S, Cinel G, Yalcin E, Kiper N, Sen V, Selimoglu Sen H, Ercan O, Keskin O, Bilgic Eltan S, Shadfan LMA, Yazan H, Ufuk Altintas D, Sasihuseyinoglu S, Sapan N, Cekic S, Cokugras H, Ayzit Kilinc A, Ramasli Gursoy T, Tana Aslan A. Clinical Features of Cystic Fibrosis Patients with Chronic Liver Disease in Turkish National Cystic Fibrosis Registry. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.104] [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]
|
27
|
Sismanlar Eyuboglu T, Dogru Ersoz D, Cakir E, Cobanoglu N, Pekcan S, Cinel G, Yalcin E, Kiper N, Sen V, Selimoglu Sen H, Ercan O, Keskin O, Bilgic Eltan S, Shadfan LMA, Yazan H, Ufuk Altintas D, Sasihuseyinoglu S, Sapan N, Cekic S, Cokugras H, Ayzit Kilinc A, Ramasli Gursoy T, Tana Aslan A. Pseudo Bartter Syndrome: The Most Common Complication in Turkish National Cystic Fibrosis Registry. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.56] [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]
|
28
|
Zeren M, Cakir E, Gurses HN. Effects of inspiratory muscle training on postural stability, pulmonary function and functional capacity in children with cystic fibrosis: A randomised controlled trial. Respir Med 2019; 148:24-30. [DOI: 10.1016/j.rmed.2019.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/18/2019] [Accepted: 01/23/2019] [Indexed: 12/27/2022]
|
29
|
Aktas Cetin E, Pur Ozyigit L, Gelmez YM, Cakir E, Gedik AH, Deniz G. CD163 levels, pro- and anti-inflammatory cytokine secretion of monocytes in children with pulmonary tuberculosis. Pediatr Pulmonol 2017; 52:675-683. [PMID: 27685837 DOI: 10.1002/ppul.23617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/23/2016] [Revised: 08/30/2016] [Accepted: 09/19/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Childhood tuberculosis (TB) comprises an important part of the world's TB burden. Monocytes set up the early phase of infection because of innate immune responses. Understanding the changes in monocyte subsets during multisystem infectious diseases may be important for the development of novel diagnostic and therapeutic strategies. The aim of this study was to evaluate the monocyte phenotype together with the cytokine secretion profiles of children with pulmonary tuberculosis. STUDY DESIGN Thirteen patients with pulmonary TB were enrolled as study group, and 14 healthy subjects as control group. Surface expressions of CD16, CD14, CD62L, CD163, CCR2, and HLA-DR of monocytes were analyzed by flow cytometry. The presence of IFN-γ, TNF-α, IL-10, IL-12, IL-23, and soluble form of CD163 (sCD163) in the antigen- and LPS-stimulated whole blood culture supernatants were detected using ELISA and Luminex. RESULTS Higher percentages of CD14++ CD16+ and CD14+ CD16++ monocyte subsets, and CCR2, CD62L and CD163 expression on circulating monocytes in children with pulmonary tuberculosis were obtained. Diminished levels of ESAT-6/CFP-10-induced IL-10 and increased levels of TB-antigen and LPS-stimulated sCD163 were found in childhood with pulmonary TB. CONCLUSIONS High expression of CD14++ CD16+ , CD14+ CD16++ , CD14+ CCR2+ , and CD14+ CD62L+ cells in childhood TB, and monocyte-derived cytokines reflected both pro- and anti-inflammatory profiles. Higher sCD163 and CD14+ CD163+ monocytes might help physicians in the differential diagnosis of pulmonary TB in children. Pediatr Pulmonol. 2017;52:675-683. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Esin Aktas Cetin
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (ASDETAE), Istanbul University, Istanbul, Turkey
| | - Leyla Pur Ozyigit
- Department of Allergy and Immunology, Koc University, Istanbul, Turkey
| | - Yusuf Metin Gelmez
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (ASDETAE), Istanbul University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Ahmet Hakan Gedik
- Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (ASDETAE), Istanbul University, Istanbul, Turkey
| |
Collapse
|
30
|
Uyan ZS, Turan I, Ay P, Cakir E, Ozturk E, Gedik AH, Gokdemir Y, Erdem E, Şen V, Karadag B, Karakoc F, Ersu R. Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans. Pediatr Pulmonol 2016; 51:308-15. [PMID: 26129911 DOI: 10.1002/ppul.23246] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/17/2015] [Accepted: 05/28/2015] [Indexed: 01/13/2023]
Abstract
The incidence of sleep-disordered breathing (SDB) increases in chronic lung diseases. Our aim was to evaluate SDB and sleep quality in children with postinfectious bronchiolitis obliterans (BO) and assess associated risk factors. We hypothesized that children with BO are at increased risk for SDB and have impaired sleep quality. We also hypothesized that severity of SDB and impairment of sleep quality is related to the severity of lung disease. Sleep Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI) questionnaires; spirometry, impulse oscillometry (IOS), and overnight polysomnography (PSG) were performed. Twenty-one patients (14 male, median age: 8.3 years) were enrolled. Five patients (25%) had a PSQ score of >0.33, predictive of a SDB. Ten patients (48%) had poor sleep quality. Four patients (19%) had an OAHI of >1/hr. Nineteen patients (90%) had a high desaturation index. Four patients (19%) had a mean oxygen saturation of <93%. Median central apnea time was 7.5 (IQR: 6.9-9.1) seconds. Central apnea index of the patients correlated positively with R5, R10, R15, R20, Z5, and negatively with X10 and X15 at IOS. There was a positive correlation between the lowest oxygen saturation and FVC, FEV1 , X5, X10, X15, X20 while there was a negative correlation between lowest saturation and the central apnea index at PSG, R5, R10, and Z5 at IOS. Mean oxygen saturation during PSG correlated positively with FVC, FEV1, FEF(25-75), X5, X10, X15, X20 results. The risk of nocturnal hypoxia is increased in patients with BO and correlated to the severity of lung disease determined by pulmonary function tests. Although BO patients have a shorter duration of central apneas, they are more prone to desaturate.
Collapse
Affiliation(s)
- Zeynep S Uyan
- Division of Pediatric Pulmonology, Kocaeli University, Kocaeli, Turkey
| | - Ihsan Turan
- Department of Pediatrics, Marmara University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Marmara University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Ersin Ozturk
- Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Ahmet H Gedik
- Division of Pediatric Pulmonology, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Ela Erdem
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Velat Şen
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| |
Collapse
|
31
|
Gedik AH, Cakir E, Torun E, Demir AD, Kucukkoc M, Erenberk U, Uzuner S, Nursoy M, Ozkaya E, Aksoy F, Gokce S, Bahali K. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr 2015; 41:73. [PMID: 26444536 PMCID: PMC4595107 DOI: 10.1186/s13052-015-0180-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to evaluate the children with chronic cough and to analyze their etiological factors according to the age groups. METHOD Five hundred sixty-three children with chronic cough were included. The last diagnosis were established and were also emphasized according to the age groups. RESULTS The mean age was 5.4 ± 3.8 years (2-months-17-years) and 52 % of them were male. The most common final diagnosis from all the participants were: asthma (24.9 %), asthma-like symptoms (19 %), protracted bacterial bronchitis (PBB) (11.9 %), and upper airway cough syndrome (9.1 %). However, psychogenic cough was the second most common diagnosis in the subjects over 6 years of age. CONCLUSION Asthma and asthma-like symptoms were the most common diagnosis in children. Different age groups in children may have a different order of frequencies. Psychogenic cough should be thought of in the common causes especially in older children.
Collapse
Affiliation(s)
- Ahmet Hakan Gedik
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Cad.) Fatih, Istanbul, 34093, Turkey.
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Cad.) Fatih, Istanbul, 34093, Turkey.
| | - Emel Torun
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey.
| | | | | | - Ufuk Erenberk
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey.
| | - Selcuk Uzuner
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey.
| | - Mustafa Nursoy
- Pediatric Allergy, Bezmialem Vakif University, Istanbul, Turkey.
| | - Emin Ozkaya
- Pediatric Allergy, Bezmialem Vakif University, Istanbul, Turkey.
| | - Fadlullah Aksoy
- Otorhinolaringology, Bezmialem Vakif University, Istanbul, Turkey.
| | - Selim Gokce
- Pediatric Gastroenterelogy, Bezmialem Vakif University, Istanbul, Turkey.
| | - Kayhan Bahali
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| |
Collapse
|
32
|
Umutoglu T, Gedik AH, Bakan M, Topuz U, Daskaya H, Ozturk E, Cakir E, Salihoglu Z. The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy. Braz J Anesthesiol 2015; 65:313-8. [DOI: 10.1016/j.bjane.2014.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/17/2014] [Indexed: 10/23/2022] Open
|
33
|
Umutoglu T, Gedik AH, Bakan M, Topuz U, Daskaya H, Ozturk E, Cakir E, Salihoglu Z. [The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy]. Rev Bras Anestesiol 2015; 65:313-8. [PMID: 26296983 DOI: 10.1016/j.bjan.2014.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/05/2014] [Accepted: 09/17/2014] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy. MATERIALS AND METHODS In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I-II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded. RESULTS Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p<0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p>0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p<0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p>0.05). CONCLUSION All airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers.
Collapse
Affiliation(s)
- Tarik Umutoglu
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia.
| | - Ahmet Hakan Gedik
- Departamento de Medicina Pulmonar Pediátrica, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| | - Mefkur Bakan
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| | - Ufuk Topuz
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| | - Hayrettin Daskaya
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| | - Erdogan Ozturk
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| | - Erkan Cakir
- Departamento de Medicina Pulmonar Pediátrica, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| | - Ziya Salihoglu
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Universidade Bezmialem Vakif, Istambul, Turquia
| |
Collapse
|
34
|
Dilek F, Ozkaya E, Kocyigit A, Yazici M, Kesgin S, Gedik AH, Cakir E. Effect of montelukast monotherapy on oxidative stress parameters and DNA damage in children with asthma. Int Arch Allergy Immunol 2015; 167:119-26. [PMID: 26303984 DOI: 10.1159/000436967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/11/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is ample knowledge reported in the literature about the role of oxidative stress in asthma pathogenesis. It is also known that the interaction of reactive oxygen species with DNA may result in DNA strand breaks. The aim of this study was to investigate if montelukast monotherapy affects oxidative stress and DNA damage parameters in a population of pediatric asthma patients. METHODS Group I consisted of 31 newly diagnosed asthmatic patients not taking any medication, and group II consisted of 32 patients who had been treated with montelukast for at least 6 months. Forty healthy control subjects were also enrolled in the study. Plasma total oxidant status (TOS) and total antioxidant status (TAS) were measured to assess oxidative stress. DNA damage was assessed by means of alkaline comet assay. RESULTS The patients in both group I and group II had statistically significant higher plasma TOS (13.1 ± 4 and 11.1 ± 4.1 μmol H2O2 equivalent/liter, respectively) and low TAS levels (1.4 ± 0.5 and 1.5 ± 0.5 mmol Trolox equivalent/liter, respectively) compared with the control group (TOS: 6.3 ± 3.5 μmol H2O2 equivalent/liter and TAS: 2.7 ± 0.6 mmol Trolox equivalent/liter; p < 0.05). DNA damage was 18.2 ± 1.0 arbitrary units (a.u.) in group I, 16.7 ± 8.2 a.u. in group II and 13.7 ± 3.4 a.u. in the control group. There were statistically significant differences only between group I and the control group (p < 0.05). CONCLUSIONS According to the findings, montelukast therapy makes only minimal but not statistically significant improvement in all TOS, TAS and DNA damage parameters.
Collapse
Affiliation(s)
- Fatih Dilek
- Divisions of Pediatric Allergy and Immunology, Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | | | | | | | | | | | | |
Collapse
|
35
|
Gedik AH, Cakir E, Gokdemir Y, Uyan ZS, Kocyigit A, Torun E, Karadag B, Ersu R, Karakoc F. Cathelicidin (LL-37) and human β2-defensin levels of children with post-infectious bronchiolitis obliterans. Clin Respir J 2015; 11:243-247. [PMID: 26073571 DOI: 10.1111/crj.12331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 04/21/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The antimicrobial peptides (AMPs) human β-defensins and cathelicidin (LL-37) are key factors in innate and adaptive immune responses of the respiratory tract and play an important role in many respiratory diseases. No data are available in the literature about the levels of these AMPs in paediatric patients with post-infectious bronchiolitis obliterans (BO). This study aimed to determine human β-defensin 2 (hBD2) and LL-37 levels and compare between post-infectious BO patients and the control group. METHOD The patients diagnosed with post-infectious BO between September 2012 and 2013 and age- and-gender matched healthy controls were enrolled in this multi-center study. Serum hBD2 and LL37 levels were determined with the enzyme-linked immunosorbent assay method. RESULTS Sixty-three post-infectious BO patients and 65 healthy children (median age 73 ± 55 and 78.74 ± 36.32 months, respectively) were enrolled in the study. The mean of hBD2 levels in patients and the control group were 1.06 ± 0.24 and 0.67 ± 0.72 ng/mL, respectively (P < 0.001). The mean of LL-37 levels in patients and the control group were 72.13 ± 29.06 and 50.10 ± 21.98 ng/mL, respectively (P < 0.001). No correlation was found between these AMPs levels and chronological age, age at the time of diagnosis, gender, Z-scores of weight and length, hospitalization numbers, the disease history before diagnosis and 25-OH D vitamin levels. CONCLUSION This is the first study to demonstrate the higher levels of serum hBD2 and LL-37 levels in paediatric post-infectious BO patients. These AMPs may have important roles in the immune systems and pathogenesis of these patients.
Collapse
Affiliation(s)
- Ahmet Hakan Gedik
- Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Kocaeli University, Istanbul, Turkey
| | | | - Emel Torun
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| |
Collapse
|
36
|
Gedik AH, Cakir E, Topuz U. Flexible Fiberoptic Bronchoscopy Through the Laryngeal Mask Airway in a Small Premature Infant. Turk Thorac J 2015. [DOI: 10.5152/ttd.2015.4389] [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]
|
37
|
Gedik AH, Cakir E, Donmez T, Ari E, Koksalan OK. Tuberculin skin test positivity without tuberculosis contact: A major challenge in childhood. J Paediatr Child Health 2015; 51:632-8. [PMID: 25440529 DOI: 10.1111/jpc.12779] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 11/27/2022]
Abstract
AIM Worldwide, tuberculin skin tests (TSTs) commonly give false positive results for those who had been given the Bacillus-Calmette-Guerin vaccine such as is routinely administered in Turkey. This study aimed to evaluate the patients referred to us who had positive TSTs despite lack of tuberculosis (TB) disease contacts. METHODS Between September 2011 and September 2012, 183 patients were prospectively evaluated for differential diagnosis of TST positivity despite lack of TB disease contact. They were then followed up by us to determine an accurate diagnosis. RESULTS Among our patients' most common symptoms indicating a need for TST were chronic cough, productive cough or sputum expectoration, and recurrent or persistent wheezing. Chest x-rays were taken of all patients, and the findings were noted. Interferon gamma release assays were performed on 75% of the patients, of which 96% were negative for TB. The most common final diagnoses were asthma (44%), allergic rhinitis (13%), bronchopneumonia (11%) and reactive lymphadenitis (6.5%). Further evaluations for TB were required of 36 patients, and TB disease was established in 12 of them (6.5%). CONCLUSIONS In patients who had had no known TB contact, the most common symptom indicating need for TST was chronic cough; the most common diagnoses were asthma and allergic rhinitis. Cavitary lesions, haemoptysis, persistent infiltration, pleural effusion and thoracic lymphadenopathy despite antibiotherapy should alert physicians to the possibility of TB.
Collapse
Affiliation(s)
- Ahmet Hakan Gedik
- Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Tugrul Donmez
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Engin Ari
- Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Orhan Kaya Koksalan
- Molecular Tuberculosis Epidemiology Laboratory, Institute for Medical Experimental Research (DETAE), Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
38
|
Kucuk U, Palo EE, Sezer O, Cakir E, Bayol U, Divrik RT. Significance of TNM staging, Demographic and Histologic Features in Predicting the Prognosis of Renal Cell Carcinoma. Acta Chir Belg 2015; 115:202-7. [PMID: 26158251 DOI: 10.1080/00015458.2015.11681097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the prognostic significance of clinical, demographic and detailed histopathological parameters in renal cell carcinoma (RCC). METHODS A total of 102 patients who underwent partial or radical nephrectomy for a renal mass between 2008 and 2013 were evaluated retrospectively. Fuhrman grade, TNM stage, macroscopic satellite tumor nodule formation, histopathological subtype, renal vein invasion (RVI), necrosis, microvessel invasion (MVI), sarcomatoid differentiation and overall survival (OS) were evaluated to determine prognostic factors. RESULTS The 102 patients consisted of 73 with clear cell tumor, 15 with papillary tumor, 12 with chromophobe tumor and 2 collecting duct RCC cases. A statistically negative relationship was observed between increasing age and OS when the patients were grouped as above and under 40 years of age. There was no statistical relationship between OS and histopathological subtype, adrenal gland invasion, and lymph node metastasis. The risk of death was 10-fold increased in patients with stage 4 tumor compared to patients with stage 1 tumor. Statistically significant macroscopical parameters for OS were satellite tumor nodule presence, Fuhrman grade, tumor size, renal sinus and perinephric fat invasion, distant metastasis, and RVI. The risk of death was 13-fold higher in cases with sarcomatoid differentiation. There was a strong correlation between the presence of a satellite tumor nodule, necrosis, sarcomatoid differentiation and the tumor stage. A statistically negative correlation was observed between OS and the MVI, sarcomatoid differentiation, and necrosis. CONCLUSION We found the Fuhrman grade, tumor size, renal sinus and perinephric fat invasion, distant metastasis, RVI, MVI, sarcomatoid differentiation, necrosis and satellite tumor nodule to be all statistically significant parameters for OS. The addition of other variables to the TNM stage and grade may improve the prediction of outcomes for RCC patients.
Collapse
|
39
|
Küçükkoç M, Gedik AH, Cakir E, Goknar N, Demir AD, Yuksel M, Guzel G. SP917RENAL TUBULAR FUNCTION IN CHILDREN WİTH NON CYSTIC FIBROSIS BRONCHIECTASIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv203.55] [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: 11/13/2022] Open
|
40
|
Cakir E, Gedik AH, Özdemir A, Buyukpınarbasili N, Bilgin M, Ozgen IT. Response to Disodium Etidronate Treatment in Three Siblings with Pulmonary Alveolar Microlithiasis. Respiration 2015; 89:583-6. [DOI: 10.1159/000375464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
|
41
|
Karagüzel G, Cakir E. Adrenal dysfunction in critically ill children. MINERVA ENDOCRINOL 2014; 39:235-243. [PMID: 25069846] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cortisol is the major glucocorticoid synthesized by the adrenal cortex and its secretion is under the control of hypothalamic-pituitary axis. There is an increase in corticotrophin-releasing hormone and corticotrophin secretion and a decrease in the negative-feedback effect during critical illness. Adrenal insufficiency (AI) in children with critical illness is defined as an inadequate glucocorticoid response, measured by the peak cortisol or the increment in the cortisol level following exogenous ACTH (corticotrophin) administration. Clinically apparent AI is uncommon in critically ill patients. The incidence of AI in critically ill children varies with the underlying disease, its severity and duration, and multiple different definitions for the diagnosis of AI. Most of the pediatric studies for evaluation of AI during critical illness focused on patients with sepsis or septic shock. In patients with sepsis or septic shock, decreased synthesis or release of corticotrophin-releasing hormone, corticotrophin, and cortisol by cytokines and other circulating mediators released during sepsis are the most likely mechanism of AI. Recent studies in critically ill children reported that the prevalence of AI was not significantly different between septic and nonseptic patients, but it was noteworthy that AI appeared to be common both in septic and nonseptic critically ill children. A multidisplinary approach is necessary to manage to AI in critically ill children. However, no concensus exists among pediatric intensivist and endocrinologysts on diagnosis or treatment of AI in pediatric critical illness.
Collapse
Affiliation(s)
- G Karagüzel
- Department of Pediatric Endocrinology Karadeniz Technical University, School of Medicine, Trabzon, Turkey -
| | | |
Collapse
|
42
|
Torun E, Cakir E, Ozgüç F, Ozgen IT. The effect of obesity degree on childhood pulmonary function tests. Balkan Med J 2014; 31:235-8. [PMID: 25337419 DOI: 10.5152/balkanmedj.2014.13101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 08/28/2013] [Accepted: 07/01/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Childhood obesity has become a global epidemic. It is related to several chronic diseases such as essential hypertension, type 2 diabetes mellitus, and renal disease. The relationship between the degree of obesity and lung functions is well defined in adults, but limited information is available about the childhood period. AIMS This study aims to determine the impact of the degree of obesity on the pulmonary functions of school children and adolescents. STUDY DESIGN Cross sectional study. METHODS Included in the study were a total of 170 school children and adolescents (9-17 years old) referred to our paediatric outpatient clinic. Of these subjects, 42 were lean and non-obese (BMI % <85), 30 subjects were overweight (BMI % >85, <95), 34 subjects were obese (BMI % >95, <97), and 64 subjects were morbidly obese (BMI % >97). Anthropometric measurements were taken and spirometry was performed on all subjects. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced vital capacity 25-75 (FEV25-75) and peak expiratory flow (PEF) were used to measure the ventilatory functions for all the subjects. RESULTS The groups showed no significant differences in age or gender. Despite no statistically significant differences in FEV1, FVC, or FEV1/FVC, there were significant reductions in PEF (p<0.001) and FEV25-75 (p<0.001) in the overweight, obese and morbidly obese subjects, when compared with those who were non-obese. CONCLUSION Overweight, obese and morbidly obese children have no obstructive abnormalities compared with healthy lean subjects.
Collapse
Affiliation(s)
- Emel Torun
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| | - Fatma Ozgüç
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| | - Ilker Tolga Ozgen
- Department of Pediatric Endocrinology and Metabolism, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
43
|
Cakir E, Torun E, Gedik AH, Umutoglu T, Aktas EC, Topuz U, Deniz G. Cathelicidin and human β-defensin 2 in bronchoalveolar lavage fluid of children with pulmonary tuberculosis. Int J Tuberc Lung Dis 2014; 18:671-5. [DOI: 10.5588/ijtld.13.0831] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- E. Cakir
- Department of Paediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - E. Torun
- Department of Paediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - A. H. Gedik
- Department of Paediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - T. Umutoglu
- Department of Anaesthesiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - E. C. Aktas
- Department of Immunology, Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - U. Topuz
- Department of Anaesthesiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - G. Deniz
- Department of Immunology, Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
44
|
Cakir E, Erdem E, Ozlu N, Seber E, Gencer S, Kilicaslan Z. Demographic and microbial characteristics and drug resistance of childhood tuberculosis in Istanbul: analysis of 1,541 cases. J Infect Dev Ctries 2014; 8:304-9. [PMID: 24619260 DOI: 10.3855/jidc.3950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/05/2013] [Accepted: 09/19/2013] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Although tuberculosis (TB) is frequently seen in Turkey, there are limited studies on childhood TB. We aimed to describe clinical and laboratory findings, including drug resistance, of children with TB in Istanbul, Turkey. METHODOLOGY The study included all children aged 0-14 years who were registered in public dispensaries between 2006 and 2010. RESULTS The study included 1,541 cases. Forty-four percent (n = 763) of the patients were male with a mean age of 8.86 ± 4.19 years. Fifty-five percent of the patients had pulmonary TB, 39% had extrapulmonary TB, and 6% had both pulmonary and extrapulmonary TB. The most common extrapulmonary involvement sites were the pleura (n = 193), lymph nodes (n = 247), and central nervous system (n = 41). Forty-one percent of the patients were evaluated microbiologically and 35% of them were positive. For the total study group, 14% of them were positive. A drug susceptibility test was performed on 108 patients. Drug resistance to at least one drug was detected in 16% (n = 17), to isoniazid in 15% (n = 16), streptomycin in 12% (n = 12), rifampicin in 9% (n = 10), ethambutol in 7% (n = 8), and multi-drug resistance in 8% (n = 9) of patients. CONCLUSIONS This is the largest analysis on demographic features and drug resistance of childhood TB in Turkey. In Turkey, the rate of microbiological diagnosis is low, similar to rates worldwide. More microbiological studies and drug resistance tests should be done and annual changes should be followed with multi-center studies.
Collapse
Affiliation(s)
- Erkan Cakir
- Bezmialem Vakif University, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
45
|
Kilicaslan I, Gulluoglu MG, Ozluk Y, Onat E, Cakir E. Prostatic tissue in testicular teratoma. Ann Diagn Pathol 2014; 18:191. [PMID: 24602990 DOI: 10.1016/j.anndiagpath.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- I Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University Istanbul, Turkey.
| | - M G Gulluoglu
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University Istanbul, Turkey
| | - Y Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University Istanbul, Turkey
| | - E Onat
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University Istanbul, Turkey
| | - E Cakir
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University Istanbul, Turkey
| |
Collapse
|
46
|
Cakir E, Cakir FB, Bingol D, Gedik AH, Soysal O. Not all that wheezes is asthma or foreign body aspiration: endobrochial inflammatory myofibroblastic tumor. Indian J Pediatr 2014; 81:306-7. [PMID: 24385264 DOI: 10.1007/s12098-013-1318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, 34093, Turkey,
| | | | | | | | | |
Collapse
|
47
|
Gedik AH, Cakir E, Soysal O, Umutoğlu T. Endobronchial lesion due to pulmonary Fusobacterium nucleatum infection in a child. Pediatr Pulmonol 2014; 49:E63-5. [PMID: 23868895 DOI: 10.1002/ppul.22834] [Citation(s) in RCA: 5] [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: 03/06/2013] [Accepted: 04/21/2013] [Indexed: 02/01/2023]
Abstract
Clinically significant infections due to the members of the genus Fusobacterium are rare. The clinical manifestations of pulmonary Fusobacterium nucleatum infections range from simple aspiration pneumonia to severe diseases as necrotizing pneumonia, lung abscess, and empyema. Endobronchial lesions and obstructions are rarely seen in children and are often a misdiagnosed result in delay of definitive treatment. Here, we report a case of endobronchial lesion due to pulmonary F. nucleatum infection in an entirely healthy child before illness. This is the first case reported in the literature of endobronchial lesion due to pulmonary F. nucleatum infection.
Collapse
Affiliation(s)
- Ahmet H Gedik
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | | |
Collapse
|
48
|
Gedik AH, Cakir E, Ozkaya E, Ari E, Nursoy M. Can appropriate diagnosis and treatment of childhood asthma reduce excessive antibiotic usage? Med Princ Pract 2014; 23:443-7. [PMID: 25034671 PMCID: PMC5586916 DOI: 10.1159/000363750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/20/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study compared the frequency of antibiotic usage and the number of asthma episodes before and after the diagnosis and treatment of pediatric asthma patients who were followed up by specialists. SUBJECTS AND METHODS Included in this study were 334 patients (211 males and 123 females) of 2-16 years of age who were diagnosed with asthma and followed up for at least 1 year in our clinic. The frequency of antibiotic usage and the number of asthma episodes in the year prior to diagnosis and treatment were compared to these same variables after 1 year of follow-up by specialists. RESULTS The median age was 84 months (range: 24-192) and 212 (63%) children were at school or in day care centers. Atopy and a family history of asthma were present in 200 (60%) of the patients, and 137 (41%) reported that at least one member of their household smoked. Antibiotics were used a median number of 7 times [interquartile range (IQR) = 6] in the year before the asthma diagnosis, and 2 times (IQR = 3) during the year after treatment (p < 0.001). The mean number of asthma episodes before diagnosis, i.e. 4 (IQR = 8) was reduced to 0 (IQR = 2) in the year after treatment when the patients were followed up by specialists (p < 0.001). CONCLUSION This study shows that appropriate diagnosis and treatment of childhood asthma significantly reduce the frequency of antibiotic usage and the number of asthmatic episodes.
Collapse
Affiliation(s)
- Ahmet Hakan Gedik
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- *Ahmet Hakan Gedik, MD, Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarý (Vatan Cad.), TR-34093 Fatih, Istanbul (Turkey), E-Mail
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Emin Ozkaya
- Division of Pediatric Allergy, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Engin Ari
- Divisions of Department of Pediatrics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa Nursoy
- Division of Pediatric Allergy, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
49
|
Torun E, Gedik AH, Cakir E, Umutoglu T, Gok O, Kilic U. Serum paraoxonase 1 activity and oxidative stress in pediatric patients with pulmonary tuberculosis. Med Princ Pract 2014; 23:426-31. [PMID: 25034194 PMCID: PMC5586969 DOI: 10.1159/000363700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the oxidative stress and paraoxonase 1 (PON1) levels in children with pulmonary tuberculosis (TB) compared to healthy controls, and to examine the association of demographical with oxidative stress. SUBJECTS AND METHODS Forty children diagnosed with pulmonary TB and 40 age- and gender-matched healthy controls were enrolled in the study. Serum total antioxidant status (TAS), total oxidant status (TOS) and PON1 levels were measured. The oxidative stress index (OSI) was calculated to indicate the degree of oxidative stress. RESULTS The TAS levels were lower (1.73 ± 0.5 vs. 2.54 ± 1.2 μmol Trolox Eq/l) while TOS levels were significantly higher (26.9 ± 14.4 vs. 13.4 ± 7.7 μmol H2O2 Eq/l) in the TB group than in the controls (p < 0.001). The OSI was significantly higher in the TB group than in the controls (21.2 ± 5.1 vs. 6.5 ± 4.9 units, p = 0.006). Serum PON1 levels were significantly lower in the TB group than in the controls (14.2 ± 13.2 vs. 28.4 ± 17.3 U/l, p < 0.001). The lower PON1 levels correlated with TAS and OSI levels but not with anthropometric parameters (r = 0.264, p = 0.018 and r = -0.255, p = 0.023, respectively). CONCLUSION The TOS and OSI levels were higher and the TAS and PON1 levels were lower in pediatric patients with pulmonary TB when compared to healthy controls. This indicates greater oxidative stress in the patients.
Collapse
Affiliation(s)
- Emel Torun
- Department of Pediatrics, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
- *Emel Torun, MD, Department of Pediatrics, Bezmialem Vakif University Hospital, Adnan Menderes Avenue, P.K., TR-34093 Fatih/Istanbul (Turkey), E-Mail
| | - Ahmet Hakan Gedik
- Department of Pediatrics, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Department of Pediatric Pulmonology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Tarik Umutoglu
- Department of Anestesiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem Gok
- Department of Medical Biology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Ulkan Kilic
- Department of Medical Biology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
50
|
Uzuner S, Bahali K, Kurban S, Erenberk U, Cakir E. A pediatric case of factitious disorder with unexplained bleeding symptoms. Gen Hosp Psychiatry 2013; 35:679.e7-8. [PMID: 24199786 DOI: 10.1016/j.genhosppsych.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/15/2012] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
Abstract
Factitious disorder is characterized by deliberate production or imitation of physical or psychological symptoms in order to adopt the sick role. The disorder can be seen as factitious bleeding. Factitious bleeding is a rare disorder in pediatric population. The concomitant appearance of hemoptysis and hematuria in the same patient has not been previously reported. In this case report, we present a pediatric case of factitious disorder with both hemoptysis and hematuria.
Collapse
Affiliation(s)
- Selcuk Uzuner
- Department of Pediatrics, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | | | | | | | | |
Collapse
|