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Öğe Clindamycin Hypersensitivity and Management in a Case with Invasive Group A Streptococcal Cellulitis Caused by Chickenpox(Aves Yayincilik, Ibrahim Kara, 2019) Durmus, Sevgi Yasar; Tanir, Gonul; Kaman, Ayse; Akcan, Ozge Metin; Demir, MerveChickenpox is commonly known as a benign exenthamatous disease of childhood that causes vesicular rashes. Symptomatic therapy is usually adequate for chickenpox but in some cases secondary bacterial infections constitute the most common cause of morbidity in children. Primer varicella is an important predisposing factor for invasive group A streptococcal infection. In the treatment of invasive group A streptococcal infection generally accepted therapeutic management includes early administration of penicillin in combination with clindamycin, intravenous immunoglobulins and early surgical intervention. In this report we describe a patient who developed clindamycin hypersensitivity during invasive group A streptococcal cellulitis management.Öğe Clinical and Laboratory Evaluations of Patients Diagnosed as Having Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 in Children: A Single Center Experience from Konya(Georg Thieme Verlag Kg, 2023) Genceli, Mustafa; Akcan, Ozge Metin; Erdogan, Kubra Nur; Kilic, Ahmet Osman; Yazar, Abdullah; Akin, Fatih; Gunes, MuhammedObjective Multisystem inflammatory syndrome in children (MIS-C), characterized by fever, inflammation, and multiorgan dysfunction, was newly defined after severe acute respiratory syndrome coronavirus 2 infection. The clinical spectrum of MIS-C can be classified as mild, moderate, and severe. We aimed to evaluate demographics, clinical presentations, laboratory findings, and treatment modalities of patients with MIS-C according to clinical severity.Methods We performed a retrospective study of patients who were diagnosed as having MIS-C between September 2020 and October 2021 in the Necmettin Erbakan University Meram Faculty of Medicine, Turkey.Results A total of 48 patients (24 females and 24 males) with a median age at diagnosis of 10.3 years (range: 42 months-17 years) were enrolled, the most common clinical severity of MIS-C was moderate. The common presentations of patients were fever (97%), nonpurulent conjunctivitis (89.6%), rashes (81.3%), fatigue (81.3%), strawberry tongue (79.2%), and myalgia (68.8%). The most common laboratory findings were lymphopenia (81.2%), thrombocytopenia (54.1%), elevated D-dimer levels (89.5%), C-reactive protein (CRP; 100%), procalcitonin (97%), erythrocyte sedimentation rate (87.5%), ferritin (95.8%), interleukin 6 (IL-6) (86.1%), and probrain natriuretic peptide (pro-BNP) (97%). High levels of CRP, procalcitonin, pro-BNP, and urea were associated with the severity of MIS-C ( p < 0.05). Fifteen of the patients were found to have pulmonary involvement. Ascites were the most common finding on abdominal ultrasonography (11 patients) and were not seen in a mild form of the disease. During the study period, two patients died.Conclusion It is important to make patient-based decisions and apply a stepwise approach in treating patients with MIS-C due to the increased risk of complications and mortality.Öğe Delta variant effect on the clinical course of adolescent COVID-19 patients(Wiley, 2023) Caglar, Hanife Tugce; Pekcan, Sevgi; Yilmaz, Asli Imran; Unal, Gokcen; Akcan, Ozge Metin; Unsacar, Mahmut Z.; Ozdemir, MehmetObjective The clinical course of new COVID-19 variants in adolescents is still unknown. The aim of this study is to evaluate the clinical characteristics of COVID-19 in adolescents and compare the differences between the original version and the delta variant. Materials and Methods The medical records of patients aged 10-18 years treated for COVID-19 between April 1, 2020 and March 31, 2022 were retrospectively reviewed. Patients were divided into four groups (asymptomatic, mild, moderate, and severe) for COVID-19 severity and into two groups according to the diagnosis date (first-second year). The primary endpoint of the study was hospital admission. Results The mean age of patients was 171.81 +/- 29.5 months, and most of them were males (n: 435, 53.3%). While the patient number was 296 (43.52%) in the first year of pandemic, it raised to 520 (54.11%) in the second year (p < 0.01). The severity of COVID-19 was mild in 667 (81.7%) patients. In the comparison of patients according to the diagnosis date (first-second years); the parameters of anosmia, ageusia, weakness, muscle pain, vomiting, hospital admission, and length of stay in hospital were statistically different (p < 0.05). In the comparison of hospitalized patients between years, the necessity of oxygen support (p < 0.001), endotracheal intubation rates (p < 0.05), length of stay in the hospital (p < 0.001), and the severity of COVID-19 (p < 0.05) was significantly higher in the second year. Conclusion The clinical course for adolescents diagnosed with COVID-19 has linearly changed with the delta variant. Our results confirmed that the delta variant is more transmissible, requires more oxygen support, increases endotracheal intubation, and prolongs the length of stay in the hospital.Öğe The epidemiologic trend of respiratory syncytial virus has returned strongly to its origin after the pandemic: Five-year data from a single center(Wiley, 2023) Caglar, Hanife Tugce; Pekcan, Sevgi; Yilmaz, Asli Imran; Unal, Gokcen; Ercan, Fatih; Savas, Suat; Akcan, Ozge MetinObjective: Only a few studies have investigated the frequency and severity of respiratory syncytial virus (RSV) infections after the end of the pandemic regulations. This study aims to investigate the frequency and severity of RSV infections before, during, and after the pandemic in Turkey.Materials and Methods: Patients under 18 years of age and those who tested positive for RSV between April 2018 and March 2023 were retrospectively reviewed. All patients were divided into three groups (pre-COVID-19, COVID-19, and post-COVID-19) according to admission date. Among inpatients, data were compared between the three groups to determine the impact of the pandemic on RSV epidemiology and clinical outcomes.Results: A total of 9567 patients were tested for RSV, of which 1073 (11.2%) were positive and included in the study. Hospitalization occurred in 447 (41.7%) patients. Inpatients were younger than outpatients (p < .000). Among the three inpatient pandemic groups, clinical outcomes were statistically significantly worse in the post-COVID-19 group than in the other two groups. SpO(2) was lower (p < .000), inhaled salbutamol requirement was higher (p < .000), length of stay was longer (p = .031), and ICU admission was higher (p = .023).Conclusion: Although the RSV trend changed within 2 years after the COVID-19 outbreak, it returned to its usual seasonality last year. After the repeal of all COVID-19 measures and the normal life began, the number of RSV-positive patients and RSV-related hospitalizations increased, and the clinical outcomes of RSV worsened. This may be a result of decreased herd immunity due to a change in society's attitude toward epidemic diseases.Öğe Evaluation of Platelet Activity Markers in Prognostic Value of Children with Crimean-Congo Hemorrhagic Fever(Georg Thieme Verlag Kg, 2020) Guven, Ahmet Sami; Duksal, Fatma; Akcan, Ozge Metin; Aygunes, Utku; Oflaz, Mehmet BurhanObjective The aim of this study is to investigate the prognostic value of platelet (PLT) activity markers in children with Crimean-Congo hemorrhagic fever (CCHF) and compare results with healthy controls. Materials and Methods A total of 135 patients with CCHF and 100 healthy children were included in this retrospective study. Mean age was 12.4 +/- 3.3 years in CCHF group, and 92 patients were male. We measured PLT count, mean platelet volume (MPV), platelet distribution width (PDW), and mean platelet mass (MPM) as PLT activity markers. Results A statistically significant decrease in MPM and PLT, and significantly higher levels of PDW and activated partial thromboplastin time (aPTT) and no significant difference in MPV were observed in patients with CCHF compared with controls. Although there were no significant differences between the severe and nonsevere CCHF groups in term of MPV and PDW, the MPM value was significantly decreased in severe patients ( p < 0.001). Furthermore, MPM values were inversely correlated with aPTT ( r = -0.617, p = 0.015), and positively correlated with PLT ( r = 0.703, p < 0.001) which are considered likely to be indicators of disease severity. Multivariate logistic regression analysis revealed MPM as an independent risk factor for severe disease. Conclusion Our study demonstrated that MPM values were decreased in severe cases compared with nonsevere in children with CCHF. The MPM as an indicator of PLT activation at the time of diagnosis in children with CCHF can be used as a prognostic index for disease severity.Öğe Outcomes of COVID-19 Infections in children: A single-center retrospective study(Wiley, 2022) Genceli, Mustafa; Akcan, Ozge Metin; Pekcan, Sevgi; Akin, Fatih; Ozdemir, Mehmet; Kilic, Ahmet Osman; Yazar, AbdullahThe COVID-19 pandemic is an important cause of morbidity and mortality, which has had a negative impact worldwide. Our aim was to describe clinical findings and outcomes of severe acute respiratory syndrome (SARS)-CoV-2 viral infection and COVID-19 cared for at a large pediatric tertiary care hospital during the first year of the pandemic. Patients aged 1 month to 18 years who were diagnosed as having COVID-19 between March 2020 and April 2021 were included. The files of patients diagnosed with COVID-19 were reviewed retrospectively. Results: Four hundred sixty seven children were included in the study. There were 34 (7.3%) patients under 1 year of age, 111 (23.8%) between 1 and 5 years, 98 (30.4%) between 5 and 10 years, 142 (30.4%) between 11 and 15 years, and 82 (17.6%) age over 15 years. Fever (88.2%), vomiting (32.4%), and diarrhea (29.4%) in patients aged under 1 year, sore throat (36.6%) in patients aged 11-15 years, and dysgeusia (11%), anosmia (14.6%), headache (18.3%), malaise (40.8%), myalgia (28%), and shortness of breath (17.1%) in those aged over 15 years were found to be significantly more common in comparison with the other age groups (p < 0.05). Thirty-five (7.5%) patients were asymptomatic, 365 (78.1%) had mild disease, 35 (7.5%) were moderate, 27 (5.8%) were severe, and five (1.07%) were critical. Leukocyte count, erythrocyte sedimentation rate, ferritin, and C-reactive protein values were significantly higher in hospitalized patients. Three patients died during the study period (0.64%). While SARS-CoV-2 infection may be asymptomatic and COVID-19 usually has a mild clinical course, some children have severe disease or mortality.Öğe Public policies to reduce sugary drink consumption in children and adolescents(Aves Yayincilik, Ibrahim Kara, 2019) Akcan, Ozge Metin[Abstract Not Availabe]Öğe Rare Cause of Soft Tissue Infection: Shewanella algae(Georg Thieme Verlag Kg, 2024) Yilik, Ezgi; Akgul, Ayse Humeyra; Genceli, Mustafa; Akcan, Ozge Metin; Kan, Seda Nur Arazi; Dogan, MetinShewanella algae is a common microorganism in nature, but a rare pathogen in humans. It is a causative agent of skin and soft tissue infections, especially in patients with skin ulcers or trauma. S. algae can enter the body through the eyes, ears, gastrointestinal tract, or respiratory tract. Immunocompromised individuals are at increased risk of developing bacteremia and sepsis from the infection. This report presents a case of posttraumatic soft tissue infection caused by S. algae in an 18-year-old male after swimming in the sea. The bacteria were cultured from the wound site.Öğe A Rare Presentation of Sphingomonas paucimobilis in a Healthy Child: Acute Ischemic Stroke(Georg Thieme Verlag Kg, 2023) Yilmaz, Busra Zeynep; Akcan, Ozge Metin; Pekcan, Sevgi; Parlatan, Havva; Emlik, Ganime Dilek; Dogan, MetinSphingomonas paucimobilis is a rarely pathogenic organism that usually infects immunocompromised patients and causes nosocomial infections, but a few community-acquired infections have been identified in relatively healthy adult patients. Herein we report a 5-year-old child who presented with acute ischemic stroke caused by S. paucimobilis that was treated successfully with antibiotics and antithrombotic agents. According to our knowledge, this is the first case of acute ischemic infarction with S. paucimobilis in a previously healthy child.Öğe Reactivation of Tuberculosis and COVID-19 in Pediatric Patients(Georg Thieme Verlag Kg, 2023) Unal, Gokcen; Pekcan, Sevgi; Akcan, Ozge Metin; Keles, Sevgi; Yilmaz, Asli Imran; Eldeniz, Fadime Ceyda; Caglar, Hanife TugceObjective Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis (TB) disease. We aimed to evaluate the association between coronavirus disease 2019 (COVID-19), COVID-19-related drugs, TB reactivation, and TB incidence during the pandemic.Methods Eight patients who were diagnosed as having TB in Meram Medical Faculty, Necmettin Erbakan University between March 1, 2020, and December 31, 2021, at the beginning of the pandemic, were enrolled in this study. The presence of COVID-19 infection was confirmed using COVID-19 antibody tests and the patients' COVID-19 history. We evaluated the demographic data, laboratory findings, imaging tests, and pathology results of all patients. Results We checked all our patients with TB using COVID-19 antibodies (immunoglobulin [Ig]G thorn IgM) or polymerase chain reaction. Seven of the eight patients were female (87.5%). The median age was 16 years. Family screening of all patients was negative, and they had bacillus Calmette-Guerin vaccine scars. Two patients had chronic diseases. One was diagnosed as having primary ciliary dyskinesia in our department (patient no. 8) and the second was under follow-up by the rheumatology department with a diagnosis of juvenile idiopathic rheumatoid arthritis.Conclusion There has been an increase in the incidence of TB in children, especially in adolescents, during the pandemic period. This may be due to the pathogenic structure of the COVID-19 virus with an unknown mechanism. In addition, lifestyle changes and changes in health care policies during the pandemic may have caused this. Further research should be performed on this topic.Öğe Risk Factors of Stenotrophomonas maltophilia Blood Stream Infections: Comparison With Other Gram-Negative Blood Stream Infections in Children(Lippincott Williams & Wilkins, 2020) Aydin, Zeynep Gokce Gayretli; Tanir, Gonul; Bayhan, Gulsum Iclal; Teke, Turkan Aydin; Akcan, Ozge Metin; Kaman, Ayse; Durmus, Sevgi YasarBackground: Stenotrophomonas maltophilia, is a nonfermentative, aerobic, Gram-negative bacilli which is intrinsically resistance to several antibiotics. Treatment options for this bacteria are quite different from the other Gram-negative bacilli, which can represent a therapeutic challenge. To initiate appropriate empiric treatment and to reduce mortality, differentiation of S. maltophilia from other Gram-negative bacteria is critically important. The aim of this study is to distinguish the risk factors of S. maltophilia blood stream infections (BSI) from other Gram-negative BSI. Methods: This was a retrospective, case-control study. Patients with S. maltophilia BSI were selected as cases and patients with non-S. maltophilia Gram-negative BSI were selected as controls. Demographic and clinical characteristics of patients were recorded. Results: Forty-eight cases with S. maltophilia BSI and 144 controls were enrolled in the study. Risk factors for S. maltophilia BSI compared with the control group includes prior use of antibiotics, especially carbapenem, pediatric intensive care unit stay, mechanical ventilator use, indwelling catheters and duration of hospitalization. Conclusions: Breakthrough infection by S. maltophilia can occur in severely ill patients being treated with carbapenem. In the presence of risk factors, to reduce morbidity and mortality, S. maltophilia should be kept in mind when starting empiric treatment.Öğe Serum Vitamins A, D, and Zinc Levels in Children with Coronavirus Disease 2019 and Multisystem Inflammatory Syndrome in Children(Georg Thieme Verlag Kg, 2022) Yilmaz, Asli Imran; Unal, Gokcen; Keles, Sevgi; Pekcan, Sevgi; Kilic, Ahmet Osman; Akcan, Ozge Metin; Erdogan, Kubra NurObjective Vitamin D, due to its immunomodulating effect, zinc, and vitamin A, which affect cellular and humoral immunity, are thought to affect the clinical severity of coronavirus disease 2019 (COVID-19) infection. The present study evaluates the association between vitamin A, D, and zinc deficiencies and disease severity in pediatric patients with COVID-19 infections. Methods The levels of vitamin A, D, and zinc at the time of diagnosis of 123 pediatric patients who presented to our hospital and were diagnosed as having hospitalized, nonhospitalized COVID-19 infection group, and multisystem inflammatory syndrome in children (MIS-C) were evaluated. The correlations of the measured levels with the disease severity and the need for intensive care or hospitalization were analyzed. Results Among the 123 patients, 21.1% (n = 26), 42.2% (n = 52), and 36.7% (n = 45) had a diagnosis of MIS-C, belonged to the hospitalized COVID-19 infection group, or belonged to the nonhospitalized COVID-19 infection group, respectively. Zinc levels were significantly lower in the MIS-C group than in the nonhospitalized group (p < 0.05). Vitamin A levels were found to be significantly lower in the MIS-C group than in the nonhospitalized group (p < 0.01) and significantly lower in the hospitalized group when compared with the nonhospitalized group (p < 0.001). Deficiencies in vitamin A, vitamin D, and zinc levels were found to be most common in the MIS-C group (42.3%) and in hospitalized COVID-19 group (15.3%). In the nonhospitalized COVID-19 group, it was found to be the lowest at 6.6%. Conclusion Based on the results of the present study and a literature review, it can be said that vitamin A, D, and zinc deficiencies may associate with the severity of COVID-19, although more studies are required to clarify this subject further.Öğe Zonulin and claudin-5 levels in multisystem inflammatory syndrome and SARS-CoV-2 infection in children(Wiley, 2022) Kilic, Ahmet O.; Akin, Fatih; Yazar, Abdullah; Akcan, Ozge Metin; Topcu, Cemile; Aydin, OrkunAim SARS-CoV-2 infection in children is generally asymptomatic or mild; however, it can lead to a life-threatening clinical condition, multisystem inflammatory syndrome in children (MIS-C), days or weeks after the infection. Increased intestinal permeability isa possible triggering factor at the onset of the hyperinflammation associated with MIS-C. Zonulin and claudin-5 are involved in intestinal permeability. In this study, we aimed to investigate serum zonulin and claudin-5 levels in SARS-CoV-2 infection and MIS-C disease. Methods The study group consisted of children diagnosed with MIS-C or SARS-CoV-2 infection who presented to a university hospital paediatric emergency or infectious diseases departments. The control group included well patients seen at the General Pediatrics units for routine follow-up. Serum zonulin and claudin-5 levels were measured at the time of diagnosis. Results Fifteen patients were included in the MIS-C group, 19 in the SARS-CoV-2 infection group and 21 in the control group. The mean zonulin level in the MIS-C group was significantly higher than in the control group (P < 0.001). Mean Claudin-5 levels were Psignificantly lower in the SARS-CoV-2 infection group than in the control group (P < 0.001). Conclusion These results indicate that increased intestinal permeability may be involved in the pathogenesis of SARS-CoV-2 infection and MIS-C disease. Larger clinical trials are needed to clarify the role of serum zonulin and claudin-5 on intestinal permeability in MIS-C and SARS-CoV-2 infection in children.
