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Öğe Alexithymia in primary ciliary dyskinesia(European Respiratory Soc Journals Ltd, 2023) Caglar, Hanife Tugce; Pekcan, Sevgi; Ercan, Fatih; Turkut, Asli; Unal, Gokcen[Abstract Not Availabe]Öğe Childhood sarcoidosis in the middle Anatolia of Turkey(Wiley, 2023) Hangul, Melih; Kose, Mehmet; Pekcan, Sevgi; Ersoy, Ali; Unal, Gokcen; Caglar, Hanife TugceObjectiveThis retrospective study aimed to describe the clinical and radiological features, diagnostic methods, laboratory findings, organ involvement, and treatment strategies of 22 patients who followed up with late-onset childhood sarcoidosis and compare them with the literature. Material and MethodThis retrospective multicenter study reviewed the medical records of 22 children with sarcoidosis who applied to the Pediatric pulmonology department of Erciyes University Faculty of Medicine and Necmettin Erbakan Faculty of Medicine in 2012 and 2022. ResultsThe mean age of the patients at the time of diagnosis was 13.1/year (interquartile range [IQR]1:6.3-[IQR]3:15.7). The most common first presenting symptom was cough 40.9% (n = 9), weight loss 31.8% (n = 7), and dyspnea 22.7% (n = 5). There were elevated levels of C-reactive protein (CRP; 59%), angiotensin-converting enzyme (ACE; 54.5%), erythrocyte sedimentation rate (ESR; 54.5%), and immunoglobulin G (IgG; 54.5%). Twenty patients (90%) received systemic steroid treatment. Eighteen (81.8%) of these patients responded positively to treatment. Two patients had a recurrence. ConclusionThe incidence of sarcoidosis in children in Turkey is currently unknown. However, a regional average of 2.2 cases per year has been documented for the first time. Contrary to previous studies, a significant prevalence of consanguineous marriage was observed in our study. While constitutional symptoms were most common in other studies, the cough was the most common symptom in our study. To our knowledge, this is one of the Turkish studies with the highest number of sarcoidosis in children and one of the few European studies on sarcoidosis in children.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 Alexitimia Level in Cystic Fibrosis Patients(European Respiratory Soc Journals Ltd, 2023) Ercan, Fatih; Erden, Semih; Bilgitay, Nail; Pekcan, Sevgi; Unal, Gokcen; Yilmaz, Asli Imran; Caglar, Hanife Tugce[Abstract Not Availabe]Öğe Evaluation of specificity and sensitivity of IRT/IRT protocol in the cystic fibrosis newborn screening program: 6-year experience of three tertiary centers(Springer, 2023) Gursoy, Tugba Ramasli; Asfuroglu, Pelin; Eyuboglu, Tugba Sismanlar; Aslan, Ayse Tana; Yilmaz, Asli Imran; Unal, Gokcen; Kibar, Busra SultanWe aimed to evaluate cutoff values of immunoreactive trypsinogen (IRT)/IRT and determine relationship between IRT values and clinical characteristics of children with cystic fibrosis (CF). This study is cross-sectional study. Data of children with positive newborn screening (NBS) between 2015 and 2021 were evaluated in three pediatric pulmonology centers. Age at admission, sex, gestational age, presence of history of meconium ileus, parental consanguinity, sibling with CF, and doll-like face appearance, first and second IRT values, sweat chloride test, fecal elastase, fecal fat, biochemistry results, and age at CF diagnosis were recorded. Sensitivity and specificity of IRT cutoff values were evaluated. Of 815 children with positive NBS, 58 (7.1%) children were diagnosed with CF. Median values of first and second IRT were 157.2 (103.7-247.6) and 113.0 (84.0-201.5) mu g/L. IRT values used in current protocol, sensitivity was determined as 96.6%, specificity as 17.2% for first IRT, and 96.6% sensitivity, 20.5% specificity for second IRT. Positive predictive value (PPV) was determined as 7.1%. When cutoff value for first IRT was estimated as 116.7 mu g/L, sensitivity was 69.0% and specificity was 69.6%, and when cutoff value was set to 88.7 mu g/L for second IRT, sensitivity was 69.0% and specificity was 69.0%. Area under curve was 0.757 for first and 0.763 for second IRT (p < 0.001, p < 0.001, respectively). PPV was calculated as 4.3%. Conclusion:Although sensitivity of CF NBS is high in our country, its PPV is significantly lower than expected from CF NBS programs. False-positive NBS results could have been overcome by revising NBS strategy.Öğe Neutrophil lymphocyte ratio, mean platelet volume, and immunoreactive trypsinogen as early inflammatory biomarkers for cystic fibrosis in infancy: A retrospective cohort study(Wiley, 2023) Eyuboglu, Tugba Sismanlar; Aslan, Ayse Tana; Asfuroglu, Pelin; Kunt, Nursima; Ersoy, Ali; Kose, Mehmet; Unal, GokcenBackgroundAirway inflammation starts in early life in cystic fibrosis (CF) and limited, objective markers are available to help identify infants with increased inflammation. We aimed to investigate neutrophil, lymphocyte ratio (NLR), mean platelet volume (MPV) and immunoreactive trypsinogen (IRT) to be a possible inflammatory biomarker for CF in infancy. MethodsThis was a retrospective cohort study in three centers. Between January 2015 and December 2022, children with CF newborn screening (NBS) positivity and diagnosed as CF were included in the study. Correlation analysis were performed with NLR, MPV, IRT and follow-up parameters such as z-scores, modified Shwachman-Kulczycki score (mSKS) at the first, second, third and sixth ages and pulmonary function test (PFT) at the sixth age. ResultsA total of 92 children with CF included in the study and 47.8% of them were female. There were no correlations between NLR, MPV and weight and height z-scores for all ages (p > 0.05), a negative correlation was found between MPV and body mass indexes (BMI) z-score at the age of 6 (r = -0.443, p = 0.038). No correlation was found between NLR, MPV and PFT parameters and mSKS at all ages (p > 0.05). There was a negative correlation between first IRT and BMI z-score at 6 years of age (r = -0.381, p = 0.046) and negative correlations between second IRT and weight and BMI z-score at the age of 6 (r = -0.462, p = 0.010; r = -0.437, p = 0.016, respectively). ConclusionHigher MPV and IRT levels during NBS period are associated with worse nutritional outcome which may reflect chronic inflammation. Children with higher MPV and IRT should be followed up closely in terms of chronic inflammation and nutritional status.Öğe Plastic Bronchitis and Human Bocavirus: A Report of Three Cases(Georg Thieme Verlag Kg, 2023) Yilmaz, Asli Imran; Copur, Ahmet; Parlatan, Havva; Caglar, Hanife Tugce; Unal, Gokcen; Ercan, Fatih; Yazar, AbdullahThis study aims to investigate and analyze the clinical features of coexisting human bocavirus (HBoV) positivity and plastic bronchitis (PB). We present three cases with no known history of cardiac surgery who presented with cough, progressive dyspnea, and atelectasis. They tested positive for HBoV in a real-time polymerase chain reaction of both nasal lavage fluids. They were diagnosed with PB as a result of bronchoscopy and pathology. PB is a rare disease characterized by forming thick rigid casts in the tracheobronchial tree, which can progress to respiratory failure. While asthma or atopy-related type 1 PB was observed in one patient, two patients were diagnosed with PB, which was thought to have developed secondary to viral infections of unknown etiology. As far as we know, HBoV-associated PB cases are rare in the literature. Besides the commonly known infectious agents, we identified a relationship with HBoV in all the presented cases.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 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 Successful treatment of postinfectious bronchiolitis obliterans with gamma globulin in a tertiary center: 10 years of experience(Wiley, 2023) Yilmaz, Asli Imran; Gul, Yahya; Kapakli, Hasan; Unal, Gokcen; Caglar, Hanife Tugce; Ercan, Fatih; Reisli, IsmailIntroductionBronchiolitis obliterans is characterized by partial or total occlusion of the bronchioles due to inflammation and fibrosis, and the most common form is postinfectious bronchiolitis obliterans (PIBO). This study aimed to retrospectively present our intravenous immunoglobulin (IVIG) treatment experience in PIBO patients with a clinically severe course despite receiving commonly used treatment protocols. Materials and MethodsThe study included patients aged 0-18 with subtle immunological abnormalities who were followed up in our center for PIBO between 2010 and 2021. Clinical evaluation, body mass index (BMI), computerized tomography (CT) image scoring, and immunological parameters were recorded before and after IVIG treatment. ResultsOf the 11 patients included in the study, 90% were male, the mean age at diagnosis was 27.1 months (range: 5-68 months) and the mean current age was 81.4 months (range: 15-188 months). The number of hospital visits due to infection and the frequency of hospitalizations decreased markedly in the patients who underwent IVIG therapy. Oxygen therapy was discontinued in all patients, and improvements in radiological severity scores were observed. BMI z-scores improved over the baseline values after IVIG therapy. ConclusionCorticosteroids are considered the best first-line treatment to control inflammation in PIBO. In our study group, PIBO patients showed favorable clinical and radiological responses to regular IVIG treatment, possibly due to minor immune deficiency secondary to steroids or as a result of undetected adaptive and innate immune defects involved in the etiology of severe PIBO.Öğe Use of Flexible Bronchoscopy in Foreign Body Aspiration(Galenos Publ House, 2022) Unal, Gokcen; Yilmaz, Asli Imran; Tok, Tahir; Pekcan, SevgiObjective: Foreign body aspiration remains a serious health problem with a potential for severe consequences, and acute and chronic problems in children. It therefore demands immediate intervention. Rigid bronchoscopy has long been the method of choice for foreign body removal but is now being replaced by flexible bronchoscopy which offers reduced trauma and the ability to access distal bronchial regions. In the presented study we assessed the patients who underwent flexible bronchoscopy for foreign body removal in our clinic. Methods: We reviewed the records of 20 patients who underwent flexible bronchoscopy due to suspected foreign body aspiration and had a foreign body removed in our clinic. Patients were analyzed in terms of sociodemographic data, foreign bodies removed, method of foreign body removal, foreign body location and time to diagnosis. Results: Our study group included nine females and 11 males. The removed foreign body was organic in 19 of the 20 patients and inorganic in one patient. Hard organic food, such as hazelnuts, peanuts, seeds, almonds, and raw corn kernel were identified in 12 patients, a piece of fishbone in one patient and a piece of gelatin in another. The pieces of soft organic food identified were apple in one patient, egg in one patient, and boiled corn kernel in one patient and removed by suction. The foreign body was removed using forceps in nine patients, and a basket was used successfully in seven patients. Conclusion: Foreign bodies can be removed with minimal complication using flexible bronchoscopy, basket, and forceps in children.