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Öğe Demographic and clinical characteristics of patients with serum sickness-like reaction(Springer London Ltd, 2018) Yorulmaz, Alaaddin; Akin, Fatih; Sert, Ahmet; Agir, Mehmet Akif; Yilmaz, Riza; Arslan, SukruIn this study, we aimed to review the demographic, clinical, and laboratory characteristics of patients who were followed up and treated with the diagnosis of serum sickness-like reactions (SSLR) in our pediatric rheumatology clinic retrospectively and emphasize the importance of early diagnosis and treatment. The files of 29 patients who were hospitalized in the pediatric rheumatology clinic between September 2016 and March 2017 with the diagnosis of type 3 hypersensitivity reaction were reviewed retrospectively. Patient records including C-reactive protein, erythrocyte sedimentation rate, serum electrolytes, blood glucose, urea, and liver function were recorded by using the computerized patient database. The gender, age, length of hospital stay, accompanying clinical findings, family history of atopy, preceding infection, and drug usage data were obtained from the files of the patients. Twenty-nine patients with the diagnosis of type 3 hypersensitivity reaction were evaluated. Fifteen (51.7%) of the patients were male and 14 (48.3%) were female. The male to female ratio was 1.07. The age distribution of patients ranged from 18 to 192 months (mean +/- SD 100.66 +/- 53.75 months). The hospitalization duration was 3-16 days (mean +/- SD 5.14 +/- 3.20 days). The use of many drugs, especially antibiotics, has increased even in the treatment of viral upper air way infections. As a result, side effects have also increased. The most important of these is SSLR. However, this disease is not well recognized by clinicians.Öğe The Evaluation of Primary School Readiness Levels of the Children Aged 66-72 Months with the Denver II Test(Kowsar Corp, 2018) Yorulmaz, Alaaddin; Sert, Sadiye; Yilmaz, Fatma Hilal; Kara, Fatih; Cinarlidere, SerifeBackground: Primary school can lead to compatibility problems in children without an early childhood education because they experience separation from their families for the first time. Objectives: In order to detect developmental delays that may arise at the school and to plan the necessary support, it was aimed to determine primary school readiness levels of the children aged 66 -72 months. Methods: This study included 91 children aged 66 - 72 months who were admitted to the Pediatric Outpatient Clinic of Beyhekim State Hospital between June 2016 and August 2016. The Denver Developmental Screening Test II which consists of 134 items was performed. The Test items are divided into four main sections and surveys whether the chilren are ready for the first grade of primary school. The test results were interpreted as normal, suspect and abnormal. Results: 36 (39.6%) of 91 patients were female and 55 (60.4%) were male. There was no statistically significant difference between the test results in terms of gender. When examining the distribution of children according to months, there was no statistically significant difference. Data for the child's age, the mother's age, the father's age, duration of breastfeeding, the age (month) at which the child started talking, walking or completed toilet training was expressed as mean +/- standard deviation. When these values were examined and also the mean values containing normal and abnormal results were compared, there was a statistically significant difference only between the months when the children started talking. When examining the results of the Denver II test, it was found that 64 (70.3%) children had abnormal development and 27 (29.7%) normal development. Conclusion: In the study evaluating primary school readiness levels of the children aged 66 -72 months, the substantial proportion of the children who were admitted to the hospital, had a developmental delay. In light of this study, all pre-school children should be evaluated before admission to primary school.Öğe Evaluation of the 10 Warning Signs in Primary and Secondary Immunodeficient Patients(Frontiers Media Sa, 2022) Eldeniz, Fadime Ceyda; Gul, Yahya; Yorulmaz, Alaaddin; Guner, Sukru Nail; Keles, Sevgi; Reisli, IsmailObjectivesTen warning signs of primary immunodeficiency (PID) were suggested by the Jeffrey Modell Foundation (JMF), to increase physician awareness of PID. These warning signs have not yet been evaluated for patients with secondary immunodeficiency (SID). This study investigated whether the 10 warning signs used for the diagnosis of PID were also sufficient for the diagnosis of SID, and explored the possibility of additional signs. MethodsThis prospective study was conducted between June and December 2020. The mothers of 162 patients with PID and SID, and mothers of 200 healthy children, were asked to complete a questionnaire about family and personal history in addition to the warning signs of PID developed by the JMF. A JMF score was created by giving one point for each Yes answer for the 10 warning signs of PID. Medical records of the patients were evaluated for possible additional warning signs for PID and SID. ResultsThe JMF scores of the PID (3.36 +/- 1.65) and SID (3.72 +/- 1.12) groups were significantly higher than the scores of the control group (0.34 +/- 0.61) (p < 0.05). A sign for immunological evaluation in two patients without warning signs in the PID group was found to be chronic diarrhea. In addition to the 10 JMF warning signs, we found that consanguinity and a family history of tuberculosis were statistically significant in our PID group, compared with the SID and control groups. ConclusionsThe JMF warning signs are important for early diagnosis of PID. Our study showed that these signs may also be used for the early diagnosis of SID in patients and, according to our results, in addition to the 10 JMF signs for PID, parental consanguinity, chronic diarrhea, and a family history of tuberculosis may also be considered warning signs for the early diagnosis of PID.Öğe Is Asymmetric Dimethylarginine a Useful Biomarker in Children With Carbon Monoxide Poisoning?(Lippincott Williams & Wilkins, 2019) Yazar, Abdullah; Akin, Fatih; Sert, Ahmet; Ture, Esra; Topcu, Cemile; Yorulmaz, Alaaddin; Ercan, FatihObjective Carbon monoxide poisoning (COP) is the leading cause of mortality and morbidity due to poisoning worldwide. Because children are affected more quick and severely from COP, they may require a longer treatment period, even if carboxyhemoglobin (CO-Hb) and/or lactate levels return to normal. Therefore, a new marker that predicts the duration of treatment and the final outcomes of COP is needed. Methods This case control study was conducted on 32 carbon monoxide-poisoned patients younger than 18 years who had been admitted to pediatric emergency department. The control group included age- and sex-matched 30 healthy children. Blood samples were obtained for analysis of arterial blood gases, CO-Hb percent, methemoglobine, lactate, and asymmetric dimethylarginine (ADMA). Results Asymmetric dimethylarginine levels were significantly increased (P < 0.05) in patients with COP on admission and after the treatment when compared with controls (1.36 [0.89-6.94], 1.69 [0.76-7.81], 1.21 [0.73-3.18] nmol/L, respectively). There was no positive correlation between CO-Hb and ADMA levels on admission and at 6 hours (P = 0.903, r = 0.218, P = 0.231, r = 0.022, respectively). Positive correlation was found between lactate and CO-Hb levels on admission (P = 0.018, r = 0.423). Conclusions This study showed that ADMA levels were still high after 6 hours of 100% oxygen therapy in children with COP, even CO-Hb and/or lactate levels return to normal range. On the basis of these results, we consider that ADMA may be a useful biomarker in patient with COP.Öğe Management of acute mitochondriopathy and encephalopathy syndrome in pediatric intensive care unite: a new clinical entity(Springer Heidelberg, 2020) Arslan, Sukru; Yorulmaz, Alaaddin; Sert, Ahmet; Akin, FatihAcute mitochondriopathy and encephalopathy syndrome(AMES) is described differently by different authors in the literature. As a new clinical entity, we aimed to present the clinical signs and symptoms, diagnosis and treatment algorithm of our patients with AMES. 56 patients aged between 2 months and 18 years who were followed up in pediatric intensive care units of Konya Training and Research Hospital and Selcuk University Medical Faculty Hospital, between January 2010 and June 2017 were included. Patients' data were obtained retrospectively from the intensive care unit patient files. 34 (60.7%) of the patients were male and 22 (39.3%) were female. The median age of our patients was 10.0 months. At the time of admission, 42 (75%) of the patients had fever, 35 (62.5%) vomiting, 27 (48.2%) abnormal behaviour and agitation and 28 (50%) convulsion. The etiological classification of patients with AMES was divided into four groups as infection, metabolic disorder, toxic, and hypoxic-ischemic. 39 (69.6%) patients were found to have infection, 10 (17.9%) patients hypoxia, 7 (12.5%) patients metabolic disorders. AMES occurs rarely, but should be kept in mind in the differential diagnosis of patients with any encephalopathy of unknown origin especially in those with a history of ingestion of drugs, previous viral infection and vomiting. Early recognition and treatment is imperative to reduce morbidity and mortality in children with AMES.Öğe Prediction of the development of pulmonary arterial hypertension with Tei Index in congenital heart diseases with left-to-right shunt(Turkish Soc Cardiology, 2019) Yucel, Mehmet; Alp, Hayrullah; Yorulmaz, Alaaddin; Karaarslan, Sevim; Baysal, TamerObjective: The aim of this study was to determine the usefulness of the Tei Index, an echocardiographic parameter, in the early determination of pulmonary artery pressure (PAP) in congenital heart disease (CHD) with a left-to-right shunt. Methods: Right and left ventricular functions were evaluated using Tei Index values determined with tissue Doppler echocardiography. Cardiac catheterization was performed in all cases. The presence of pulmonary arterial hypertension (PAH) was defined as a mean PAP of >= 25 mm Hg and a pulmonary vascular resistance index of >3 WU/m(2). Patients with a pulmonary/systemic blood flow ratio of >= 2 were considered candidates for surgery. Results: The Tei Index values measured from the left ventricular posterior wall and the right ventricular anterior wall were found to be significantly higher in the patients with PAH (0.68 +/- 0.18, 0.67 +/- 0.16, respectively) compared with the patients without PAH (0.56 +/- 0.16, p=0.027; 0.51 +/- 0.12 p=0.001). A significant correlation was detected between the Tei Index value measured from the left ventricular posterior wall and the mean PAP (correlation coefficient: 0.491). Conclusion: The right ventricular Tei Index values in children with CHD and a left-to-right shunt can be used as a parameter to follow up on the potential development of PAH, to make a diagnosis in the early period, and to make a timely decision about surgery.Öğe Primer immün yetmezlik tanısı ile takip edilen hastaların retrospektif olarak değerlendirilmesi(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 2007) Yorulmaz, Alaaddin; Reisli, İsmailPrimer immün yetmezlikler, primer ya da doğumsal immün yetmezlik bozukluklarısonucunda gelişen kronik ve/veya yineleyen bakteriyel, viral, fungal ve protozoalenfeksiyonlarla seyreden hastalıklar grubudur. Çocuk Sağlığı ve Hastalıkları mmünoloji veAllerji bilim dalında takip edilen 1054 hastanın klinik, laboratuar ve demografik özelliklerideğerlendirildi. Hastalarımızın 647'si (%61,4) erkek, 407'si (%38,6) kız idi. Hastaların tanıyaşı ortalama 55,5 ay olup, 2 ay ile 552 ay arasında değişiyordu. Hastalarımızdan 2 olgu hariçdiğerleri pediatrik yaş grubundaydı. Hastalarımızın %92,8'ini (n:978) antikor eksikliğinebağlı immün yetmezlikler oluşturmaktaydı. Diğerleri arasında ağır kombine immünyetersizlikler %2,4 (n:25), diğer iyi tanımlanmış immün yetmezlik sendromları %1,7(n:18), immün sistemin regülasyon bozuklukları %0,9 (n:9), fagositik sistem bozuklukları%0,4 (n:4), kompleman eksiklikleri %0,1 (n:1), doğal immün sistemde eksiklikleseyreden hastalıklar %1,4 (n:15) ve diğer immün yetersizlikler %0,4 (n:4) oranındaydı.Hastaların başvuru anında saptanan klinik bulgular; tekrarlayan ÜSYE %54,4, ASYE %47,4,sinüzit %38,9, otitis media %25,3, astım bulguları %15,9, alerji deri bulguları %15,0,gastroenterit %9,2, moniliazis %5,6, YE %4,0, sepsis %1,7, menenjit %1,1, tekrarlayan ciltenfeksiyonu %0,9 oranında saptandı. ÜSYE, ASYE ve sinüzit diğer eşlik eden semptomlaragöre anlamlı olarak yüksekdi (p<0,05). Hastalarımızın ebeveynleri arasında %37,5 oranındaakraba evliliği olduğu saptandı. Akraba evliliği oranı, SCID'de %84, fagositer işlevbozukluğunda %75, CVID'de %73,3 oranında tespit edildi. SCID, diğer iyi tanımlanmışimmün yetersizlikler ve immün sistemin regülasyon bozukluğuna bağlı hastalıklarda 1. dereceakraba evliliği, diğer P Y'lere göre anlamlı olarak yüksek saptandı (p<0,05). Tekrarlayanenfeksiyonlar nedeniyle 379 (%36) hastaya trimetoprim-kotrimaksazol profilaksisi başlandı.63 (%6,0) hastada bilgisayarlı tomografi (BT) ve/veya HRCT ile kronik akciğer hastalığıtespit edildi. Hastalarımızdan 401'ine (%38,0) astım tanısı konuldu. Sonuç olarak tekrarlayanenfeksiyonları olan ve antibiyotik tedavisine dirençli hastalarda mutlaka primer immünyetersizlik düşünülmelidir. Komplikasyonların azaltılabilmesi için erken tanı ve tedavininönemli olduğunu düşünüyoruz.