Publications by authors named "Kadriye Yurdakök"

59 Publications

Urinary bisphenol A levels in prepubertal children with exogenous obesity according to presence of metabolic syndrome.

J Pediatr Endocrinol Metab 2021 Apr 24;34(4):495-502. Epub 2021 Feb 24.

Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objectives: Recent studies have shown a potential link between chronic exposure to Bisphenol A (BPA) and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. In this study, we aimed at comparing BPA exposure levels between controls and otherwise healthy, drug-naive, pre-pubertal children having exogenous obesity with/without metabolic syndrome.

Methods: A total of 63 pre-pubertal children with exogenous obesity whom 27 of them having metabolic syndrome attending Hacettepe University Ihsan Dogramaci Children's Hospital were included in this study. The control group consisted of 34 age- and sex-matched healthy children with no significant underlying medical conditions. Urinary BPA levels were measured using LC-MS/MS (high-performance liquid chromatography coupled with tandem mass spectrometry) methodology.

Results: Urinary BPA levels among obese children were significantly higher than those of the control group (median: 22.9 μg/g-creatinine and 6.9 μg/g-creatinine, respectively; p=0.0001). When adjusted with generalized linear models for age, gender and scores of body mass index, obese children having metabolic syndrome had significantly higher urinary BPA levels than obese children without metabolic syndrome and both obese groups had considerably elevated levels of urinary BPA than the controls (estimated marginal mean ± standard error: 42.3 ± 7.4 μg/g-creatinine, 22.6 ± 3.5 μg/g-creatinine and 12.1 ± 2.5 μg/g-creatinine, respectively, p=0.0001).

Conclusions: This study shows much higher BPA exposure among obese children with metabolic syndrome during the prepubertal period.
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http://dx.doi.org/10.1515/jpem-2020-0371DOI Listing
April 2021

Validity Analysis on the Findings of Dehydration in 2 to 24-Month-Old Children With Acute Diarrhea.

Pediatr Emerg Care 2020 Jan 6. Epub 2020 Jan 6.

Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Department of Pediatrics, Social Pediatrics Unit, Sihhiye, Ankara.

Objective: The most common cause of diarrheal mortality in children is dehydration. In this study, we aimed to assess the validity (sensitivity and specificity) of history and the clinical and laboratory findings in in the diagnosis of dehydration in children younger than 2 years with acute diarrhea.

Methods: One hundred twenty-six 2 to 24-month-old children with acute diarrhea, who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital's Diarrheal Diseases Treatment and Training Unit, were included. The patients were examined on admission for clinical findings of dehydration. Percent weight loss on admission was calculated by using the weight on admission and the weight after the diarrhea resolution and was used as the golden standard for analyzing the validity of clinical and laboratory findings.

Results: Compared with the golden standard, dehydration was overestimated in 13% of the cases and underestimated in 7% when using only the World Health Organization criteria. Dehydrated children had higher diarrheal frequency and longer anuria time. Thirst, weakness, sunken fontanelle, sunken eyes, decreased tears, dry mucous membranes, and dry lip were detected in children with 2% or greater of weight loss. The most valid laboratory findings were low serum pH (<7.30), low bicarbonate (<15 mmol/L), and hyperurisemia (>5.8 mg/dL). In multivariate analysis, physical findings, such as thirst, dry mucous membranes, weakness, sunken eyes, hoarse crying, and low pH, were found to be significant for the diagnosis of dehydration.

Conclusions: In children with acute diarrhea, diarrheal frequency and last urination time should be asked, thirst, dry mucous membranes, weakness, sunken eyes, and hoarse crying should be examined.
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http://dx.doi.org/10.1097/PEC.0000000000001980DOI Listing
January 2020

Prenatal bisphenol a and phthalate exposure are risk factors for male reproductive system development and cord blood sex hormone levels.

Reprod Toxicol 2019 08 3;87:146-155. Epub 2019 Jun 3.

Department of Pediatrics, Neonatology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Bisphenol A (BPA) and phthalates can adversely affect the fetal development. However, observational studies on the effects of these chemicals on fetal male reproductive system are still limited. A hundred of umbilical cord blood samples were analyzed for the levels of BPA, di-2-ethylhexyl phthalate (DEHP), mono-2-ethylhexyl phthalate (MEHP), and sex hormones. After birth, male newborns underwent physical examination that included measurements of anogenital distance, stretched penile length (SPL), and penile width. BPA, DEHP and MEHP levels were detectable in ≈99% of cord blood samples. In covariate-adjusted models, cord blood BPA levels were inversely associated with SPL of newborns and positively associated with cord blood estradiol levels. In addition, there was a significant inverse relationship between cord blood DEHP levels and anogenital distance index of newborn males. Our results suggest that in utero BPA and DEHP exposure exerted adverse effects on fetal male reproductive development and cord blood estradiol levels.
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http://dx.doi.org/10.1016/j.reprotox.2019.05.065DOI Listing
August 2019

A comparison between the feeding practices of parents and grandparents.

Eur J Pediatr 2018 Dec 19;177(12):1785-1794. Epub 2018 Sep 19.

Department of Pediatrics, Hacettepe University, Ankara, Turkey.

The aim of this study is to evaluate and compare mothers' and grandparents' feeding behaviours, the differences between the behaviours, the relationship between children's feeding problems and grandparents' feeding behaviours, as well as the relationship between grandparents' feeding behaviour and children's body mass index (BMI). This study prompts physicians to pay attention to the on feeding behaviours of grandmothers when evaluating the feeding problems and behaviours of children. This study is a controlled case study. Two hundred children (between 2 and 5 years of age) were included. Amongst these children, 150 of them were only fed by their mothers and 50 of them were fed by both their mother and grandmother. The feeding behaviour was evaluated by the Comprehensive Feeding Practices Questionnaire (CFPQ).Three domains emerged in this study: Some of the feeding behaviours were significantly different between the mothers and grandmothers who were questioned in the CFPQ. The feeding behaviours are related to the feeding problems; in this study, we show that, in some cases, whether some feeding behaviours were applied either more or less had a significant influence on feeding problems. There were positive correlations between the feeding behaviours of mothers and grandmothers. Conclusion: There is limited research about grandmothers' influence on child feeding. Research in grandmothers' feeding behaviours may reveal key concerns in children feeding problems and in preventing childhood obesity. What is Known: • According to studies, there are differences between the feeding behaviours of mothers and grandmothers. What is New: • This study is the first to explore the relationship between the feeding problems and feeding behaviours of both mothers and grandmothers. Also, a comparison of the mothers' and fathers' mothers' feeding behaviours has not yet been carried out.
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http://dx.doi.org/10.1007/s00431-018-3244-5DOI Listing
December 2018

Urinary bisphenol-A levels in children with type 1 diabetes mellitus.

J Pediatr Endocrinol Metab 2018 Aug;31(8):829-836

Hacettepe University, Faculty of Medicine, Department of Pediatrics, Sihhiye, Ankara, Turkey.

Background: Bisphenol-A (BPA) is one of the most abundantly produced chemicals globally. Concerns have been raised about BPA's possible role in the pathogenesis of type 1 diabetes mellitus (T1DM). The main aim of the current study was to evaluate the possible association between BPA exposure and T1DM. The second aim was to investigate children's possible BPA exposure routes in Turkey.

Methods: A total of 100 children aged between 5 and 18 years including 50 children with T1DM and 50 healthy children were included. Urinary BPA levels of all children were measured using high-performance liquid chromatography. Mothers of children enrolled in the study were also requested to complete a survey that included questions on the sociodemographic characteristics, medical history and possible BPA exposure routes of their children.

Results: In the T1DM group, urinary BPA levels were slightly higher compared to the control group, but this difference was not significant (p=0.510). However, there was an inverse relationship between current urinary BPA levels and birth weight. It was found that the use of plastic kettles and the consumption of dairy products in plastic boxes significantly increased the urinary BPA concentrations in all subjects.

Conclusions: Although there was no significant association between urinary BPA levels and T1DM, we found an inverse relationship between current urinary BPA levels and birth weight. This finding might be important for prenatal exposure, and further prospective research must be conducted. Also, the use of plastic kettles, which has not been mentioned much in the literature before, was found to be an important exposure route for BPA.
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http://dx.doi.org/10.1515/jpem-2018-0141DOI Listing
August 2018

Low zinc levels may contribute to gynecomastia in puberty.

J Trace Elem Med Biol 2017 Dec 2;44:274-278. Epub 2017 Sep 2.

Department of Toxicology, Hacettepe University, Faculty of Pharmacy, Ankara, Turkey; Adolescent Unit, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Sıhhiye Ankara, Turkey. Electronic address:

This study aimed to determine whether there were any differences in trace element levels between adolescent boys with gynecomastia and control boys and to determine the correlations between the levels of trace elements and body mass index (BMI) and sex hormones. The pubertal gynecomastia group comprised of 41 patients (mean age=13.2 ±0.9 years), who were admitted to Hacettepe University İhsan Doğramacı Children's Hospital in Ankara. Control group comprised of 21 healthy male children. Analyses of trace element levels were performed atomic absorption spectrometry. The mean zinc level of control group was 101.33±16.87μg/dL and the mean zinc level of gynecomastia group was 81.36±17,43μg/dL (20% lower in gynecomastia patients, p=0.0001). However, the mean copper and manganese levels of gynecomastia patients were not statistically different than the control group. There were significant positive correlations between plasma zinc and total testosterone levels in gynecomastia group (r=0.592; p<0.05). There was a significant negative correlation between plasma zinc levels and BMI (r=-0.311; p<0.05). These results indicate that zinc deficiency might be one of the underlying factors of gynecomastia, the importance of which needs to be further elucidated.
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http://dx.doi.org/10.1016/j.jtemb.2017.09.001DOI Listing
December 2017

Parents' Attitudes and Adherence to Unintentional Injury Prevention Measures in Ankara, Turkey.

Balkan Med J 2017 Aug 6;34(4):335-342. Epub 2017 Apr 6.

Department of Pediatrics, Social Pediatrics Unit, Hacettepe University School of Medicine, Ankara, Turkey.

Background: Childhood unintentional injuries are perceived as a leading public health issue since they are one of the preventable causes of paediatric mortality and morbidity. Whether and how parental factors are related to childhood injury has been researched insufficiently.

Aims: To investigate parents' attitudes to preventive measures of unintentional childhood injury, and the parental adherence to these measures.

Study Design: Cross-sectional, descriptive study.

Methods: The data were collected from the parents of children younger than ten years of age admitted to university hospital outpatient clinics for any reason and who agreed to be involved in the study. The first part of the questionnaire included sociodemographic profiles of participating children. Serious injuries were considered to be any injury that requires hospital admission. The second part of the questionnaire was prepared to evaluate parents' adherence to injury prevention rules. A total score calculation about the adherence of the parents to the injury prevention rules was worked out the addition of the scores of each answer given in each age group. Answers for each item given by the parents were scored as wrong (0), sometimes (1) or correct (2). The score for each item was added and the result normalized to 100 points. Only complete questionnaires were used for analysis.

Results: A total of 1126 children and parent pairs agreed to participate in the survey. It was found that 13.8% of the participating children had experienced at least one serious injury. Although three-quarters of the parents had received information about injury prevention, the overall injury prevention scores were found to be low. As children's age increased, the total injury prevention scores of parents decreased significantly. Injury prevention scores were shown to increase significantly with high education and maternal occupation. However, scores were shown to decrease significantly with increased child age and family size.

Conclusion: Our study shows that parental adherence to the child safety measures aimed at decreasing the unintentional injury risk of children is not satisfactory in Turkey. In particular, parents of 5-9-year-old children, big families (more than five people), parents with less than 8 years of education and non-working mothers should be the main target groups for intervention strategies according to our study results.
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http://dx.doi.org/10.4274/balkanmedj.2016.1776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615966PMC
August 2017

Plasma phthalate and bisphenol a levels and oxidant-antioxidant status in autistic children.

Environ Toxicol Pharmacol 2016 Apr 9;43:149-58. Epub 2016 Mar 9.

Hacettepe University Faculty of Medicine, Department of Pediatrics, Social Pediatrics Unit, Developmental Pediatrics Unit, Ankara 06100, Turkey.

Phthalates and bisphenol A (BPA) are endocrine disruting chemicals (EDCs) that are suggested to exert neurotoxic effects. This study aimed to determine plasma phthalates and BPA levels along with oxidant/antioxidant status in autistic children [n=51; including 12 children were diagnosed with "Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)]. Plasma levels of BPA, di (2-ethylhexyl)-phthalate (DEHP) and its main metabolite mono (2-ethylhexyl)-phthalate (MEHP); thiobarbituric acid reactive substance (TBARS) and carbonyl groups; erythrocyte glutathione peroxidase (GPx1), thioredoxin reductase (TrxR), catalase (CAT), superoxide dismutase (SOD) and glutathione reductase (GR) activities and glutathione (GSH) and selenium levels were measured. Plasma BPA levels of children with PDD-NOS were significantly higher than both classic autistic children and controls (n=50). Carbonyl, selenium concentrations and GPx1, SOD and GR activities were higher (p<0.05); CAT activity was markedly lower in study group. BPA exposure might be associated with PDD-NOS. Intracellular imbalance between oxidant and antioxidant status might facilitate its neurotoxicity.
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http://dx.doi.org/10.1016/j.etap.2016.03.006DOI Listing
April 2016

Maternal risk factors associated with lead, mercury and cadmium levels in umbilical cord blood, breast milk and newborn hair.

J Matern Fetal Neonatal Med 2016 Mar 2;29(6):954-61. Epub 2015 Apr 2.

d Analytic Toxicology Laboratory , Refik Saydam National Public Health Agency , Ankara , Turkey.

Objective: Lead (Pb), mercury (Hg) and cadmium (Cd) are environmental pollutants that are wide spread throughout the world. The present study aimed to investigate the level of exposure to Pb, Hg and Cd during the prenatal period, and the possible routes of maternal exposure to these toxic heavy metals.

Participants: The study included 123 mothers and their newborns. Umbilical cord blood samples were collected immediately after delivery, and breast milk and newborn hair samples were collected between postpartum d 3 and 10.

Results: Among the 121 cord blood samples that were analyzed, Pb was present in 120 (99.2%) and the mean level was 1.66 ± 1.60 µg dL(-1) (range:
Discussion: Among the 107 breast milk samples analyzed, 89 (83.2%) had a detectable level of Pb and the mean level was 14.56 ± 12.13 µgL(-1). Detection rate of Cd in breast milk was higher in women who resided near to city waste disposal site. Detection rate of Cd in cord blood was significantly higher in the women who consumed ≥2 servings of fish weekly. Maternal exposure to environmental tobacco smoke (ETS) resulted in elevated levels of Pb and Cd in newborn hair samples.

Conclusion: Most of the study samples had detectable levels of Pb, Hg and Cd, indicating that there was long-term maternal exposure prior to and during pregnancy, and a considerable number of the cord and breast milk samples had levels that exceeded the present accepted safety level.
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http://dx.doi.org/10.3109/14767058.2015.1026255DOI Listing
March 2016

Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: a case study and overview.

Turk J Pediatr 2013 May-Jun;55(3):337-43

Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.

While many physicians are familiar with the sexual or physical abuse of children, there is little awareness about Munchausen syndrome by proxy (MSBP). As case reports of MSBP increase, awareness among physicians is thought to increase as well. We thus present herein a 16-month-old girl who admitted to Hacettepe University İhsan Doğramacı Children's Hospital with the complaint of seizure, recurrent apnea and thigh abscess, who was later diagnosed as MSBP. The case was being followed by the Child Protection Team of the hospital (Haceteppe University Child Protection Unit [HU-CPU]). HU-CPU contributed to the early detection of this case and protected the child from a possible fatal outcome. The mother was confronted for MSBP and refused to take responsibility for her child's symptoms. As seen in this case, when MSBP is suspected, psychiatric evaluation of the mother, evaluation of the mother-child interaction and collection of a detailed family and social history can have a positive impact on the prognosis in these cases. This case report underlines the importance of multidisciplinary team work to share the responsibility and reduce the burden during the treatment process of these difficult and complicated cases.
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July 2014

A community-based iron supplementation program, "Iron-Like Turkey", and the following prevalence of anemia among infants aged 12-23 months.

Turk J Pediatr 2013 Jan-Feb;55(1):16-28

Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

During the second year of the "Iron-like Turkey" Project, in which all children aged 4-6 months in Turkey receive iron supplementation for 5 months, we aimed to assess the utilization of iron supplementation in the field, as well as the prevalence of anemia in healthy infants aged 12-23 months, while determining a variety of sociodemographic and nutritional factors for anemia in three of the 12 NUTS (Nomenclature of Territorial Units for Statistics) regions (regions with the highest, lowest and middle under-5 malnutrition levels). In a community-based, cross-sectional survey using a multi-staged, weighted, cluster-selected sample, children aged 12-23 months with birthweight ≥2500 g, no chronic illness, no history of blood disease, and from term and singleton pregnancy were enrolled; 1589 children met the criteria. The mean±SD age of children surveyed was 17.8±3.6 months. Of the parents, 72.4% claimed that their physician had recommended iron supplementation, and 68.8% had given supplementation to their children. Overall prevalence of anemia was 7.3%. Multivariate analysis revealed that the frequency of anemia decreased significantly in older infants, when supplementation was recommended by health providers, when an infant was breastfed longer than 6 months, and when the mother received iron supplementation during pregnancy. However, anemia prevalence increased when the infant received iron supplementation at a later age (³9 months), lived in a crowded family (³6 persons), and when the mother had a history of iron deficiency anemia. Anemic infants had significantly lower z scores of weight for age than non-anemic ones. This survey suggests that iron supplementation during pregnancy, initiation of iron supplementation in infants at 4-6 months of age, effective counseling on supplementation, subsequent compliance, support of breastfeeding, and effective training of health care personnel are effective strategies for prevention of anemia in the community.
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July 2013

The analysis of child abuse and neglect cases assessed by a multidisciplinary study group between 2005-2008.

Turk J Pediatr 2012 Jul-Aug;54(4):333-43

Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.

This study aimed to evaluate the diagnosis, treatment and follow-up of child abuse and neglect (CAN) cases. Subjects were 102 cases that were clinically assessed by the multidisciplinary hospital team. Early and late childhood cases (according to the age at first abuse) were compared by means of characteristics of abuse. Among the 102 subjects, 64 were female and 38 were male (mean age: 8.68 years). Being abused by someone within the family was found to be significantly higher in preschool children compared to children in late childhood. 27.5% (n: 28) of the cases concomitantly had low socioeconomic and educational level and high parental psychological problems and 64.8% had psychiatric problems. A limited number of studies have compared characteristics of early and late childhood abuse considering the age of onset of maltreatment. Consistent with the literature, our study showed that early age of onset of maltreatment is a poor prognostic factor in many ways.
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August 2013

Salmonella gastroenteritis in children (clinical characteristics and antibiotic susceptibility): comparison of the years 1995-2001 and 2002-2008.

Turk J Pediatr 2012 Sep-Oct;54(5):465-73

Social Pediatrics Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Turkey.

We document herein the prevalence and serotype distribution among Salmonella enterica strains isolated from children treated for diarrhea over two seven-year periods spanning 14 years. Four hundred and eight (1.38%) S. enterica cases were isolated among 29,601 diarrheal admissions. Among the Salmonella isolates, 63.7% were serogroup D and 29.9% were serogroup B. Overall, 21.7% of cases were under one year of age, with 2.1% being younger than three months. Bloody diarrhea was found in 18.8% of the cases. The resistance rates were 25.8%, 18.2%, 7.0%, 4.7%, and 0.3%, to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin, respectively. In conclusion, our study has revealed that the predominance of Salmonella serogroup D continues. The clinical features of our patients were mostly mild, with no deaths or severe complications. While resistance to antimicrobial agents changes constantly, it is important to keep these strains under surveillance in order to formulate policies for the rational use of antimicrobial agents.
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April 2013

Family and infant characteristics in relation to age at walking in Turkey.

Turk J Pediatr 2012 May-Jun;54(3):260-8

Social Pediatrics Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

The purpose of this study was to assess the onset of independent ambulation relative to possible relationships with maternal and infant characteristics. In a cross-sectional study, the health files of 1,553 Turkish children aged 12-23 months were selected by the multistage sampling method in the Nomenclature of Territorial Units for Statistics (NUTS) regions coded as low, medium and high malnutrition levels in Turkey. Children were selected from health centers by systematic sampling technique in each region. Kaplan-Meier analysis and estimated mean values were used for data description; log-rank test and the Cox multivariable regression analysis were applied for data analysis. Maternal education level, occupation, region of residence, gestational iron supplementation, child's gender, child's nutritional status, and presence of anemia in the infant during the survey period demonstrated significant relationships with walking unassisted in the univariate analysis. However, multivariable analysis showed that high maternal education, absence of parental consanguinity and appropriate weight-for-age Z score were positively associated with earlier age of walking. These findings showed the importance of improvement in girls' education, prevention of postnatal growth retardation and improvement in diet quality for children's gross motor development. In addition, counseling programs should be given to decrease the rate of parental consanguinity.
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December 2012

Mercury exposure via breast-milk in infants from a suburban area of Ankara, Turkey.

Turk J Pediatr 2012 Mar-Apr;54(2):136-43

Department of Pediatrics, Fatih University Faculty of Medicine, Ankara, Turkey.

The objective of this study was to evaluate mercury (Hg) levels in breast-milk in the postpartum 2nd month and to determine the relationship between Hg levels and sociodemographic parameters, maternal nutritional habits, presence of dental amalgam, maternal depression, maternal anemia, and growth status of infants. One hundred forty-four mothers residing in a suburban area in Ankara were invited at the 2nd month postpartum. A questionnaire concerning sociodemographic characteristics, vitamin intake during pregnancy and in the 2nd month postpartum, consumption of fish and viscera, smoking habits, and presence of dental fillings was applied. Hg could be detected in samples of 18% of the mothers, all levels of which were higher than the Hg limit in breast-milk reported by the World Health Organization. The Hg levels were higher in mothers who consumed viscera than in those who did not. Turkish women can still safely breastfeed their children, but Hg contamination in breast-milk should be monitored during the lactation period.
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August 2012

Clinical characteristics and antibiotic resistance of Shigella gastroenteritis in Ankara, Turkey between 2003 and 2009, and comparison with previous reports.

Int J Infect Dis 2011 Dec 7;15(12):e849-53. Epub 2011 Oct 7.

Department of Pediatrics, Social Pediatrics Unit, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey.

Objectives: The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002.

Methods: A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics.

Results: The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p<0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p<0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively).

Conclusions: There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases.
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http://dx.doi.org/10.1016/j.ijid.2011.08.008DOI Listing
December 2011

Hepatitis A seroprevalence among infants aged 12 months in Ankara.

Turk J Pediatr 2011 Jan-Feb;53(1):114-6

Division of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Seroprevalence studies in various age groups contribute to a better understanding of hepatitis A infection and response to hepatitis A immunization. Hepatitis A seroprevalence in 12-month-old infants from Ankara was studied. Among 601 healthy infants, overall hepatitis A seropositivity was found to be 23.5%. There were no gender differences in seropositivity (22.6% for male and 24.5% for female infants). Although vaccination of infants would be an ideal prevention strategy, presence of maternal anti-hepatitis A virus (HAV) antibody interferes with the immune response to hepatitis A vaccine in infants and young children. Therefore, further knowledge about decay of maternal antibody in infants is important in determining the optimal age for vaccination against hepatitis A. There is no recommendation for routine hepatitis A vaccination in Turkey. However, we need more seroprevalence studies in different age groups to decide the appropriate timing/age of vaccination.
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June 2011

Zinc supplementation and TNF-α levels in vaccinated cardiac patients.

J Trace Elem Med Biol 2011 Apr 22;25(2):85-90. Epub 2011 Apr 22.

Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objective: To investigate whether zinc supplementation could affect serum tumor necrosis factor-alpha (TNF-α) levels in congenital and acquired cardiac patients attending for an influenza vaccine.

Methods: 9-18 years old, voluntary children with cardiac disease were weighed, measured height and blood samples for hemoglobin level, zinc level, IgA and IgG titers of influenza A and B serotypes and TNF-α levels were obtained. The children were randomly assigned to 1 of 2 groups: ZV group received both zinc supplementation and influenza vaccine; V group received influenza vaccine. Serum TNF-α levels were measured at 28 days after the immunization.

Results: Mean (±SD) serum zinc level was 100 (±20) μg/dL. Cases with congenital heart disease had lower serum zinc levels than acquired ones (93±17 μg/dL, 116±18 μg/dL; respectively, p<0.001). Median titers of serum TNF-α decreased after vaccination (78.9 pg/mL, 74.8 pg/mL; p<0.05) but this significant change occurred only in ZV group (77.1 pg/mL, 73.4 pg/mL; p=0.001). Vaccine associated adverse events were similar in ZV and V groups except malaise (0% in ZV and 23.8% in V group; p<0.05). Adverse events were similar in patients with congenital and acquired heart diseases. During the previous influenza season, 77.3% had more than two episodes of upper respiratory tract infection (URTI), however, after vaccination only 13.6% had more than two episode of URTI.

Conclusion: Zinc supplementation has a beneficial effect on malaise, one of the influenza vaccine associated adverse events, and decrease serum TNF-α levels.
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http://dx.doi.org/10.1016/j.jtemb.2011.03.002DOI Listing
April 2011

Breast milk lead and cadmium levels from suburban areas of Ankara.

Sci Total Environ 2011 Jun 14;409(13):2467-72. Epub 2011 Apr 14.

Department of Pediatrics, Fatih University Hospital, Ankara, Turkey.

The objectives of this study were (1) to evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk at 2 months postpartum, (2) to investigate the relationship between Pb and Cd levels in breast milk and some sociodemographic parameters and (3) to detect whether these levels have any influence on the infant's physical status or on postpartum depression in the mothers. Pb and Cd levels in breast milk were determined by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The median breast milk concentrations of Pb and Cd were 20.59 and 0.67 μg/l, respectively. In 125 (87%) of 144 samples, Pb levels were higher than the limit in breast milk reported by the World Health Organization (WHO) (> 5 μg/l). Breast milk Cd levels were > 1 μg/l in 52 (36%) mothers. The mothers with a history of anemia at any time had higher breast milk Pb levels than those without a history of anemia (21.1 versus 17.9 μg/l; p=0.0052). The median breast milk Cd levels in active and passive smokers during pregnancy were significantly higher than in non-smokers (0.89, 0.00 μg/l, respectively; p=0.023). The breast milk Cd levels of the mothers who did not use iron and vitamin supplements for 2 months postpartum were found to be higher than in those who did use the supplements (iron: 0.73, 0.00 μg/l, p=0.023; vitamin: 0.78, 0.00 μg/l, p=0.004, respectively). Breast milk Cd levels at the 2nd month were correlated negatively with the z scores of head circumference and the weight for age at birth (r=-0.257, p=0.041 and r=-0.251, p=0.026, respectively) in girls. We found no correlation between the breast milk Pb and Cd levels and the Edinburgh Postpartum Depression Scale scores. Breast milk monitoring programs should be conducted that have tested considerable numbers of women over time in view of the high levels of Pb in breast milk in this study.
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http://dx.doi.org/10.1016/j.scitotenv.2011.02.035DOI Listing
June 2011

Sensitivity and specificity of bloody diarrhea in shigella gastroenteritis.

Turk J Pediatr 2010 Sep-Oct;52(5):488-90

Social Pediatrics Unit, Department of Pediatrics, Ihsan Dogramac, Children's Hospital, Microbiology Laboratory, Hacettepe University, Ankara, Turkey.

The sensitivity and specificity of bloody diarrhea in the diagnosis of shigella gastroenteritis in a Shigella sonnei prevalent center was investigated. The shigella-proven gastroenteritis cases who were admitted to Hacettepe University Ihsan Doğramaci Children's Hospital Diarrheal Diseases Unit (Jan 2003 - Oct 2006) constituted the study group (n=65). Age- and sex-matched children admitting to the same center with non-shigella diarrhea constituted the control group (n=65). The sensitivity, specificity, and positive and negative predictive values of bloody diarrhea were found to be 30%, 100%, 100% and 58%, respectively. Sensitivity of bloody diarrhea in the diagnosis of shigella gastroenteritis was low in this center. New strategies and recommendations in the management of mild nonbloody cases are needed.
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April 2011

Effect of activity and television viewing on BMI z-score in early adolescents in Turkey.

World J Pediatr 2011 Feb 30;7(1):37-40. Epub 2010 Dec 30.

Department of Pediatrics, Social Pediatrics Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: television, computer and other causes of increased inactivity are reported to be among the major causes of obesity. This cross-sectional study was aimed to evaluate the effect of television viewing and other daily activities on body mass index (BMI) z-score of early adolescents.

Methods: a total of 860 students and their parents (581) from different socioeconomic level schools were included. They were instructed to fill in a self-designed questionnaire. Weight and height were measured, and BMI z-scores were calculated.

Results: BMI z-score was higher in boys and in those attending high socioeconomic level schools. Children with a BMI z-score >2SD watched television (2.5 ± 0.9 h/day) longer than those with <-2SD (1.6 ± 0.8 h/day) (P=0.027). The three categories (<-2SD, -2SD-2SD, >2SD) differed significantly according to maternal (P<0.05) and paternal (P<0.005) BMI. Linear logistic regression analysis revealed that socioeconomic level, maternal BMI and paternal BMI are factors affecting BMI z-score significantly.

Conclusion: genetic and/or family environment which may affect the nutrition and activity of adolescents seems to be the most important factor affecting their BMI z-score.
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http://dx.doi.org/10.1007/s12519-011-0243-2DOI Listing
February 2011

Why are they having infant colic? A nested case-control study.

Paediatr Perinat Epidemiol 2010 Nov 17;24(6):584-96. Epub 2010 Aug 17.

Department of Pediatrics, Hacettepe University Medical School, Ankara, Turkey.

We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3-72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Doğramacı Children's Hospital at 30-45 days post partum. At 40-55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non-colic. When the infants were 7-8 months old, another interview was done. The colic group had higher proportions of less-educated (≤ 8 years) and smoking mothers, extended family and families with domestic violence than the non-colic group. The colic group of mothers had significantly higher rates of 'impaired bonding' in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non-colic group. No differences were revealed for faecal enzyme activities. At 7-8 months, the colic group was shorter than the non-colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant.
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http://dx.doi.org/10.1111/j.1365-3016.2010.01150.xDOI Listing
November 2010

The urinary cotinine levels of infants and the determinants.

Turk J Pediatr 2010 May-Jun;52(3):294-300

Dr. Sami Ulus Children's and Maternity Training and Research Hospital, Ankara, Turkey.

The aim of this study was to determine the effect of the route of tobacco smoke exposure on urinary cotinine levels of infants. A cross-sectional analysis was done on 254 six-month-old infants. The infants were grouped according to the route of tobacco smoke exposure. The urinary cotinine/creatinine ratios were determined. Forty-nine percent (124/254) of mothers were smokers. Urinary cotinine levels in infants of smoking mothers were statistically significantly higher than levels in infants of non-smoking mothers. The highest mean cotinine/creatinine level was found in the breast-milk-exposed group. Linear regression analysis showed that maternal smoking increased urinary cotinine level by 541 times and breastfeeding increased it by 171 times, whereas early start of formula feeding decreased it by 63 times. Tobacco exposure by breastfeeding may be more harmful than other routes of exposure. Mothers should be encouraged to stop smoking during the breastfeeding period even if they avoid exposing their infants to passive tobacco smoke.
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September 2010

Effect of glutamine supplementation on lymphocyte subsets in children with acute diarrhea.

Turk J Pediatr 2010 May-Jun;52(3):262-6

Unit of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

To study the effect of glutamine supplementation on lymphocyte subpopulation counts in children with acute diarrhea, children aged 6-24 months were enrolled in a double-blind randomized study. Cases had received either 0.3 g/kg/day of glutamine or placebo orally for seven days. The counts of blood leukocytes, lymphocytes and lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+, CD16+CD56+) were determined both on admission and seven days later using a flow cytometry. When adjusting for sex, current breastfeeding status, dehydration, and nutritional status of children, lymphocyte subpopulations did not differ significantly between the glutamine- and placebo-supplemented groups on the 7th day of intervention.
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September 2010

Measles, mumps, and rubella antibody status and response to immunization in children after therapy for acute lymphoblastic leukemia.

Pediatr Hematol Oncol 2010 Aug;27(5):333-43

Hematology Unit Hacettepe University Ihsan Doğramaci Children's Hospital, Hematology Unit, Ankara, Turkey.

Seventy-seven patients with acute lymphoblastic leukemia (ALL) who were in complete remission and whose therapies had been stopped for at least 6 months before enrollment in this study were retrospectively analyzed regarding their antibody status for measles, mumps, and rubella, with the aim to demonstrate the seropositivity rate after treatment in the authors' group. Each patient's serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) method to determine the antibody titers before and after immunization. Measles serology was available in 77 children; 45 (58%) were seronegative. Initial ages of measle-seronegative patients were statistically lower than those of seropositive cases (median 3.29 versus 4.91 years, respectively). Mumps serology was available in 76 children; 36 (47%) were seronegative. Mumps-seropositive cases tended to have more frequent previous history of infection than seronegative cases (55.0% versus 28.6%, respectively, P = .05). Rubella serology was available in 76 children, and 20 (26.3%) were seronegative. It was determined that initial ages of rubella-seronegative patients were statistically lower than those of seropositive cases (median 3.03 versus 4.32 years, respectively). The authors concluded based on the results of their study that at a median of 3.31 years after completion of chemotherapy for ALL, the majority of cases had antibody levels lower than protective values for measles (58.4%); however, these values were 47.3% for mumps and 26.3% for rubella. Seroconversion rates after measles (55%) and mumps vaccination (57.1%) were still low. However, in the available cases, relatively adequate response to rubella vaccination (92.3%) was observed.
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http://dx.doi.org/10.3109/08880011003767720DOI Listing
August 2010

Factors associated with breastfeeding initiation time in a Baby-Friendly Hospital.

Turk J Pediatr 2010 Jan-Feb;52(1):10-6

Unit of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

The purpose of this study was to investigate maternal, gestational, and neonatal features associated with the early initiation of breastfeeding. A descriptive study was done between July-October 2006 in the maternity ward of Dr. Zekai Tahir Burak Maternity and Research Hospital, a certificated Baby-Friendly Hospital. Babies with postpartum health problems and those hospitalized in the newborn intensive care unit were not included into the study. A total of 577 mothers participated within 4 to 36 hours' postpartum on a voluntary basis. The mothers completed a questionnaire about the gestational, maternal, neonatal, and first suckling characteristics. Of the 577 cases, 35.2% initiated breastfeeding within the first hour while 72.8% of them initiated breastfeeding within the first two hours of birth. In the multivariate logistic analysis, it was found that the factors affecting early breastfeeding status (within the first 2 hours of birth) were maternal illness during pregnancy, cesarean section and preterm birth. We concluded that the prevention of premature birth, limitation of cesarean section indication, management of maternal anemia, regular and effective pregnancy follow-up visits are important for the early initiation of breastfeeding.
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May 2010

Maternal and environmental determinants of breast-milk mercury concentrations.

Turk J Pediatr 2010 Jan-Feb;52(1):1-9

Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

We aimed to evaluate the maternal factors [including dietary habits, dental care, smoking, anemia, levels of breast-milk zinc (Zn) and iron (Fe), and levels of serum selenium (Se), Zn and copper (Cu)] that influence breast-milk mercury (Hg) concentrations and to investigate whether there is any relation between Hg concentrations and infant growth and development during the exclusive breastfeeding period and in the second year of life. Forty-four healthy mother-infant pairs in the 10-20-day postpartum period were enrolled in the study. Maternal history and blood samples for hemoglobin, Fe, Fe binding capacity, ferritin, Se, Zn, and Cu and breast-milk samples for Fe, Zn and Hg were taken. Infant growth and development during the exclusive breastfeeding period and in the second year of life were followed. The mean concentration of breast-milk Hg was 3.42 +/- 1.66 microg/L. Serum Se levels were negatively correlated with milk Hg levels. Multivariate analysis revealed that active/passive smoking and offal intake during pregnancy and presence of maternal anemia had an impact on increased milk Hg concentrations. Preventive strategies for mercury exposure should include management of iron deficiency anemia, cessation of smoking exposure and proper nutrition during the pregnancy period.
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May 2010

Seasonal and gender differences in hemoglobin value in infants at 5-7 months of age.

Turk J Pediatr 2009 Nov-Dec;51(6):572-7

Unit of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Our aims were to analyze the changes in hemoglobin (Hb) value according to gestational age, birth weight, sex, birth season, and weight gain and to detect distribution of Hb values among healthy infants, breastfed for at least four months and receiving routine health care. We conducted a descriptive study using the data of 469 healthy infants at 5-7 months of age in Hacettepe University Ihsan Doğramaci Children's Hospital Well-Baby Clinic between 2001-2004. Infants with acute or chronic illness, exchange transfusion and those who had taken or were currently taking iron supplementation were not included into the study. Information regarding the child was obtained from hospital files. Infants with Hb value <10.5 g/dl and <9.5 g/dl were considered to have mild and moderate anemia, respectively. The mean Hb value was 10.7 g/dl (SD = 0.90). The prevalence of anemia was 41.4%. Boys had significantly lower Hb, hematocrit and mean corpuscular volume values and higher red cell distribution width values than girls. Infants born before 37 weeks of gestational age had moderate anemia more frequently. Anemia at 5-7 months of age was more frequent in infants born in spring and summer than in those born in fall and winter (49.2%, 26.8%, p<0.001). Birth weight was positively correlated with Hb value at 5-7 months of age (r=0.14, p=0.003). In the present study, female gender, at-term birth, birth in winter and fall, weight appropriate for gestational age, and regular weight gain showed the lowest risk for anemia development in infants aged 5-7 months with a breast-feeding period of more than four months.
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March 2010

Serological response to influenza vaccine after hematopoetic stem cell transplantation.

Ann Hematol 2010 Sep 30;89(9):913-8. Epub 2010 Jan 30.

Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Vaccination is the best strategy to prevent influenza infection that is a potential cause of morbidity and mortality in immunosuppressed patients. Here, we evaluated the factors that may affect serological response to influenza vaccine in patients who have undergone hematopoetic stem cell transplantation (HSCT). Sixty-one HSCT recipients were included in the study during the 2007-2008 influenza season. Serum samples prior to vaccination and 6-10 weeks after vaccination were collected. Samples were assayed for antibodies to influenza virus A/H1N1, A/H3N2, and B strains by hemagglutination-inhibition assay. The patients were followed in terms of clinical symptoms up to the next influenza season and for adverse effects within a month after vaccination. Overall, pre-vaccine seroprotection rate against all vaccine antigens (A/H1N1, A/H3N2, and B antigens) was 45.1%, post-vaccine seroprotection rate 91% and seroconversion rate was 28.3%. Seroconversion rates were found to be low against B in patients who were vaccinated in the late influenza season (p = 0.018; respectively). Five patients (10.9%) had no immune response against H1N1. Adverse events were reported in 19.6% (n = 9/46) of the patients. In conclusion, the patients should be vaccinated as early as possible in the influenza season, before they are exposed to the virus.
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http://dx.doi.org/10.1007/s00277-009-0897-1DOI Listing
September 2010

The effect of systemic zinc supplementation on oral health in low socioeconomic level children.

Turk J Pediatr 2009 Sep-Oct;51(5):424-8

Department of Pediatrics, Başkent University Faculty of Medicine, Turkey.

There is limited evidence about the effects of systemic zinc supplementation on oral health in healthy children. The aim of this study is to determine the effect of oral zinc supplementation on oral health in low socioeconomic level primary school children. In this double-blind randomized study, 68 children were randomly separated into two groups (study and placebo) to receive 15 mg/day elemental zinc or placebo syrup five days a week for 10 weeks. Oral examinations were performed before and after supplementation. After supplementation, the Gingival Index improved statistically in both groups (p < 0.05). However, the Plaque Index improved statistically only in the zinc group (p = 0.02). After supplementation, the Plaque Index scores increased in 13 cases and decreased in 15 in the placebo group (p = 0.70) and increased in only 6 cases and decreased in 18 in the study group (p = 0.02). Oral zinc supplementation may contribute to the prevention of dental caries in low socioeconomic level primary school healthy children.
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February 2010