Publications by authors named "Metin Uysalol"

14 Publications

  • Page 1 of 1

Nailfold capillaroscopy: A sensitive method for evaluating microvascular involvement in children with SARS-CoV-2 infection.

Microvasc Res 2021 11 10;138:104196. Epub 2021 Jun 10.

Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Electronic address:

Objectives: The hyperinflammatory state and the viral invasion may result in endothelial dysfunction in SARS-CoV-2 infection. Although a method foreseeing microvascular dysfunction has not been defined yet, studies conducted in patients diagnosed with COVID-19 have demonstrated the presence of endotheliitis. With this study, we aimed to investigate the microvascular circulation in patients diagnosed with COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by nailfold videocapillaroscopy (NVC).

Methods: Thirty-one patients with SARS-CoV-2 infection, 25 of whom were diagnosed with COVID-19 and 6 with MIS-C and 58 healthy peers were included in the study. NVC was performed in eight fingers with 2 images per finger and 16 images were examined for the morphology of capillaries, presence of pericapillary edema, microhemorrhage, avascular area, and neoangiogenesis. Capillary length, capillary width, apical loop, arterial and venous width, and intercapillary distance were measured from three consecutive capillaries from the ring finger of the non-dominant hand.

Results: COVID-19 patients showed significantly more capillary ramification (p < 0.001), capillary meandering (p = 0.04), microhemorrhage (p < 0.001), neoangiogenesis (p < 0.001), capillary tortuosity (p = 0.003). Capillary density (p = 0.002) and capillary length (p = 0.002) were significantly lower in the patient group while intercapillary distance (p = 0.01) was significantly longer compared with healthy volunteers. Morphologically, patients with MIS-C had a higher frequency of capillary ramification and neoangiogenesis compared with COVID-19 patients (p = 0.04).

Conclusion: Abnormal capillary alterations seen in COVID-19 and MIS-C patients indicate both similar and different aspects of these two spectra of SARS-CoV-2 infection and NVC appears to be a simple and non-invasive method for evaluation of microvascular involvement.
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http://dx.doi.org/10.1016/j.mvr.2021.104196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190529PMC
November 2021

The Effect of a Cartoon and an Information Video About Intravenous Insertion on Pain and Fear in Children Aged 6 to 12 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial.

J Emerg Nurs 2021 Jan 18;47(1):76-87. Epub 2020 Jul 18.

Introduction: Intravenous insertion is the most common invasive procedure made for administering intravascular fluid and medicine. Peripheral venous catheterization may cause pain, fear, and stress in children. This study aimed to compare the effects of watching a cartoon and an information video about intravenous insertion on the pain and fear levels of children aged 6-12 years.

Methods: The study was an experimental, randomized controlled clinical trial. It was conducted with 477 children aged 6-12 years randomized into 3 groups: the informative animated video group, the cartoon group, and the control group. Fear and pain perception were evaluated on the basis of the feedback from the child, observer nurse, and parents. The Children's Fear Scale was used to evaluate the fear level and the Wong-Baker FACES Scale was used to assess pain levels. Data were analyzed using one-way analysis of variance, the chi-square test, and the intraclass correlation coefficient test.

Results: The children who watched the information video before the intravenous insertion procedure and those who watched a cartoon during the procedure had lower mean pain and fear scores as evaluated by the child (pain: F = 278.67, P = 0.001; fear: F = 294.88, P = 0.001), parent (pain: F = 279.53, P = 0.001; fear: F = 294.47, P = 0.001), and nurse (pain: F = 286.88, P = 0.001; fear: F = 300.81, P = 0.001) than children in the control group.

Discussion: This study showed that watching an animation video or a cartoon was effective in lowering children's perceived level of pain and fear during an intravenous insertion intervention.
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http://dx.doi.org/10.1016/j.jen.2020.04.011DOI Listing
January 2021

Evaluation of the Efficacy and Safety of 3 Different Management Protocols in Pediatric Diabetic Ketoacidosis.

Pediatr Emerg Care 2019 Mar 22. Epub 2019 Mar 22.

Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Objective: Management protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among medical centers. The aim of this study was to investigate the efficacy and safety of 3 different fluid protocols in the management of DKA.

Methods: Fluid management protocols with sodium contents of 75, 100, and 154 mEq/L NaCl were compared. In all groups, after the initial rehydration, the protocols differed from each other in terms of the maintenance fluid, which had different rates of infusion and sodium contents. Clinical status and blood glucose levels were checked every hour during the first 12 hours. Biochemical tests were repeated at 2, 6, 12, 24, and 36 hours.

Results: The medical records of 144 patients were evaluated. Cerebral edema developed in 18% of the patients. The incidence of cerebral edema was lowest in the group that received fluid therapy with a sodium content of 154 mEq/L NaCl at least 4 to 6 hours and had a constant rate of infusion for 48 hours. The patients with cerebral edema had lower initial pH and HCO3 and severe dehydration with higher initial plasma osmolality. There was no significant difference between the groups in terms of the recovery times of blood glucose, pH, HCO3, and the time of transition to subcutaneous insulin therapy.

Conclusions: Severity of acidosis and dehydration are associated with the development of cerebral edema. It can be concluded that fluid therapy with higher Na content and a constant maintenance rate may present less risk for the patient with DKA.
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http://dx.doi.org/10.1097/PEC.0000000000001770DOI Listing
March 2019

Rational drug use for acute bronchiolitis in emergency care.

Turk J Pediatr 2017 ;59(2):155-161

Department of Pediatric Emergency, Istanbul University, Istanbul Faculty of Medicine; İstanbul, Turkey.

Uysalol M, Haşlak F, Özünal ZG, Vehid H, Uzel N. Rational drug use for acute bronchiolitis in emergency care. Turk J Pediatr 2017; 59: 155-161. Despite the large variety of inhaled treatment options of acute bronchiolitis, there is no generally agreed treatment regime. This study aimed to determine the most appropriate treatment option. This was a double-blind randomized prospective clinical trial and has been performed in emergency department. The mean age of the 378 infants included in the study was 7.63 ± 4.6 months, and 54.8% (207) were boys. Patients were randomized by using the lottery method for simple random sample into 5 different treatment options; 3% hypertonic saline, nebulized adrenaline, nebulized adrenaline mixed with 3% hypertonic saline, nebulized salbutamol, and as control group; normal saline (0.9% NaCl). From the first treatment time until discharge time; treatment durations, adverse events and readmission rates within the first fifteen days were recorded for each patient. Nebulized adrenaline mixed with 3% hypertonic saline, as compared with other options, were associated with a significantly higher discharge rate at 4th hours (p < 0.001) and shorter length of hospital stay (p=0.039). However, there was no significant difference between options with regard to adverse events, discharge rates at 24th hours, and readmission rates within the first fifteen days. The superiority of discharge rates at 4 hours of nebulized adrenaline mixed with 3% hypertonic saline, was evaluated as `better acute response` and can be helpful to reduce hospitalization needs. Additionally, this option seems to be more effective to reduce length of hospital stay.
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http://dx.doi.org/10.24953/turkjped.2017.02.007DOI Listing
November 2018

Clinical differences of influenza subspecies among hospitalized children.

Turk Pediatri Ars 2017 Mar 1;52(1):15-22. Epub 2017 Mar 1.

Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Aim: Clinical findings, mortality, and morbidity rates differ among influenza subspecies. Awareness of these differences will lead physicians to choose the proper diagnostic and therapeutic strategies and to foresee possible complications. The aim of this study was to evaluate the clinical differences of influenza subspecies among hospitalized children.

Material And Methods: Hospitalized children with proven influenza infection by polymerase chain reaction on nasopharyngeal swab specimens in our clinic, between December 2013 and March 2016, were enrolled. These children were divided into 3 groups as Influenza A/H1N1 (n=42), Influenza A/H3N2 (n=23), and Influenza B (n=35).

Results: The median age of the children was 51.5 months (range, 3-204 months). The most common presenting symptoms were fever (n=83), cough (n=58), and difficulty in breathing (n=25). The most common non-respiratory findings were lymphadenopathy (n=18) and gastrointestinal system involvement (n=17). Sixty-two percent of the patients (n=62) had chronic diseases. H1N1 and H3N2 were significantly more common among patients with chronic neurologic disorders and renal failure, respectively. Leukopenia (n=32) and thrombocytopenia (n=22) were the most common pathologic laboratory findings. Neutropenia, elevated CRP levels, and antibiotic use were significantly more common among patients with H1N1 infection. Seven patients were transferred to the intensive care unit with diagnoses of acute respiratory distress syndrome (n=4), encephalitis (n=2), and bronchiolitis (n=1). Two patients with chronic diseases and H1N1 infection died secondary to acute respiratory distress syndrome.

Conclusions: Influenza A/H1N1 infection represented more severe clinical disease.
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http://dx.doi.org/10.5152/TurkPediatriArs.2017.4695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396817PMC
March 2017

A 3 Year-Old Male Child Ingested Approximately 750 Grams of Elemental Mercury.

Balkan Med J 2016 Jul 1;33(4):467-9. Epub 2016 Jul 1.

Department of Pediatrics, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Background: The oral ingestion of elemental mercury is unlikely to cause systemic toxicity, as it is poorly absorbed through the gastrointestinal system. However, abnormal gastrointestinal function or anatomy may allow elemental mercury into the bloodstream and the peritoneal space. Systemic effects of massive oral intake of mercury have rarely been reported.

Case Report: In this paper, we are presenting the highest single oral intake of elemental mercury by a child aged 3 years. A Libyan boy aged 3 years ingested approximately 750 grams of elemental mercury and was still asymptomatic.

Conclusion: The patient had no existing disease or abnormal gastrointestinal function or anatomy. The physical examination was normal. His serum mercury level was 91 µg/L (normal: <5 µg/L), and he showed no clinical manifestations. Exposure to mercury in children through different circumstances remains a likely occurrence.
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http://dx.doi.org/10.5152/balkanmedj.2016.15197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001828PMC
July 2016

Influenza in the pediatric population in Istanbul: a one center experience 2009-2014.

Epidemiol Mikrobiol Imunol 2016 Mar;65(1):46-50

Introduction: The aim of the study was to evaluate the clinical characteristics of pediatric patients with influenza infection.

Material And Methods: The patients hospitalized with confirmed influenza between October 2009 and May 2014 were enrolled in this study.

Results: The mean age of the patients was 66 ± 53 months (1-204 months). Fifty-four percent of patients had a chronic underlying disease. Twenty-four patients needed mechanical ventilation support and a two-month-old patient with liver disease died. Except for the 2009-2010 season, all patients who received mechanical ventilation had underlying disease. The hospital admission months were December-February in 2010-2011 and January-March in 2011-2012 as well as in 2012-2013. Convulsion was observed frequently in influenza A cases, and influenza B tended to be detected in older patients (p = 0.024). The most common symptoms in pediatric patients were fever and cough.

Conclusion: It is obvious that to protect against circulating influenza viruses, the risk-based strategy of annual influenza immunization should target school-aged children and children with underlying conditions, especially neurological and pulmonary diseases.
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March 2016

Predictive factor for first wheezing episode.

Turk J Pediatr 2015 Jul-Aug;57(4):367-73

Division of Pediatric Infectious Diseases, Department of Microbiology and Clinical Microbiology, Istanbul University, Istanbul Faculty of Medicine İstanbul, Turkey.

The aim of study was to evaluate various risk in patients who were hospitalized with moderate to severe virus-induced wheezing. Infants hospitalized with virus-induced wheezing were enrolled in the study. Respiratory viruses were detected in nasopharyngeal swab and total IgE levels and skin prick tests were performed in all patients. The mean age of the patients was 11.2±9 months. The most common detected viral agents were Respiratory Syncytial Virus, (33.6%), Influenza virus (16.3.%). Children with positive family history of atopy had their first virus-induced wheezing at an earlier age (9.0 ±7.8 months) than the others (14.2±10.8 months), (p=0.007). Atopy and viral etiology did not significantly influence clinical severity of the disease. Although children with positive parental history of atopy experience first virus-induced wheezing at an earlier age, personal atopy was not found as a risk factor for predicting the severity of the first virus-induced wheezy episode.
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February 2017

Gastrointestinal Involvement of Blue Rubber Bleb Nevus Syndrome in a 16-Year-Old Boy.

J Pediatr Gastroenterol Nutr 2015 Oct;61(4):e16

*Department of Pediatrics, Gastroenterology, Hepatology, and Nutrition †Department of Pediatrics, Emergency Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MPG.0000000000000310DOI Listing
October 2015

Serum level of vitamin D and trace elements in children with recurrent wheezing: a cross-sectional study.

BMC Pediatr 2014 Oct 16;14:270. Epub 2014 Oct 16.

Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390 Istanbul, Turkey.

Background: We aimed to show the relationship between recurrence of wheezing and serum levels of vitamin D, zinc, and copper in wheezy children compared with a healthy group.

Methods: In this cross sectional study, seventy-three children with wheezing and seventy-five controls were included without a follow-up period. The clinical characteristics of the children were assessed, the asthma predictive index and temporal pattern of wheeze were determined. The serum levels of vitamin D, zinc, and copper were measured. Pearson correlation analysis was used to evaluate the relationship between homogeneously distributed variables.

Results: Thirty-two of the seventy-three children (43.8%) had more than three wheezing attacks (recurrent wheezing). The Asthma Predictive Index index was positive in 26 patients (35.6%). When classified to temporal pattern of wheeze, fifty-three of the study group (72.6%) had episodic wheezing and the remainder (27.4%) was classified as multiple-trigger wheezing. We found no overall significant difference between the study and control group in terms of vitamin D and trace elements . The vitamin D and zinc levels were significantly lower and serum copper and copper/zinc ratio was significantly higher in patients with recurrent wheezing (p =0.03, p <0.01, p =0.013, p <0.01, respectively) positive Asthma Predictive Index and multiple-trigger temporal pattern of wheeze compared with patients with non- recurrent wheezing, negative Asthma Predictive Index and episodic temporal pattern of wheeze.

Conclusion: It may be postulated that for the determination of asthma risk in patients with recurrent wheezing, the serum level of vitamin D, copper and zinc can be used as a routine biomarker alongside the Asthma Predictive Index and temporal pattern of wheeze.
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http://dx.doi.org/10.1186/1471-2431-14-270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286924PMC
October 2014

A Rare Form of Guillan Barre Syndrome: A Child Diagnosed with Anti-GD1a and Anti-GD1b Positive Pharyngeal-Cervical-Brachial Variant.

Balkan Med J 2013 Sep 1;30(3):337-41. Epub 2013 Sep 1.

Department of Pediatrics, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.

Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant.

Case Report: Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery.

Conclusion: In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes.
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http://dx.doi.org/10.5152/balkanmedj.2013.8334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115905PMC
September 2013

Role of vitamin D in children with hepatosteatosis.

J Pediatr Gastroenterol Nutr 2014 Jul;59(1):106-11

*Division of Ambulatory Pediatrics, Department of Pediatrics †Division of Pediatric Radiology, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul ‡Department of Forensic Medicine, Faculty of Medicine, Bulent Ecevit University, Zonguldak §Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics ||Department of Biochemistry, Istanbul Faculty of Medicine ¶Department of Social Pediatrics, Institute of Child Health #Division of Pediatric Emergency Medicine, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Background: The increasing incidence of obesity in children is a significant risk factor for nonalcoholic fatty liver disease and obesity-associated morbidity. Vitamin D has a major role in bone mineral metabolism and has antimicrobial, antioxidant properties. In this study we aimed to investigate the role of vitamin D in children with obesity with hepatosteatosis.

Methods: A total of 101 children with obesity were included in this study. Hepatosteatosis was diagnosed and graded using ultrasonography. Serum levels of 25-hydroxyvitamin D (25-(OH) vitamin D), calcium, phosphate, alkaline phosphatase, and parathormone were tested. Two-sided t test and Pearson χ tests were used for the relation between vitamin D and hepatosteatosis.

Results: In our study group, 45.5% were girls (n=46) and the mean age was 11.5 ± 2.8 years (range 3-17 years). Hepatosteatosis was identified in 58 children (57.4%). The diagnosis of grade 1 and grade 2 hepatosteatosis was made in 41 (40.6%) and 17 (16.8%) children, respectively. Median serum 25-(OH) vitamin D levels in children without hepatosteatosis was 16.4 ng/mL (interquartile range 12.4-24.8 ng/mL), whereas children with grade 1 and grade 2 hepatosteatosis had 25-(OH) vitamin D levels of 14.2 ng/mL (interquartile range 9.5-21.2 ng/mL) and 11.5 ng/mL (interquartile range 7.5-16.7 ng/mL), respectively (P=0.005). There was a positive correlation between insulin resistance and the grade of hepatosteatosis (P=0.03).

Conclusions: Serum vitamin D levels in children with obesity with hepatosteatosis are significantly lower than vitamin D levels in children with obesity without hepatosteatosis. In this observational study we only refer to the association of vitamin D deficiency/insufficiency with hepatosteatosis.
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http://dx.doi.org/10.1097/MPG.0000000000000371DOI Listing
July 2014

Childhood asthma and vitamin D deficiency in Turkey: is there cause and effect relationship between them?

Ital J Pediatr 2013 Dec 13;39:78. Epub 2013 Dec 13.

Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Fatih/Capa, 34093 Istanbul, Turkey.

Background: Epidemiological studies show that vitamin D deficiency and insufficiency are common worldwide and associated with many diseases including asthma. Our aim was to evaluate vitamin D insufficiency and its clinical consequences.

Methods: This cross-sectional study was carried out on 170 children consisted of 85 who were asthmatic and 85 who were not, aged 2 to 14 years in Tekirdag, Turkey, from September 2009 to May 2010. Children's basal serum D vitamin levels were determined, and their eating habits, vitamin D intake, exposure to sunlight and use of health services during the previous year were investigated. The severity of asthma and levels of asthma control were assessed according to the Global Initiative for Asthma guidelines.

Results: The difference between mean vitamin D levels in the asthmatic group (mean +/- SD) 16.6 +/- 8.5 ng/mL and the healthy control group (mean +/- SD) 28.2 +/- 19.5 ng/mL was found to be statistically significant (p < 0.001). Children in the asthma group had less exposure to sunlight and ate a diet less rich in vitamin D (p < 0.001). A significant difference was observed between the groups regarding the frequency of respiratory tract infections leading to emergency unit admissions and number of hospitalizations (p < 0.001). It was also shown that a decrease in vitamin D level increased the severity of asthma (p < 0.001) and decreased the frequency of controlled asthma (p = 0.010).

Conclusion: This study has demonstrated the correlation between plasma 25 (OH) D levels and childhood asthma. Evidently, this relationship being influenced by multiple factors other than vitamin D, further studies should be conducted to explore the interrelation between all such factors.
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http://dx.doi.org/10.1186/1824-7288-39-78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3892001PMC
December 2013

Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children.

Pediatr Int 2003 Oct;45(5):555-9

Department of Pediatrics, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Background: Intervention trials have shown that zinc may be efficacious in treating acute diarrhea in children of developing countries. A double-blind placebo-controlled study was designed to evaluate the effects of zinc supplementation on the clinical course and duration of diarrhea in malnourished Turkish children.

Methods: The study group comprised 40 subjects with low zinc levels (Group 1a) and 52 subjects with normal zinc levels (Group 1b). The control group was also comprised of two subgroups: 36 subjects with low zinc levels (Group 2a) and 54 subject with normal zinc levels (Group 2b). Forty-three percent of children in the study group and 40% of controls had low serum zinc levels (<14 micromol/L), and 43% of subjects in both groups had very low serum zinc concentrations (<10 micromol/L). The study group were given 20 mg zinc per day for 10 days and the control group were given 750 mg glucose per day as a placebo for 10 days.

Results: The mean duration of diarrhea was shorter and the percentage of children with consistent diarrhea for more than 3-7 days was lower in the study subgroups than in the control subgroups. Prolonged diarrhea was present in 12% of children in the study group, and in 44% and 37% of children in the hypozincemic and normozincemic control subgroups, respectively. The was no significant difference among the four subgroups of children in the number of cases with post-enrollment diarrhea of a duration of>14 days. Stool frequency over the first 4 days after enrollment was lower in children in the study group.

Conclusion: It was concluded that zinc supplementation in malnourished children with acute diarrhea may reduce the severity and duration of diarrhea, especially in children with low zinc levels.
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http://dx.doi.org/10.1046/j.1442-200x.2003.01772.xDOI Listing
October 2003
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