Publications by authors named "Pekcan S"

59 Publications

The knowledge and considerations of the physicians regarding the inhaler devices in asthma and COPD: the INTEDA-1 study.

Tuberk Toraks 2013 ;61(3):183-92

Division of Pediatric Chest Diseases, Faculty of Meram Medicine, Necmettin Erbakan University, Konya, Turkey.

Introduction: The present paper was aimed at indicating and discussing the possible problems related to inhaler devices by considering the knowledge and practices of the physicians regarding the inhalation therapies.

Materials And Methods: The present study is a prospective, cross-sectional survey carried out by Turkish Respiratory Society Inhalation Therapy Group between February 2010 and February 2011 with a participation of ten individual centres. Seven inhaler devices that were available on the market in the country were assessed. The data on the problems that 684 clinicians actively attending patients with respiratory disorders experienced in daily clinical practice or their evaluations of their patients were obtained through the questionnaire.

Results: The respondents, most of whom were pulmonologist (37.5%), and pediatrist (38.1%), had been,on average, 11.6 years in profession. The source of information on inhalers and administration techniques were reported to be mainly the internet and patient leaflets. Of the participants only 18.5% reported to have had adequate knowledge of inhaler devices and proper administration techniques. Most of the participants stated that they themselves provided the instructions of administration and that the method was often verbal explanation. The physicians believed that although approximately 60% of the patients used the drug correctly, 40.7% made critical mistakes to have adverse effects on the therapeutic outcome. The most important criteria on which the physians lay greater emphasis in choosing the inhaler devices were the physical capability, skills and age of the patients.

Conclusion: The awareness of proper use of inhaler devices is a fundamental prerequisite for effective inhalation therapy has been improved in physicians. The results of the present study have shown that more effort is required for professional training. Assisting the physicans with medical personnel for training of the patients and educational motivation are required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5578/tt.5343DOI Listing
March 2015

Multicentric analysis of childhood tuberculosis in Turkey.

Turk J Pediatr 2013 Mar-Apr;55(2):121-9

Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya-Turkey.

Only a few series of pediatric tuberculosis (TB) have been reported in the last 20 years. The purpose of this study was to evaluate the clinical, radiological, microbiological, and treatment characteristics of childhood TB. A total of 539 children with childhood TB diagnosed over a 12-year period (1994-2005) in 16 different centers in Turkey participated in the study. The medical records of all childhood TB patients were investigated. A total of 539 children (274 males, 265 females) with childhood TB aged 10 days-17 years participated in the study. Age distribution was nearly equal among all age groups. We detected the index case in 39.8% of the patients. More than one index case was detected in 17.3% of the patients. A minimum 15-mm induration is accepted on tuberculin skin test (TST) following Bacillus Calmette-Guérin (BCG) vaccination. The TST was positive in 55.3% of the patients. Acid-fast bacillus smear was positive in 133, and polymerase chain reaction for Mycobacterium tuberculosis was positive in 45 patients. In 75 patients (13.9%), cultures yielded M. tuberculosis. One hundred fifty-one patients (28%) did not present for followup, and families of 5 patients (0.9%) discontinued the treatment. Pulmonary TB (n=285) and meningeal TB (n=85) were the most frequent diseases. In 29% of the patients, there was poor adherence to treatment or patients were lost to follow-up. We have demonstrated that household contact screening procedures play a major and important role, especially considering the high ratio of cases with contact index cases. We also recommend that the positive TST values should be reviewed according to the local cut-off data and should be specified in as many countries as possible. In view of the considerably high percentages of patients lost to follow-up and treatment discontinuation observed in our study, we suggest that application of directly observed treatment short-course (DOTS) is preferable.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2013

Complex sleep apnea syndrome in a child with Chiari malformation type 1.

Turk J Pediatr 2013 Jan-Feb;55(1):107-11

Department of Chest Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.

There are few reports of a patient presenting with symptoms of obstructive sleep apnea syndrome (OSAS) as the sole manifestation of Chiari malformation type 1 (CM1). In the literature, complex sleep apnea syndrome (CompSAS) was also reported as a rare condition related to CM1 patients. We report the case of a 13-year-old patient with the complaint of snoring and difficulty in breathing during sleep, but otherwise healthy. After an initial polysomnography, the patient was diagnosed with OSAS and nocturnal continuous hypoxemia. The child underwent titration to pressure of continuous positive airway pressure (CPAP); obstructive apnea improved but central apnea (i.e., CompSAS) and nocturnal continuous hypoxemia persisted. Magnetic resonance imaging led to diagnosis of CM1. Her central apnea and nocturnal hypoxemia resolved following bi-level positive airway pressure-spontaneous-timed (S/T) (BiPAPS/ T) treatment. We emphasize that the CM1 cases can admit with only breathing problems during sleep without concomitant neurological findings, and this malformation can cause central apnea resistant to CPAP.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2013

The role of serum Pseudomonas aeruginosa antibodies in the diagnosis and follow-up of cystic fibrosis.

Turk J Pediatr 2013 Jan-Feb;55(1):50-7

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

In cystic fibrosis (CF), if Pseudomonas aeruginosa (Pa) infection is not diagnosed and treated early, chronic colonization occurs, which causes rapid decline in pulmonary functions. The aim of this study was to evaluate Pa antibodies, compare them with Pa cultures and determine their role in early diagnosis and follow-up. Ninety CF patients were included; they were divided into chronic, intermittent, negative, and mucoid groups. They were evaluated every 3-6 months. In each visit, pulmonary function tests and sputum cultures were obtained, and Pa antibodies exotoxin A (ExoA), elastase (ELA) and alkaline protease (AP) were determined in the serum by enzyme-linked immunosorbent assay (ELISA). The most specific test that discriminated chronic colonized patients from noncolonized patients was Pa culture, and the presence of at least one antibody had the highest sensitivity. AP had the highest specificity, and ELA had the highest sensitivity. All antibodies were highest in the mucoid group. ELA was highest in chronic and lowest in the negative group. The presence of antibodies was much higher than positive Pa cultures in patients younger than five years of age. A negative correlation between forced expiratory volume in 1 second (FEV1) and AP was determined only in the mucoid group. In the two-year follow-up, antibody presence did not show a regular pattern. In CF, Pa antibodies can be early markers for diagnosis, especially in young children who cannot expectorate, but they should only be used together with sputum cultures for long-term follow-up and treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2013

Cystic and cavitary lung lesions in children: radiologic findings with pathologic correlation.

J Clin Imaging Sci 2013 31;3:60. Epub 2013 Dec 31.

Department of Radiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.

A number of diseases produce focal or multiple thin-walled or thick-walled air- or fluid-containing cysts or cavitary lung lesions in both infants and children. In infants and children, there is a spectrum of focal or multifocal cystic and cavitary lung lesions including congenital lobar emphysema, congenital cystic adenomatoid malformation, pleuropulmonary blastoma, bronchogenic cyst, pulmonary sequestration, Langerhans cell histiocytosis, airway diseases, infectious diseases (bacterial infection, fungal infection, etc.), hydatid cysts, destroid lung, and traumatic pseudocyst. For the evaluation of cystic or cavitary lung lesion in infants and children, imaging plays an important role in accurate early diagnosis and optimal patient management. Therefore, a practical imaging approach based on the most sensitive and least invasive imaging modality in an efficient and cost-effective manner is paramount. We reviewed the conventional radiographs and computed tomography findings of the most common cystic and cavitary lung lesions in infants and children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/2156-7514.124087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935260PMC
June 2014

Comparing the efficacy of nebulizer recombinant human DNase and hypertonic saline as monotherapy and combined treatment in the treatment of persistent atelectasis in mechanically ventilated newborns.

Pediatr Int 2012 Feb;54(1):131-6

Division of Neonatology, Selcuk University Meram Medical Faculty, Konya, Turkey.

Background: The purpose of the present study was to compare the cost-effectiveness and efficacy of nebulizer recombinant human DNase (rhDNase) and hypertonic saline (HS) as monotherapy and combined treatment in neonatal atelectasis.

Methods: Eighty-seven newborns with persistent atelectasis who did not respond to traditional treatment were studied retrospectively. Group 1 did not receive nebulizer drugs; Group 2 received 7%HS; Group 3 received rhDNase; and Group 4 received both 7%HS and rhDNase. Subjects' chest X-ray scores, partial pressure of CO(2), respiratory rate, fraction of inspired oxygen (FiO(2)) peak inspiratory pressure, atelectasis healing rate, median duration of nebulizer treatment and costs were compared.

Results: Percentages of improvement in atelectasis on Day 3 of treatment in Group 1, Group 2, Group 3 and Group 4 were 27, 70, 81 and 95%, respectively, while median duration of treatment was 8.1, 3.3, 2.9 and 2.4 days, respectively. Comparison of chest X-ray scores, partial pressure of CO(2), respiratory rate, FiO(2) and peak inspiratory pressure values before and 48 h after treatment did not yield a significant difference for the control group (P > 0.05), while a marked improvement was observed in other groups for all parameters (P < 0.05). The most distinct improvement was in Group 4, followed by Group 3.

Conclusions: Although both the combined treatment with HS and rhDNase and their monotherapies are effective in the treatment of persistent atelectasis in newborns receiving mechanical ventilation, their combined use produces higher efficacy. The efficacy of rhDNase is superior to monotherapy with HS. Use of these two treatments concomitantly reduces the cost. To the best of our knowledge, the present study is the first to use HS alone or in combination with rhDNase in newborn patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1442-200X.2011.03519.xDOI Listing
February 2012

A rare cause of bacteremia in a pediatric patient with Down syndrome: Sphingomonas paucimobilis.

Int J Med Sci 2011 14;8(7):537-9. Epub 2011 Sep 14.

Department of Medical Microbiology, Selcuk University Meram Faculty of Medicine, Konya, Turkey.

Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non fermentative, gram negative motile bacillus. S. paucimobilis which is widely found in nature and hospital environments rarely cause serious or life threatening infections. In this report, a case of hospital acquired bloodstream infection due to S. paucimobilis in a patient with Down syndrome who was on treatment for presumed pneumonia is presented. A one year-old child patient who was a known case of Down syndrome and had previously experienced cardiac surgery was hospitalized and treated for pneumonia. On the 12th day of hospitalization, blood cultures were taken because of a high body temperature. One of the blood cultures was positive for gram-negative rods. After 48 hour of incubation, the sub-cultures on blood agar medium yielded pure growth of a yellow, non-fermentative, gram-negative, rod-shaped bacterium. The microorganism was positive for oxidase, and esculin hydrolysis, while negative for urea and nitrate reduction, citrate utilisation and motility. The isolate had been identified as S. paucimobilis by using Vitek 2 system. The antibiotic susceptibility test was also performed with the same system and the strain was found to be susceptible to piperacillin-tazobactam and other antibiotics. Treatment with intravenous piperacilin-tazobactam (150 mg/kg/day) was initiated. He responded well to the treatment and was discharged after 10 days. This case is reported to emphasize that S. paucimobilis should be kept in mind as a nosocomial infectious agent in patients with Down syndrome and immunosuppressive patients and the infections should be treated according to the sensitivity test results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180768PMC
http://dx.doi.org/10.7150/ijms.8.537DOI Listing
January 2012

[Cystic echinococcosis mimicking tuberculosis in childhood].

Turkiye Parazitol Derg 2011 ;35(1):53-6

Selçuk Üniversitesi Meram Tıp Fakültesi, Çocuk Göğüs Hastalıkları Bilim Dalı, Konya, Turkey.

Both cystic echinococcosis (CE) and tuberculosis (Tbc) are important health problems in developing countries. Pulmonary CE and Tbc have to be differentiated from other diseases as they have increased the risk of morbidity and mortality. Besides, these two diseases can mimic each other. Here, we discuss a 7 year-old patient admitted with fever, cough who was unresponsive to nonspecific antibiotic treatment given for pneumonia, had Tbc treatment due to a positive tuberculin skin test and radiologic appearance consistent with Tbc and on follow-up. He was eventually diagnosed as CE based on a cystic lesion consistent with CE in the liver and echinococcosis specific IgE positivity and was succesfully treated with anti-parasitic therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/tpd.2011.14DOI Listing
July 2012

Pediatric pulmonology in a developing country: our focus.

Turk J Pediatr 2011 Jan-Feb;53(1):11-8

Department of Pediatrics, Selçuk University Faculty of Medicine, Konya, Turkey.

This study was designed to determine the profile of our pediatric pulmonology unit in Turkey, a developing country, by investigating the patients admitted to our unit for the first time. Our objectives were: to determine the profile of patients admitted for the first time, to compare their initial diagnoses before referral to our hospital with the diagnoses determined in our unit, to determine the definitive diagnoses for patients requiring advanced intervention with invasive diagnostic methods, and to follow the treatments, operations and invasive-noninvasive mechanical ventilation practices. With these objectives in mind, the records of 412 patients who visited the pediatric pulmonology clinic within a six-month period were reviewed. The referral diagnoses, consisting mostly of primary ciliary dyskinesia, recurrent lung infections caused by immune deficiency and bronchiectasis, as well as definitive diagnoses were recorded. Tuberculosis (14%), cystic fibrosis (7.8%), bronchiectasis (4.6%), immune deficiency (1.6%), hydatid cyst (2%), and primary ciliary dyskinesia (1%) were the most commonly diagnosed diseases. Final diagnosis in 145 of the 412 patients (35.2%) differed from the referral diagnosis. Consanguineous marriages are encountered more commonly in developing countries like Turkey, leading to an increased incidence of genetic diseases such as primary ciliary dysgenesis, cystic fibrosis and immune deficiencies. Infectious diseases such as hydatid cyst and tuberculosis are also common. In any country in which there is a unique distribution of diseases, in other words, a characteristic and unique disease spectrum, courses and instructional fellowship programs should be arranged accordingly.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2011

Freeman-Sheldon (whistling face) syndrome with hyperpyrexia in the newborn: case report.

Genet Couns 2010 ;21(3):347-51

Department of Neonatology, Selcuk University, Konya, Turkey.

Freeman Sheldon syndrome (FSS) is a rare, multiple congenital contracture syndrome that is relatively well-known, since affected children have a striking appearance. This entity was historically referred to as the "whistling-face syndrome". Malignant hyperthermia and hyperpyrexia have been documented in FSS after general anesthesia related to the neuropathy. We report a male neonate with FSS and hyperpyrexia without anesthesia. To our knowledge, our patient is the first in the literature with hyperpyrexia in the newborn period without anesthesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2010

Home mechanical ventilation: outcomes according to remoteness from health center and different family education levels.

Turk J Pediatr 2010 May-Jun;52(3):267-73

Pediatric Chest Diseases Unit, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Throughout the world, home mechanical ventilation (HMV) is being increasingly employed to treat patients suffering from chronic respiratory failure. This present study aimed to examine the characteristics and outcomes of 27 children seen in our department over a four-year period who were treated with HMV. The causes of chronic respiratory failure were as follows: 16 (59.3%) neuromuscular disease, 6 (22.2%) primary respiratory diseases, 3 (11.1%) congenital heart disease, and 2 (7.4%) storage disease. The mean age was 59.4 months (1 day-15 years); mean follow-up for invasive ventilation was 356 (0-1200) days and for non-invasive HMV was 517 (30-1440) days. With respect to maternal educational level, 13 had graduated from elementary school and 14 from high school or university. Nine of our patients resided in Ankara, while 18 lived in rural areas of Turkey. Eleven of the 27 patients died during the HMV period (1-36 months) at home. Five patients were weaned from HMV between 1-19 months. Our experience showed that HMV can be applied successfully in chronic respiratory failure patients in Turkey. Length of the follow-up period and mortality rate were not affected by the patient's place of residence (city center or rural) or maternal level of education.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2010

B-cell maturation and antibody responses in individuals carrying a mutated CD19 allele.

Genes Immun 2010 Oct 6;11(7):523-30. Epub 2010 May 6.

Department of Pediatric Immunology and Allergy, Selçuk University, Konya, Turkey.

Homozygous CD19 mutations lead to an antibody deficiency due to disruption of the CD19 complex and consequent impaired signaling by the B-cell antigen receptor. We studied the effects of heterozygous CD19 mutations on peripheral B-cell development and antibody responses in a large family with multiple consanguineous marriages. Sequence analysis of 96 family members revealed 30 carriers of the CD19 mutation. Lymphocyte subset counts were not significantly different between carriers and noncarriers in three different age groups (0-10 years; 11-18 years; adults). B cells of carriers had reduced CD19 and CD21 median expression levels, and had reduced proportions of transitional (0-10 years) and CD5(+) B cells (adults). CD19 carriers did not show clinical signs of immunodeficiency; they were well capable to produce normal serum Ig levels and had normal responses to primary and booster vaccinations. The frequency of mutated Vκ alleles was not affected. Heterozygous loss of CD19 causes some changes in the naive B-cell compartment, but overall in vivo B-cell maturation or humoral immunity is not affected. Many antibody deficiencies are not monogenetic, but likely caused by a combination of multiple genetic variations. Therefore, functional analyses of immune cell function should be carried out to show whether heterozygous mutations contribute to disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/gene.2010.22DOI Listing
October 2010

TAP1 and TAP2 gene polymorphisms in childhood cystic echinococcosis.

Parasitol Int 2010 Jun 26;59(2):283-5. Epub 2010 Feb 26.

Hacettepe University, Department of Pediatrics, Chest Diseases Unit, Ankara, Turkey.

The incidence of cystic echinococcosis (CE) due to Echinococcus granulosus is as high as 2000-2500 patients per year in Turkey. Whether genetic characteristics of the Turkish population cause a tendency to the disease is currently unknown. We aimed at studying the role of TAP gene polymorphisms in Turkish children with cystic echinococcosis. For an overview of allelic distribution of TAP1 and TAP2 genes, genotypes of 85 patients with CE and 100 controls were studied. To determine the genotype-phenotype correlation, 81 of the patients whose clinical data were available were analyzed. For TAP1-637, Asp/Gly heterozygosity was significantly more prevalent in CE patients than in controls (20 vs. 4%, odds ratio 6.0), while Gly/Gly homozygosity was less frequent (5 vs. 14%). For TAP2-379, Ile/Val heterozygosity was significantly more prevalent in CE patients than in controls (14 vs. 1%, odds ratio 16.27), while Ile/Ile homozygosity was less frequent (13 vs. 25%). TAP1-637 and TAP2-379 polymorphisms may have a role in causing genetic tendency for CE in children. The data may reflect the genetic properties of the Turkish population or may reveal the minor role of TAP gene polymorphisms in CE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.parint.2010.02.012DOI Listing
June 2010

The role of human leucocyte antigens in children with hydatid disease: their association with clinical condition and prognosis.

Parasitol Res 2010 Mar 29;106(4):795-800. Epub 2010 Jan 29.

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

Hydatid disease (HD) is a parasitosis caused by Echinococcus granulosus, which is still an important health problem worldwide, and our country is an endemic region for HD. There is little information regarding the role of human leucocyte antigen (HLA) in genetic susceptibility or resistance to HD. In this study, we aimed to investigate the HLA profile of Turkish children with HD and to compare them with healthy individuals. We also planned to investigate whether HLAs have a potential role in the predisposition to or prevention of the occurrence of HD and to study the relationship between the clinical features of HD and the HLA profile of the patients. The study included 81 children (25 boys, 56 girls) with HD aged between 3 and 18 years. All the patients' and control subjects' HLA class I and II antigens were examined, antigen allele frequencies were calculated, and clinical characteristics were also evaluated. The frequency of HLA-B18, -DR1, and -DR15 alleles were significantly different between the patients and healthy groups; HLA-DR15 antigen might be associated with HD occurrence, and the presence of HLA-B18 and HLA-DR1 antigens might be associated with HD resistance. Compared with the healthy group, patients with lung HD had a significant increase in HLA-B44 frequency, and liver HD patients had a significant increase in HLA-DR15 antigen frequency. Furthermore, presence of HLA-DR11 was found to be a significant factor associated with cure of the disease. We concluded that HLA types have significant impact on the development of HD and clinical course of disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00436-009-1719-zDOI Listing
March 2010

Does defective apoptosis play a role in cystic fibrosis lung disease?

Arch Med Res 2009 Oct 25;40(7):561-4. Epub 2009 Sep 25.

Department of Pediatrics, Hacettepe University, Ankara, Turkey.

Background And Aims: Although apoptotic dysfunction has recently been suggested in cystic fibrosis (CF), there are few studies reported concerning apoptosis in CF with controversial results. The aim of this study was to investigate apoptosis in CF human lung tissues and compare with non-CF bronchiectatic and normal healthy lung tissues. We also investigated the relation between apoptosis and histopathological features of tissues and microbiological factors influencing apoptosis.

Methods: Lung tissue samples from CF (n=30), non-CF bronchiectasis (n=28, BE group) and normal control cases (n=24, C group) were included in the study. Histological examination of H & E-stained archived slides was performed and TUNEL method was used to detect DNA fragmentation.

Results: Apoptotic alveolar epithelial cells were significantly increased in the CF group compared to BE and C groups (p=0.046). Bronchopneumonia (BP) was present in 15 CF cases (50%), whereas none of the cases in C group had BP (p=0.0001). Apoptosis was significantly increased in cases with BP (n=17) compared to cases without BP (n=65) (p=0.04).

Conclusions: Apoptotic epithelial cells and BP were significantly increased in the CF group and excess level of apoptosis may be the result of enhanced occurrence of BP. Apoptotic cells were alveolar epithelial cells in the great majority of the patients and were not detected in other locations where CFTR expression is much more prominent than alveolar cells. We may postulate that increased apoptotic findings in the alveolar epithelium were related with the presence of chronic infections rather than CFTR dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arcmed.2009.07.005DOI Listing
October 2009

Cystic fibrosis with acute myelogenous leukemia.

Turk J Pediatr 2009 May-Jun;51(3):290-3

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

Hematologic malignancies including acute leukemias rarely associate with cystic fibrosis (CF). In this paper, we describe a case who was diagnosed with CF when she was three months old and presented with acute myelogenous leukemia (AML) at the age of 17 years. Although she received reduced doses of chemotherapy because of her clinical status she responded well. She is the first CF patient who developed AML in our department among 296 CF patients over a 22-year period.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2009

Pediatric pleural effusions: etiological evaluation in 492 patients over 29 years.

Turk J Pediatr 2009 May-Jun;51(3):214-9

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

Pediatric pleural effusions present a changing profile over time, both in terms of etiological subgroups and causative microorganisms in parapneumonic effusions. This retrospective study aimed to review pediatric pleural effusions in a large cohort over a 29-year period, with special emphasis on the etiological subgroups and microbiological causes of parapneumonic effusions. The medical records of 492 pediatric patients were reviewed for a comparison of subgroups of pleural effusions and microbiological causes of parapneumonic effusions between three decades. Parapneumonic effusions (381 patients) made up 77.4% of the group. Tuberculous pleurisy decreased, but malignant effusions doubled in number over time. A causative microorganism was identified in 34.6% overall, with Staphylococcus aureus and Streptococcus pneumoniae being the two most common. Relative frequency of S. aureus decreased, whereas pneumococci and Haemophilus influenzae were more frequent in recent years.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2009

Gorham-Stout Syndrome with chylothorax: successful remission by interferon alpha-2b.

Pediatr Pulmonol 2009 Jun;44(6):613-5

Department of Pediatrics, Division of Pediatric Pulmonology Unit, Hacettepe University, Ankara, Turkey.

Gorham-Stout syndrome is a rare disease and most often recognized in children and young adults. Chylothorax is a serious complication of Gorham-Stout syndrome. The treatment of either Gorham-Stout syndrome or chylothorax is still a dilemma. We described a 9-year-old girl with Gorham-Stout syndrome and chylothorax who was admitted to our hospital because of dyspnea, orthopnea, and bone pain, and treated with interferon alpha-2b.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.20849DOI Listing
June 2009

Congenital tuberculosis in premature twins after in vitro fertilisation.

BMJ Case Rep 2009 7;2009. Epub 2009 Sep 7.

Neonatology, Meram Medical Faculty, Selcuk University, Meram-Konya, Konya, 42080, Turkey.

Genital tuberculosis is a major cause of infertility in countries where tuberculosis is endemic. With recent advances in assisted reproductive technology, women with tuberculous endometritis may become pregnant and ultimately have children with congenital tuberculosis. In vitro fertilisation represents a useful treatment for infertility. Congenital tuberculosis is a rare and severe, rapidly progressive, disease. Making an early diagnosis of congenital tuberculosis is difficult, because it can mimic many neonatal illnesses. To the best of our knowledge, we report the first cases of premature twins with congenital tuberculosis following in vitro fertilisation. After the diagnosis of genital tuberculosis in the mother, the twins were screened and diagnosed for tuberculosis. The twins dramatically improved after anti-tuberculosis therapy. We also wish to draw attention to the importance of searching for genital tuberculosis as the possible cause of congenital infection, even if the mother is asymptomatic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr.05.2009.1894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027786PMC
November 2011

A 4-month-old boy with acrodermatitis enteropathica-like symptoms.

Eur J Pediatr 2009 Jan 11;168(1):119-21. Epub 2008 Sep 11.

Department of Pediatrics, Division of Pediatric Pulmonology Unit, Hacettepe University, School of Medicine, Ankara, 06100, Turkey.

A 4-month-old boy was admitted for having diffuse eruption in the perianal region, legs, trunk hands, and face with failure to thrive, edema, hypoalbuminemia, and anemia. The patient was thought to have acrodermatitis enteropathica-like eruption due to malabsorption. The eruption completely resolved with enzyme supplement and proper nutrition and skin care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-008-0825-8DOI Listing
January 2009

Gastric organo-axial malrotation coexisting respiratory symptoms.

Eur J Pediatr 2009 Apr 5;168(4):491-4. Epub 2008 Jul 5.

Department of Pediatrics, Pediatric Pulmonology Unit, Hacettepe University, School of Medicine, Ankara, 06100, Turkey.

Gastric malrotation is defined as a torsion of stomach around its short or long axis. It is a rare disease in childhood. Gastric malrotation may present either as a surgical emergency or as chronic abdominal symptoms. There is limited data about the respiratory symptoms associated with gastric malrotation. The aim of this study was to review the records of 14 children who presented with respiratory symptoms and diagnosed as gastric organo-axial malrotation. Between August 2005 and August 2007, 14 children diagnosed as having gastric organo-axial malrotation participated in this study. There were 11 boys and three girls with a mean age of 7.1 months. All patients were symptomatic. Presenting symptoms included wheezing in four patients, recurrent pneumonia in four, chronic cough in two, chronic cough and apnea in two, recurrent pneumonia and chronic cough in one, and chronic cough and failure to thrive in one. All of our patients had organo-axial gastric malrotation. Gastroesophageal reflux was found in nine patients (64.2%). Six patients were treated with surgery and antireflux medication and the remaining eight patients with antireflux medication. In conclusion, it is probable that gastric malrotation associated with massive or occult gastroesophageal reflux could be responsible for the respiratory symptoms such as chronic cough, recurrent pneumonia, wheezing, and apnea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-008-0777-zDOI Listing
April 2009

Doll-like face: is it an underestimated clinical presentation of cystic fibrosis?

Pediatr Pulmonol 2008 Jul;43(7):634-7

Department of Pediatrics, Division of Pediatric Pulmonology Unit, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Unlabelled: Cystic fibrosis (CF) is the most prevalant inheritable chronic disease in caucasian children. The clinical syndrome of kwashiorkor is well-recognized complication of CF. The edema of the face can be seen in kwashiorkor. As doll-like face is very rare and underestimated clinical presentation of CF patients complicated with hypoproteinemia we evaluated demographic features and laboratory characteristics of 5 patients diagnosed as CF with doll-like face.

Methods: Between June 2005 and January 2008, 115 children were diagnosed as having CF enrolled in our center. Five infants were diagnosed as CF with doll-like face before the age of 6 months participitated in study.

Results: The incidence of doll-like face younger than the 6 months of age were 9.4% in our center. 48 infants diagnosed as CF without doll-like face before the age of 6 months participitated in the study as controls (group2). Physical examination revealed doll-like face and pitting edema of lower extremities in group 1. Their weight and length were under the third centile. Laboratory findings of group 1 include: mean hemoglobin 7.6g/dl; mean total protein 4.4 g/dl; albumin 2.3 g/dl. When compared control group in order to; 11.4 g/dl (range 7.6-17.9); 6.2 g/dl (range 4.0-8.8); 4.7 g/dl (range 2.1-5.8). mean hemoglobin, total protein and albumin values were lower in group 1.

Conclusion: In a subgroup of patients, doll-like face may be the presenting manifestation of CF. Especially in developing countries clinicians should be aware of in patients with malnutrition and doll-like face and CF should be considered in differential diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.20819DOI Listing
July 2008

A case of congenital agenesis of the right pulmonary artery presenting with hemoptysis and mimicking pulmonary hemosiderosis.

Eur J Pediatr 2009 Feb 14;168(2):217-20. Epub 2008 May 14.

Department of Pediatrics, Hacettepe University, Ankara, Turkey.

Congenital unilateral absence of a pulmonary artery is a rare anomaly most frequently accompanied by other cardiovascular anomalies. We report a 10-year-old girl presenting with fatigue and recurrent hemoptysis who was initially misdiagnosed with idiopathic pulmonary hemosiderosis. Her symptoms did not resolve despite treatment so she was referred to our center for further evaluation. We carried out an angiography which revealed the absence of the right pulmonary artery and multiple collaterals originating from the right subclavian and right internal mammary arteries supplying the right lung. During the follow-up the patient developed a severe episode of pulmonary infection and pulmonary hypertension which responded well to medical treatment. Physicians should be aware of the congenital absence of the right pulmonary artery especially in patients presenting with recurrent respiratory symptoms. Although this condition is generally considered to have a good prognosis, close observation is mandatory in order to prevent further complications and comorbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-008-0726-xDOI Listing
February 2009

Interferon-gamma assays for the diagnosis of tuberculosis infection before using tumour necrosis factor-alpha blockers.

Int J Tuberc Lung Dis 2007 Nov;11(11):1177-82

Hacettepe University Faculty of Medicine, Pediatric Pulmonary Diseases Unit, Ankara, Turkey.

Objectives: Patients who receive tumour necrosis factor-alpha (TNF-alpha) blockers are mostly immunosuppressed. A study was performed to investigate whether an interferon-gamma (IFN-gamma) assay could represent an alternative approach to the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI) in these patients.

Design: We prospectively enrolled 106 individuals into the study in two groups. Group 1 consisted of 38 healthy individuals and Group 2 included 68 patients with chronic inflammatory diseases evaluated for LTBI before the use of TNF-alpha blockers.

Results: Of all participants, nine had indeterminate IFN-gamma test results. Agreement between the two tests was poor in both groups (kappa values respectively -0.54 and 0.18). In a total of 97 subjects, 10 (10.3%) were positive by the IFN-gamma test and 49 (50.5%) by TST.

Conclusion: We found poor agreement between TST and the IFN-gamma test in our study. Our limited preliminary data should be accepted as a basis for designing future studies that will be helpful for physicians to decide whether the IFN-gamma test is more sensitive than the TST test in detecting LTBI before the use of TNF-alpha blockers.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2007

Environmental tobacco smoke exposure and respiratory morbidity in children.

Inhal Toxicol 2007 Jul;19(9):779-85

Hacettepe University Pediatric Pulmonary Diseases Unit, Ankara, Turkey.

Environmental tobacco smoke (ETS) contains carcinogenic and toxic agents. Smoking might have a more serious effect on children than adults. We aimed to examine the effects of passive smoking on pulmonary function and respiratory health in children and to assess the concordance between parental self-reported smoking habits and urinary cotinine levels in their children. This cross-sectional study was conducted in the winter with the participation of 131 children (9-12 yr old). The procedure for each subject consisted of administration of a questionnaire to the parents, and collection of a urine sample and measurement of lung function in each child. Cotinine level excreted into urine was analyzed with respect to parental self-reported smoking behavior. Working mothers and mothers with higher level of education tended to smoke more at home (p values, respectively, .002 and .005). There was a statistical difference between the urinary cotinine levels of children when divided into two groups according to their fathers' smoking behavior at home (p = .0001). No statistically significant difference was determined in the mean episodes of respiratory infections treated during the last 12 mo among the groups formed according to daily number of cigarettes smoked by the parents at home (1: not exposed; 2: < 5 cigarettes; 3: 5-10 cigarettes; 4: > 10 cigarettes), or among the groups formed according to urinary cotinine levels (1: < 10 ng/ml; 2: > or =10 ng/ml). No significant difference was demonstrated in any of the respiratory function parameters investigated between the groups considered. The reliability of the declarations of the parents in the estimation of ETS exposure of children was low. Children are unable to remove themselves from ETS exposure. It is better to reduce the percentage of parents who smoke rather than to isolate smokers or increase ventilation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08958370701402085DOI Listing
July 2007

An epidemic of pseudo-Bartter syndrome in cystic fibrosis patients.

Eur J Pediatr 2008 Jan 24;167(1):115-6. Epub 2007 Feb 24.

Department of Pediatrics, Division of Chest Diseases Unit, School of Medicine, Hacettepe University, 06100 Ankara, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-007-0413-3DOI Listing
January 2008

The role of TAP1 and TAP2 gene polymorphism in idiopathic bronchiectasis in children.

Pediatr Pulmonol 2007 Mar;42(3):237-41

Pediatric Pulmonary Medicine Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Bronchiectasis is characterized by permanent changes in the structure and function of the airways. Its cause cannot be identified in some cases. A genetic disease can predispose to bronchiectasis in our country, where consanguinity of parents is common. Transporter associated with antigen presentation (TAP) deficiency syndrome is characterized by recurrent bacterial lower respiratory tract infections, which cause bronchiectasis. Our aim was to document the relationship between idiopathic bronchiectasis and TAP gene polymorphisms. Forty-four patients with idiopathic bronchiectasis and 100 healthy individuals as the control group were included. DNA was extracted and gene polymorphisms for TAP1 and TAP2 were studied. When compared to healthy controls, in the patient group, Ile/Ile genotype was decreased and Ile/Val genotype was increased in TAP1-333 polymorphism analysis; Asp/Asp and Gly/Gly genotypes were decreased and Asp/Gly frequency was increased in TAP1-637 polymorphism analysis; Ile/Val genotype was increased and Ile/Ile genotype was decreased in TAP2-379 polymorphism analysis; and Thr/Thr genotype frequency was decreased and Thr/Ala and Ala/Ala genotypes were increased in TAP2-665 polymorphism analysis. No statistically significant difference between patient and control groups was noted only in TAP2-565 polymorphism analysis. These results indicate that TAP gene polymorphisms may have had a role in the development of bronchiectasis in our patient group. Therefore, TAP deficiency syndrome should be considered in children with idiopathic diagnosis, since early diagnosis of the disease will improve life quality and survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ppul.20560DOI Listing
March 2007

Fatal agranulocytosis developed in the course of carbamazepine therapy. A case report and review of the literature.

Turk J Pediatr 1995 Jan-Mar;37(1):73-7

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

A case of fatal agranulocytosis in an adolescent who was on carbamazepine therapy is presented. The clinical and laboratory findings suggest that the primary cause of the disorder was neutropenia rather than infection, and the preceding factor for neutropenia was carbamazepine. The timing of occurrence of the hematologic picture, its dependency on dose increments, and the lack of symptoms until infection supervened are consistent with an idiosyncratic-toxic drug reaction (type 2 drug reaction). This is the first reported agranulocytosis case due to crabamazepine in adolescence.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 1995
-->