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ABSTRACT: We conducted this prospective randomized trial of intravenous immunoglobulin (IVIG) treatment in children with newly diagnosed immune thrombocytopenic purpura (ITP) to compare the efficacy of IVIG to standard and higher doses of anti-D IVIG. Seventy-eight patients who were previously untreated and between the age of 1 and 18 years with newly diagnosed acute ITP and a platelet concentration less than 20 × 10/l were eligible for enrollment. In this study IVIG treatment was compared with two different doses of anti-D. Study patients were randomized to receive treatment according to one of the two single anti-D IVIG doses [50 μg/kg (n = 19) or 75 μg/kg (n = 20)] or 2 g/kg (400 mg/kg per day, 5 day) total dose of IVIG (n = 39). There is a significant increase of 24th hour, 48th hour, 72nd hour, 7th day and 30th day platelet counts in IVIG (2 g/kg, total dose) group compared to anti-D IVIG 50 μg/kg and anti-D IVIG 75 μg/kg groups. However, there were no difference between 24th hour, 48th hour, 72nd hour, 7th day and 30th day platelet counts across anti-D IVIG 50 μg/kg and anti-D IVIG 75 μg/kg groups. In conclusion, this study suggests that IVIG is well tolerated and significantly more effective than standard and high-dose anti-D IVIG for the treatment of newly diagnosed ITP in children. Apart from this, we believe that IVIG might be the first-line treatment of these patients. Regarding this issue further prospective studies comparing different IVIG treatment regimens with anti-D IVIG treatment regimens are needed.
Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 03/2013; · 1.25 Impact Factor
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ABSTRACT: The aim was to assess the myocardial functions in infants with iron deficiency anemia (IDA). The findings of 22 infants with IDA and 16 healthy infants were compared. Complete blood count in all infants, serum iron level, total iron binding capacity (TIBC), and serum ferritin level in patients were evaluated. Echocardiography with tissue Doppler imaging (TDI) was performed in all infants. The mean hemoglobin was 8.5 versus 11 g/dL, hematocrit was 26.7 versus 33.1% and the mean corpuscular volume (MCV) was 59.8 versus 72.2 fL in patients and controls, respectively. The median serum iron level was 14.5 μg/dL, TIBC was 444 μg/dL, and serum ferritin level was 4.9 ng/mL in patients. There were significant differences between patients and controls for the myocardial performance indexes of the left ventricle (LV) (0.57 vs. 0.45, P < .05), interventricular septum (IVS) (0.56 vs. 0.48, P < .05), and the right ventricle (RV) (0.56 vs. 0.41, P < .05). The similar significances were also present for the ejection times (ET) of the LV (173.1 vs. 212.1 ms, P < .05), IVS (173.7 vs. 195.6 ms, P < .05), and RV (169.9 vs. 213.3 ms, P < .05). In spite of negatively significant correlations between hemoglobin, hematocrit, MCV and MPI, the correlations between these parameters and ET were positively significant. However, there were no correlations between serum iron level, TIBC, serum ferritin level, and the TDI parameters of patients. According to these findings, we could say that, the IDA affects the myocardial functions in a negative manner.
Pediatric Hematology and Oncology 02/2013; · 0.89 Impact Factor
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ABSTRACT: Objective: The aim of this study is to evaluate how fish oil supplementation in children affects platelet function tests in vitro. Materials and Methods: The study included 62 children (20 healthy children without any medications and 42 healthy children who volunteered to take fish oil supplementation) aged between 2 and 12 years. In the group of children taking fish oil supplementation, the baseline, fourth week, and eighth week values for platelet function tests were obtained. Results: In the platelet aggregation tests induced by high dose of ADP after 8 weeks, the values were significantly higher compared with the values measured before the use of fish oil. The fish oil-supplemented group's values showed an increase in the fourth-week measurements compared with the control group and the baseline measurements in terms of platelet secretion test induced by collagen, standard dose of thrombin, and high-dose thrombin. Platelet secretion tests induced by standard dose of ADP at the end of the eighth week showed an increase compared with baseline test values. Conclusion: This study was done in in-vitro conditions wherein the platelet function in the pediatric age group was analyzed and it was found that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in fish oil especially exhibit in-vitro hyperaggregation and increase the secretion of platelets. As a result of this, we consider that it is necessary to be careful while using fish oil supplementation in children as an antithrombotic agent and for a variety of other indications.
Pediatric Hematology and Oncology 01/2013; · 0.89 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this study was to determine the relation between iron deficiency anemia (IDA) and serum leptin, hepcidin, and ghrelin levels. METHODS: Thirty children with IDA and 28 healthy children between the ages of 6 months and 6 years admitted to our hospital were evaluated prospectively. IDA was diagnosed based on clinical and laboratory findings. All children with IDA were treated with iron II-glycine-sulphate complex for 3 months. Complete blood count; iron metabolism parameters; and serum leptin, hepcidin, and ghrelin levels were studied in all healthy children and in children with IDA before and after treatment. RESULTS: In children with IDA, the decrease seen in serum leptin levels after the iron treatment was not statistically significant. However, the increase seen in serum hepcidin levels after the iron treatment was statistically significant (P = 0.038). Hepcidin levels were significantly higher in children with IDA who received iron treatment compared to healthy children (P = 0.008). After the iron treatment, serum ghrelin levels in children with IDA were also significantly higher compared to the levels before treatment and healthy children (P = 0.019 and 0.000, respectively). CONCLUSION: Serum ghrelin and hepcidin levels increase with iron treatment in children with IDA. In view of the higher serum ghrelin and hepcidin levels after iron treatment when compared to pretreatment levels and the healthy children, we suggest that the iron treatment has an important role in serum hepcidin and ghrelin synthesis. J. Clin. Lab. Anal. 00:1-5, 2012. © 2012 Wiley Periodicals, Inc.
Journal of Clinical Laboratory Analysis 01/2013; · 1.38 Impact Factor
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ABSTRACT: In this article, we present a 7-year-old boy with Schoenlein-Henoch purpura (HSP) presented with compartment syndrome and factor XIII deficiency and treated with recombinant factor VIIa and fasciotomy. Treatment decisions for patients with HSP presenting with compartment syndrome should be made on a case-by-case basis. Factor XIII deficiency should be in mind in these patients. The use of recombinant factor VIIa might be effective and well tolerated for treating hemorrhage in patients with HSP and compartment syndrome. Surgical treatment should be preferred in patients with compartment syndrome. However, in patients who have a coagulation defect, the first priority is to correct the clotting deficiency. The use of recombinant factor VIIa is a treatment option for children who develop compartment syndrome due to a coagulation defect.
Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 10/2012; · 1.25 Impact Factor
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ABSTRACT: To determine the effects of an anaphylaxis guideline presentation in residency training, which is an important period for having skilled and knowledgable doctors in the future and see how the residents' level of knowledge changes after presentation. The study is the first in Turkey to identify ways to integrate clinical practice guidelines (CPGs) in residency training.
In this interventional study to evaluate a continuous medical education (CME) intervention without a comparison group, a clinical practice guidelines on diagnosis and management of anaphylaxis was presented to the Family Medicine and paediatrics residents at the Ankara Training and Research Hospital, by a specialist in paediatric allergy. The presentation was done within routine training sessions. A test was applied before and 10 weeks after the presentation. Electronic sources and hard copies were used for dissemination. The results were analysed with SPSS 15.0. The categorical data was analysed with Fisher's Exact test and the Mann-Whitney U test was used to compare the groups. The threshold for statistical significance was set at P < 0.05.
The post-test scores were 58.2/100 for family physicians and 71.7/100 for paediatricians. For both pre- and post-test, paediatricians had significantly higher scores than the family physicians (p < 0.05). On the other hand, the family physicians had significantly higher post-test scores than their own pre-test scores (p < 0.05), while there was no significant increase in the scores of the paediatricians (p > 0.05).
The study adds to limited information on the effects of clinical practice guidelines in Turkey. It shows us that the awareness of CPGs is low among physicians, and further research is needed to determine the potential role of clinical practice guidelines in continuous medical education. Physicians need a better training about how to manage anaphylaxis, and the best methods to identify their training needs must be determined.
Journal of the Pakistan Medical Association 02/2012; 62(2):102-6.
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ABSTRACT: The aim of this study was to investigate the effects of thyroid hormone deficiencies in childhood on the elements of coagulation proteins. Consecutive 54 children with hypothyroidism and 55 healthy controls aged 1 month-16 years were enrolled. One year after Na-L-thyroxine treatment, the study parameters were reevaluated. Thyroid function tests, procoagulant and anticoagulant proteins were performed for children with hypothyroidism and healthy controls. Significant decreased results were found in children with hypothyroidism in terms of fibrinogen, TT, and anticoagulant proteins including AT, PC, PS, and fPS. Significant increases were found with respect to APTT, fibrinogen, and TT. In the evaluation of posttreatment changes a statistically significant increase was found in vWF, FVIII, AT, PC, PS, and fPS. A positive correlation was found between fT4 and vWF, FVIII, PC, and PS. We would like to emphasize that the coagulation system especially vWF and FVIII, and particularly the anticoagulant system, should be monitored closely in patients followed up for hypothyroidism. Thyroid hormones should be examined and, if necessary, hormone replacement therapy should be administered in patients followed up for a predisposition to coagulation. Additionally, further studies with larger series are needed to investigate the effects of hypothyroidism on the coagulation system.
International Journal of Endocrinology 01/2012; 2012:156854. · 1.87 Impact Factor
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Pediatrics International 02/2011; 53(1):102-5. · 0.63 Impact Factor
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ABSTRACT: We report a pediatric patient with chronic idiopathic thrombocytopenic purpura who suffered from an influenza A (H1N1) virus infection. A 13-year-old girl presented with fever, coughing, and generalized petechiae. The influenza A antigen was positive in her pharyngeal aspirate. She was successfully treated with neuraminidase inhibitor oseltamivir phosphate. Her platelet counts progressively increased with oseltamivir phosphate without another blood product or agent. We suggest that oseltamivir phosphate can be used in patients with immune thrombocytopenic purpura who present with influenza virus A infection. We also suggest that oseltamivir phosphate can be effective in patients with immune thrombocytopenic purpura. Large study groups are needed to confirm the relationship between idiopathic thrombocytopenic purpura and neurominidase inhibitors.
Pathophysiology of Haemostasis and Thrombosis 11/2010; 37(2-4):55-8. · 2.23 Impact Factor
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ABSTRACT: The authors present a case of a 36-day-old infant with intracranial and intramuscular hemorrhage due to vitamin K deficiency bleeding, who received intramuscular vitamin K prophylaxis at birth. In this case, laboratory tests showed anemia, liver dysfunction with cholestasis, and coagulopathy, consistent with vitamin K deficiency abnormality. Serological analyses showed that cytomegalovirus immunoglobulin (Ig)M and IgG avidity were both positive. The infant was treated successfully with intravenous ganciclovir and blood products. This case suggests that it is imperative to meticulously investigate the etiology in neonates with late-onset hemorrhagic disease of the newborn. Cholestatic liver disease caused by congenital cytomegalovirus infection should be in mind in term infants who presented with late-onset hemorrhagic disease.
Pediatric Hematology and Oncology 11/2010; 28(1):78-82. · 0.89 Impact Factor
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ABSTRACT: To assess whether apoB/apoA1 ratio is associated or not with metabolic syndrome in obese children.
A 198 obese children and 41 healthy control subjects were enrolled in a cross-sectional study. The apoB/apoA1 ratio and other metabolic syndrome components in obese children with/without metabolic syndrome were compared to healthy controls.
The apoA1 level did not show significant difference (p = 0.664) but apoB level (p = 0.000) and apoB/apoA1 ratio (p = 0.001) were significantly higher in obese group than in control group. Also, the apoB/apoA1 ratio was significantly higher in obese children with metabolic syndrome when compared to obese children without metabolic syndrome (p = 0.007) and showed positive correlation with triglyceride (r = 0.404, p = 0.000) and negative correlation with high-density lipoprotein cholesterol (r = -0.593, p = 0.000).
The apoB/apoA1 ratio is associated with metabolic syndrome in obese children. An elevated apoB/apoA1 ratio may constitute an important feature of the metabolic syndrome. There is a need for long term follow-up studies concerning cardiovascular risk in obese children with metabolic syndrome and high apoB/apoA1 ratio.
The Indian Journal of Pediatrics 10/2010; 77(11):1261-5. · 0.52 Impact Factor
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ABSTRACT: We evaluated familial aggregation of metabolic syndrome components in obese children. A total of 198 obese children and their parents were enrolled in a prospective cohort study and were evaluated for the intrafamilial relationships of metabolic syndrome components. Metabolic syndrome was diagnosed in 25 (26%) of 96 obese boys, in 27 (26.4%) of 102 obese girls, in 53 (34.8%) of 152 mothers, and in 37 (33.6%) of 110 fathers. Compared with obese boys, obese girls showed higher correlations with their mothers for waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol and with their fathers for total cholesterol. Compared with obese girls, obese boys showed higher correlations with their fathers for waist circumference, body mass index, high-density lipoprotein cholesterol, triglyceride, fasting plasma glucose, and diastolic blood pressure and with their mothers for total cholesterol, low-density lipoprotein, and triglyceride. There was a significant resemblance of metabolic syndrome and its components among families. Gender-related correlations should be considered for future interventions.
The Endocrinologist 08/2010; 20(5):240-242. · 0.09 Impact Factor
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ABSTRACT: Rotavirus was related to causing intussusception when the first generation rotavirus vaccine was introduced. However, the association between natural rotavirus infection and intussusception remains an area of concern and controversy. A few studies have found that rotavirus infection can cause intussusception. On the other hand, several studies were unable to find an association of intussusception with natural rotavirus infection. Herein, we describe a patient who developed intussusception following rotavirus diarrhea during the course of hospitalization and recovered by spontaneous resolution the next day. This rotavirus belonged to serotype G9P[6]. The case is presented here as an evidence that natural rotavirus infection is associated with intussusception. Comprehensive research is needed to identify whether intussusception by rotavirus has a propensity to resolve spontaneousey.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 09/2009; 20(3):209-13. · 0.47 Impact Factor
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ABSTRACT: Intracranial involvement by Hodgkin disease is rare. We report a pediatric patient with Hodgkin disease who had intracranial disease at presentation. The patient was referred to our hospital with a suspicion of central nervous system tumor. Although the most common presenting feature of intracranial Hodgkin disease is cranial nerve palsy with brain parenchyma being the most common intracranial site of involvement, to our best knowledge no pediatric case of Hodgkin disease presented with isolated cavernous sinus syndrome reported. We report this rare case because of its unusual presentation, in which Hodgkin disease presented with cavernous sinus syndrome. Physicians should consider the probability of Hodgkin disease in children of all ages who present with cavernous sinus syndrome.
Journal of Pediatric Hematology/Oncology 08/2009; 31(10):774-7. · 1.16 Impact Factor
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The Clinical journal of pain 06/2009; 25(4):349-50. · 3.01 Impact Factor
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Canan A Agirtan,
Taner Akar,
Seher Akbas,
Recep Akdur,
Cahide Aydin,
Gulsen Aytar,
Suat Ayyildiz,
Sevgi Baskan,
Tugba Belgemen,
Ozdecan Bezirci, [......],
Betul Ulukol,
Runa Uslu,
Fatma V Tas,
Nilgun Vatandas,
Sevtap Velipasaoglu,
Fatih Yagmur,
Aydin Yağmurlu,
Songul Yalcin,
Sukruye Yavuz,
Kadriye Yurdakok
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ABSTRACT: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome.
A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software.
Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period.
A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear.
Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.
Child abuse & neglect 05/2009; 33(4):247-55. · 2.34 Impact Factor
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ABSTRACT: We report a case of primary hyperparathyroidism associated with prolonged hungry syndrome (HBS) after parathyroid adenomectomy in a 10-year-old girl. Bone mineral density (BMD) revealed severe loss of cancellous BMD. Overt bone disease, high alkaline phosphatase, decreased cancellous BMD and a large adenoma can be used as preoperative predictive risk factors of HBS in children.
Indian pediatrics 03/2009; 46(2):178-80. · 1.05 Impact Factor
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ABSTRACT: Hepatitis A virus (HAV) is the most common cause of hepatitis in childhood and an important public health problem. The objective of the present study was to determine the seroprevalence of hepatitis A and patient demographics in children between 1 and 15 years old who were admitted to a pediatric outpatient clinic in Ankara, Turkey.
Hepatitis IgM and G antibodies were determined in the sera of children who attended the outpatient clinic. Informed consent was obtained from all subjects or their parents.
The mean age of the children (n = 335) was 7.9 +/- 2.1 years; 47.5% of them were girls. The overall anti-HAV IgG prevalence in children aged 1-15 years was 47.2%. The positivity of hepatitis A IgM was highest in the 6-10 years age group (22.7%; P < 0.001). HAV IgG was highest in the 11-15 years age group (69.4%; P < 0.001). A total of 95.6% of the children had social insurance, 49.3% were living in poverty. The socioeconomic level of 82.4% of subjects was low. The history of hepatitis in their families was 6.9%.
Hepatitis A is intermediate endemic in Ankara and children must be vaccinated before school age, in addition to health education and improved sanitation.
Pediatrics International 02/2009; 51(1):5-8. · 0.63 Impact Factor
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ABSTRACT: Voiding dysfunction may result in lower urinary tract symptoms in children and is associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). The aim of this study was to assess the relationship between detrusor pressure, VUR and abnormal renal scintigraphy findings in children with dysfunctional voiding.
Between 2004 and 2007, 30 children with VUR and voiding dysfunction, 22 girls and 8 boys, median age 8.2 years, were evaluated. Urodynamic study, renal scan and voiding cystourethrography were performed in all patients.
The degree of the renal scarring was found to be associated with the detrusor pressures (p = 0.018). The highest detrusor pressure was shown in the group of urge syndrome. The degree of the VUR was found to be correlated with the detrusor pressures (p = 0.038). In our study group, VUR had resolved in 11 (37%) patients, had improved in grade in 10 (33%) patients and remained unchanged in 9 (30%) patients after anticholinergic therapy. No significant relationship was found between the duration of therapy and the voiding patterns (p = 0.389).
Every child with VUR should undergo a careful evaluation of its bladder function. The patients who have high detrusor pressures should be evaluated carefully for the presence of VUR and renal damage.
Urologia Internationalis 02/2009; 82(1):77-80. · 0.99 Impact Factor
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ABSTRACT: To compare a combined dose of ketamine and midazolam versus ketamine alone in the sedation of children requiring lumbar puncture.
A randomized, controlled study, conducted between January 2004 and December 2006.
The Pediatric Emergency Department (PED) at Ankara Training and Research Hospital, Turkey.
A random sample of 99 children (59 boys, 40 girls) aged 2-14 years (mean age 6.5+/-3.7) undergoing lumbar puncture.
Participants were randomized to receive intravenous (IV) ketamine only (1 mg/kg; IVK) (n=51) or ketamine plus midazolam (1 mg/kg ketamine+0.1 mg/kg midazolam; IVKM) (n=48).
The mean time to sedation and adverse events.
The mean time to sedation was significantly shorter in the IVKM group than the IVK group (2.6+/-1.1 and 3.4+/-1.7 min, respectively; P=0.01). The parental satisfaction was significantly higher in the IVKM group (P=0.001). Also the fasting time and recovery time did not differ between groups, nor was there a significant difference in nausea/vomiting between groups. Nightmares or crying spells were more common in the IVK group than in the IVKM group (P=0.04).
We conclude that adding midazolam to ketamine did not increase the frequency of adverse events and that the combined sedative was superior to ketamine alone in terms of speed of sedation and parental satisfaction.
Indian pediatrics 12/2008; 45(11):899-904. · 1.05 Impact Factor
