Oksan Derinoz

Gazi University, Engüri, Ankara, Turkey

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Publications (11)24.56 Total impact

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    ABSTRACT: No information exists on how the knowledge or the practice of pediatricians regarding anaphylaxis episodes vary with episode severity. The aim of this study was to assess and compare pediatrician knowledge on the management of mild and severe anaphylaxis using clinical scenarios and to determine factors that affect their decisions.
    Pediatrics International 06/2014; 56(3):323-7. · 0.73 Impact Factor
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    ABSTRACT: Knowledge of factors that affect relapse will allow close monitoring of patients at risk, resulting in a decreased rate of readmission to the emergency department. To determine risk factors associated with relapse within 7 days after treatment of asthma exacerbations in children. This was a multicenter, prospective study of children with asthma attacks. Patients between the ages of 6 months and 17 years who met the criteria between June 2009 and September 2012 were considered. The study included 1177 patients (775 males [65.8%]) with a mean (SD) age of 70.72 (48.24) months. Of them, 199 (16.9%) had a relapse within 1 week after being discharged from the hospital. Factors independently associated with relapse identified by a logistic regression model for the 1,177 study visits were having taken a short-acting inhaled β2-agonist within 6 hours before admission (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.728-3.426; P = .001), presence of retraction on physical examination (OR, 1.76; 95% CI, 1.123-2.774; P = .01), no prescription for high-dose inhaled steroids on release (OR, 2.02; 95% CI, 1.370-3.002; P < .001), and not being given a written instructional plan (OR, 1.55; 95% CI, 1.080-2.226; P = .02). Whereas having taken short-acting β2-agonists within 6 hours before admission and the presence of retractions on physical examination increased the risk of relapse after treatment of the acute attack, being given high-dose inhaled steroids and a written instructional plan when being sent home reduced the risk.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 02/2014; · 2.75 Impact Factor
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    ABSTRACT: Most cases of acute dystonia are mild and easy to manage; nevertheless, some of them can be fatal because of the involvement of certain muscle groups such as the laryngeal muscles, thus requiring urgent intervention. In the literature, approach to life-threatening acute dystonia has not been investigated thoroughly, although the diagnosis is a challenge, and treatment should be offered immediately. Herein the management of life-threatening acute dystonia is discussed via 2 case reports.
    Pediatric emergency care 03/2013; 29(3):380-2. · 0.92 Impact Factor
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    ABSTRACT: Objective: To assess and compare management preferences of physicians for moderate and severe acute asthma based on case scenarios and to determine the factors influencing their decisions. Methods: A questionnaire based on the Global Initiative on Asthma (GINA) guideline and comprising eight questions on management of acute asthma was delivered to participants of two national pediatric congresses. Management of moderate and severe acute asthma cases was evaluated by two clinical case scenarios for estimation of acute attack severity, initial treatment, treatment after 1 h, and discharge recommendations. A uniform answer box comprising the possible choices was provided just below the questions, and respondents were requested to tick the answers they thought appropriate. Results: Four-hundred and eighteen questionnaires were analyzed. All questions regarding moderate and severe acute asthma case scenarios were answered accurately by 15.8% and 17.0% of physicians, respectively. The initial treatment of moderate and severe cases was known by 100.0% and 78.2%, respectively, of physicians. Knowledge of the appropriate plan for treatment after 1 h was low both for moderate (45.0%) and severe attacks (35.4%). Discharge recommendations were adequate in 32.5% and 70.8% of physicians for moderate and severe attacks, respectively. Multiple logistic regression analysis revealed that working at a hospital with a continuing medical education program was the only significant predictor of a correct response to all questions regarding severe attacks (p = 0.04; 95%CI, 1.02-3.21). No predictors were found for information on moderate attacks. Conclusions: Pediatricians have difficulty in planning treatment after 1 hour both moderate and severe asthma attacks. Postgraduate education programs that target physicians in hospitals without continuing medical education facilities may improve guideline adherence.
    Journal of Asthma 02/2013; · 1.83 Impact Factor
  • Oksan Derinoz, Hamdi C Emeksiz
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    ABSTRACT: Topical application of eye drops may cause mild or severe adverse ocular or systemic effects. Children, particularly infants, are more prone to systemic adverse effects of topical eye drops because of their lower body mass and blood volume, immature metabolism, and immaturity of excretory, nervous, and cardiovascular systems. Early recognition of signs and symptoms of systemic toxicity is very important. Most of the signs and symptoms can resolve spontaneously; however, in severe cases, physostigmine treatment may be required. Respiratory distress is a rare adverse effect of cyclopentolate. We report an infant who developed respiratory distress after ocular instillation of cyclopentolate and was successfully treated with physostigmine. The benefit of physostigmine use with close follow-up should be borne in mind in cases with a life-threatening cyclopentolate adverse effect.
    PEDIATRICS 08/2012; 130(3):e703-5. · 5.30 Impact Factor
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    Oksan Derinoz, Ayla Akca Caglar
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    ABSTRACT: AIM: To examine cases with drug-induced dystonic reactions (DIDRs), to identify the complaints of the application, to classify the drugs causing those dystonic reactions (DRs) and to determine the treatment options and protective measures to prevent DIDRs. METHOD: The authors retrospectively analysed 55 cases with DIDRs at paediatric emergency department (PED) in a 5-year period. RESULTS: The mean age of the patients was 145.07±56.30 months, and of the 55 cases, 28 cases (50.9%) were boys. Antiemetics and antipsychotics were the most common causes of DIDRs. 35 (70%) patients developed DIDRs at therapeutic doses. Treatment side effect was the most common cause of the DIDRs (78.2%). The most common DIDRs were abnormal postures of the head and neck (56.6%). Laryngospasm was observed only in four cases (7.3%) that used either antipsychotics or psychostimulants. 51 (92.7%) children were treated with parenteral diphenhydramine successfully. CONCLUSION: Dystonia is a common side effect of certain drugs, even when therapeutic doses are administered. Although the most common DIDRs were abnormal postures of the head and neck, rare life-threatening conditions, may develop particularly due to use of antipsychotics. In treatment, diphenhydramine could effectively be used through parenteral way to eliminate the cholinergic effects of those drugs. However, the easiest and the safest way to prevent the development of DRs is to avoid unnecessary drug usage. In conclusion, physicians should be aware that antiemetic and antipsychotic drugs are associated with DRs in normal doses and that those drugs should be prescribed with a correct indication.
    Emergency Medicine Journal 03/2012; · 1.78 Impact Factor
  • Oksan Derinoz, Anil Er
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    ABSTRACT: A 4-year-old boy, who had no prior history of convulsions, presented with inability to walk, disequilibrium, dysarthria (incoherent speech), and impaired cognition (disorientation) following the instillation of 1% cyclopentolate, a commonly used mydriatic in pediatric practice. This case demonstrates the uncommon, although serious, atropine-like adverse effect of cyclopentolate eyedrops in usual dosage in child.
    Pediatric emergency care 01/2012; 28(1):59-60. · 0.92 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the effect of Rho kinase inhibitor, Y-27632 on the intestinal apoptosis in endotoxemic infant rats. Wistar albino 15-17-day-old rat pups (n = 21) were randomized to three experimental groups: (1) controls; (2) endotoxemia (LPS); and (3) endotoxemia treated with Y-27632 (LPS + Y-27632). Endotoxemia was induced in rats by intraperitoneal (i.p) injection of lipopolysaccharide (Escherichia coli serotype 0111:B4; 10 mg/kg). Y-27632 was administered 5 mg/kg i.p at three times, just, 8 and 16 h after LPS injection. Twenty-four hours after LPS injection, intestinal apoptosis was assessed by hematoxylin and eosin staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay and immunohistochemistry for active caspase-3. Endotoxemia induced extensive apoptotic injury in the intestinal tissues. The administration of Y-27632 to endotoxemic infant rats caused a marked decrease in the number of apoptotic cells in both intestinal epithelium and lamina propria. In conclusion, the inhibition of Rho kinase with Y-27632 diminished the intestinal apoptotic damage induced by endotoxemia in infant rats.
    Journal of molecular histology 12/2011; 43(1):81-7. · 1.75 Impact Factor
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    ABSTRACT: Part of the problems related to proper use of the epinephrine autoinjector may be related to the design of the autoinjector itself. We investigated whether minor modifications in the design of the currently available epinephrine autoinjector ease its use and abrogate common use errors. All interns other than those who had previously worked in allergy department in a medical school were invited to the study. Two identical epinephrine autoinjector trainers (Epipen trainer(®) ) were used, one of which was modified by changing the gray safety cap to red and placing a yellow arrow pointing to the black injection tip. A written and visual instruction sheet for each trainer was provided. Participants were asked to demonstrate the use of the Epipen trainer either with the original or with the modified one. They were scored and timed for their demonstration. Out of the 224 interns who were invited to participate, one hundred and sixty-four interns (73.2%) participated in the study. The number of participants correctly demonstrating the use of epinephrine autoinjectors was 22.6% and 65% in unmodified and modified trainer groups, respectively (p < 0.001). The mean time to administer trainers was 26.78 ± 10.6 and 15.88 ± 2.55 s; total median scores were 3.08 ± 1.48 and 4.47 ± 0.84 in unmodified and modified groups, respectively (p < 0.001 for both). Significantly fewer participants had presumptive unintentional injection injury while using modified (5%) compared with unmodified trainer (45.2%) (p < 0.001). Few and simple modifications in the design of epinephrine autoinjector were found effective in increasing its correct use and decreasing common use errors by untrained users. (Clinical trials identifier: NCT01217138).
    Pediatric Allergy and Immunology 07/2011; 22(7):729-33. · 3.38 Impact Factor
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    ABSTRACT: The majority of physicians do not know how to use epinephrine autoinjectors. This displays that current education of physicians on anaphylaxis is inadequate for a thorough practice. We hypothesize that a theoretical lecture together with a practical session on epinephrine autoinjector use will improve its proper use by physicians. Residents, specialists, and consultants from General Pediatrics excluding allergists and allergy fellows were included in this study. All physicians were given an eight-item questionnaire followed by a practical session scoring and timing ability to use epinephrine autoinjector trainer. This ensued with one-to-one hands-on training on correct autoinjector use. Finally, a joint theoretical lecture on anaphylaxis including re-demonstration of epinephrine autoinjector use was given. All physicians were scored a second time on use of epinephrine autoinjector 6 months later. One hundred fifty-one of 196 participants completed all steps of the study in four tertiary hospitals. Correct use of epinephrine autoinjector improved from 23.3% to 74.2%, mean score from 3.49 ± 1.14 to 4.66 ± 0.65, need for prospectus from 91.4% to 29.1%, and mean time to administer autoinjector from 28.01 ± 6.22 s to 19.62 ± 5.01 s (p < 0.001 for each). The rate of most common mistakes during autoinjector use decreased but the ranking did not change. An integrated theoretical and practical education increased correct of epinephrine autoinjector use by physicians. Ongoing mistakes despite this education may be related with its design.
    Pediatric Allergy and Immunology 02/2011; 22(6):590-3. · 3.38 Impact Factor
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    ABSTRACT: Hyperlipidemia is a major factor accompanying atherosclerosis. As the basis of atherosclerotic heart disease begins at early childhood, we aim to find out which children should be tested for hypercholesterolemia, what the high cholesterol level in children is and what cautions should be taken to avoid atherosclerosis. The study was carried on 2096 school children (1043 male, 1053 female) in Ankara. Their mean age was 9.03 years. Demographic properties of the study group and their families were determined and the serum lipid levels of the subjects were obtained. The relation between these demographic properties and lipid levels were investigated. In 135 of the subjects' serum cholesterol level was >or=200 mg/dL and in 83 subjects serum LDL-cholesterol level was >or=130 mg/dL. Despite 64.4% of the subjects reported a family history of hyperlipidemia, no relations between family history and serum lipid levels were found. We suggest that regardless of family history, all children over 5 years should be screened for hyperlipidemia. Education about hyperlipidemia and precautions for its complications should be given to both children and families. The best and easiest way to reach children is to screen them at schools. School is also a good place for education of children about hyperlipidemia and risk factors.
    Acta Paediatrica 12/2007; 96(12):1794-8. · 1.84 Impact Factor