Tanıl Kendirli

Ankara University, Engüri, Ankara, Turkey

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Publications (24)19.09 Total impact


  • No preview · Article · Jan 2016 · Paediatrics and international child health
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    Full-text · Article · Dec 2015
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    ABSTRACT: Purpose: To determine the efficiency of noninvasive mechanical ventilation (NIV) both in protection from intubation and in preventing reintubation of postextubation in patients in the pediatric intensive care unit (PICU). Methods: A prospective observational study was conducted in a multidisciplinary 10-bed tertiary PICU of a university hospital. All patients were admitted to our unit from June 2012 to May 2014 and deemed to be candidates to receive continuous positive airway pressure or bilevel positive airway pressure. Measurements and results: We performed 160 NIV episodes in 137 patients. Their median age was 9 months (range, 1-240 months), and their median weight was 7.5 kg (range, 2.5-65 kg). Fifty-seven percent of patients were male. Noninvasive mechanical ventilation was successful in 70% (112 episodes) of patients. There was an underlying illness in 83.8% (134 episodes) of the patients. Bilevel positive airway pressure support was given to 57.5% (92 episodes) of the patients, whereas the remaining 42.5% (68 episodes) received continuous positive airway pressure support. Among the causes of respiratory failure in our patients, the most frequent were postextubation, pneumonia, bronchiolitis, atelectasia, and cardiogenic pulmonary edema. Sedation was applied in 43.1% of the episodes. Complications were detected in 29 episodes (18.1 %). The NIV failure group showed higher Pediatric Risk of Mortality III-24 score, shorter NIV duration, more frequent underlying disease, lower number fed, longer length of PICU stay, and hospital stay, and mortality was higher. Conclusions: Noninvasive mechanical ventilation effectively and reliably reduced endotracheal intubation in the treatment of respiratory failure due to different clinical situations. Our results suggest that NIV can play an important role in PICUs in helping to avoid intubation and prevent reintubation. Although there were serious underlying diseases in most of our patients, such as immunosuppression, 70% avoided intubation with use of NIV.
    No preview · Article · Dec 2015 · Journal of critical care
  • Tanıl Kendirli · Serap Teber · Tuba Pekacar · Mustafa Argun · Gülhis Deda
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    ABSTRACT: Botulism is an acute, flaccid paralytic illness caused by the neurotoxin produced by Clostridium species. Three forms of botulism are known; infant botulism, food borne, and wound botulism. We report an 11-year-old boy with food borne botulism diagnosed on electromyography. Although his clinical findings improved in 10 days, his symptoms recurred, showing a biphasic course. After 3 weeks, he was symptom free. His electromyography findings were also normal on the 3rd week. After 3 weeks, he was discharged without clinical symptoms.
    No preview · Article · Jul 2015 · Journal of pediatric neurology: JPN

  • No preview · Article · Jul 2015 · Journal of pediatric neurology: JPN
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    ABSTRACT: Niemann-Pick disease type C (NPC) is a fatal autosomal recessive lipid storage disease associated with impaired trafficking of unesterified cholesterol and glycolipids in lysosomes and late endosomes. This disease is commonly characterized by hepatosplenomegaly and severe progressive neurological dysfunction. There are two defective genes that cause this illness. One of these genes is NPC1 gene which is the cause of illness in 95% of the patients. The other gene is the rare type NPC2 which is the cause of illness in 5% of the patients. Patients with NPC2 usually present with respiratory distress in early infancy, which is rather unusual with NPC1. This article discusses about a patient who died at an early age from pulmonary involvement and who subsequently was found to have a novel homozygous mutation of NPC2 gene.
    No preview · Article · May 2015
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    Full-text · Article · Jan 2015
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    ABSTRACT: A very rare syndrome of rapid-onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation (ROHHAD) has been recently described as causing morbidity due to hypothalamic dysfunction and respiratory arrest. Its prognosis is poor and often cardiac arrest occurs due to alveolar hypoventilation. This disorder can mimic genetic obesity syndromes and several endocrine disorders. We present a 13-year-old female patient who was reported to be healthy until the age of 3 years. She was admitted to our emergency department, presenting with respiratory distress. Features matching ROHHAD syndrome such as rapid-onset obesity, alveolar hypoventilation, central hypothyroidism, hyperprolactinemia, Raynaud phenomenon and hypothalamic hypernatremia were detected in the patient. In addition to these features, the patient was found to have hypergonadotropic hypogonadism and megaloblastic anemia. Because of its high mortality and morbidity, the possibility of ROHHAD syndrome needs to be considered in all pediatric cases of early- and rapid-onset obesity associated with hypothalamic-pituitary endocrine dysfunction.
    Full-text · Article · Dec 2014 · Journal of Clinical Research in Pediatric Endocrinology
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    ABSTRACT: Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of treatment with antipsychotic medication. NMS has also been associated with non-neuroleptic agents that block central dopamine pathways, such as metoclopramide, amoxapine and lithium. Metoclopromide has antidopaminergic properties and is a rare but well-recognized perpetrator in the development of NMS. NMS has a constellation of signs and symptoms, including hyperthermia, muscle rigidity, autonomic instability, tachycardia, tachypnea, diaphoresis, hypertension and altered mental status. We present a 2-year-old girl who developed neuroleptic malignant syndrome after metoclopromide therapy. High-dose metoclopromide was given to our patient, and it is very likely that she was dehydrated while using metoclopromide, as she developed NMS two hours after treatment. The patient was discharged on the sixth day after admission to our hospital, having been cured. In summary, NMS developed in this patient very soon after metoclopromide treatment. NMS is a life-threatening emergency; if not recognized, or left untreated, it may be fatal. Therefore, early recognition of the developing signs and symptoms, along with a thorough medical history, is of great importance.
    No preview · Article · Sep 2014 · The Turkish journal of pediatrics
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    ABSTRACT: For many decades, the primary treatment of acute respiratory failure has been mechanical ventilation. Intubation and mechanical ventilation carry complications such as upper respiratory system trauma, barotrauma, volutrauma, oxytrauma, atelectrauma, and nosocomial infection, and they increase mortality. Noninvasive mechanical ventilation (NIMV) applied to a specially selected group of patients has more advantages than invasive ventilation, especially the decreased number of complications. We present a three-year-old girl who had prolonged invasive mechanical ventilation (IMV) and weaning failure due to severe tracheal bleeding after Fontan operation. She could not be extubated for 20 days after admission to our Pediatric Intensive Care Unit (PICU) because of life-threatening airway bleedings from within the endotracheal tube. Owing to the severe bleedings during endotracheal aspirations, it was decided to change her mechanical ventilation to NIMV. NIMV was performed successfully for 12 days without difficulty, and she was discharged from the hospital on the 55th postoperative day with normal clinical findings. Noninvasive ventilation has an increasing use in critically ill children. NIMV should be considered in prolonged mechanical ventilation and weaning failure from IMV in critically ill children.
    No preview · Article · May 2014 · The Turkish journal of pediatrics
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    ABSTRACT: Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare autosomal recessive congenital disorder that includes childhood-onset camptodactyly, synovial hyperplasia-related arthropathy, progressive coxa vara deformity and noninflammatory pericarditis. A seven-year-old male patient had a diagnosis of CACP. He had pericardial effusion and underwent surgical tube drainage. CACP syndrome is seen very rarely, and differential diagnosis is very important. CACP is usually treated medically, but surgery may sometimes be preferred, as in our patient.
    Full-text · Article · May 2014 · The Turkish journal of pediatrics
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    ABSTRACT: Giriş: Solunum yollarında darlık, konjenital bronkotrakeomalazi veya eksternal vasküler kompresyona sekonder gelişebilir. Sol ana bronşta darlık sıklıkla arkus aorta anomalisinde görülebilir. Parsiyel anormal pulmoner venöz dönüş (PAPVD), atrial septal defekt (ASD), patent duktus arteriosus(PDA) ile birlikte sol ana bronşta darlık olan 4 aylık infantı sunmak istiyoruz. Olgu Sunumu: 4 aylık kız hastada solunum sıkıntısını takiben PAPVD, ASD, PDA tespit edildi. BT anjiografide kardiomegali, inen aortanın orta hatta seyrettiği, sağ üst ve alt pulmoner venlerin sağ atriuma açıldığı, sol akciğer total kollapsı, sol ana bronşun aort ve sağ pulmoner arasından geçtiği görüldü (Resim 1,2). Hasta solunum sıkıntısı nedeniyle entübe edildi, sol torakotomi yaklaşımıyla PDA ligasyonu yapıldı. Postoperatif erken dönemde ekstübe edildi, ancak post-operatif 40. günde reentube edildikten sonra 3 ay boyunca ekstübe edilememesi üzerine hastaya 7 aylıkken PAPVD total korreksiyonu yapıldı. Takipte sol akciğerde total atelektaziye rağmen hasta ekstube edilebildi. BPAP desteğinde SaO2 %90 olarak izlenmektedir. Tartışma ve Sonuç: Primer bronkotrakeomalazi, immature kartilaj sonucu oluşur. Sekonder malazi, ekstrensek vasküler kompresyon, intraluminal obstrüksiyon, rekürren bronşit, uzamış entübasyon ve trakeostomi sonucu normal kartilajın dejenerasyonuna bağlı gelişebilir. İnnominate arterin arcus aorta distalinden ayrılmasına bağlı kompresyon sonucu gelişebilir. Stridor, apne, sık pnömoni halinde aortopeksi yapılabilir. Double arcus aortada ise disfaji, dispne halinde hipoplazik arkusun divizyonu gerekir. Pulmoner arter slingte ise stenotik trakeal segment rezeke edildikten sonra trakea yeniden anastomoze edilmeden önce arter trakeanın anterioruna çekilebilir. Hoffer, tedaviyi ve mortaliteyi etkileyen faktörlerin stenotik segmentin uzunluğu ile eşlik eden anomaliler olduğunu belirtmiştir. Fokal malazi olguları stentle tedavi edilirken, diffüz olgularda trakeoplasti yapılabilir. Hastamızda, PAPVD ASD PDA’ya bağlı gelişen PHT sonucu ileri derece genişleyen sağ pulmoner arter ile orta hatta seyreden aorta arasında, sol ana bronşun sıkıştığını düşünüyoruz. Zamanında uygulanan cerrahi düzeltmeyle klinik bulgularda olumlu gelişme olsa da iyileşiyileşmenin zaman alabileceği unutulmamalıdır. Uzun süre izlem önemlidir.
    Full-text · Conference Paper · Apr 2014
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    ABSTRACT: Giriş: Akut viral miyokardit, nadiren görülen bir hastalıktır. Hızla kalp yetmezliği gelişme riski nedeniyle yüksek mortaliteyle seyredebilir. Ventriküler destek sistemleri (VAD), agresif medikal tedaviye yanıt vermeyen akut viral miyokarditte yaşam kurtarıcı bir yaklaşım olabilir. Bu amaçla LVAD uyguladığımız ilk pediatrik hastamızı sunmak istiyoruz. Olgu: 5 yaşında kız hastada, bocavirusa bağlı viral myokardit sonrası kalp yetmezliği gelişti. Ekokardiografide, LVEF %21, 2-3 mitral yetmezlik, patent foramen ovale tespit edildi. ProBNP 35000 pg/mL, CK-MB 11,7ng/mL, troponin I 0,287 ng/mL idi. Yoğun bakımda milrinon, furosemid, enapril, digoksin, asetilsalisilikasit, İVİG tedavisine rağmen genel durumu kötüleşen ve entübe edilen hastaya 20. günde, sol ventrikül apeksinden inlet asendan aortaya outlet kanül yerleştirilerek LVAD implante edildi (Resim 1,2). INR 2,5-4 aralığında tutuldu. İzlemde kan basıncı 90/60 mmhg olarak izlendi. İmplantasyonun 8. gününde nedeni bilinmeyen arrest sonrası yapılan resüsitasyonu takiben hastada nörolojik bulgular mevcuttu. Beyin tomografisinde bilateral oksipital ve parietal alanlarda yaygın iskemi lehine düşünülen multipl lezyon tespit edildi. Hasta halen yoğun bakımda vital bulguları stabil, ekstube izlenmekte, inotrop destek almamaktadır. Tartışma ve Sonuç: LVAD’lar son yıllarda kalp yetmezliğinde transplantasyona veya iyileşmeye köprüleme amaçlı kullanılabilmektedir. Literatürde stroke ve tromboembolik komplikasyonlar en önemli mortalite ve morbidite kaynağı olmaya devam etmekte ve pek çok vaka serisinde çocuk hastalarda, erişkinlere gore daha sık nörolojik komplikasyon olduğu belirtilmektedir. 5 yaşındaki hastamızda viral miyokardite sekonder gelişen ve medikal tedaviye yanıt alınamayan kalp yetmezliğinde, transplantasyona köprüleme amaçlı LVAD uygulanmıştır. İmplantasyon öncesi yüksek doz inotrop tedavi bu sayede kesilebilmiştir. Hasta halen post-operatif 50. gününde herhangi bir medikasyon almamaktadır. VAD’lar, akut kalp yetmezliği ile komplike viral miyokarditte hastalığın ciddiyet ve yaygınlığına göre tek ve biventriküler destek sistemleri şeklinde uygulanabilmektedir. Yoğun bakım takipleri sırasında çeşitli komplikasyonlar görülse de, ciddi sol ventrikül disfonksiyonunda zamanında uygulanan LVAD’larla hemodinamik destek sağlamak mümkündür.
    Full-text · Conference Paper · Apr 2014
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    ABSTRACT: We report a rare case of interventricular septal hematoma after patch closure of a perimembranous ventricular septal defect in a 10-month-old infant. Intraoperative transesophageal echocardiography was not performed. Routine transthoracic echocardiography at the 1st postoperative hour showed a huge intramural hematoma causing severe thickening of the ventricular septum. The patient's hemodynamics were stable and surgical revision was not required. The patient recovered well without complication.
    No preview · Article · Feb 2014 · The Turkish journal of pediatrics
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    ABSTRACT: The aims of this study were to review the frequency, characteristics, and the clinical course of primary immunodeficiency (PID) patients admitted to pediatric intensive care unit (PICU) and attempt to identify factors related with mortality that might predict a poor outcome. We performed a retrospective review of children with PID aged 1 month to 18 years and admitted to PICU from January 2002 to January 2012 in our tertiary teaching children's hospital. There were a total of 51 patients accounting for 71 admissions to the PICU. The most common diagnosis was severe combined immunodeficiency. Respiratory problems were the leading cause for admission. A total of 20 patients received hematopoietic stem cell transplantation. Immune reconstitution was achieved in 9 (45 %) patients and eight of them did survive. In all 56 % of all admission episodes resulted in survival. Risk factors for mortality included requirement of mechanical ventilation (P < .001), number of organ system failure (P = .013), need for renal replacement therapy (P < .001), use of inotropes (P < .001), higher Pediatric Logistic Organ Dysfunction (PELOD) score (P = .005), and length of PICU stay (P < .001). This is the first study regarding the outcome and mortality-related risk factors for PID patients requiring PICU admission. We suggest that PICU management is as important as early diagnosis and treatment for these patients. Prediction of those at risk for poorer outcome might be beneficial for accurate intensive care management and survival.
    No preview · Article · Feb 2014 · Journal of Clinical Immunology
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    ABSTRACT: Respiratory syncytial virus (RSV) is the leading cause of viral respiratory tract infections in infants and young children. Although the course of RSV infection is usually benign, a small proportion of infants require mechanical ventilation for respiratory failure. We describe an eight-month-old previously healthy female who developed bilateral pneumothorax and acute respiratory distress syndrome (ARDS) secondary to RSV infection. Because of the severe hypoxemia, three doses of surfactant were administered and prone positioning was implemented for nine days. After a prolonged course of mechanical ventilation, she was extubated at day 21 and discharged from the pediatric intensive care unit four days later. We conclude that RSV infections can be severe, and some patients may require mechanical ventilation. Supportive therapies like surfactant replacement therapy and prone positioning can be beneficial in patients with ARDS in whom severe hypoxemia persists despite high levels of positive end-expiratory pressure (PEEP) and plateau pressures.
    No preview · Article · Sep 2013 · The Turkish journal of pediatrics
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    ABSTRACT: Abstract Causes of hyperglycemia in critically ill non-diabetic children may differ from those in adults. The objective of this study was to investigate the pathogenesis of critical illness hyperglycemia (CIH) in terms of insulin resistance and β-cell dysfunction. Critically ill children with blood glucose (BG) levels of >150 mg/dL (8.3 mmol/L) were enrolled in the study. Insulin sensitivity and β-cell function in the hyperglycemic and euglycemic periods were analyzed with BG/insulin and BG/C-peptide ratios, and utilizing homeostasis model assessment (HOMA). A total of 40 patients were enrolled in the study. BG/insulin and BG/C-peptide ratios were significantly higher in the hyperglycemic period. The HOMA-B and S scores for the hyperglycemic period revealed that out of all the patients who survived (n=30), 20 had β-cell dysfunction, while the remaining (n=11) had insulin resistance. β-cell dysfunction was significantly higher in the hyperglycemic period (p<0.001). As in adults, β-cell dysfunction may play a major role in the pathophysiology of CIH in children.
    No preview · Article · May 2013 · Journal of pediatric endocrinology & metabolism: JPEM
  • Cağlar Odek · Tanıl Kendirli · Funda Cipe · Banu Katlan · Figen Doğu
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    ABSTRACT: Pressure-induced urticaria is a non-immunoglobulin E-mediated type of urticaria. Some patients only have angioedema, and the term pressure-induced angioedema (PIA) is more appropriate for them. PIA has not previously been reported in association with endotracheal tube. Here we describe two patients who developed PIA after endotracheal intubation. There were no histories of angioedema, drug and food allergy in both patients. Tests for specific aero-allergens and latex were negative. Serum total immunoglobulin E and C4 levels were in normal ranges. Antihistamines and intravenous steroid therapy were ineffective. Angioedema regressed with intravenous epinephrine infusion and did not relapse after extubation. Conclusion: We suggest that endotracheal tubes can cause PIA. Epinephrine therapy should be used early at treatment, especially in the patients who are at great risk for life-threatening airway problems.
    No preview · Article · Apr 2012 · European Journal of Pediatrics
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    ABSTRACT: Hashimoto encephalopathy is a rare, clinically heterogenous condition. Its treatment is based on corticosteroids. A previously normal 12-year-old boy was admitted to our pediatric emergency department with status epilepticus. He experienced a recurrence of status epilepticus after pentobarbital withdrawal, and required repeated resumptions of drug-induced coma. He manifested acute personality changes. His limbic encephalitis markers were normal, but his level of anti-thyroid peroxidase antibody was high. A diagnosis of Hashimoto encephalopathy was considered. Our patient responded to plasmapheresis instead of corticosteroid treatment. This case report is the first, to the best of our knowledge, of plasmapheresis because of Hashimoto encephalopathy in a child.
    No preview · Article · Feb 2012 · Pediatric Neurology
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    ABSTRACT: The purpose of our study was to evaluate and analyse the prevalence and association of acute kidney injury (AKI) as defined by paediatric Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (pRIFLE) and Acute Kidney Injury Network (AKIN) classifications in a paediatric intensive care unit (PICU). A prospective analysis of all patients that were admitted to our PICU between June 2009 and December 2010 was performed. Patients were classified according to AKIN and pRIFLE criteria. One hundred and eighty-nine patients (mean age 45.9 ± 54.7 months; 110 male, 79 female) were enrolled. Sixty-three (33.3%) patients developed AKI by AKIN criteria and 68 (35.9%) patients developed AKI by pRIFLE criteria. All patients that had AKI according to AKIN criteria also had this diagnosis with pRIFLE criteria. Five patients had developed AKI only according to pRIFLE classification, four of them owing to reduction in their estimated creatinine clearance and one of them owing to changes over 1-week period. The mean length of PICU stay was longer, need for mechanical ventilation and mortality rates were higher in patients with AKI when compared to patients without AKI. Although both pRIFLE and AKIN criteria were very helpful in the detection of patients with AKI even in the early stages of it, pRIFLE seems to be more sensitive in paediatric patients.
    No preview · Article · Nov 2011 · Acta Paediatrica

Publication Stats

32 Citations
19.09 Total Impact Points

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Institutions

  • 2008-2014
    • Ankara University
      • • Department of Pediatric Intensive Care
      • • Department of Pediatric Nephrology
      Engüri, Ankara, Turkey