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Iseri Nepesov M, Kilic O, Sali E, Yesil E, Akar A, Kaman A, Metin Akcan O, Kilic Cil M, Ozlu C, Lacinel Gurlevik S, Ulusoy E, Cetin BS, Akici N, Cakir D, Uslu Aygun FD, Hancerli CO, Tekin Yilmaz A, Alkan G, Uygun H, Bucak IH, Bursal B, Celik T, Sutcu M, Oz FN, Gayretli Aydin ZG, Karbuz A, Akturk H, Kepenekli E, Emiroglu M, Oncel S, Nuhoglu C, Korucu IH, Incesu M, Kaya A, Bombaci H, Dinleyici M, Carman KB, Duman M, Turel O, Yilmaz D, Alabaz D, Belet N, Tanir G, Turgut M, Celebi S, Kuyucu N, Arisoy ES, Durmaz G, Kaya M, Kara A, Dinleyici EC. Pathogens in Pediatric Septic Arthritis: A Multi-Center Study in Turkiye (PEDSART Study). Children (Basel) 2024; 11:134. [PMID: 38275444 PMCID: PMC10813905 DOI: 10.3390/children11010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. METHODS In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. RESULTS Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. CONCLUSIONS Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.
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Affiliation(s)
- Merve Iseri Nepesov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye; (M.I.N.); (O.K.)
| | - Omer Kilic
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye; (M.I.N.); (O.K.)
| | - Enes Sali
- Department of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
| | - Edanur Yesil
- Department of Pediatric Infectious Diseases, Mersin City Hospital, Mersin 33240, Türkiye
| | - Asuman Akar
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin 33110, Türkiye
| | - Ayse Kaman
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Ozge Metin Akcan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye
| | - Merve Kilic Cil
- Department of Pediatric Infectious Diseases, Adana City Hospital, Adana 01230, Türkiye
| | - Canan Ozlu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35210, Türkiye
| | - Sibel Lacinel Gurlevik
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye
| | - Emel Ulusoy
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Health Sciences Izmir Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir 35210, Türkiye
| | - Benhur Sirvan Cetin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri 38030, Türkiye
| | - Narin Akici
- Department of Pediatrics, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Deniz Cakir
- Department of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
| | - Fatma Deniz Uslu Aygun
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Cerrahpaşa University, Istanbul 34098, Türkiye
| | - Cafer Ozgur Hancerli
- Department of Orthopedics and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul 34303, Türkiye
| | - Ayse Tekin Yilmaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Gulsum Alkan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya 42130, Türkiye
| | - Hatice Uygun
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Ibrahim Hakan Bucak
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Burcu Bursal
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul 34303, Türkiye
| | - Taylan Celik
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale 17020, Türkiye
| | - Murat Sutcu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Istinye University, Istanbul 34010, Türkiye
| | - Fatma Nur Oz
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Zeynep Gokce Gayretli Aydin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Türkiye
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul 34384, Türkiye
| | - Hacer Akturk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Koc University, Istanbul 34010, Türkiye
| | - Eda Kepenekli
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul 34854, Türkiye
| | - Melike Emiroglu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya 42130, Türkiye
| | - Selim Oncel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Cagatay Nuhoglu
- Department of Pediatrics, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Ismail Hakki Korucu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye
| | - Mustafa Incesu
- Department of Orthopedics and Traumatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Ahmet Kaya
- Department of Orthopedics and Traumatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Hasan Bombaci
- Department of Orthopedics and Traumatology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Meltem Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Kursat Bora Carman
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Murat Duman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35160, Türkiye
| | - Ozden Turel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Medeniyet University, Istanbul 34700, Türkiye
| | - Dilek Yilmaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Derya Alabaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana 01330, Türkiye
| | - Nursen Belet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35210, Türkiye
| | - Gonul Tanir
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Mehmet Turgut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Solmaz Celebi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Uludag University, Bursa 16059, Türkiye
| | - Necdet Kuyucu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin 33110, Türkiye
| | - Emin Sami Arisoy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Gul Durmaz
- Department of Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Mucahit Kaya
- Diagen Biotechnological Systems Healthcare and Automation Company, Ankara 06070, Türkiye
| | - Ates Kara
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
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2
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Yilmaz D, Ekemen Keles Y, Emiroglu M, Duramaz BB, Ugur C, Aldemir Kocabas B, Celik T, Ozdemir H, Bayturan S, Turel O, Erdeniz EH, Cakici O, Cakmak Taskin E, Erbas İC, Genceli M, Sari EE, Caymaz C, Kizil MC, Sutcu M, Demirbuga A, Alkan G, Bagcı Z, Timurtas Dayar G, Ozkan EA, Tekin Yilmaz A, Akca M, Yesil E, Kara SS, Akturk H, Yasar B, Umit Z, Uygun H, Erdem N, Buyukcam A, Karadag Oncel E, Tuter Oz SK, Cetin HS, Anil AB, Yilmaz R, Zengin N, Uzuner S, Albayrak H, Borakay O, Topal S, Arslan G, Yazar A, Ozer A, Kendirli T, Kara EM, Demirkol D, Battal F, Kosker M, Metin Akcan O, Kihtir HS, Gul D, Zararci K, Alakaya M, Kula N, Celik E, Petmezci E, Evren G, Kara Aksay A, Konca C, Sert A, Arslan D, Bornaun H, Tekeli O, Bal A, Sahin IO, Demir S, Sap F, Akyol MB, Tanidir IC, Donmez YN, Ucar T, Coban S, Arga G, Hancerli Torun S, Karpuz D, Celik SF, Varan C, Elmali F, Oncel S, Belet N, Hatipoglu N, Dalgic Karabulut N, Turgut M, Somer A, Kuyucu N, Dinleyici EC, Ciftci E, Kara A. Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study). Eur J Pediatr 2023; 182:5531-5542. [PMID: 37782350 DOI: 10.1007/s00431-023-05207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU). METHODS This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented. RESULTS A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells × μL, platelet count 153 vs. 212 cells × 103/ μL, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 μg/L, ferritin 644 vs. 334 μg/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log D-dimer (µg/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care. WHAT IS KNOWN • Lymphopenia and thrombocytopenia were an independent predictor factors in patients with MISC who needed to stay in intensive care unit. • The possibility of the need to stay in the intensive care unit in patients with MISC who had Kawasaki disease-like findings was controversial compared with those who did not. WHAT IS NEW • A one-unit increase log D dimer and log troponin was demonstrated to require for intensive care unit by 1.8 and 1.4 times, respectively. • Serum procalcitonin levels had the best performance to predict stay in the intensive care unit stay.
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Affiliation(s)
| | - Yildiz Ekemen Keles
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey.
| | | | | | - Cuneyt Ugur
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | - Talyan Celik
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | - Halil Ozdemir
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Ozden Turel
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Emine Ergul Sari
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Canan Caymaz
- Başakşehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | | | - Murat Sutcu
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Zafer Bagcı
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | | | | | | | | | | | | | - Belma Yasar
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Hatice Uygun
- Adıyaman Research and Training Hospital, Adiyaman, Turkey
| | | | - Ayse Buyukcam
- Ankara Gulhane Research and Training Hospital, Ankara, Turkey
| | - Eda Karadag Oncel
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | | | | | - Ayse Berna Anil
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
- Pediatric Intensive Care, Health Sciences University Tepecik Training and Research Hospital, Izmir, Izmir, Turkey
| | | | | | - Selcuk Uzuner
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | | | | | - Sevgi Topal
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gazi Arslan
- Dokuz Eylül University Hospital, Izmir, Turkey
| | - Abdullah Yazar
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Arife Ozer
- Health Sciences University Van Training and Research Hospital, Van, Turkey
| | - Tanil Kendirli
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Intensive Care, Ankara University Hospital, Ankara, Turkey
| | | | | | - Fatih Battal
- Canakkale On Sekiz Mart University Hospital, Canakkale, Turkey
| | | | | | | | - Doruk Gul
- İstinye University Hospital, Istanbul, Turkey
| | | | | | - Nilgun Kula
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Elif Celik
- Aydin Adnan Menderes University Hospital, Aydin, Turkey
| | - Ercument Petmezci
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ahu Kara Aksay
- Health Sciences University Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Gaziler Street Number: 468, 35020, Yenisehir Konak/Izmir, Turkey
| | - Capan Konca
- Adiyaman University Hospital, Adiyaman, Turkey
| | - Ahmet Sert
- Selcuk University Hospital, Konya, Turkey
| | - Derya Arslan
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | - Helen Bornaun
- Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Onur Tekeli
- Antalya Training and Research Hospital, Antalya, Turkey
| | - Alkan Bal
- Celal Bayar University Hospital, Manisa, Turkey
| | | | - Selcan Demir
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Fatih Sap
- Necmettin Erbakan University, Meram Hospital, Konya, Turkey
| | - Mehmet Bedir Akyol
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | | | | | - Tayfun Ucar
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
- Pediatric Cardiology, Ankara University Hospital, Ankara, Turkey
| | - Senay Coban
- Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | | | | | - Celal Varan
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | - Selim Oncel
- Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Nevin Hatipoglu
- Health Science University İstanbul Bakırkoy Dr. Sadi Konuk Training and Research Hospital TR, Istanbul, Turkey
| | - Nazan Dalgic Karabulut
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Ayper Somer
- Istanbul University Hospital, Istanbul, Turkey
| | | | | | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ates Kara
- Hacettepe University Hospital, Ankara, Turkey
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3
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Yilmaz Ciftdogan D, Ekemen Keles Y, Karbuz A, Cetin BS, Elmas Bozdemir S, Kepenekli Kadayifci E, Metin Akcan O, Ozer A, Erat T, Sutcu M, Buyukcam A, Belet N, Erdeniz EH, Dalgic Karabulut N, Hancerli Torun S, Oncel S, Orbak Z, Turel O, Gayretli Aydin ZG, Kilic O, Yahsi A, Kara Aksay A, Ergenc Z, Petmezci MT, Oflaz MB, Sarikaya R, Otar Yener G, Ozen S, Gul D, Arslan G, Kara SS, Demirkol D, Yazici Ozkaya P, Yozgat Y, Varan C, Kara M, Arga G, Yakut N, Kilic AO, Cakici O, Kucuk M, Kaba O, Karaoglu Asrak H, Bursal Duramaz B, Dalkiran T, Berna Anil A, Turgut M, Karapinar B, Somer A, Elmali F, Dinleyici EC, Ciftci E, Kara A. Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study). J Paediatr Child Health 2022; 58:1069-1078. [PMID: 35199895 PMCID: PMC9115147 DOI: 10.1111/jpc.15913] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/19/2021] [Accepted: 02/06/2022] [Indexed: 12/11/2022]
Abstract
AIM Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey. METHODS The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis. RESULTS The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died. CONCLUSION The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
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Affiliation(s)
- Dilek Yilmaz Ciftdogan
- Department of Pediatric Infectious Diseases, Faculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey,Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Yildiz Ekemen Keles
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Adem Karbuz
- Department of Pediatric Infectious DiseasesIstanbul Professor Doctor Cemil Tascioglu City HospitalIstanbulTurkey
| | - Benhur Sirvan Cetin
- Department of Pediatric Infectious Diseases, Faculty of MedicineErciyes UniversityKayseriTurkey
| | - Sefika Elmas Bozdemir
- Department of Pediatric Infectious DiseasesBursa Dortcelik Children's HospitalBursaTurkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Ozge Metin Akcan
- Department of Pediatric Infectious Diseases, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Arife Ozer
- Division of Pediatric Infectious Diseases, Van Training and Research HospitalUniversity of Health SciencesVanTurkey
| | - Tugba Erat
- Division of Pediatric Infectious DiseasesSanliurfa Training and Research HospitalSanliurfaTurkey
| | - Murat Sutcu
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstinye University HospitalIstanbulTurkey
| | - Ayse Buyukcam
- Division of Pediatric Infectious DiseasesGaziantep CG Obstetrics and Children's HospitalGaziantepTurkey
| | - Nursen Belet
- Department of Pediatric Infectious Diseases, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Emine Hafize Erdeniz
- Department of Pediatric Infectious DiseasesOndokuz Mayis University HospitalSamsunTurkey
| | - Nazan Dalgic Karabulut
- Division of Pediatric Infectious DiseasesHealth Sciences University Sisli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Selim Oncel
- Department of Pediatric Infectious Diseases, Faculty of MedicineKocaeli University HospitalKocaeliTurkey
| | - Zerrin Orbak
- Department of Pediatrics, Faculty of Dentistry and MedicineAtatürk UniversityErzurumTurkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Zeynep Gokce Gayretli Aydin
- Department of Pediatric Infectious Diseases, Faculty of MedicineKaradeniz Teknik University HospitalTrabzonTurkey
| | - Omer Kilic
- Department of Pediatric Infectious Diseases, Faculty of MedicineOsmangazi University HospitalEskisehirTurkey
| | - Aysun Yahsi
- Division of Pediatric Infectious Diseases, Samsun Training and Research HospitalUniversity of Health SciencesSamsunTurkey
| | - Ahu Kara Aksay
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research HospitalUniversity of Health SciencesIzmirTurkey
| | - Zeynep Ergenc
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Mey Talip Petmezci
- Department of Intensive CareIstanbul Professor Doctor Cemil Tascioglu City HospitalIstanbulTurkey
| | - Mehmet Burhan Oflaz
- Department of Pediatric Cardiology, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Remzi Sarikaya
- Division of Cardiology, Van Training and Research HospitalUniversity of Health SciencesVanTurkey
| | - Gülcin Otar Yener
- Division of Pediatric RomatologySanliurfa Training and Research HospitalSanliurfaTurkey
| | - Seval Ozen
- Department of Pediatric Infectious Diseases, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Doruk Gul
- Department of Pediatrics, Faculty of MedicineIstinye University HospitalIstanbulTurkey
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Faculty of MedicineAydin Adnan Menderes UniversityAydinTurkey
| | - Demet Demirkol
- Department of Pediatric Intensive Care, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Pinar Yazici Ozkaya
- Department of Pediatric Intensive Care, Faculty of MedicineEge University HospitalIzmirTurkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Celal Varan
- Department of Pediatric Cardiology, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Manolya Kara
- Division of Pediatric Infectious DiseasesNecip Fazil City HospitalKahramanmarasTurkey
| | - Gul Arga
- Department of Pediatric Infectious Diseases, Faculty of MedicineAnkara University HospitalAnkaraTurkey
| | - Nurhayat Yakut
- Department of Pediatric Infectious Diseases, Faculty of MedicinePendik Training and Research Hospital, Marmara UniversityIstanbulTurkey
| | - Ahmet Osman Kilic
- Department of Pediatrics, Faculty of MedicineNecmettin Erbakan University, Meram HospitalKonyaTurkey
| | - Ozlem Cakici
- Department of Pediatric Infectious Diseases, Faculty of MedicineKocaeli University HospitalKocaeliTurkey
| | - Mehmet Kucuk
- Division of Pediatric Cardiolgy, Samsun Training and Research HospitalUniversity of Health SciencesSamsunTurkey
| | - Ozge Kaba
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Hatice Karaoglu Asrak
- Department of Pediatric Infectious Diseases, Faculty of MedicineDokuz Eylul University HospitalİzmirTurkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Faculty of MedicineBezmialem Vakif University HospitalIstanbulTurkey
| | - Tahir Dalkiran
- Division of Pediatric Intensive CareNecip Fazil City HospitalKahramanmarasTurkey
| | - Ayse Berna Anil
- Department of Pediatric Intensive Care, Faculty of MedicineIzmir Katip Celebi UniversityIzmirTurkey
| | - Mehmet Turgut
- Department of Pediatric Infectious Diseases, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
| | - Bulent Karapinar
- Department of Pediatric Intensive Care, Faculty of MedicineEge University HospitalIzmirTurkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Faculty of MedicineIstanbul University HospitalIstanbulTurkey
| | - Ferhan Elmali
- Department of BiostatisticsIzmir Katip Celebi UniversityIzmirTurkey
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of MedicineEskisehir Osmangazi UniversityEskisehirTurkey
| | - Ergin Ciftci
- Department of Pediatric Infectious Diseases, Faculty of MedicineAnkara University HospitalAnkaraTurkey
| | - Ates Kara
- Department of Pediatric Infectious Diseases, Faculty of MedicineHacettepe University HospitalAnkaraTurkey
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4
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Yilmaz Ciftdogan D, Ekemen Keles Y, Cetin BS, Dalgic Karabulut N, Emiroglu M, Bagci Z, Buyukcam A, Erdeniz EH, Arga G, Yesil E, Cakici O, Karbuz A, Sahbudak Bal Z, Kara SS, Ozer A, Metin Akcan O, Elmas Bozdemir S, Anil AB, Uygun H, Kilic O, Hancerli Torun S, Umit Z, Sutcu M, Ozgokce Ozmen B, Karaoglu Asrak H, Alkan G, Kara Aksay A, Ugur C, Birbilen AZ, Bursal Duramaz B, Akyuz Ozkan E, Burakay O, Yildirim Arslan S, Karadag Oncel E, Celik SF, Kilic AO, Ozen S, Sarikaya R, Demirkol D, Arslan G, Turel O, Sert A, Sari E, Orbak Z, Sahin IO, Varan C, Akturk H, Tuter Oz SK, Durak F, Oflaz MB, Kara M, Karpuz D, Talip Petmezci M, Hatipoglu N, Oncel S, Turgut M, Elmali F, Somer A, Kuyucu N, Dinleyici EC, Kurugöl Z, Ciftci E, Kara A. COVID-19 associated multisystemic inflammatory syndrome in 614 children with and without overlap with Kawasaki disease-Turk MIS-C study group. Eur J Pediatr 2022; 181:2031-2043. [PMID: 35129668 PMCID: PMC8819197 DOI: 10.1007/s00431-022-04390-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 12/17/2022]
Abstract
Multisystemic inflammatory syndrome (MIS-C) diagnosis remains difficult because the clinical features overlap with Kawasaki disease (KD). The study aims to highlight the clinical and laboratory features and outcomes of patients with MISC whose clinical manifestations overlap with or without KD. This study is a retrospective analysis of a case series designed for patients aged 1 month to 18 years in 28 hospitals between November 1, 2020, and June 9, 2021. Patient demographics, complaints, laboratory results, echocardiographic results, system involvement, and outcomes were recorded. A total of 614 patients were enrolled; the median age was 7.4 years (interquartile range (IQR) 3.9-12 years). A total of 277 (45.1%) patients with MIS-C had manifestations that overlapped with KD, including 92 (33.3%) patients with complete KD and 185 (66.7%) with incomplete KD. Lymphocyte and platelet counts were significantly lower in patients with MISC, overlapped with KD (lymphocyte count 1080 vs. 1280 cells × μL, p = 0.028; platelet count 166 vs. 216 cells × 103/μL, p < 0.001). The median serum procalcitonin levels were statistically higher in patients overlapped with KD (3.18 vs. 1.68 µg/L, p = 0.001). Coronary artery dilatation was statistically significant in patients with overlap with KD (13.4% vs. 6.8%, p = 0.007), while myocarditis was significantly more common in patients without overlap with KD features (2.6% vs 7.4%, p = 0.009). The association between clinical and laboratory findings and overlap with KD was investigated. Age > 12 years reduced the risk of overlap with KD by 66% (p < 0.001, 95% CI 0.217-0.550), lethargy increased the risk of overlap with KD by 2.6-fold (p = 0.011, 95% CI 1.244-5.439), and each unit more albumin (g/dl) reduced the risk of overlap with KD by 60% (p < 0.001, 95% CI 0.298-0.559). CONCLUSION Almost half of the patients with MISC had clinical features that overlapped with KD; in particular, incomplete KD was present. The median age was lower in patients with KD-like features. Lymphocyte and platelet counts were lower, and ferritin and procalcitonin levels were significantly higher in patients with overlap with KD. WHAT IS KNOWN • In some cases of MIS-C, the clinical symptoms overlap with Kawasaki disease. • Compared to Kawasaki disease, lymphopenia was an independent predictor of MIS-C. WHAT IS NEW • Half of the patients had clinical features that overlapped with Kawasaki disease. • In patients whose clinical features overlapped with KD, procalcitonin levels were almost 15 times higher than normal. • Lethargy increased the risk of overlap with KD by 2.6-fold in MIS-C patients. • Transient bradycardia was noted in approximately 10% of our patients after initiation of treatment.
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Affiliation(s)
- Dilek Yilmaz Ciftdogan
- Izmir Katip Celebi University, Izmir, Turkey
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Yildiz Ekemen Keles
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Nazan Dalgic Karabulut
- Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Zafer Bagci
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | - Ayse Buyukcam
- Gaziantep CG Obstetrics and Children’s Hospital, Gaziantep, Turkey
| | | | - Gul Arga
- Ankara University Hospital, Ankara, Turkey
| | | | | | - Adem Karbuz
- Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | | | - Arife Ozer
- Van Training and Research Hospital, Van, Turkey
| | | | | | | | | | - Omer Kilic
- Osmangazi University Hospital, Eskisehir, Turkey
| | | | | | - Murat Sutcu
- Istinye University Hospital, Istanbul, Turkey
| | | | | | | | - Ahu Kara Aksay
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Cuneyt Ugur
- University of Health Sciences Konya Health Application and Research Center, Konya, Turkey
| | | | | | | | | | | | - Eda Karadag Oncel
- Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey
| | | | | | - Seval Ozen
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | | | - Gazi Arslan
- Dokuz Eylul University Hospital, İzmir, Turkey
| | - Ozden Turel
- Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Ahmet Sert
- Selcuk University Hospital, Konya, Turkey
| | - Ergul Sari
- Bakirkoy Sadi Konuk Children Hospital, Istanbul, Turkey
| | | | | | - Celal Varan
- Adiyaman University Hospital, Adiyaman, Turkey
| | | | | | - Fatih Durak
- Gaziantep CG Obstetrics and Children’s Hospital, Gaziantep, Turkey
| | | | | | | | - Mey Talip Petmezci
- Istanbul Professor Doctor Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | - Selim Oncel
- Kocaeli University Hospital, Kocaeli, Turkey
| | | | | | - Ayper Somer
- Istanbul University Hospital, Istanbul, Turkey
| | | | | | | | | | - Ates Kara
- Hacettepe University Hospital, Ankara, Turkey
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5
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Dalgic N, Sahin A, Torun SH, Kaba O, Onal P, Yilmaz AT, Turel O, Yasar B, Kara M, Aygun D, Kilinc A, Oncel S, Duramaz BB, Urganci N, Somer A, Cokugras H, Arisoy ES. Active and Latent Tuberculosis in Children Treated with Anti-TNF-α: A Retrospective Multicenter Study. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1743195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective This study aimed to investigate the frequency of latent and active tuberculosis (TB) in pediatric patients receiving anti-tumor necrosis factor (TNF)-α therapy.
Methods Patients younger than 18 years with various inflammatory diseases and treated with anti-TNF-α agents in the past five years were included in the study. The patients' ages, follow-ups, medications received, clinical and laboratory findings, and treatments applied were recorded retrospectively.
Results Of the 160 patients included in the study, 78 (48.8%) were girls. The mean age was 139.54 ± 48.74 (30–226) months. Sixty (37.5%) patients had inflammatory eye disease, 55 (34.4%) had rheumatologic and autoimmune disease, and 45 (28.1%) had inflammatory bowel disease. As anti-TNF-α treatment, 67 (41.9%) patients received adalimumab, 50 (31.2%) received infliximab, and 43 (26.9%) received etanercept. As a result of TB screening performed prior to the treatment, 44 (25.4%) patients were started on isoniazid treatment with the diagnosis of latent TB. During follow-up, latent TB infection was detected in 16 (9.2%) patients and isoniazid treatment was started. The time to develop latent TB under anti-TNF-α treatment ranged from 3 to 28 months. During the treatment, active TB infection developed in two (1.2%) patients and anti-TB treatment was initiated.
Conclusion It is of vital importance to evaluate patients receiving, or planned to receive, anti-TNF-α treatment, for TB infection and to initiate appropriate treatments if latent or active TB infection is identified.
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Affiliation(s)
- Nazan Dalgic
- Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayse Sahin
- Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selda Hancerli Torun
- Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozge Kaba
- Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Onal
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Ayse Tekin Yilmaz
- Section of Internal Medical Sciences, Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Belma Yasar
- Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Manolya Kara
- Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Deniz Aygun
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Ayse Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Selim Oncel
- Section of Internal Medical Sciences, Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Nafiye Urganci
- Division of Pediatric Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Disease, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Emin Sami Arisoy
- Section of Internal Medical Sciences, Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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6
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Turel O, Demir AD, Cakir FB, Bursal Duramaz B, Kaba O. Is your diagnosis cat scratch disease, not lymphoma? Pediatr Int 2021; 63:851-853. [PMID: 33999468 DOI: 10.1111/ped.14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ozden Turel
- Departments of, Department of, Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Fatma Betul Cakir
- Department of, Pediatric Hematology and Oncology, Bezmialem Vakif University, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Departments of, Department of, Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozge Kaba
- Department of, Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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7
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Turel O, Abdillah FK, Yozgat CY, Uzuner S, Duramaz BB, Dundar TT, Seyithanoglu MH, Yesilbas O, Kutlu NO. A Rare Presentation of Neurobrucellosis in a 6-Year-Old Pediatric Patient with Sagittal Sinus Thrombosis. Neuropediatrics 2021; 52:48-51. [PMID: 33017853 DOI: 10.1055/s-0040-1715482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Brucellosis is one of the most common zoonosis worldwide. It is still endemic in many regions of the world. A 6-year-old female was admitted to the emergency department (ED) due to a sudden change in consciousness, urinary incontinence, vomiting, and difficulty in walking. Neurological examination demonstrated abducens nerve paralysis, mild-to-moderate motor deficit in hemiparesis in the left arm. Brain magnetic resonance imaging showed a hemorrhagic focus at the right frontal lobe and thrombosis in the superior sagittal sinus of the brain. The diagnosis of neurobrucellosis was confirmed by identifying Brucella spp. in the blood culture on the day 6 of pediatric intensive care unit admission; thus, trimethoprim-sulfamethoxazole and rifampicin, and ceftriaxone were promptly initiated. Despite neuroprotective management and acetazolamide, the patient's neurological problems and high intracranial pressure (ICP) persisted. An external ventricular drainage tube and a Codman ICP monitor were placed to be on the consent vigilance of the patient's neurological condition. The patient's ICP continued to increase despite the current treatment regimen; therefore, a decompressive bitemporal craniectomy was performed. The ICP level of the patient returned to its normal range immediately after the craniectomy. The patient did not have any notable neurologic sequelae at the first-year follow-up. Neurobrucellosis is a rare complication of systemic brucellosis and may present as meningitis, encephalitis, myelitis, radiculitis, and/or neuritis. Herein, we describe a six-year-old girl with brucellosis complicated with cerebral vein thrombosis. This case illustrates the need for close monitoring of patients with unexplained neurological signs or symptoms for brucellosis in endemic areas.
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Affiliation(s)
- Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Selcuk Uzuner
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Tolga Turan Dundar
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Nurettin Onur Kutlu
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
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8
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Yesilbas O, Yozgat CY, Nizam OG, Bursal Duramaz B, Turel O. Life-threatening multiple brain abscesses secondary to Actinomyces odontolyticus. Pediatr Int 2020; 62:1307-1308. [PMID: 33242922 DOI: 10.1111/ped.14362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/30/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Osman Yesilbas
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Oznur Gokce Nizam
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
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9
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Duramaz BB, Turel O, Korkmaz C, Karadogan MT, Yozgat CY, Iscan A, Sümbül B, Erenberk U. A Snapshot of Pediatric Patients with COVID-19 in a Pandemic Hospital. Klin Padiatr 2020; 233:24-30. [PMID: 33124020 DOI: 10.1055/a-1263-1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM Reports describing coronavirus disease 2019 (Covid-19) in children are fewer than adult studies due to milder clinical picture. We aimed to share our experience at a single center with an emphasis on collective decision making. MATERIALS AND METHODS A suspected case was defined as the presence of symptoms suggestive of COVID-19 and/or positive contact history. SARS-CoV-2 PCR positive patients were defined as confirmed COVID-19. Between March 12, 2020, and May 15, 2020, all children presenting with fever, cough, or respiratory difficulty were investigated for COVID-19. A total of 719 children were examined at outpatient clinics, and 495 were tested with polymerase chain reaction (PCR) for suspicion of COVID-19. A team was organized for monitoring and treating patients either as outpatients or hospitalization. Patients were evaluated in terms of age, gender, travel history, epidemiological history, clinical symptoms and signs, laboratory and radiological findings, treatment, and outcome. RESULTS Sixty patients were hospitalized for suspicion of COVID-19. Forty-three patients were diagnosed as probable or confirmed COVID-19. 21 of 43 patients (48.8%) were PCR confirmed. The remaining 22 were diagnosed by epidemiologic history, clinical assessment, and computerized thorax tomography (CT) findings. The median age was 126 and 78.5 months in PCR positives and PCR negatives, respectively and the youngest patient was a 28 days old baby. Nineteen of the patients had an upper respiratory infection (44.1%). Although five patients had no clinical signs, chest X-ray, or CT revealed pneumonia. CONCLUSIONS As previously reported, the clinical manifestations of COVID-19 in children are mostly mild. Even very young kids can become infected following exposure to sick family members. International and local guidelines are valuable for decision making since it is a new disease. A combination of chest disease, infectious diseases, and emergency care physicians approach will aid the appropriate management of cases.
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Affiliation(s)
| | - Ozden Turel
- Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul
| | | | | | | | - Akin Iscan
- Faculty of Medicine, Bezmialem Vakif University, Istanbul
| | - Bilge Sümbül
- Pediatric Neurology, Bezmialem Vakif University, Istanbul
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10
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Yozgat CY, Uzuner S, Ay Y, Temur HO, Bursal Duramaz B, Turel O, Calim M, Buyukpinarbasili N, Yozgat Y. Lifesaving Treatment of Aortic Valve Staphylococcus aureus Endocarditis: Daptomycin and Early Surgical Therapy. J Pediatr Intensive Care 2020; 10:298-302. [PMID: 34745704 DOI: 10.1055/s-0040-1713614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/13/2020] [Indexed: 10/23/2022] Open
Abstract
Infective endocarditis (IE) is an uncommon infection in children. The recommended treatment for native valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus infection is antistaphylococcal penicillins such as nafcillin or oxacillin. If the initial therapy fails in IE, it can lead to catastrophic results. Nowadays, daptomycin is the best alternative antimicrobial agent to treat children with severe infections, when standard antimicrobial therapy does not yield a result. Herein, in this article, we described a case of a 16-year-old boy who had aortic valve S. aureus endocarditis with septic embolization and stroke. The patient was successfully treated only with daptomycin as well as surgical therapy in the early phase of the infection.
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Affiliation(s)
| | - Selcuk Uzuner
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Yasin Ay
- Department of Cardiovascular Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Hafize Otcu Temur
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University, Istanbul, Turkey
| | - Nur Buyukpinarbasili
- Department of Pathology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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11
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Yozgat CY, Uzuner S, Bursal Duramaz B, Yozgat Y, Erenberk U, Iscan A, Turel O. Dermatological manifestation of pediatrics multisystem inflammatory syndrome associated with COVID-19 in a 3-year-old girl. Dermatol Ther 2020; 33:e13770. [PMID: 32500647 PMCID: PMC7300549 DOI: 10.1111/dth.13770] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | - Selcuk Uzuner
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ufuk Erenberk
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Akin Iscan
- Department of Pediatric Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
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12
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Bursal Duramaz B, Yozgat CY, Yozgat Y, Turel O. Appearance of skin rash in pediatric patients with COVID-19: Three case presentations. Dermatol Ther 2020; 33:e13594. [PMID: 32412681 PMCID: PMC7261998 DOI: 10.1111/dth.13594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
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13
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Yozgat Y, Uzuner S, Demir AD, Ogur M, Yozgat CY, Turel O. A 13-Year-Old Boy Who Has Kawasaki Disease Shock Syndrome Presents with Parotitis. J Pediatr Intensive Care 2019; 9:60-63. [PMID: 31984160 DOI: 10.1055/s-0039-1697978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022] Open
Abstract
We report a 13-year-old boy who (initially) had symptoms of toxic shock-like syndrome and mumps. Then, the patient was hospitalized in the pediatric intensive care unit (PICU) because of his ongoing hemodynamic instability (low blood pressure of 70/30 mm Hg and capillary refill time of > 4 seconds). During his stay in the PICU, the patient was treated with fluid resuscitation and vasoactive infusion and at the same time was diagnosed with Kawasaki disease shock syndrome (KDSS), when giant right coronary artery aneurysms were detected on echocardiographic examination. This case illustrates the risk of KDSS in patient who carries both parotitis and toxic shock-like syndrome. The clinicians should be cautious about detecting any types of coronary artery aneurysms in such patients. This is the first case of KDSS associated with parotitis reported in the literature.
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Affiliation(s)
- Yilmaz Yozgat
- Department of Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Selcuk Uzuner
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Aysegul Dogan Demir
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa Ogur
- Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Ozden Turel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
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Ceylan AN, Turel O, Gultepe BS, Inan E, Turkmen AV, Doymaz MZ. Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6: A Preliminary Report from Istanbul. Pol J Microbiol 2019; 68:165-171. [PMID: 31257789 DOI: 10.21307/pjm-2019-016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 11/11/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is caused by various serotypes of Enterovirus genus. Coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71) were known to be the only responsible agents for these epidemics; however, this opinion was challenged after the detection that coxsackievirus A6 (CV-A6) was the responsible species for the outbreak in Finland in 2008. HFMD is frequently seen in Turkey, and no detailed study on its clinical and microbiological epidemiology has previously been reported. The present study addresses this question. Twenty-seven patient samples collected between 2015 and 2017 were included in the study. Typing was conducted by RT-PCR and the sequencing applied directly to patient's samples and as well as to the viral cultures with pan-enterovirus and serotype-specific primers. The presence of Enterovirus in 12 of 27 HFMD samples was shown with RT-PCR. The causative agent for three of these 12 samples was CV-A16, one of the most frequent two serotypes around the world, and the remaining nine samples was CV-A6. The findings of the study are relevant since it pertains to the molecular epidemiology of HFMD in Turkey, a gateway country where different serotypes might be circulating and transmitted. The findings also support the notion that CV-A6 cases are rising in number, which has caused more severe clinical features and widespread rashes in recent outbreaks. Hand, foot, and mouth disease (HFMD) is caused by various serotypes of Enterovirus genus. Coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71) were known to be the only responsible agents for these epidemics; however, this opinion was challenged after the detection that coxsackievirus A6 (CV-A6) was the responsible species for the outbreak in Finland in 2008. HFMD is frequently seen in Turkey, and no detailed study on its clinical and microbiological epidemiology has previously been reported. The present study addresses this question. Twenty-seven patient samples collected between 2015 and 2017 were included in the study. Typing was conducted by RT-PCR and the sequencing applied directly to patient’s samples and as well as to the viral cultures with pan-enterovirus and serotype-specific primers. The presence of Enterovirus in 12 of 27 HFMD samples was shown with RT-PCR. The causative agent for three of these 12 samples was CV-A16, one of the most frequent two serotypes around the world, and the remaining nine samples was CV-A6. The findings of the study are relevant since it pertains to the molecular epidemiology of HFMD in Turkey, a gateway country where different serotypes might be circulating and transmitted. The findings also support the notion that CV-A6 cases are rising in number, which has caused more severe clinical features and widespread rashes in recent outbreaks.
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Affiliation(s)
- Ayse N Ceylan
- Bezmialem Vakif University, Department of Medical Microbiology , Istanbul , Turkey
| | - Ozden Turel
- Bezmialem Vakif University, Department of Pediatrics , Istanbul , Turkey
| | - Bilge Sumbul Gultepe
- Bezmialem Vakif University, Department of Medical Microbiology , Istanbul , Turkey
| | - Elif Inan
- Bezmialem Vakif University, Department of Pediatrics , Istanbul , Turkey
| | | | - Mehmet Z Doymaz
- Bezmialem Vakif University, Department of Medical Microbiology , Istanbul , Turkey ; Bezmialem Vakif University, Beykoz Institute of Life Sciences and Biotechnology (BILSAB) , Istanbul , Turkey
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15
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Ceylan AN, Turel O, Gultepe BS, Inan E, Turkmen AV, Doymaz MZ. Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6: A Preliminary Report from Istanbul. Pol J Microbiol 2019. [PMID: 31257789 PMCID: PMC7260638 DOI: 10.33073/pjm-2019-016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is caused by various serotypes of Enterovirus genus. Coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71) were known to be the only responsible agents for these epidemics; however, this opinion was challenged after the detection that coxsackievirus A6 (CV-A6) was the responsible species for the outbreak in Finland in 2008. HFMD is frequently seen in Turkey, and no detailed study on its clinical and microbiological epidemiology has previously been reported. The present study addresses this question. Twenty-seven patient samples collected between 2015 and 2017 were included in the study. Typing was conducted by RT-PCR and the sequencing applied directly to patient’s samples and as well as to the viral cultures with pan-enterovirus and serotype-specific primers. The presence of Enterovirus in 12 of 27 HFMD samples was shown with RT-PCR. The causative agent for three of these 12 samples was CV-A16, one of the most frequent two serotypes around the world, and the remaining nine samples was CV-A6. The findings of the study are relevant since it pertains to the molecular epidemiology of HFMD in Turkey, a gateway country where different serotypes might be circulating and transmitted. The findings also support the notion that CV-A6 cases are rising in number, which has caused more severe clinical features and widespread rashes in recent outbreaks.
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Affiliation(s)
- Ayse N Ceylan
- Bezmialem Vakif University, Department of Medical Microbiology , Istanbul , Turkey
| | - Ozden Turel
- Bezmialem Vakif University, Department of Pediatrics , Istanbul , Turkey
| | - Bilge Sumbul Gultepe
- Bezmialem Vakif University, Department of Medical Microbiology , Istanbul , Turkey
| | - Elif Inan
- Bezmialem Vakif University, Department of Pediatrics , Istanbul , Turkey
| | | | - Mehmet Z Doymaz
- Bezmialem Vakif University, Department of Medical Microbiology , Istanbul , Turkey ; Bezmialem Vakif University, Beykoz Institute of Life Sciences and Biotechnology (BILSAB) , Istanbul , Turkey
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Turel O, Mirapoglu SL, Yuksel M, Ceylan A, Gultepe BS. Perforated appendicitis in children: antimicrobial susceptibility and antimicrobial stewardship. J Glob Antimicrob Resist 2019; 16:159-161. [PMID: 30268808 DOI: 10.1016/j.jgar.2018.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022] Open
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Yakut N, Soysal A, Kepenekli Kadayifci E, Dalgic N, Yılmaz Ciftdogan D, Karaaslan A, Akkoc G, Ocal Demir S, Cagan E, Celikboya E, Kanik A, Dagcinar A, Yilmaz A, Ozer F, Camlar M, Turel O, Bakir M. Ventriculoperitoneal shunt infections and re-infections in children: a multicentre retrospective study. Br J Neurosurg 2018; 32:196-200. [DOI: 10.1080/02688697.2018.1467373] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Ahmet Soysal
- Marmara University School of Medicine, Istanbul, Turkey
| | | | - Nazan Dalgic
- Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | | | - Gulsen Akkoc
- Marmara University School of Medicine, Istanbul, Turkey
| | | | - Eren Cagan
- Bursa Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Ezgi Celikboya
- Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ali Kanik
- İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Adem Yilmaz
- Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fusun Ozer
- İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mahmut Camlar
- İzmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ozden Turel
- Bezmialem University School Of Medicine, Istanbul, Turkey
| | - Mustafa Bakir
- Marmara University School of Medicine, Istanbul, Turkey
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Turel O, Aygun D, Kardas M, Torun E, Hershfield M, Camcıoglu Y. A case of severe combined immunodeficiency caused by adenosine deaminase deficiency with a new mutation. Pediatr Neonatol 2018; 59:97-99. [PMID: 28823388 DOI: 10.1016/j.pedneo.2016.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/10/2016] [Accepted: 10/14/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ozden Turel
- Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.
| | - Deniz Aygun
- Department of Pediatric Infectious Diseases, Clinical Immunology and Allergy, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Murat Kardas
- Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.
| | - Emel Torun
- Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.
| | - Micheal Hershfield
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, USA.
| | - Yıldız Camcıoglu
- Department of Pediatric Infectious Diseases, Clinical Immunology and Allergy, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Dinleyici EC, Martínez-Martínez D, Kara A, Karbuz A, Dalgic N, Metin O, Yazar AS, Guven S, Kurugol Z, Turel O, Kucukkoc M, Yasa O, Eren M, Ozen M, Martí JM, P. Garay C, Vandenplas Y, Moya A. Time Series Analysis of the Microbiota of Children Suffering From Acute Infectious Diarrhea and Their Recovery After Treatment. Front Microbiol 2018; 9:1230. [PMID: 29946306 PMCID: PMC6005867 DOI: 10.3389/fmicb.2018.01230] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/22/2018] [Indexed: 02/05/2023] Open
Abstract
Gut microbiota is closely related to acute infectious diarrhea, one of the leading causes of mortality and morbidity in children worldwide. Understanding the dynamics of the recovery from this disease is of clinical interest. This work aims to correlate the dynamics of gut microbiota with the evolution of children who were suffering from acute infectious diarrhea caused by a rotavirus, and their recovery after the administration of a probiotic, Saccharomyces boulardii CNCM I-745. The experiment involved 10 children with acute infectious diarrhea caused by a rotavirus, and six healthy children, all aged between 3 and 4 years. The children who suffered the rotavirus infection received S. boulardii CNCM I-745 twice daily for the first 5 days of the experiment. Fecal samples were collected from each participant at 0, 3, 5, 10, and 30 days after probiotic administration. Microbial composition was characterized by 16S rRNA gene sequencing. Alpha and beta diversity were calculated, along with dynamical analysis based on Taylor's law to assess the temporal stability of the microbiota. All children infected with the rotavirus stopped having diarrhea at day 3 after the intervention. We observed low alpha diversities in the first 5 days (p-value < 0.05, Wilcoxon test), larger at 10 and 30 days after probiotic treatment. Canonical correspondence analysis (CCA) showed differences in the gut microbiota of healthy children and of those who suffered from acute diarrhea in the first days (p-value < 0.05, ADONIS test), but not in the last days of the experiment. Temporal variability was larger in children infected with the rotavirus than in healthy ones. In particular, Gammaproteobacteria class was found to be abundant in children with acute diarrhea. We identified the microbiota transition from a diseased state to a healthy one with time, whose characterization may lead to relevant clinical data. This work highlights the importance of using time series for the study of dysbiosis related to diarrhea.
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Affiliation(s)
- Ener C. Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Ates Kara
- Pediatric Infectious Disease Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Adem Karbuz
- Department of Pediatrics, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Nazan Dalgic
- Division of Pediatric Infectious Diseases, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ozge Metin
- Division of Pediatric Infectious Diseases, Konya Training and Research Hospital, Konya, Turkey
| | - Ahmet S. Yazar
- Department of Pediatrics, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Sirin Guven
- Department of Pediatrics, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Zafer Kurugol
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Disease Unit, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Kucukkoc
- Department of Pediatric Infectious Disease Unit, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Olcay Yasa
- Department of Pediatrics, Goztepe Training and Research Hospital, SB Istanbul Medeniyet University, Istanbul, Turkey
| | - Makbule Eren
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Metehan Ozen
- Department of Pediatrics, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Jose Manuel Martí
- Institute for Integrative Systems Biology, Catedrático José Beltrán, Valencia, Spain
| | - Carlos P. Garay
- Institute for Integrative Systems Biology, Catedrático José Beltrán, Valencia, Spain
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrés Moya
- Institute for Integrative Systems Biology, Catedrático José Beltrán, Valencia, Spain
- Area de Genómica y Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Salud Pública), Valencia, Spain
- CIBER en Epidemiología y Salud Pública (CIBEResp), Madrid, Spain
- *Correspondence: Andrés Moya
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Vehapoglu A, Goknar N, Turel O, Torun E, Ozgurhan G. Risk factors for childhood obesity: Do the birth weight, type of delivery, and mother's overweight have an implication on current weight status? World J Pediatr 2017; 13:457-464. [PMID: 28434072 DOI: 10.1007/s12519-017-0030-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to identify risk factors, including the type of delivery, breastfeeding and its duration, birth weight, the timing of solid food introduction, the mother's education level at birth, and smoking status during pregnancy, that are associated with obesity in children living in Istanbul. METHODS This study involving 4990 healthy children aged 2-14 years, at an outpatient clinic in a tertiary care hospital from June 2012 to July 2014. RESULTS The overall rates of overweight and obesity in children were 13.1% and 7.8%, respectively. Results demonstrated that 44.5% of children were delivered by caesarean section. In all age groups, 7.8% of children delivered by caesarean section were obese compared with 7.9% of children born vaginally. No significant association between caesarean section delivery and obesity in childhood was found in our study [odds ratio (OR)=0.98, 95% confidence interval (CI)=0.64-2.87, P=0.454]. There was also no association between duration of breastfeeding and the introduction of solid foods before 4 months or after 6 months of age and childhood obesity (OR=0.95, 95% CI=0.69-1.3, P=0.771; OR=0.99, 95% CI=0.64-1.53, P=0.261). Regression analyses revealed that children with birth weights greater than 3801 g or those with maternal body mass index (BMI) equal to or greater than 30 had an increased risk of being obese or overweight (OR=1.78, 95% CI=1.19-2.65; OR=3.95, 95% CI=1.94-5.81). CONCLUSIONS This study demonstrated that increased birth weight and maternal BMI are significant risk factors for obesity in children living in Istanbul, Turkey. No relation between caesarean section delivery and childhood obesity was found in this study.
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Affiliation(s)
- Aysel Vehapoglu
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Vatan Street, Fatih, Istanbul, 34093, Turkey.
| | - Nilufer Goknar
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Vatan Street, Fatih, Istanbul, 34093, Turkey
| | - Ozden Turel
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Vatan Street, Fatih, Istanbul, 34093, Turkey
| | - Emel Torun
- Department of Pediatrics, Bezmialem Vakıf University, Faculty of Medicine, Vatan Street, Fatih, Istanbul, 34093, Turkey
| | - Gamze Ozgurhan
- Department of Pediatrics, Suleymaniye Obstetrics and Gynecology Hospital, Istanbul, Turkey
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Turel O, Romashkin A, Morrison KM. A model linking video gaming, sleep quality, sweet drinks consumption and obesity among children and youth. Clin Obes 2017; 7:191-198. [PMID: 28320073 DOI: 10.1111/cob.12191] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/07/2017] [Accepted: 02/19/2017] [Indexed: 12/30/2022]
Abstract
There is a growing need to curb paediatric obesity. The aim of this study is to untangle associations between video-game-use attributes and obesity as a first step towards identifying and examining possible interventions. Cross-sectional time-lagged cohort study was employed using parent-child surveys (t1) and objective physical activity and physiological measures (t2) from 125 children/adolescents (mean age = 13.06, 9-17-year-olds) who play video games, recruited from two clinics at a Canadian academic children's hospital. Structural equation modelling and analysis of covariance were employed for inference. The results of the study are as follows: (i) self-reported video-game play duration in the 4-h window before bedtime is related to greater abdominal adiposity (waist-to-height ratio) and this association may be mediated through reduced sleep quality (measured with the Pittsburgh Sleep Quality Index); and (ii) self-reported average video-game session duration is associated with greater abdominal adiposity and this association may be mediated through higher self-reported sweet drinks consumption while playing video games and reduced sleep quality. Video-game play duration in the 4-h window before bedtime, typical video-game session duration, sweet drinks consumption while playing video games and poor sleep quality have aversive associations with abdominal adiposity. Paediatricians and researchers should further explore how these factors can be altered through behavioural or pharmacological interventions as a means to reduce paediatric obesity.
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Affiliation(s)
- O Turel
- Department of Information Systems and Decision Sciences, California State University, Fullerton, Fullerton, CA, USA
- Brain and Creativity Institute, Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - A Romashkin
- Department of Pediatrics, McMaster Children Hospital and Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - K M Morrison
- Department of Pediatrics, McMaster Children Hospital and Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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22
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Yakut N, Soysal A, Kadayifci EK, Dalgic N, Ciftdogan DY, Karaaslan A, Cagan E, Celikboya E, Kanik A, Dagcinar A, Yilmaz A, Ozer F, Camlar M, Turel O, Bakir M. Persistant High Cerebrospinal Fluid Protein May Be a Risk Factor for Ventriculoperitoneal Shunt Reinfection in Children. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nurhayat Yakut
- Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Ahmet Soysal
- Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Nazan Dalgic
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | | | - Ayse Karaaslan
- Pediatric Infectious Diseases, TC. Sağlık Bakanlığı Dr. Lütfi Kırdar Kartal EA Hastanesi, Istanbul, Turkey
| | - Eren Cagan
- Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Ezgi Celikboya
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Ali Kanik
- Tepecik Research and Training Hospital, Izmir, Turkey
| | - Adnan Dagcinar
- Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Adem Yilmaz
- Neurosurgery, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Fusun Ozer
- Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Mahmut Camlar
- Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Ozden Turel
- Pediatric Infectious Diseases, Bezmialem University School of Medicine, Istanbul, Turkey
| | - Mustafa Bakir
- Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
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Sutcu M, Salman N, Akturk H, Dalgıc N, Turel O, Kuzdan C, Kadayifci EK, Sener D, Karbuz A, Erturan Z, Somer A. Epidemiologic and microbiologic evaluation of nosocomial infections associated with Candida spp in children: A multicenter study from Istanbul, Turkey. Am J Infect Control 2016; 44:1139-1143. [PMID: 27339794 DOI: 10.1016/j.ajic.2016.03.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to establish species distribution of Candida isolates from pediatric patients in Istanbul, Turkey, and to determine risk factors associated with nosocomial Candida infections. METHODS This study was conducted between June 2013 and June 2014 by participation of 7 medical centers in Istanbul. Candida spp strains isolated from the clinical specimens of pediatric patients were included. Clinical features were recorded on a standardized data collection sheet. RESULTS A total of 134 systemic Candida infections were identified in 134 patients. The patients were admitted in pediatric and neonatal intensive care units (41.8% and 9.7%, respectively) and in pediatric wards (48.5%). Candida albicans was the most prevalent species (47%), followed by Candida parapsilosis (13.4%), Candida tropicalis (8.2%), Candida glabrata (4.5%), Candida lusitaniae (3.7%), Candida kefyr (2.2%), Candida guilliermondii (1.5%), Candida dubliniensis (0.7%), and Candida krusei (0.7%). Types of Candida infections were candidemia (50.7%), urinary tract infection (33.6%), surgical site infection (4.5%), central nervous system infection (3.7%), catheter infection (3.7%), and intra-abdominal infection (3.7%). In multivariate analysis, younger age (1-24 months) and detection of non-albicans Candida spp was found to be risk factors associated with candidemia (P = 0.040; odds ratio [OR], 4.1; 95% confidence interval [CI], 1.06-15.86; and P = 0.02; OR, 2.4; 95% CI, 1.10-5.53, respectively). CONCLUSIONS This study provides an update for the epidemiology of nosocomial Candida infections in Istanbul, which is important for the management of patients and implementation of appropriate infection control measures.
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Affiliation(s)
- Murat Sutcu
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Nuran Salman
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hacer Akturk
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nazan Dalgıc
- Department of Pediatric Infectious Diseases, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Canan Kuzdan
- Department of Pediatric Infectious Diseases, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Eda Kepenekli Kadayifci
- Department of Pediatric Infectious Diseases, Marmara University Medical Faculty, Istanbul, Turkey
| | - Dicle Sener
- Department of Pediatric Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Zayre Erturan
- Department of Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Dinleyici E, Kara A, Dalgic N, Kurugol Z, Arica V, Metin O, Temur E, Turel O, Guven S, Yasa O, Bulut S, Tanir G, Yazar A, Karbuz A, Sancar M, Erguven M, Akca G, Eren M, Ozen M, Vandenplas Y. Saccharomyces boulardii CNCM I-745 reduces the duration of diarrhoea, length of emergency care and hospital stay in children with acute diarrhoea. Benef Microbes 2015; 6:415-21. [DOI: 10.3920/bm2014.0086] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Evidence from the literature has shown that Saccharomyces boulardii provides a clinically significant benefit in the treatment of acute infectious diarrhoea in children. In this multicentre, randomised, prospective, controlled, single blind clinical trial performed in children with acute watery diarrhoea, we aimed to evaluate the impact of S. boulardii CNCM I-745 in hospitalised children, in children requiring emergency care unit (ECU) stay and in outpatient settings. The primary endpoint was the duration of diarrhoea (in hours). Secondary outcome measures were duration of hospitalisation and diarrhoea at the 3rd day of intervention. In the whole study group (363 children), the duration of diarrhoea was approximately 24 h shorter in the S. boulardii group (75.4±33.1 vs 99.8±32.5 h, P<0.001). The effect of S. boulardii (diarrhoea-free children) was observed starting at 48 h. After 72 h, only 27.3% of the children receiving probiotic still had watery diarrhoea, in contrast to 48.5% in the control group (P<0.001). The duration of diarrhoea was significantly reduced in the probiotic group in hospital, ECU and outpatient settings (P<0.001, P<0.01 and P<0.001, respectively). The percentage of diarrhoea-free children was significantly larger after 48 and 72 h in all settings. The mean length of hospital stay was shorter with more than 36 h difference in the S. boulardii group (4.60±1.72 vs 6.12±1.71 days, P<0.001). The mean length of ECU stay was shorter with more than 19 h difference in the probiotic group (1.20±0.4 vs 2.0±0.3 days, P<0.001). No adverse effects related to the probiotic were noted. Because treatment can shorten the duration of diarrhoea and reduce the length of ECU and hospital stay, there is likely a social and economic benefit of S. boulardii CNCM I-745 in adjunction to oral rehydration solution in acute infectious gastroenteritis in children.
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Affiliation(s)
- E.C. Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Pediatric Intensive Care and Infectious Disease Unit, 26480 Eskisehir, Turkey
| | - A. Kara
- Hacettepe University Faculty of Medicine, Pediatric Infectious Disease Unit, 06100 Sıhhiye, Ankara, Turkey
| | - N. Dalgic
- Sisli Etfal Training and Research Hospital, Division of Pediatric Infectious Diseases, Halaskargazi St., 34371 Sisli, Istanbul, Turkey
| | - Z. Kurugol
- Ege University Faculty of Medicine, Department of Pediatrics, Bornova, 35100 Izmir, Turkey
| | - V. Arica
- Okmeydani Education and Research Hospital, Department of Pediatrics, Darulaceze St. 27, 34384 Istanbul, Turkey
| | - O. Metin
- Dr. Sami Ulus Research and Training Hospital of Women’s and Children’s Health and Diseases, Pediatric Infectious Disease Unit, Altindag, 06090 Ankara, Turkey
| | - E. Temur
- Balikligol State Hospital, 63050 Sanliurfa, Turkey
| | - O. Turel
- Department of Pediatric Infectious Disease Unit, Bezmialem Vakif University, Faculty of Medicine, Vatan St., 34093 Istanbul
| | - S. Guven
- Umraniye Education & Research Hospital, Department of Pediatrics, Adem Yavuz St. 1, Istanbul, Turkey
| | - O. Yasa
- Department of Pediatrics, Goztepe Training and Research Hospital, SB Istanbul Medeniyet University, Dr. Erkin St., Istanbul, Turkey
| | - S. Bulut
- Ege University Faculty of Medicine, Department of Pediatrics, Bornova, 35100 Izmir, Turkey
| | - G. Tanir
- Dr. Sami Ulus Research and Training Hospital of Women’s and Children’s Health and Diseases, Pediatric Infectious Disease Unit, Altindag, 06090 Ankara, Turkey
| | - A.S. Yazar
- Umraniye Education & Research Hospital, Department of Pediatrics, Adem Yavuz St. 1, Istanbul, Turkey
| | - A. Karbuz
- Okmeydani Education and Research Hospital, Department of Pediatrics, Darulaceze St. 27, 34384 Istanbul, Turkey
| | - M. Sancar
- Marmara University Faculty of Pharmacy, Clinical Pharmacy Department, Tıbbiye St. 49, 34688 Haydarpasa, Istanbul
| | - M. Erguven
- Department of Pediatrics, Goztepe Training and Research Hospital, SB Istanbul Medeniyet University, Dr. Erkin St., Istanbul, Turkey
| | - G. Akca
- Sisli Etfal Training and Research Hospital, Division of Pediatric Infectious Diseases, Halaskargazi St., 34371 Sisli, Istanbul, Turkey
| | - M. Eren
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics Gastroenterology and Hepatology, 26480 Eskisehir, Turkey
| | - M. Ozen
- Faculty of Medicine, Department of Pediatrics, Acibadem University, Halkali, 34303, Istanbul
| | - Y. Vandenplas
- Department of Paediatrics, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Dinleyici EC, Dalgic N, Guven S, Metin O, Yasa O, Kurugol Z, Turel O, Tanir G, Yazar AS, Arica V, Sancar M, Karbuz A, Eren M, Ozen M, Kara A, Vandenplas Y. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. J Pediatr (Rio J) 2015; 91:392-6. [PMID: 25986615 DOI: 10.1016/j.jped.2014.10.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/20/2014] [Accepted: 10/23/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea. METHODS This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1×10(8)CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded. RESULTS The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15h, 60.4±24.5h [95% CI: 51.0-69.7h] vs. 74.3±15.3h [95% CI: 68.7-79.9h], p<0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79, p<0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted. CONCLUSION L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.
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Affiliation(s)
- Ener Cagri Dinleyici
- Faculty of Medicine, Department of Pediatrics, Pediatric Intensive Care and Infectious Disease Unit, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Nazan Dalgic
- Division of Pediatric Infectious Diseases, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sirin Guven
- Department of Pediatrics, Umraniye Education & Research Hospital, Istanbul, Turkey
| | - Ozge Metin
- Pediatric Infectious Disease Unit, Dr. Sami Ulus Research and Training Hospital of Women's and Children's Health and Diseases, Ankara, Turkey
| | - Olcay Yasa
- Department of Pediatrics, Goztepe Training and Research Hospital, SB Istanbul Medeniyet University, Istanbul, Turkey
| | - Zafer Kurugol
- Department of Pediatrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Disease Unit, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Gonul Tanir
- Pediatric Infectious Disease Unit, Dr. Sami Ulus Research and Training Hospital of Women's and Children's Health and Diseases, Ankara, Turkey
| | - Ahmet Sami Yazar
- Department of Pediatrics, Umraniye Education & Research Hospital, Istanbul, Turkey
| | - Vefik Arica
- Department of Pediatrics, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Mesut Sancar
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Adem Karbuz
- Department of Pediatrics, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Makbule Eren
- Faculty of Medicine, Pediatric Infectious Disease Unit, Hacettepe University, Ankara, Turkey
| | - Metehan Ozen
- Department of Pediatrics, Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - Ates Kara
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Dinleyici EC, Dalgic N, Guven S, Metin O, Yasa O, Kurugol Z, Turel O, Tanir G, Yazar AS, Arica V, Sancar M, Karbuz A, Eren M, Ozen M, Kara A, Vandenplas Y. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting. Jornal de Pediatria (Versão em Português) 2015. [DOI: 10.1016/j.jpedp.2015.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tugcu D, Turel O, Aydogan G, Akcay A, Salcioglu Z, Akici F, Sen H, Demirkaya M, Taskin N, Gurler N. Successful treatment of multiresistant Achromobacter xylosoxidans bacteremia in a child with acute myeloid leukemia. Ann Saudi Med 2015; 35:168-9. [PMID: 26336026 PMCID: PMC6074130 DOI: 10.5144/0256-4947.2015.168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Achromobacter xylosoxidans is an aerobic gram-negative bacillus and important cause of bacteremia in immunocompromised patients. We describe a leukemia pediatric patient with severe neutropenia who developed bacteremia with A xylosoxidans resistant to multiple antibiotics, and treated the patient with tigecycline and piperacillin-tazobactam in addition to supportive medications.
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Affiliation(s)
- Deniz Tugcu
- Dr Deniz Tugcu, Kanuni Sultan Suleyman Training and Research Hospital, Department of Pediatric Haematology- Oncology, Turgut Özal Cd. No:1 Halkal, Küçükçekmece, Istanbul 34306, Turkey, T: +90 532 2860318, F: + 0212 571 47 90,
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Vehapoglu A, Turel O, Turkmen S, Inal BB, Aksoy T, Ozgurhan G, Ersoy M. Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms. Med Princ Pract 2015; 24:332-8. [PMID: 26022378 PMCID: PMC5588252 DOI: 10.1159/000431035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/30/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the 25-hydroxyvitamin D [25(OH)D] status of children with growing pains and to evaluate the efficacy of vitamin D treatment on the resolution of pain symptoms. SUBJECTS AND METHODS One hundred and twenty children with growing pains were included in a prospective cohort study. Serum 25(OH)D and bone mineral levels were measured in all subjects at the time of enrollment. The pain intensity of those with vitamin D deficiency was measured using a pain visual analog scale (VAS). After a single oral dose of vitamin D, the pain intensity was remeasured by means of the VAS at 3 months. The 25(OH)D levels and VAS scores before and after oral vitamin D administration were compared by means of a paired Student's t test. RESULTS In the 120 children with growing pains, vitamin D insufficiency was noted in 104 (86.6%). Following vitamin D supplementation, the mean 25(OH)D levels increased from 13.4 ± 7.2 to 44.5 ± 16.4 ng/ml, the mean pain VAS score decreased from 6.8 ± 1.9 to 2.9 ± 2.5 cm (a mean reduction of -3.8 ± 2.1, p < 0.001) and the difference was statistically significant. CONCLUSION Supplementation with oral vitamin D resulted in a significant reduction in pain intensity among these children with growing pains who had hypovitaminosis D.
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Affiliation(s)
- Aysel Vehapoglu
- Department of Pediatrics, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey
- *Aysel Vehapoglu, Department of Pediatrics, Bezmialem Vak�f University, School of Medicine, Vatan Street, Fatih, TR–34093 Istanbul (Turkey), E-Mail
| | - Ozden Turel
- Department of Pediatrics, Bezmialem Vakıf University School of Medicine, Istanbul, Turkey
| | - Serdar Turkmen
- Department of Biochemistry, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Berrin Belcik Inal
- Department of Biochemistry, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Turgut Aksoy
- Department of Biochemistry, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Gamze Ozgurhan
- Department of Pediatrics, Suleymaniye Obstetrics and Gynecology Hospital, Istanbul, Turkey
| | - Murat Ersoy
- Department of Biochemistry, Istanbul Training and Research Hospital, Istanbul, Turkey
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Karaaslan A, Kadayifçi EK, Turel O, Toprak DG, Soysal A, Bakir M. Intraventricular ciprofloxacin usage in treatment of multidrug-resistant central nervous system infections: report of four cases. Pediatr Rep 2014; 6:5619. [PMID: 25635219 PMCID: PMC4292061 DOI: 10.4081/pr.2014.5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/11/2014] [Accepted: 11/08/2014] [Indexed: 11/23/2022] Open
Abstract
In recent years, multidrug-resistant microorganisms appear as important nosocomial pathogens which treatment is quite difficult. As sufficient drug levels could not be achieved in cerebrospinal fluid during intravenous antibiotic therapy for central nervous system infections and due to multidrug-resistance treatment alternatives are limited. In this study, four cases of central nervous system infections due to multidrug-resistant microorganisms who were successfully treated with removal of the devices and intraventricular ciprofloxacin are presented. In conclusion, intraventricular ciprofloxacin can be used for treatment of central nervous system infections if the causative microorganism is sensitive to the drug and no other alternative therapy is available.
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Affiliation(s)
- Ayşe Karaaslan
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine , Istanbul, Turkey
| | - Eda Kepenekli Kadayifçi
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine , Istanbul, Turkey
| | - Ozden Turel
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine , Istanbul, Turkey
| | - Demet Gedikbaşi Toprak
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine , Istanbul, Turkey
| | - Ahmet Soysal
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine , Istanbul, Turkey
| | - Mustafa Bakir
- Department of Pediatric Infectious Diseases, Marmara University School of Medicine , Istanbul, Turkey
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Hatipoglu N, Hatipoglu H, Turel O, Aydogmus C, Engerek N, Erkal S, Siraneci R. Serum Magnesium Concentration in Children with Asthma. Eurasian J Pulmonol 2014. [DOI: 10.5152/solunum.2014.25993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
- Ozden Turel
- Department of Pediatrics; Faculty of Medicine; Bezmialem Vakif University
| | - Nilufer Goknar
- Department of Pediatrics; Faculty of Medicine; Bezmialem Vakif University
| | - Selcuk Uzuner
- Department of Pediatrics; Faculty of Medicine; Bezmialem Vakif University
| | - Ozgur Kasapcopur
- Department of Pediatrics; Cerrahpasa Medical Faculty; Istanbul Turkey
| | - Laurence Cuisset
- Assistance Publique Hôpitaux de Paris; Hôpital Cochin; Paris France
- Institut Cochin; Université Paris Descartes; Inserm; Paris France
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Turel O, Bakir M, Gonen I, Hatipoglu N, Aydogmus C, Hosaf E, Siraneci R. Children Hospitalized for Varicella: Complications and Cost Burden. Value Health Reg Issues 2013; 2:226-230. [PMID: 29702869 DOI: 10.1016/j.vhri.2013.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the direct medical cost of hospital admissions for patients with varicella (i.e., chickenpox) to assess the cost burden of varicella from a health care perspective for ultimate use in health economics studies in Turkey. METHODS Records of children hospitalized with varicella at the Bakirkoy Maternity and Children's Hospital between November of 2006 and June of 2011 were reviewed. Reasons for hospitalization, types of varicella-associated complications, and direct medical cost of hospitalization were noted. Patients with underlying risk factors were excluded. Data obtained from one hospital were used to estimate the national cost of the disease. RESULTS During the 4.5-year study period, 234 patients were hospitalized with varicella. Of these cases, 48 (20%) children previously ill with underlying cancers or chronic diseases were excluded from the study. Ultimately, 186 previously healthy children (age range: 14 days to 159 months, median age: 14 months) were included. The main reasons for hospitalization were complications related to varicella (79%), the most frequent of which was skin and soft tissue infections, followed by neurological complications and pneumonia. The median cost of hospitalization per patient was US $283, 50% of which was attributed to medication costs. The annual cost for varicella hospitalizations in Turkey was estimated at US $396,200. CONCLUSIONS A significant number of healthy children are hospitalized for varicella and associated complications. Descriptions of these complications and their related costs provide important data for cost-effectiveness studies for decisions about the inclusion of the varicella vaccine in a childhood vaccination program.
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Affiliation(s)
- Ozden Turel
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
| | - Mustafa Bakir
- Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ismail Gonen
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey; Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Nevin Hatipoglu
- Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Cigdem Aydogmus
- Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Emine Hosaf
- Department of Microbiology, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
| | - Rengin Siraneci
- Department of Pediatrics, Bakirkoy Maternity and Children's Educational and Treatment Hospital, Istanbul, Turkey
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Dundaroz R, Erenberk U, Turel O, Demir AD, Ozkaya E, Erel O. Oxidative and antioxidative status of children with acute bronchiolitis. J Pediatr (Rio J) 2013; 89:407-11. [PMID: 23796358 DOI: 10.1016/j.jped.2012.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/05/2012] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Oxidative stress has been shown to contribute to the pathogenesis of acute and chronic lung inflammatory diseases. This article aimed to evaluate the oxidant/antioxidant status of children with acute bronchiolitis through the measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index. METHODS Children with acute bronchiolitis admitted to the pediatric emergency department of a university hospital between January and April of 2012 were compared with age-matched healthy controls. Patients with acute bronchiolitis were classified as mild and moderate bronchiolitis. Oxidative and antioxidative status were assessed by measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index. RESULTS Thirty-one children with acute bronchiolitis aged between 3 months and 2 years, and 39 healthy children were included. Total oxidative status (TOS) was higher in patients with acute bronchiolitis than the control group (5.16±1.99 μmol H2O2 versus 3.78±1.78 μmol H2O2 [p=0.004]). Total antioxidant capacity (TAC) was lower in children with bronchiolitis than the control group (2.51±0.37 μmol Trolox eqv/L versus 2.75±0.39 μmol Trolox eqv/L [p=0.013]). Patients with moderate bronchiolitis presented higher TOS levels than those with mild bronchiolitis and the control group (p=0.03, p<0.001, respectively). Patients with moderate bronchiolitis had higher oxidative stress index levels than the control group (p=0.015). Oxygen saturation level of bronchiolitis patients was inversely correlated with TOS (r=-0.476, p<0.05). CONCLUSION The balance between oxidant and antioxidant systems is disrupted in children with moderate bronchiolitis, which indicates that this stress factor may have a role in the pathogenesis of the disease.
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Affiliation(s)
- Rusen Dundaroz
- Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
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Dundaroz R, Erenberk U, Turel O, Demir AD, Ozkaya E, Erel O. Oxidative and antioxidative status of children with acute bronchiolitis. Jornal de Pediatria (Versão em Português) 2013. [DOI: 10.1016/j.jpedp.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Dinleyici EC, Kurugol Z, Turel O, Hatipoglu N, Devrim I, Agin H, Gunay I, Yasa O, Erguven M, Bayram N, Kizildemir A, Alhan E, Kocabas E, Tezer H, Aykan HH, Dalgic N, Kilic B, Sensoy G, Belet N, Kulcu NU, Say A, Tas MA, Ciftci E, Ince E, Ozdemir H, Emiroglu M, Odabas D, Yargic ZA, Nuhoglu C, Carman KB, Celebi S, Hacimustafaoglu M, Elevli M, Ekici Z, Celik U, Kondolot M, Ozturk M, Tapisiz A, Ozen M, Tepeli H, Parlakay A, Kara A, Somer A, Caliskan B, Velipasalioglu S, Oncel S, Arisoy ES, Guler E, Dalkiran T, Aygun D, Akarsu S. The epidemiology and economic impact of varicella-related hospitalizations in Turkey from 2008 to 2010: a nationwide survey during the pre-vaccine era (VARICOMP study). Eur J Pediatr 2012; 171:817-25. [PMID: 22170238 DOI: 10.1007/s00431-011-1650-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022]
Abstract
Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (<0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children <1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.
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Topal E, Hatipoglu N, Turel O, Aydogmus C, Hatipoglu H, Erkal S, Siraneci R. Seroprevalence of Hepatitis A and Hepatitis A Vaccination Rate in Preschool Age in İstanbul Urban. Çocuk Enf Derg 2011. [DOI: 10.5152/ced.2011.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Toprak D, Soysal A, Turel O, Dal T, Özkan Ö, Soyletir G, Bakir M. Hickman Catheter-Related Bacteremia with <i>Kluyvera cryocrescens</i>: a Case Report. Jpn J Infect Dis 2008. [DOI: 10.7883/yoken.jjid.2008.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Demet Toprak
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Marmara University School of Medicine, Turkey
| | - Ahmet Soysal
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Marmara University School of Medicine, Turkey
| | - Ozden Turel
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Marmara University School of Medicine, Turkey
| | - Tuba Dal
- Department of Microbiology, Marmara University School of Medicine, Turkey
| | - Özlem Özkan
- Department of Microbiology, Marmara University School of Medicine, Turkey
| | - Guner Soyletir
- Department of Microbiology, Marmara University School of Medicine, Turkey
| | - Mustafa Bakir
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Marmara University School of Medicine, Turkey
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Toprak D, Soysal A, Turel O, Dal T, Ozkan O, Soyletir G, Bakir M. Hickman Catheter-Related Bacteremia with Kluyvera cryocrescens: a Case Report. Jpn J Infect Dis 2008; 61:229-230. [PMID: 18503178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This report describes a 2-year-old child with neuroectodermal tumor presenting with febrile neutropenia. Blood cultures drawn from the peripheral vein and Hickman catheter revealed Kluyvera cryocrescens growth. The Hickman catheter was removed and the patient was successfully treated with cefepime and amikacin. Isolation of Kluyvera spp. from clinical specimens is rare. This saprophyte microorganism may cause serious central venous catheter infections, especially in immunosuppressed patients. Clinicians should be aware of its virulence and resistance to many antibiotics.
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Affiliation(s)
- Demet Toprak
- Department of Pediatrics, Marmara Univesity School of Medicine, Istanbul, Turkey.
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