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    EVALUATION OF INSULIN RESISTANCE IN PATIENTS WITH PREMATURE ADRENARCHE
    (Ümit Muhammet KOÇYİĞİT, 2023) Çelik, Nurullah; Ünsal, Gülşah
    Purpose: There is a conflicting result in terms of insulin resistance (IR) in children with Premature Adrenarche (PA). The study aimed to investigate the IR and Trıglycerıde-Glucose (Ty-G) index in patıents wıth PA. Material and Methods: This cross-sectional study was conducted in a tertiary pediatric endocrinology clinic with 160 children aged 6-8 years old. The study group (n=75) were selected cases diagnosed with PA. Seventy-nine age and sex-matched children were also selected as a control group. Ty-G İndex, Homeostasis Model of Insulin Resistance (HOMA-IR), and atherogenic index of plasma (AIP) were calculated. Results: Trıglycerıde-Glucose index, AIP, and HOMA-IR were similar (p>0.05). Ty-G İndex was positively correlated with AIP (r=0.61, p
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    Pathogenesis and prevention of intraventricular hemorrhage in newborns
    (Nova Science Publishers, Inc., 2023) Ünsal, Gülşah; Kilicbay, Fatih
    Germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH) is one of the most important complications in preterm neonates. Despite improved care services in the field of neonatal intensive care, this complication is still encountered. Just as GMH-IVH leads to short-term complications, it can also lead to long-term permanent sequelae such as neurodevelopmental disorders and cerebral palsy, and by leading to hemodynamic disorders, severe hemorrhage can even result in death. After the development of GMH-IVH, there is no specific treatment. Therefore, prevention of the hemorrhage is the most important treatment step and knowing the pathogenesis will be of benefit in preventing GMH-IVH. The aim of this study was to report the frequency of GMH-IVH and to inform and raise awareness of the pathogenesis, prevention, diagnosis, and follow up. © 2023 Nova Science Publishers, Inc. All rights reserved.
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    PERIODIC FEVER, APHTHOUS STOMATITIS, PHARYNGITIS, (PFAPA) SYNDROME AND NLRP3 GENE ASSOCIATION
    (Sivas Cumhuriyet Üniversitesi, 2023) Ünsal, Gülşah
    PFAPA syndrome, which also includes aphthous stomatitis, pharyngitis, and adenitis, is the most common type of recurrent fever in children. Usually happens before the age of five. This syndrome is characterized by attacks lasting 3-7 days, recurring every 2-8 weeks with high fever (39 C and above) accompanied by at least one of the signs of aphthous stomatitis, pharyngitis, and/or cervical adenitis. Between attacks, the child is completely healthy.PFAPA is a benign disease that regresses with age. Steroids are used in the treatment of attacks. Colchicine is often preferred in prophylactic treatment. However, if there is no response to medical treatment, surgery (tonsillectomy) can be performed. Genetic and environmental factors are considered in the etiology. Genetic susceptibility concentrated on the genes for Familiar Mediterranean Fever (FMF, MEFV), TNF-Receptor-Associated Periodic Syndrome (TRAPS, gene TNFRF1A), HyperIgDSyndrome (HIDS, gene MVK), and Cryopyrin-Associated Periodic Syndrome (CAPS, gene NLRP3). But its etiology is still unknown.
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    Periyodik ateş, aftöz stomatit, farenjit, servikal adenit (PFAPA) sendromu tanılı hastalarda NLRP3 gen mutasyonu
    (Sivas Cumhuriyet Üniversitesi, 2019) Ünsal, Gülşah; Ekici, Mahmut
    PFAPA; periyodik ateş, aftöz stomatit, farenjit ve servikal lenfadenitin başlıca bulgu olduğu bir hastalıktır. Hastaların çoğunda aile öyküsünün pozitif olması nedeniyle genetik bir yatkınlık olduğu düşünülen bu hastalıkta en çok üzerinde durulan genler MEFV, NLRP3 genleridir. Bu çalışmadaki amacımız PFAPA tanısı ile takip ettiğimiz hastalarımızdaki NLRP3 gen mutasyonunu araştırmaktır. 01.02.2018-01.09.2018 tarihleri arasında Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Polikliniği'ne başvuran ve PFAPA sendromu tanılı hastalar çalışmaya alındı. Hasta dosyaları retrospektif olarak demografik, klinik ve laboratuar verileri açısından değerlendirildi. Hastaların yaşı, cinsiyeti, atak özellikleri, laboratuar bulguları, özgeçmişleri ve soy geçmişleri değerlendirmeye alındı. Hastaların tanı yaşı, şikayetleri, otoimmün hastalık olup olmadığı, ailede PFAPA 'lı olan birinin varlığı, ailede tonsillektomi öyküsünün varlığı, ailede Ailevi Akdeniz Ateşi (FMF) öyküsünün varlığı, atak süresi, ataklar arasındaki süre, atak esnasında prednizolona yanıt, profilaktik kolşisin kullanımı ve kolşisin sonrası atakların azalıp azalmadığı karşılaştırıldı. Sağlıklı bireylerin olduğu kontrol grubu Grup 1, PFAPA klinik bulgularına sahip olan hastalar da Grup 2 olarak adlandırıldı. Bu iki grup verileri açısından karşılaştırıldı. Vakaların 6'sı (%42,9) kız, 8'i (%57,1) erkekti. Ortalama yaş 55,71 ± 18,93 ay olarak bulundu. Ortalama tanı yaşı ise 36,35 ± 12,38 ay olarak bulundu. Klinik bulgular değerlendirildiğinde sıklık durumuna göre ateş %100, farenjit %78,6, servikal lenfadenit %64.3, aftöz stomatit %35,7 oranında saptanmıştır. Çalışmamızda hasta bireylerin ilk tanı aldıkları yaşları minimum 18 ay, maksimum 62 ay olup ilk tanı aldıkları yaş ortalaması 36,35 ± 12,38 ay olarak bulunmuştur. Ayrıca hasta bireylerin yaş ortalaması 55,71 ± 18,93 ay olarak bulunmuştur. Bireylerin tamamının boy ve kiloları normal persantilde idi. Hastaların atak esnasında bakılan CRP düzeyinin, eritrosit sedimantasyon hızının ( ESR) , WBC sayısı, ANC sayısı ve nötrofil yüzdesinin yüksek olduğu görülmüştür. Çalışmamızda tedavi olarak verilen tek doz prednizolana yanıt %100 olarak bulunmuştur. Profilaktik olarak kolşisin kullanan hasta sayısı 5 (%35,7) idi. Kolşisin kullananlarda ataklar arası süre göz önüne alındığında; kolşisin kullanımı öncesi ortalama 20,80 ± 5,84 gün iken, kolşisin kullanımı sonrasında ataklar arası sürenin ortalama 53,60 ± 15,22 gün olarak değiştiği ataklar arası sürenin uzadığı görülmüştür. Ailesinde PFAPA öyküsü bulunan hasta sayısı 12 (% 85,7) idi. Ailede tonsillektomi öyküsü olan hasta bireylerin sayısı 5 (% 35.7) iken; ailede FMF öyküsü olan hasta bireylerin sayısı 4 (% 28,6) idi. Çalışmamızda hastalar MEFV gen mutasyonu analizi yönünden değerlendirildiğinde 7 hastada (%50) mutasyon saptanmamışken, 5 hastada (%35.7) ise mutasyon saptandı. MEFV gen mutasyonu bakılan 12 hasta dikkate alındığında ise mutasyon tespit edilen hasta oranı % 41. 66 olarak bulunmuştur. NLRP 3 gen mutasyonu hastaların hiçbirinde tespit edilmedi. Sonuç olarak PFAPA Sendromu çocukluk döneminde tekrarlayan ateş şikayeti olan çocuklarda ayrıcı tanılar içerisinde düşünülmelidir. Aile öyküsünün yüksek oranda pozitif olması, PFAPA sendromunun genetik yatkınlığının olabileceğini düşündürmektedir.
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    Sleeping Habits, Sleeping Problems and Affecting Factors in Children Aged 6-10
    (Tokat Gaziosmanpasa University, 2021) Ünsal, Gülşah; Korğalı, Elif Ünver; Tan, Ayça Kömürlüoğlu; Ongun, Ebru Atike
    Objective: Sleep is associated with physical growth, emotional-behavioral development and academic performance in children. For a healthy life, children need adequate and quality sleep. The aim of this study was to examine the sleep habits of 6-10 year old primary school children, to determine sleep problems and the factors affecting it. Method: This descriptive, questionnaire study was conducted with parents of healthy children aged 0-6 years who presented at the General Pediatrics Polyclinic. The questionnaire includes questions about the sociodemographic characteristics, home and room conditions, bedtime routines and sleep patterns in infancy, as well as the short form of the 'Child Sleep Habits Questionnaire' (CSHQ). The children were divided into groups as those with sleep problems (Group 1; CSHQ> 41) and those without (Group 2; CSHQ≤ 41). Results: The average daily sleep time of the children (n=302) was 9.33±1.09 hours, while 60.9% of them went to bed at ≤22:00, 11.9% of them were >23.00 and 72.8% woke up at ≤08:00. In this study 62.9% of children have sleep problems. Group1 had a higher rate of household smokers (55.8% and 36.6%, p=0.001, respectively), and children had shorter daily sleep times (9.21±1.22 and 9.51±0.80 hours, respectively, p=0.008). Parent education, mother’s sleep problems, bedtime routines, sleep patterns in infancy, and the parents’ attitude towards sleep were found to be associated with sleep problems in children. If there is no sleep pattern in infancy (OR: 7.637, 95CL 2.28-25.53), no reading before bedtime (OR: 1.726, 95CL 1.07-2.79), and no rules about sleep in the family (OR: 2.426, 95CL 1.45-4.06), the possibility of sleep problems in children increases. Conclusion: Children between the ages of 6-10 have a high rate of sleep problems. In order for children to gain a healthy sleep habit; families should be made aware, bedtime routines should be established and the importance of sleep should be emphasized in child health follow-ups.
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    Troponin-T value as a prognostic marker in neonates diagnosed with neonatal encephalopathy and receiving hypothermia treatment
    (2023) Ünsal, Gülşah; Tunç, Gaffari; Taştanoğlu, Hüseyin; Çelik, Nurullah
    Abstract. – OBJECTIVE: The aim of this study was to investigate the effect of Tropo nin-T levels on the prognosis of neonatal en cephalopathy (NE). PATIENTS AND METHODS: The study in cluded one hundred and eleven newborns diag nosed with NE and receiving hypothermia treat ment. The cases were separated into 2 groups according to the SARNAT classification as Stage 2 or Stage 3. The groups were compared in re spect of anthropometric characteristics, APGAR scores, and biochemical parameters. The cases were also separated into 3 groups according to the Troponin-T levels and were compared with respect to the clinical course. RESULTS: The serum Troponin-T (p=0.012), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p<0.0001), and lac tate levels (p=0.04) in the Sarnat Stage 3 group were statistically significantly higher than in the Sarnat stage 2 group. A significant positive correlation was determined between the Tropo nin-T level and the total duration of respirato ry support (r=0.20, p=0.03). A significant pos itive correlation was determined between the ALT/AST ratio and the length of stay in hos pital (r=0.29, p=0.001), duration of intubation (r=0.32, p=0.01), and total duration of respira tory support (r=0.36, p<0.001). A statistically significant difference was determined in mor tality rates between the 3 subgroups of Tropo nin-T levels; Group 1: 2.8%, Group 2:5.4%, and Group 3: 15.8%. (p=0.04, χ²=4.74). A cut-off val ue of 164 ng/L for Troponin-T was determined to predict mortality with 77% sensitivity and 67% specificity (AUC=0.73, p=0.023). When the groups were compared according to Troponin-T level, a statistically significant difference was determined in respect of length of stay in hos pital (p=0.03, χ²=6.95) and total duration of ox ygen support (p=0.01, χ²=9.12). CONCLUSIONS: The serum Troponin-T level can be evaluated as a prognostic marker in cas es followed up with a diagnosis of NE and re ceiving hypothermia treatment. There is a need for further prospective studies with larger sam ples on this subject.