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Öğe Childhood PFAPA Syndrome Cases in a University Hospital in Turkey: A 10-Year Analysis(Sivas Cumhuriyet Üniversitesi, 2023) Ekici, Mahmut; Şimşek, Cemile Ece ÇağlarAim: Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is characterized by recurrent fever attacks every 3-6 weeks lasting 3-6 days, associated with at least one of the three main symptoms. This study aimed to evaluate the demographic, clinical features, laboratory findings, and effectiveness of the applied treatment in patients with PFAPA syndrome. Materials and Methods: A total of 73 patients diagnosed with PFAPA syndrome, aged between 0-18 years, who presented to Sivas Cumhuriyet University Hospital Pediatric Outpatient Clinic between 01.01.2012 and 31.12.2022, were included in this study. Demographic data such as age, gender, symptoms, laboratory findings, treatment and efficacy of the treatment were analysed. Results: Out of the 73 patients, 34 (46.6%) were female and 39 (53.4%) were male. The mean and median age at diagnosis were 3.85±1.47 years and 3.30 (1.1-7.5) years, respectively. The most common presenting complaint was fever. Fever was present in 64 (87.6%) of the 73 patients. Pharyngitis was observed in 56 (76.7%) patients, cervical adenitis in 26 (35.6%), cryptic tonsillitis in 12 (16.5%), and aphthous stomatitis in 15 (20.6%). Leukopenia and neutropenia were not detected in patients at the time of diagnosis. Neutrophilia was observed in 59 (80.8%) patients, and leukocytosis in 64 (87.7%) patients. Prior to treatment, CRP levels were found to be higher than the reference value of 8 mg/L in all patients. Prior to treatment, ESR values were within normal range (lower than 20 mm/h) in 10 (13.7%) patients and higher than 20 mm/h in 63 (86.3%) patients. Tonsillectomy was performed in 10 (13.7%) of 73 patients. Discussion and Conclusion: The possibility of PFAPA syndrome should be considered in the differential diagnosis of patients younger than 5 years of age who present with recurrent episodes of fever and tonsillitis and whose fever does not decrease despite antibiotic treatment. In this way, early diagnosis can be made, unnecessary antibiotic use can be avoided and thus unnecessary investigations, treatment and hospitalisations can be prevented.Öğe Evaluation of hematological parameters and iron level in obese children and adolescents(Ankara Yildirim Beyazit University, 2019) Şimsek, Cemile Ece Ça?lar; Çelik, Nurullah; Aygünes, Utku; Dönmez, Amine Yavuz; Avci, Ezgi; Ekici, MahmutObjectives: The aim of the study was to investigate hematological parameters and iron level in obese children and adolescents in different age groups. Materials and Methods: The study population consisted of hundred fifty-four obese children and adolescents aged between 3 and 18 years, who were being followed at the Cumhuriyet University Faculty of Medicine Hospital, Pediatric Endocrinology Clinic. As the control group, 158 healthy age and sex-matched children were also included. The children were divided into three groups according to age: Group 1 (3-7 years), Group 2 (7-12 years), and Group 3 (12-18 years). Hematological parameters, serum iron, total iron-binding capacity, and ferritin levels were compared, and their correlations with body mass index (BMI) were investigated. Results: The mean ages of the control (10.66±3.40; %55.80 girls) and case (10± 4.16; %62 girls) groups were similar. When compared serum iron, total iron-binding capacity, transferrin saturation and ferritin levels, in obese children aged between 12-18 years, serum iron and transferrin saturation was lower whereas ferritin level and total iron-binding capacity were higher (p<0.001). On the other hand, the ferritin level and total iron-binding capacity were higher in obese children aged between 7-12 years, while the other parameters were similar. When the correlations between BMI-SDS and hematological parameters were evaluated; positive correlations with white blood cell count (r = 0.46, p< 0.001), absolute neutrophil count (r = 0.40, p< 0.001) and ferritin levels (r = 0.36, P <0.001), while a negative correlation with transferrin saturation percentage (r = -0.22, p = 0.02) were found. Conclusion: Obese adolescents are prone to iron deficiency with low saturation index. Therefore, ferritin level may be misled for investigating iron deficiency status in obese adolescents. © 2019 Ankara Yildirim Beyazit University. All rights reserved.Öğe Evaluation of the Demographical, Clinical, Laboratory Findings and Treatments of Pediatric Patients with Brucellosis Diagnosis in the Pediatrıcs Department of the Faculty of Medicine at Sivas Cumhuriyet University Between 2009 and 2019(2022) Şimşek, Cemile; Ekici, MahmutPurpose: The purpose of the present study is to evaluate the demographical and clinical characteristics, laboratory findings, all symptoms, treatments received, durations of hospital stay and prognosis after treatment of the pediatric patients with brucellosis diagnosis followed-up in the Pediatrics Department of the Research and Application Hospital of Sivas Cumhuriyet University.\rMaterials and Methods: In this study, 51 patients within the age group 0 and 18, who were diagnosed with brucellosis and who presented to the Pediatrics Department of Research and Application Hospital of Sivas Cumhuriyet University between January 1st, 2009 and December 31st, 2019, were included. The files of the patients were analyzed retrospectively. The diagnosis was made in all patients with the presence of history, clinical symptoms and findings by the positivity (?1/160) of the Standard Tube Agglutination Test (STA) and/or by the growth of Brucella species in the blood culture. The time the patients who were included in the study presented to the hospital, their ages, gender, place of residence, intake of raw milk and dairy products, contact history with farm animals, time elapsed until diagnosis, Brucella history in the other members of the family, the properties of their houses, the number of people living in the house, social insurance, physical examination findings, laboratory findings, all symptoms of the patient, treatments received, duration of hospital stay, complications and prognosis after treatment were examined and recorded.\rFindings: 41 of the patients (80.4%) were males and 10 of them (19.6%) were females. The ages of the patients were between 2 and 17, and the average age was 10.9±4.10. The time it took between the patients’ onset of complaints and the diagnosis of brucellosis varied between 1 and 30 days, and the average number of days was 10. The most frequent complaint was fever which was seen in 39 (76.5 %) patients. The second most frequent complaint was joint pain observed in 34 (66.7 %) patients. 15 (29.4 %)of the patients presented with fever and 12 (23.5 %) patients had joint swelling. Statistically significant difference was observed between the Erythrocyte Sedimentation Rates (ESH), C-Reactive Protein (CRP) valuesbefore and after the treatment (p=0.001, p=0.002). Before the treatment, Platelets (PLT), Aspartate Aminotransferase(AST) and Alanine Aminotransferase (ALT) were significantly high (p=0.010, p=0.000, p=0.000).\rConclusion: Because Turkey is an endemic zone for Brucellosis, Brucellosis must be considered for every child with complaints of long-lasting fever, perspiration and joint pain. Both clinical and serological evaluations of the family members of the patient with brucellosis diagnosis might be needed. This would enable the early diagnosis and treatments of probable cases. Diagnosis and treatment of the disease in the early stage, awareness-raising in public against consuming raw milk and/or dairy products in places where animal breeding is prevalent, especially in the rural areas, training of the public and the health personnel on the causes of Brucellosis transmission and the methods of protection from Brucellosis would be the precautions to be protected from this infection and would lead to a reduction in the development of complications.Öğe Hypernatremic Dehydration in Breastfed Term Infants: Retrospective Evaluation of 159 Cases(MARY ANN LIEBERT, INC, 2017) Korgali, Elif Unver; Cihan, Meric Kaymak; Oguzalp, Tahir; Sahinbas, Ali; Ekici, MahmutObjectives: The aim of this study was to reveal the frequency, presenting complaints, risk factors, complications, and ways for prevention of hypernatremic dehydration (HD) among term breastfed infants. Methods: The files of 159 breastfed term infants hospitalized because of HD between the years 2009 and 2014 were examined retrospectively in the Neonatal Intensive Care Unit of Sivas State Hospital, Turkey. The patients were classified according to serum sodium (Na) levels, group 1 (Na: 146-149 mEq/L, n = 68) and group 2 (Na >= 150 mEq/L, n = 91). Results: The most common complaint was fever (67.9%), and the most common physical finding was oral mucosal dryness (76%). There were positive correlations between serum Na levels and weight loss, hospital stay, admission age, admission to neonatal unit after discharge, serum urea levels, and body temperature (p < 0.05). The normalization period of Na levels was significantly longer (21.7 +/- 8.8 versus 29.3 +/- 17.8 hours, p = 0.03), and Na reduction rate was faster in group 2 (0.41 +/- 0.3 versus 0.50 +/- 0.3 mEq/L/hour, p = 0.02). Bradycardia was seen more commonly in group 2 (1.5% versus 16.5%, p = 0.002). Conclusions: HD is a significant condition that should be treated appropriately to avoid serious complications.Öğe The Antiepileptogenic Effect of Metformin and Possible Interaction with Neuroinflammation in the Pentylenetetrazole-Kindling Model in Rats(Maik Nauka/Interperiodica/Springer, 2023) Ekici, Mahmut; Taskiran, Ahmet SevkiAlthough the exact origins of epilepsy are unclear, it is suggested that cellular damage, oxidative stress, and neuroinflammation all play a role in the development of epilepsy. Though Metformin was reported to have anti-seizure properties in previous research, more investigations have been required to understand the activity of metformin on the inflammatory markers in epilepsy. The aim of our investigation was to study the antiepileptogenic effect of metformin and its possible interaction with neuroinflammation in the pentylenetetrazole-kindling model in rats. In this investigation, 24 male Wistar albino rats were employed. Four groups of animals were formed (control, pentylenetetrazole, positive control (valproic acid + PTZ), and metformin (metformin + PTZ)). The rats were injected with PTZ (35 mg/kg) 30 min after receiving the medicine or saline once every other day for 12 times, and their behaviors were examined. After completing the epileptic model process, ELISA methods were used to measure inflammatory markers in the cortex and hippocampus (TNF-& alpha;, IL-1 & beta;, NF-kB, COX-1, COX-2, iNOS, and NO). Metformin suppressed seizure stages and decreased TNF-& alpha;, NF-kB, COX-1, COX-2, iNOS, and NO levels in the hippocampus and cerebral cortex. IL-1 & beta; level, on the other hand, is reduced only in the hippocampus. Metformin has antiepileptogenic effect and it might be related its interaction with neuroinflammation.Öğe Thyroid hormones as a potential prognostic markers for neonates with hypoxic ischemic encephalopathy(Ümit Muhammet KOÇYİĞİT, 2022) Tunç, Gaffari; Çelik, Nurullah; Kılıçbay, Fatih; Ekici, MahmutBACKGROUND: Hypoxic ischemic encephalopathy (HIE) is one of the most important causes of mortality and morbidity in newborns. Few studies with conflicting results have been conducted on the effect of perinatal asphyxia and thyroid hormones METHODS: A total of 96 newborns (46 patients with HIE and 50 controls) were included in the study. Electroencephalography (EEG) results, cranial magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), Sarnat Stages, and the presence of seizures of the HIE group were recorded. Thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels of all cases were also measured between 5-10 days. Patients with HIE were separated into 3 groups according to the fT4 (≤1.52 ng / dL, 1.52-1.84 ng / dL, and ≥1.84 ng / dL), and TSH (≤2.56 IU / mL. 2.56-5.3 1IU / Ml, and ≥5.31 IU / mL) levels. RESULTS: All the newborns with seizures were in the 1st or 2nd tertiles of fT4, none of those with high fT4 (>1.84 ng/dL), and the difference was statistically significant (x2=6.61; p=0.036). A negative correlation was determined between fT4 level and duration of hospitalization (=-0.43; p=0.03), duration of respiratory support (r=-0.32; p=0.029), duration of intubation (r=-0.40; p=0.006), and time to full oral feeding (r=-0.40; p=0.006). The TSH level was only correlated with the duration of hospitalization (r=-0.34, p=0.02). CONCLUSIONS: Free T4 level may be used as a prognostic marker in newborns with HIE. Further multicenter, larger, and prospective studies are needed to support and confirm these findings.Öğe Tracheal Bronchus and Extremity Anomaly in a Seven month Old Child(Derman Medical Publ, 2014) Duksal, Fatma; Ekici, Mahmut; Aslaner, Betul; Cevit, Omer; Kaptanoglu, MelihAbnormalities resulted from trachea or main bronchi are the rare causes of recurrent pulmonary infections. This ratio is increasing in patients with cardiac, renal, limb abnormalities or genetic disorders. Tracheal bronchus was diagnosed in a patient with recurrent pulmonary infections and extremity anomalies. In this article, a 7-month old male patient with tracheal bronchus is presented.Öğe Trombositopeni’ye Bağlı Yalancı Pozitif Cinsel İstismar Tablosu Oluşumu: Bir Olgu Sunumu(2021) Polater, Erdoğan; Bütün, Celal; Ekici, Mahmut; Sarı, Seda AybükeÇocuk istismarı karmaşık nedenleri ve trajik sonuçları olan tıbbi, hukuki, gelişimsel ve psiko-sosyal kapsamlı ciddi bir sorundur. Çocuğun cinselistismarı ise çocuk istismarı tipleri içerisinde saptanması en zor olanıdır. Tanı konulmasında ciddi zorluklarla karşılaşılan ve çoğunluğu günyüzüne çıkmamış önemli bir halk sağlığı problemidir. Olgumuz iki yaş üç aylık kız çocuğu, hemolitik üremik sendrom nedeniyle anogenitalbölgede saptanan trombositopeniye bağlı ekimoz, deri altı kanama gibi bulgulara bağlı adli bildiriminin yapılması ve cinsel istismar şüphesiile değerlendirilmesi sonrası olgu olarak seçilmiştir. İstismar bulgularını tanımanın önemi ile birlikte ayırıcı tanısında bazı hastalıklar veyalezyonların iyi değerlendirilebilmesi gerekmektedir. Bu çalışmada, cinsel istismar olarak yanlış pozitif değerlendirilen bulguların ayırıcıtanısında hematolojik, gastrointestinal ve bazı enfeksiyon hastalıklarının göz önünde bulundurulması gerektiğine bir olgu sunumu üzerindendikkat çekmek amaçlandı.Öğe Valproik Asit’in Sıçanlarda Pentilentetrazol ile Oluşturulan Epileptik Nöbet Sonrası Hipokampüs ve Kortekste Meydana Gelen DNA Hasarı ve Apoptozis Üzerine Etkisi(2020) Ekici, Mahmut; Taşkıran, Ahmet ŞevkiValproik asit (VPA) epilepsi tedavisinde yaygın olarak kullanılan bir kimyasal ajandır. Son zamanlarda yapılan çalışmalarVPA’in nöronlar üzerine bazı olumsuz etkilerinin olabileceğini göstermiştir fakat bu konu henüz netlik kazanmamıştır. Buçalışmanın amacı VPA’in sıçanlarda pentilentetrazol (PTZ) ile oluşturulan epileptik nöbet sonrası hipokampüs ve kortekstemeydana gelen DNA hasarı ve apoptozis üzerine etkisini ortaya koymaktır. Çalışmada 18 adet 230-250 gram ağırlığında erkek sıçankullanılmıştır. Sıçanlar kontrol (serum fizyolojik 1 ml kg-1+ serum fizyolojik 1 ml kg-1; n=6), PTZ (serum fizyolojik 1 ml kg-1 +PTZ; n=6) ve VPA (150 mg kg-1VPA + PTZ; n=6) olmak üzere üç gruba ayrılmıştır. PTZ grubu ve VPA grubuna belirtilen dozlardauygulanmasından yarım saat sonra 45 mg kg-1 pentilentetrazol intraperitoneal olarak uygulanarak nöbet oluşumu sağlanmıştır. Nöbetoluşumundan 24 saat sonra tüm sıçanların beyin dokuları çıkarılmış, korteks ve hipokampüs bölgeleri alınmıştır. Korteks vehipokampüs dokularında enzim bağlı immüno sorbent (ELISA) yöntemi ile DNA hasar belirteci olan 8-hidroksi-2'-deoksiguanozin(8-OhDG) ve apoptozis belirteci olan caspase-3 ölçülmüştür. One way ANOVA varyans analizi ile istatistiksel değerlendirmeyapılmıştır. PTZ grubunda 8-OhDG seviyesi hem korteks hem de hipokampüste kontrol grubuna göre artmıştır (p<0.05). Bununlabirlikte, VPA nöbet sonrası 8-OhDG seviyesini korteks ve hipokampüste PTZ grubuna kıyasla yükseltmiştir (p<0.05). Ayrıca,kortekste caspase-3 seviyesi PTZ grubunda kontrole göre anlamlı olarak artmıştır (p<0.05). Bunun yanı sıra, VPA kortekste PTZgrubuna kıyasla caspase-3 seviyesini anlamlı olarak yükseltmiştir (p<0.05). Sonuç olarak, VPA sıçanlarda nöbet sonrası meydanagelen DNA hasarı ve apoptozisi arttırmıştır.
