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Öğe A pseudohypoparathyroidism case with rarely seen intracranial calcification in childhood(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2014) Korkmaz, Ozlem; Gursu, Hazim Alper; Kaya, Ali; Aldemir, Betul AslanerIntroduction: Pseudohypoparathyroidism (PHPT) is characterized with end-organ resistance to parathormone (PTH) although normal hormone secretion. It is divided into two groups as Type 1 and Type 2. Furthermore, Type 1 PHPT is subdivided into 3 subgroups as 'a', 'b' and 'c'. Case: A 10-year-old male patient was admitted to our department with numbness and spasm in hands and we have detected hypocalcemia, hyperphosphatemia and increased parathormone levels. Cranial computed tomography revealed patchy calcific areas in phenotypically normal case. Conclusion: We primarily considered the case as having PHPT Type 1b or Type 2 and started active vitamine D and calcium replacement therapies which improved clinical and laboratory findings.Öğe Akondrogenezis Tip 2 (Langer-Saldino)(T.C. Sağlık Bakanlığı Ankara Şehir Hastanesi, 2013) Kaya, Ali; Güven, Ahmet Sami; Demir, Mevlüt; Güneş, Hatice; Duksal, Fatma; Aygüneş, Utku; Gültekin, AsımAkondrogenezis; ileri derecede kısa ekstremiteler, vertebra korpuslarında kemikleşme defekti, fıçı tarzında toraks, kısa gövde, şişkin abdomen ve büyümüş kafa ile karakterize, otozomal resesif geçişli, nadir görülen bir osteokondroplazidir. İskelet displazili pek çok olgu gebeliğin 16-24. haftalarında anormal ultrasonografik bulgularla tanınabilmektedir. Bu yazıda doğum sonrası klinik ve radyolojik olarak akondrogenezis tip 2 tanısı konulan bir olgu sunulmaktadır. Annenin iki abortus öyküsü olmasına rağmen, gebelik takipleri düzenli yapılmadığı için prenatal tanı konulamamıştır. İskelet deformiteleri ile seyreden akondrogenezis, otozomal dominant ve resesif olarak kalıtılmaları nedeniyle sonraki gebeliklerde genetik danışmanlık verilebilmesi için prenatal tanı önemlidir.Öğe Anterior Rhinomanometry and Determination of Nasal Mucociliary Clearance Time With the Saccharin Test in Children With Crimean-Congo Hemorrhagic Fever(LIPPINCOTT WILLIAMS & WILKINS, 2013) Altuntas, Emine Elif; Kaya, Ali; Uysal, Ismail Onder; Cevit, Omer; Icagasioglu, Dilara; Muderris, SuphiObjectives: Crimean-Congo hemorrhagic fever (CCHF), like other viral infections, may prolong mucociliary clearance time and increase nasal resistance in children. The aim of the present prospective case-control study was to study, using saccharin and anterior rhinomanometry tests, whether CCHF infections caused any change in nasal physiology. Methods: Overall, 40 subjects, 20 of whom had CCHF (group 1) and 20 of whom were healthy controls (group 2), were enrolled in this study. The definitive diagnosis of CCHF infection was made based on typical clinical and epidemiological findings and detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by reverse transcription-polymerase chain reaction. Anterior rhinomanometry was performed in all participants according to current recommendations of the Committee Report on Standardization of Rhinomanometry. A saccharin test was used to evaluate mucociliary clearance, and nasal mucociliary clearance time was assessed with the saccharin test as described previously. Results: In our patients, the mean time from the application of saccharin crystals to the first feeling of a sweet taste was 6.77 +/- 3.25 minutes (range 2-16 min). In terms of the mean time from the application of saccharin crystals to the first feeling of a sweet taste, there was no difference between two groups. The mean total air flow was 637.60 +/- 76.18 mL/s (range 490-760 mL/s). The mean total nasal airway resistance was 0.24 +/- 0.03 Pa/mL s (range 0.20-0.31 Pa/mL s). In terms of the degree of nasal air flow and nasal airway resistance and the total air flow and total nasal airway resistance of each nostril, there was no difference between the 2 groups. Conclusions: The results obtained in anterior rhinomanometry and saccharin test showed that there was no statistically significant difference between CCHF (+) patients and controls. These results suggest us that CCHF virus infection does not affect nasal physiology. However, this is the first study performed on this issue and further studies on larger series need to be performed.Öğe Assessment of 17 Pediatric Cases With Colchicine Poisoning in a 2-Year Period(LIPPINCOTT WILLIAMS & WILKINS, 2016) Alaygut, Demet; Kilic, Suar Caki; Kaya, Ali; Oflaz, Mehmet Burhan; Bolat, Fatih; Cevit, Omer; Icagasioglu, Fusun DilaraAim The aim of the study is to discuss clinical effects, treatments, and outcomes of pediatric colchicine poisoning. Method This study was designed as an observational case series study. The medical records of children aged between 0 and 18 years, who were hospitalized for colchicine poisoning at the Department of Pediatric Intensive Care Unit, Cumhuriyet University Faculty of Medicine, between January 2010 and January 2012, were retrospectively evaluated. Results We presented 17 children with colchicine poisoning. The mean (SD, range) age of patients was 71.5 (69.19, 18-204) months. The period to apply to the hospital after taking the medications was 7.3 hours (7.97, 30 minutes-26 hours) on average. The use of colchicine was due to diagnosis of Familial Mediterranean fever (FMF) in the families of 8 patients, diagnosis of Behcet disease in 1 patient's father, diagnosis of Behcet disease in 1 patient herself, and diagnosis of FMF in 6 patients themselves. Thirteen patients had taken colchicine at the dose of less than 0.5 mg/kg known as subtoxic and 1 patient had taken colchicine at the dose of greater than 0.8 mg/kg, and doses taken by 3 patients were not known. Fourteen patients (82.4%) had involuntary drug intake. Fifty percent of them were symptomatic at the moment of application and all had gastrointestinal complaints. All patients were observed in intensive care unit upon first admission and received supportive care. One of patients showed total alopecia, one showed leucocytosis, and another one showed acute abdomen picture. None of the patients showed mortality. Conclusions Mortality of colchicine toxicity is high and quick assessment is absolutely required. In regions where FMF is common and the use of colchicine is high, clinicians should pay attention to symptoms and findings related to colchicine intoxication and keep them in mind in differential diagnosis.Öğe Bradycardia Seen In Children With Crimean-Congo Hemorrhagic Fever(MARY ANN LIEBERT, INC, 2013) Oflaz, Mehmet Burhan; Kucukdurmaz, Zekeriya; Guven, A. Sami; Karapinar, Hekim; Kaya, Ali; Sancakdar, Enver; Deveci, Koksal; Gul, Ibrahim; Erdem, Alim; Cevit, Omer; Icagasioglu, F. DilaraIntroduction: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. Methods: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. Results: Fifty-two patients (mean age 11.24.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 +/- 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). Conclusion: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.Öğe Can the Mild Clinical Course of Crimean-Congo Hemorrhagic Fever in Children Be Explained by Cytokine Responses?(WILEY, 2013) Ozsurekci, Yasemin; Arasli, Mehmet; Oncel, Eda Karadag; Caglayik, Dilek Yagci; Kaya, Ali; Icagasioglu, Fusun Dilara; Engin, Aynur; Korukluoglu, Gulay; Elaldi, Nazif; Ceyhan, MehmetCytokines are possibly one of the factors responsible for death due to Crimean-Congo hemorrhagic fever (CCHF). This study aimed to determine the differences between the cytokine levels in children and adult patients with CCHF; the influence of cytokines; and the severity of the course of the disease, which seems to be milder in children. Thirty-four children and 36 adult patients diagnosed with CCHF between 2010 and 2011 were included in this study. Diagnosis was performed by serology or by the polymerase chain reaction for CCHF virus. Levels of IFN-, TNF-, IL-1, IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-12 p70, IL-13, IL-17A, and IL-22 were measured in all serum samples. Although the disease had a fatal course in three adult patients, there were no deaths in children. Statistically significant differences were not observed between the cytokine concentrations in the adults and children. No differences were detected between the serum cytokine levels in the children with moderate and those with a severe clinical course of the disease. In the adult patients with fatal outcome, significantly higher serum levels of IL-2, IL-5, IL-9, IL-12 p70, and IL-13 were detected as compared to the cytokine levels in patients who survived the infection. No differences were detected between the serum levels of IFN-, IL-1, IL-17A, IL-22, IL-10, IL-6, IL-4, and TNF- in the patients who died and those who survived. Thus, the milder clinical course in children with CCHF cannot be explained by the cytokine network alone. The incomplete maturation of the immune system and timing and scale of immune responses could change the outcome dramatically. J Med. Virol. 85:1955-1959, 2013. (c) 2013 Wiley Periodicals, Inc.Öğe Cardiac findings in children with Crimean-Congo hemorrhagic fever(INT SCIENTIFIC LITERATURE, INC, 2011) Gul, Ibrahim; Kaya, Ali; Guven, Ahmet Sami; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Yilmaz, Ahmet; Icagasioglu, Fusun Dilara; Tandogan, IzzetBackground: Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. Material/Methods: Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological Findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. Results: Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12 2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (<1 cm) pericardial effusion. Fifteen (65%) patients had segmental wall motion abnormalities (hypokinesia). A second echocardiography revealed that all wall motion abnormalities had disappeared; the pericardial effusion persisted in only 2 of 7 patients (28%). Conclusions: Cardiac involvement appears to be more frequent in children with CCHF disease than in adults, but it is slighter and almost totally reversible; however, the course of the disease in children is milder than it is in adults.Öğe A child with an unusual complication of Crimean-Congo hemorrhagic fever: Hemorrhagic pleural effusion(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016) Sahin, Irfan Oguz; Guven, Ahmet Sami; Kaya, Ali; Guney, Cengiz; Cevit, Omer; Arslan, Mesut…Öğe Comparison of efficacies of divalent, trivalent irons and divalent iron plus zinc preparations in paediatric patients with iron deficiency anemia(2010) Arabaci, Fatih Ibrahim; Kaya, Ali; Gültekin, Asim; Iça?asio?lu, Füsun Dilara; Mutlu, Esma CansuObjective: In the present study, our aim was to determine the prevalence of iron deficiency (ID) and iron deficiency anaemia (IDA) in children between 6 months-6 years old and to compare efficacy of oral Fe+2 (ferrous sulphate), Fe+3 (ferric polymaltose) and Fe+2 + Zn (ferrous fumarate+zinc sulphate) preparations in the treatment of iron deficiency anaemia. Material and Methods: The present study was conducted on 271 children (aged 6 months to 6 years) applying to our polyclinic. ID was diagnosed if hemoglobine (Hb) concentration was >11 g/dL and ferritin level was <12 ng/mL. Eighty one of the cases included in the study and having Hb <11 g/dL and ferritin <12 ng/mL were diagnosed with IDA. Those having IDA were divided into three groups. Those in the first group (n= 27), second group (n= 28) and third group (n= 26) were randomized to Fe+2, Fe +3 and Fe+2 + Zntreatments respectively. Iron treatment was administered on empty stomach as 3 x 2 mg/kg/day for 12 weeks. Results: The prevalences of ID and IDA were found to be 19.6% and 29.9%. When the groups were compared in terms of post-treatment Hb values, the increase in Hb values of those in Fe+2 group was statistically significantly higher than those observed in other groups. When the increase in Hb values of Fe+3 and Fe+2 + Zn groups were compared, there was no statistically significant difference. When mean corpuscular volume, serum iron, ferritin and reticulocyte response were compared to each other, the difference between Fe+2 and Fe+3 groups was statistically significant whereas no statistically significant difference was found between Fe+2 and Fe+2 + Zn or between Fe+2 + Zn and Fe+3 groups. Conclusion: The prevalences of ID and IDA detected in our study are similar to those reported in previous studies. We believe that oral administration of Fe+2 preparations alone in IDA is more efficient. Copyright © 2010 by Türkiye Klinikleri.Öğe Crimean-Congo hemorrhagic fever disease due to tick bite with very long incubation periods(ELSEVIER SCI LTD, 2011) Kaya, Ali; Engin, Aynur; Guven, Ahmet Sami; Icagasioglu, Fusun Dilara; Cevit, Omer; Elaldi, Nazif; Gulturk, AbdulazizBackground: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate, and is one of the viral hemorrhagic fever syndromes. The average mortality rate of CCHF is 3-30%. Research indicates that the longest incubation period after a tick bite is 12 days in CCHF disease. However, in clinical practice, we encounter patients with CCHF as a result of tick bites with much longer incubation periods (max. 53 days) than those reported in the literature. We present herein CCHF cases presumably infected through tick bites and having incubation periods longer than the upper limit reported in the literature. Methods: We analyzed the cases of the 825 CCHF patients admitted to our hospital from 2007 to 2010 and found that 312 of them had undoubtedly been bitten by a tick. We searched the patient records for information on the incubation period and found that 12 patients had experienced an incubation period of over 12 days, which is the longest incubation period stated in the literature for patients definitely bitten by a tick. Results: A total of 12 patients (eight males and four females, with a mean age of 45 years) were recruited into this study. Five (41.7%) of the 12 patients had positive CCHF virus-specific IgM antibodies, three (25%) had a positive reverse transcription polymerase chain reaction test for CCHF virus, and four (33.3%) had positive results in both tests during the acute and/or convalescent phase of the disease. In these cases, the interval between tick bite and the onset of symptoms was a mean of 23.6 days (range 13-53 days). Conclusion: Physicians serving in endemic regions should be aware of these longer incubation periods after a tick bite. It is suggested that they perform more follow-ups on clinically and serologically highly suspected patients than they currently do. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Elevated chemokine levels during adult but not pediatric Crimean-Congo hemorrhagic fever(ELSEVIER SCIENCE BV, 2015) Arasli, Mehmet; Ozsurekci, Yasemin; Elaldi, Nazif; McAuley, Alexander J.; Oncel, Eda Karadag; Tekin, Ishak Ozel; Gozel, Mustafa Gokhan; Kaya, Ali; Icagasioglu, Fusun Dilara; Caglayik, Dilek Yagci; Korukluoglu, Gulay; Kokturk, Furuzan; Bakir, Mehmet; Bente, Dennis A.; Ceyhan, MehmetBackground: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral zoonosis. Clinical reports indicate the severity of CCHF is milder in children than adults. The chemokines are important chemoattractant mediators of the host immune system. Objectives: The main aim of the study was to identify whether or not there were any differences in chemokine levels between the pediatric and adult patients and control groups, and whether there was any correlation with disease severity. Study design: The serum levels of select chemokines including chemokine (C-C) ligand 2 (CCL2), CCL3, CCL4, chemokine (C-X-C) ligand 8 (CXCL8), CXCL9, and granulocyte-colony stimulating factor (G-CSF) in 29 adult and 32 pediatric CCHF patients and in 35 healthy children and 40 healthy adult control groups were studied by flow cytometric bead immunoassay method. Results: Great variability was detected in the serum levels of the chemokines for both the adult and pediatric patients and controls. With the exception of G-CSF, the median serum levels of CCL2, CCL3, CCL4, CXCL8, and CXCL9 were found to be significantly higher in the adult patients compared to adult controls (2364.7 vs. 761 pg/ml; 714.1 vs. 75.2 pg/ml; 88.6 vs. 25.5 pg/ml; 217.9 vs. 18.3 pg/ml; 875 vs. 352.2 pg/ml, respectively, p < 0.0001 for all comparisons). Among the chemokines the median CCL4 and G-CSF levels were significantly higher in the pediatric patients compared to pediatric controls (40.3 vs. 7.1 pg/ml, p < 0.0001; 0.1 vs. 0.1 pg/ml, p = 0.049, respectively). Conclusion: The results of this study showed prominent chemokine raising in adult CCHF patients compared to children CCHF patients. (C) 2015 Elsevier B.V. All rights reserved.Öğe Evaluation of Clinical and Laboratory Findings of Pediatric and Adult Patients with Oropharyngeal Tularemia in Turkey: a Combination of Surgical Drainage and Antibiotic Therapy Increases Treatment Success(NATL INST INFECTIOUS DISEASES, 2014) Gozel, Mustafa Gokhan; Engin, Aynur; Altuntas, Emine Elif; Salk, Ismail; Kaya, Ali; Ceik, Cem; Dokmetas, Ilyas; Bakir, Mehmet; Elaldi, NazifWe analyzed the clinical and laboratory findings of both pediatric and adult patients with oropharyngeal tularemia. We also compared the therapeutic outcomes of patients who underwent surgical drainage of lymph nodes early or late during antibiotic therapy. A total of 68 patients with oropharyngeal tularemia, including 26 children and 42 adults, were enrolled in this study. The average duration between symptom onset and hospital admission was 20.8 days (4-60 days) in the pediatric group and 32.6 days (4-90 days) in the adult group (P = 0.009). The most frequently observed clinical symptoms were sore throat (100% and 100%), fever (96.2% and 90.5%), tonsillitis (69.2% and 78.6%), and rash (15.4% and 11.9%) in the pediatric and adult groups, respectively. However, the frequencies of erythema, tenderness, and fluctuant of enlarged lymph nodes were significantly higher in the adult group than in the pediatric group (P = 0.005, P = 0.029, and P = 0.041, respectively). Treatment failure was observed in 2 (7.7%) pediatric patients and 4 (9.5%) adult patients, for a total of 6 (8.8%) treatment failures in the study group. Similar clinical findings and treatment outcomes were observed in both groups. We concluded that a combination of surgical drainage and antibiotic therapy increases treatment success for patients diagnosed with oropharyngeal tularemia.Öğe Evaluation of cochlear function using transient evoked otoacoustic emission in children with Familial Mediterranean Fever(ELSEVIER IRELAND LTD, 2012) Uysal, Ismail Onder; Gurbuzler, Levent; Kaya, Ali; Koc, Sema; Gulturk, Sefa; Cevit, Omer; Muderris, SuphiObjective: The aim of this study was to investigate cochlear functions in children with Familial Mediterranean Fever (FMF). Methods: Fifty-six FMF patients (112 ears) and 30 healthy control subjects (60 ears) were included in the study. Transient evoked otoacoustic emission (TEOAE) was investigated. Numerical measurements of TEOAE, except the correlation percentage (%), included response amplitude (dB) and signal/noise (SN) ratio. Results: There was no statistically significant difference in age and sex in the two groups. Mean TEOAE correlation percentage, signal/noise ratio, TEOAE amplitudes in 1, 1.5, 2, 3 and 4 Hz frequency values were not different between the two groups (p > 0.05). Conclusions: In this study using the TEOAE test, we found that FMF did not cause outer cell hair damage in children. In the literature, there is no study on outer cell hair damage in children or adults with FMF, so this is the first investigational study. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Öğe Evaluation of cochlear involvement by transient evoked otoacoustic emission test in children with Crimean-Congo hemorrhagic fever(ELSEVIER IRELAND LTD, 2011) Uysal, Ismail Onder; Kaya, Ali; Guven, Ahmet Sami; Altuntas, Emine Elif; Muderris, SuphiObjective: The aim of this study was to investigate cochlear involvement in child patients with Crimean-Congo hemorrhagic fever (CCHF) disease. Methods: Twenty-eight CCHF disease patients (56 ears) and 26 sex- and age-matched healthy control subjects (52 ears) were included in the study. Pure-tone audiometry at frequencies 0.25, 0.5, 1, 2, 4, and 6 kHz, immittance measures including tympanometry and acoustic reflex testing, and transient evoked otoacoustic emission (TEOAE) testing were performed in the patients and controls. Results: The proportion with a result of 'fail' for the TEOAE test in the CCHF patients was not statistically significant from the control group (p > 0.05). Conclusions: CCHF disease does not impair cochlear function in children. The clinical course of CCHF among children seems to be milder than in adults. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe Evaluation of cytokines as Th1/Th2 markers in pathogenesis of children with Crimean-Congo hemorrhagic fever(E-CENTURY PUBLISHING CORP, 2014) Sancakdar, Enver; Guven, Ahmet Sami; Uysal, Elif Bilge; Kaya, Ali; Deveci, Koksal; Karapinar, Hekim; Akkar, IsmailCytokine networks play a key role in the pathogenesis of the disease in Crimean-Congo Hemorrhagic Fever (CCHF) patients. Therefore, our aim was to study the effects of cytokine levels on the pathogenesis and severity of the disease in children with CCHF. Fifty-two patients diagnosed with CCHF and 34 healthy controls (HC) were included in the study. The patients with CCHF were divided into two groups (severe and non-severe). The levels of the Interleukin-10 (IL-10), IL-12, IL-6, Endothelin-1 (ET-1) and tumor necrosis factor-alpha (TNF-alpha) were measured in all groups. IL-12 levels did not show any difference between the CCHF and HC groups and among the severe, non-severe and HC groups. IL-10 and ET-1 levels were significantly higher in the severe group when compared to the non-severe group and the HC group. Moreover, IL-10 and ET-1 levels were significantly higher in the non-severe group when compared to the HC group. In terms of IL-6 and TNF-alpha levels, there was no difference between the severe and non-severe groups while the said levels were significantly higher in the severe group when compared to the HC group. The results of the present study showing significantly higher IL-10 and ET-1 levels in the severe group suggest that Th2-mediated humoral immunity is more effective in the pathogenesis and severity of CCHF in children.Öğe Evaluation of Endothelium Functions by Flow-mediated Dilatation in Pediatric Patients With Crimean-Congo Hemorrhagic Fever(LIPPINCOTT WILLIAMS & WILKINS, 2015) Karapinar, Hekim; Kaya, Ali; Uysal, Elif Bilge; Kucukdurmaz, Zekeriya; Deveci, Koksal; Guven, Ahmet Sami; Sancakdar, Enver; Yilmaz, AhmetBackground: Crimean-Congo hemorrhagic fever (CCHF) is a systemic viral disease that also affects the endothelium. Thrombocytopenia and hemorrhage are seen in this disease. But, the cause of thrombocytopenia is not clear. We hypothesized that endothelium dysfunction may be the cause of thrombocytopenia. We evaluated the endothelium functions by flow-mediated dilatation (FMD) in CCHF. Methods: Consecutive children with suspected CCHF who applied to our hospital were evaluated for recruitment into the study. FMD analysis was done in the active and healing period of the disease. Diagnosis was confirmed or ruled out by polymerase chain reaction and/or ELISA test. Basal brachial artery diameter (BBAD) and dilated brachial artery diameter (DBAD) after ischemic period were measured and percent dilatations [(DBAD-BBAD)/BBAD, FMD%] were computed from all subjects. Results: Fifty-four children (40 male, mean age 12.4 +/- 4.4 years) were recruited into the study. CCHF diagnosis was confirmed in 28 children and ruled out in 26 children. Groups were similar for age and gender. FMD% was significantly decreased in CCHF patients when comparing this with the control patients in the active period (2.65 +/- 2.76 vs. 13.76 +/- 7.95, P < 0.001). FMD% was correlated with platelet count in the active period of the disease (r = 0.599, P = 0.004). FMD% was recovered in the healing period (2.65 +/- 2.76 vs. 14.72 +/- 2.66, P < 0.001) and was not significantly different from basal values of control patients (P > 0.05). Conclusions: FMD is significantly decreased in CCHF and recovers in the healing period. So, endothelium functions are disturbed, and disturbance is correlated with thrombocytopenia in CCHF.Öğe Evaluation of etiological factors in childhood poisonings(2018) Aygüneş, Utku; Kaya, AliObjective: Poisoning represents one of the most common medical emergencies in childhood, and epidemiologicalproperties differ from country to country. Thus, special epidemiological surveillance for each country is necessary todetermine the problem according to which preventive measures can be taken. The aim of this study was to identifyregional, familial, socioeconomic and economic characteristics of intoxications and investigate the factors that mayfacilitate such intoxications.Method: 318 poisoning cases aged between 1 month-17 years (44±18 months on average) who were taken to thePediatric Emergency Service of Sivas Cumhuriyet University Faculty of Medicine were evaluated retrospectively.Results: The ratio of poisoning cases to all pediatric emergency admissions was 5.1%. 65.1% of the cases were males,and the ratio of males to females was 1.8:1. Of the poisoning agents, 66% (n: 210) were pharmacologic and 34% (n:108) were non-pharmacologic agents. The highest rate of poisoning was in the 25 months-5 years of age group (75.2%),and the most common poisoning agents were drugs. When evaluated by seasons, 40.3% of the patients referred to thehospital in the summer, 25.2% in the spring, 18.2% in the winter and 16.4% in the autumn. It was determined that66.2% of the poisoning cases occurred at home and 33.8% occurred outside home. Of the poisoning cases, 7.9% weredue to suicide, %11.3 were due to ignorance, %69.2 were accidental, %0.6 were iatrogenic, %0.6 were due toaddiction, %0.3 were due to exposure, %1.6 due to adverse effects and %6.3 were due to other reasons. It wasdetermined that accidental intake of drugs was the most common poisoning agent in our region.Conclusions: This study will contribute significantly in determining the poisoning profile of the region, raisingawareness of healthcare personnel and the society and taking preventive measures.Öğe The Evaluation of Hypoxia-Inducible Factor 1 in N-Nitro-L-Arginine Methyl Ester Preeclampsia Model of Pregnant Rats(BMJ PUBLISHING GROUP, 2011) Kaya, Ali; Boztosun, Abdullah; Seckin, Hulya; Guven, Ahmet Sami; Kucukdurmaz, Zekeriya; Gulturk, Sefa; Cevit, OmerObjective: The objective of the study was to evaluate hypoxia-inducible factor 1 (HIF-1), which plays a major role in the stimulation of angiogenesis in placental tissues, by using immunohistochemical staining in preeclampsia model of rats, developed by N-nitro-L-arginine methyl ester (L-NAME) Methods: Thirty pregnant rats were randomized into 2 groups (n = 15 in each group) on day 10 of gestation. L-NAME was given to rats in the study group by gavage. On days 0, 10, and 20 of gestation, rats were weighted, and urine protein values and blood pressures were measured. Hypoxia-inducible factor 1 expressions were assessed with immunohistochemical staining by using avidin-biotin peroxidase via selecting preparation. Results: Systolic and diastolic blood pressures and urine protein value of L-NAME group on day 20 of gestation were found to be significantly higher than those obtained on days 0 and 10 of gestation in the same group and those obtained on day 20 of gestation in the sham group (P < 0.05). Maternal weight, number of fetuses, and mean fetal weight of rats in L-NAME group on day 20 of gestation were found to be significantly lower than those obtained from rats in the sham group (P < 0.05). Regarding HIF-1 expression of placental tissues, mild immunohistochemical staining was found in 2 rats (13.4%) and moderate in 13 rats (86.6%) in the L-NAME group. A significant difference was found in terms of HIF-1 positivity in the maternal placentas of both groups (P < 0.05). Conclusions: L-NAME preeclampsia model of pregnant rats is consistent with human preeclampsia in terms of hypertension, proteinuria, and intrauterine growth retardation; in addition, it also shows evidence of placental hypoxia findings.Öğe Evaluation of Renal Involvement in Children with Crimean-Congo Hemorrhagic Fever(NATL INST INFECTIOUS DISEASES, 2013) Deveci, Koksal; Uysal, Elif Bilge; Kaya, Ali; Sancakdar, Enver; Alkan, FilizThe aim of the present study was to evaluate renal involvement in children with Crimean-Congo hemorrhagic fever (CCHF). Forty-four children infected with CCHF virus and 30 controls were enrolled in the study. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine protein levels were measured in the patient and control groups. Clinical and laboratory findings of the patient and control groups were compared. uNGAL levels were higher in the patient group than that in the control group (P < 0.001). Of the 44 patients, 26 (59.1%) were proteinuric. uNGAL levels in proteinuric patients were higher than those in non-proteinuric patients (P = 0.035). There was a positive correlation between uNGAL and urine protein levels in the patient group. (R = 0.614, P < 0.001). Due to renal involvement, increased proteinuria and increased uNGAL levels were observed in children with CCHF. In these children, measuring urine total protein and uNGAL levels can be useful to monitor renal involvement due to CCHF.Öğe Evaluation of Serum Perforin, Caspase-3, sFasL and M-30 Levels as Apoptotic Markers in Children With Crimean-Congo Hemorrhagic Fever(LIPPINCOTT WILLIAMS & WILKINS, 2015) Guven, Ahmet S.; Sancakdar, Enver; Uysal, Elif B.; Kaya, Ali; Oflaz, Mehmet B.; Karapinar, Hekim; Bolat, Fatih; Tuzcu, Nevin; Deveci, Koksal; Cevit, Omer; Icagasioglu, Fusun D.Background: Apoptosis is a main regulator in responses of cellular immunity throughout systemic viral infections. Perforin, soluble Fas ligand, caspase-3 and caspase-cleaved cytokeratin-18 (M-30) are mediators of apoptosis. The aim of this study is the evaluation of Crimean-Congo hemorrhagic fever (CCHF) disease changes in the levels of these apoptotic markers and the relation of these changes with disease severity. Methods: Forty-nine hospitalized children with CCHF and 36 healthy controls were enrolled in this prospective study. The CCHF patients were classified into 2 groups based on disease severity (severe group and nonsevere group). Demographic characteristics and clinical and laboratory findings of all patients were recorded on admission. Results: Serum perforin, caspase-3 and soluble Fas ligand levels were found to be significantly higher both in the severe and nonsevere CCHF groups than the healthy control group (P < 0.05), but there was no significant difference in these apoptotic markers between severe and nonsevere CCHF groups (P > 0.05). In addition, serum M-30 levels did not differ significantly among all groups (P > 0.05). There was a positive correlation between serum values for perforin, caspase-3 and M-30 and the disease's severity criteria such as aspartate aminotransferase and/or alanine aminotransferase. The serum levels of all these markers were negatively correlated with disease severity criteria such as the platelet count. Conclusions: In this study, we concluded that the interactions of cytolytic granules containing perforin and caspase cascade and Fas-FasL may play an important role in the pathogenesis of CCHF in children.
