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Item Pediatric Neutropenic Patients Care in Turkey(AVES YAYINCILIK, IBRAHIM KARA, 2019-01-01) Aydin, Zeynep Gokce Gayretli; Buyukcam, Ayse; Kara, Ates; Karbuz, Adem; Soysal, Ahmet; Tapisiz, Anil Aktas; Parlakay, Aslinur Ozkaya; Somer, Ayper; Caliskan, Ayse Bahar Budan; Kocabas, Bilge Aldemir; Okur, Dicle Sener; Ciftdogan, Dilek Yilmaz; Arisoy, Emin Sami; Kocabas, Emine; Ciftci, Ergin; Erduran, Erol; Vardar, Fadil; Tanir, Gonul; Sensoy, S. Gulnar; Bayhan, Gulsum Iclal; Devrim, Ilker; Celik, Melda; Ozen, Metehan; Kosker, Muhammet; Erguven, Muferret; Dalgic, Nazan; Hatipoglu, Nevin; Oz, Fatma Nur; Belet, Nursen; Akcan, Ozge Metin; Ceylan, Ozgur; Siraneci, Rengin; Bozdemir, Sefika Elmas; Ozkasap, Serdar; Celebi, Solmaz; Celik, Umit; Camcioglu, Yildiz; Kara, Aybuke Akaslan; Kupeli, Begul; Gulhan, Belgin; Albayrak, Eda; Erdeniz, Emine Hafize; Yasa, Emine Olcay; Turkkan, Emine; Tezer, Hasan; Sutcu, Murat; Bayram, Nuri; Hatipoglu, Sami; Oncel, Selim; Celik, Taylan; Torun, Yasemin Altuner; Koksal, Yavuz; Cay, Ummuhan; Kara, Ahu; Yoruk, Mustafa Asim; Demirdag, Tugba BedirObjective: Infection is a common complication in children with malignancies. There is no consistent guidance for environmental infection control and isolation precautions for neutropenic patients (NP). There are differences between centers. The aim of this questionnaire study was to determine these differences in Turkey. Material and Methods: A multicenter-descriptive questionnaire was conducted on 36 centers from different geografical locations of Turkey. Bone marrow transplantation units were excluded. Each center was contacted at least three-times. Questionnaire was answered by two different doctors from each center. Results: Thirty-six centers including 20 (55.5\%) University Hospitals, 12 (\%33.3) Research Hospitals, three (8.3\%) State Hospital and one Private University Hospital participated in this survey. 94.3\% of the centers had a bed capacity of 50 beds and over. Twenty-one (58.3\%) centers had pediatric infection ward that followed febrile NP. All centers had an infection control committee. 25\% (9/36) of the centers always followed pediatric neutropenic fever patients in a single room. 66.6\% (24/36) of the centers had toilet in all patients' room. The door features of patients' room included mostly (94.1\%, 32/34) manually opened door. Ten (27.7\%) centers had hepa filter system, five of them had positive-negative pressure room. Thirteen (38.2\%, 13/34) centers prefered hickmann catheter for accessing a patient's central line. Training was given for catheteter care in all centers. Sixteen (44.4\%) centers had determined policies about keeping toys in patient rooms. Visitor restrictions were performed in all centers. None of the centers allowed plants or flowers in hospital rooms. There was a neutropenic diet specific for pediatric NP provided in twenty-seven centers (75\%). Conclusion: The prevention and control of infection contributes to the improvement of the prognosis of patients with hematological malignancies. Physicians must be aware of the infection risks and take precautions for infectious complications through the neutropenic period and standard protocols should be established and implemented for patients with hematological malignancies.Item Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey(FRONTIERS MEDIA SA, 2022-01-01) Kiral, Eylem; Kirel, Birgul; Havan, Merve; Keskin, Mehmet; Karaoglan, Murat; Yildirim, Ahmet; Kangin, Murat; Talay, Mehmet Nur; Urun, Tuba; Altug, Umit; Kesici, Selman; Tufan, Erennur; Kacmaz, Ebru; Bozan, Gurkan; Azapagasi, Ebru; Uysal Yazici, Mutlu; Ozturk, Zeynelabidin; Yesilbas, Osman; Karaguzel, Gulay; Kaya, Gulay; Barlas, Ulkem; Duyu, Muhterem; Boyraz, Merve; Sevketoglu, Esra; Akcay, Nihal; Hancili, Suna; Guven, Ayla; Dursun, Oguz; Tekerek, Nazan Ulgen; Ozcifci, Gokcen; Yazici, Pinar; Turanli, Eda; Kendirli, Tanil; Kahveci, Fevzi; Yetimakman, Ayse Filiz; Citak, Agop; Sik, Guntulu; Bingol, Ibrahim; Aygun, Fatih; Durak, Cansu; Yilmaz, Resul; Bugrul, Fuat; Sari, Yusuf; Tekguc, Hakan; Albayrak, Hatice; Yener, Nazik; Agin, Hasan; Soydan, Ekin; Yildizdas, Dincer; Dilek, Semine Ozdemir; Yalindag, Nilufer; Incekoy-Girgin, Feyza; Alacakir, Nuri; Tutunculer, Filiz; Arslanaoglu, Mehmet Ozgur; Aydin, Can; Bilgin, Muzaffer; Simsek, Enver; Dinleyici, Ener CagriIntroductionThere have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection. MethodsThis is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year. ResultsThe percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabetes (p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission. DiscussionThe frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemicItem Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics(WILEY, 2022-01-01) Munblit, Daniel; Greenhawt, Matthew; Brough, Helen A.; Pushkareva, Anna; Karimova, Diana; Demidova, Anastasia; Warner, John O.; Kalayci, Omer; Sediva, Anna; Untersmayr, Eva; Rodriguez del Rio, Pablo; Vazquez-Ortiz, Marta; Arasi, Stefania; Alvaro-Lozano, Montserrat; Tsabouri, Sophia; Galli, Elena; Beken, Burcin; Eigenmann, Philippe A.By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.Item Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report(OXFORD UNIV PRESS, 2009-01-01) Bakkaloglu, Sevcan A.; Saygili, Arda; Sever, Lale; Noyan, Aytul; Akman, Sema; Ekim, Mesiha; Aksu, Nejat; Doganay, Beyza; Yildiz, Nurdan; Duzova, Ali; Soylu, Alper; Alpay, Harika; Sonmez, Ferah; Civilibal, Mahmut; Erdem, Sevcan; Kardelen, FiratMethods. We aimed to clarify arteriosclerotic risk and to document possible relationships between cardiovascular risk factors and echocardiographic parameters in paediatric peritoneal dialysis (PD) patients. M-mode/Doppler/tissue Doppler echocardiographic studies and lipid/lipoproteins, homocysteine, high-sensitivity C-reactive protein (HS-CRP) levels and carotid intima-media thickness (CIMT) were determined in 59 patients (age: 14.2 +/- 4.5 years) and in 36 healthy subjects. Results. Structural and functional cardiac abnormalities were observed in patients on maintenance dialysis. Increased left ventricular mass index (LVMI, P = 0.000), relative wall thickness (P = 0.000), myocardial performance index (MPI, P = 0.000) were documented in the patients. Lipoprotein (a) (P = 0.000), homocysteine (P = 0.001), HS-CRP (P = 0.000) and CIMT (P = 0.000) were significantly elevated in the patients. Left ventricular hypertrophy (LVH) was prevalent in 68\% of the patients. Patients with LVH had higher levels of HS-CRP (P = 0.001) and CIMT (P = 0.028) than those without LVH. Haemoglobin was an independent predictor of LVMI (beta: -8.9, P = 0.001), while residual diuresis and CIMT were independent predictors of diastolic dysfunction (beta: -0.45, P = 0.034 and beta: 5.90, P = 0.008, respectively). Albumin (beta: -0.72, P = 0.018) and Kt/V urea (beta: -0.48, P = 0.012) were significant predictors of CIMT. There were positive correlations between LVMI and CIMT. HS-CRP was positively correlated with LVMI as well as CIMT. Conclusions. Elevated levels of atherosclerotic/inflammatory risk factors, low haemoglobin levels and loss of residual renal function and their negative effects on heart are of remarkable importance in paediatric patients on maintenance peritoneal dialysis. Achieving recommended targets for haemoglobin, blood pressure and Kt/V urea, preserving residual renal function as well as managing inflammation and subsequent arteriosclerosis is obviously essential to improve the patients' prognosis.Item Impact of peritoneal transport characteristics on cardiac function in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report(OXFORD UNIV PRESS, 2010-01-01) Bakkaloglu, Sevcan A.; Saygili, Arda; Sever, Lale; Aksu, Nejat; Noyan, Aytul; Akman, Sema; Ekim, Mesiha; Doganay, Beyza; Yildiz, Nurdan; Akalin, Figen; Caliskan, Salim; Kara, Orhan D.; Duzova, Ali; Soylu, Alper; Atalay, SemraMethods. One hundred and ten PD patients (13 +/- 5 years, PD vintage: 31 +/- 27 months) were enrolled into the study. Four-hour dialysate/plasma creatinine ratio was used for differentiating PET groups. Thirty-eight patients were high transporters, 29 were high-average transporters and 43 were low-average/low transporters. Echocardiography was performed in all subjects. Results. Age, PD vintage, dialysate glucose concentration, ultrafiltration volume, urine volume and blood pressure levels were similar in all PET groups. No biochemical or echocardiographic data (ejection fraction, fractional shortening, left ventricular mass index, myocardial performance index, power Doppler E/tissue Doppler E ratio reflecting diastolic function) were different among PET groups except lower albumin (P = 0.025) levels in high transporters and higher high-sensitivity C-reactive protein (P = 0.026) levels in high and high-average transporters compared to other transport groups. Conclusions. Cardiac structural and functional abnormalities are highly prevalent among paediatric PD patients. Transport rates did not have a significant effect on biochemical parameters or cardiac structural/functional parameters. It might be suggested that being a high transporter does not provide a disadvantage in terms of atherogenic tendency and cardiac disease in paediatric PD patients. Oligoanuria, anaemia and hypertension were independent predictors of cardiac disease.Item Is Functional Improvement Always Correlated with Symptomatic Improvement in Children with Attention-Deficit/Hyperactivity Disorder Managed with Oros Methylphenidate? A Prospective Open-Label Naturalistic Follow-Up Study(AVES, 2020-01-01) Tarakcioglu, Mahmut Cem; Caliskan, Yasin; Kadak, Muhammed Tayyib; Aliyev, Nilufer Okumus; Aksoy, Umut Mert; Tufan, Ali Evren; Gundogdu, Ozlem Yildiz; Memik, Nursu Cakin; Weiss, Margaret D.Background: To investigate the relationship between symptomatic improvement and functional improvement in children with attention deficit hyperactivity disorder (ADHD) who were being treated with OROS methylphenidate. Methods: Parents evaluated the severity of ADHD symptoms on the Turgay-DSM-IV ADHD/Disruptive Behavior Disorders Scale (T-DSM-IV). They assessed functioning on the Weiss Functional Impairment Rating Scale - Parent Form (WFIRS-P), and the Pediatric Quality of Life Inventory (PedsQL) was used to assess quality of life. Clinicians rated global outcome on the Clinical Global Impressions Scale (CGI). Response was measured in terms of the following criteria: a 20\% change in symptoms, a CGI-I score that was much improved (2) or very much improved (1), or an improvement of 0.25 (the minimally important difference) on the WFIRS. Improvement in quality of life was defined as >= 20\% change in PedsQL score. Results: Sixty-three children completed the study. After 12 weeks, 77.7\% of patients met the a priori criteria for treatment response rate. Among patients who exhibited improvement in symptoms, 42.9\% also showed improved functioning. Among those who showed improved functioning, 95.5\% showed improvement in symptoms. Of patients who showed improvement in symptoms, 34.6\% percent also showed improvement in quality of life. Of those who showed improvement in quality of life, 94.4\% also showed improvement in symptoms. Conclusions: Evaluation of changes in functional improvement, quality of life improvement, and symptom improvement during ADHD treatment enables clinicians to identify individuals whose functional impairment/quality of life persists despite symptom improvement. On that basis, additional treatment interventions can be organized for those individuals.Item Clinical and electrophysiological evaluation of pediatric Wolff-Parkinson-White patients(TURKISH SOC CARDIOLOGY, 2015-01-01) Yildirim, Isil; Ozer, Sema; Karagoz, Tevfik; Sahin, Murat; Ozkutlu, Suheyla; Alehan, Dursun; Celiker, AlpayObjective: Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized by electro-cardiographic (ECG) findings of a short PR interval and a delta wave. The objective of this study was to evaluate the electrophysiological properties of children with WPW syndrome and to develop an algorithm for the management of these patients with limited access to electrophysiological study. Methods: A retrospective review of all pediatric patients who underwent electrophysiological evaluation for WPW syndrome was performed. Results: One hundred nine patients underwent electrophysiological evaluation at a single tertiary center between 1997 and 2011. The median age of the patients was 11 years (0.1-18). Of the 109 patients, 82 presented with tachycardia (median age 11 (0.1-18) years), and 14 presented with syncope (median age 12 (6-16) years)Item Successful treatment of pediatric post-liver transplant Kaposi's sarcoma with paclitaxel(TURKISH J PEDIATRICS, 2020-01-01) Sen, Hilal Susam; Ates, Belen Terlemez; Yilmazbas, Pinar; Ocak, Suheyla; Kirimlioglu, Hale; Gokce, Selim; Acarli, KorayBackground. Kaposi's sarcoma (KS) is a complication of immunosuppressive therapy for transplant recipients. Unlike adult recipients, KS in pediatric organ transplantation is quite rare. Treatment is usually withdrawal of immunosuppressionItem Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery(TURKISH SOC CARDIOLOGY, 2017-01-01) Erek, Ersin; Aydin, Selim; Suzan, Dilek; Yildiz, Okan; Altin, Firat; Kirat, Baris; Demir, Ibrahim Halil; Odemis, EnderObjective: Extracorporeal membrane oxygenation (ECMO) is used to provide cardiorespiratory support during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitationItem Is conservative treatment an effective option for pilonidal sinus disease in children?(WILEY, 2018-01-01) Cevik, Muazez; Dorterler, Mustafa Erman; Abbasoglu, LatifPilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature