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Öğe Can platelet count, platelet mass index and mean platelet volume be parameters in retinopathy of prematurity?(Yuzuncu Yil University Faculty of Medicine, 2022) Değer, İbrahim; Ertuğrul, Sabahattin; Kaya, İrfan Kemal; Yılmaz, Sibel Tanrıverdi; Yolbaş, İlyasPlatelet parameters such as platelet count (PLT), mean platelet volume (MPV) and platelet mass index (PMI) are associated with physiological and pathological functions in various inflammatory diseases. The aim of the present study was to investigate whether platelet parameters were related to retinopath y of prematurity (ROP) in premature newborns. We retrospectively evaluated the platelet count, platelet mass index, and MPV parameters measured on the first day and 28th day, which belonged to patients, who were examined for retinopathy of prematurity at n eonatal intensive care unit. Among 343 patients enrolled by the study, 52.8 % (181) were male and 47.2 %(162) were female. The PLT level studied on the first day was 231.6±84(x1000/mm3) in the ROP group and 207.8±81.6(x1000/mm3) in the non ROP group, and t he PLT level studied on the 28th day was 409.9±179.4(x1000/mm3) in the ROP group and 350.7±140.4(x1000/mm3) in the non ROP group. There was a significant difference between the two groups regarding both PLT levels (p=0.007, p=0.006, respectively). The PMI level studied on the first day was 1854.1±774.7 in the ROP group and 1638.2±753.3 in the non ROP group, and the PMI level studied on the 28th day was 3784.5±1797.4 in the ROP group and 3302.8±1452.9 in the non ROP group. This study showed that platelet count and platelet mass index measured on the first and 28th days are important parameters in patients who undergo ROP examination, and these parameters measured prior to examination will guide clinicians in diagnostic process.Öğe Continuous veno-venous hemodiafiltration in neonates with maple syrup urine disease(Wiley, 2022) Değer, İbrahim; Çelik, Muhittin; Taş, İbrahim; Samancı, SerhatIntroduction Herein, we aimed to discuss our experience in 16 newborn patients with Maple syrup urine disease (MSUD) who were treated with urgent renal replacement therapy (RRT). Methods The patients underwent continuous veno-venous hemodiafiltration (CVVHDF) or peritoneal dialysis (PD) as renal replacement therapy. Results Eleven (68.75%) patients underwent CVVHDF and five (31.25%) underwent peritoneal dialysis. The median leucine reduction rate per hour was 2.56% (1.75-7.6) in the CVVHDF group, 0.78% (0.54-1.83) in the PD group, and was significantly higher in the CVVHDF group (p = 0.001). Posttreatment plasma leucine levels were found to be 198 (20-721) mu mol/L in the CVVHDF group and 600 (250-967) mu mol/L in the PD group, and CVVHDF was found to be significantly lower (p = 0.08). Complications such as hypotension, electrolyte imbalance, and filter obstruction occurred in the CVVHDF group. Conclusion This study showed that CVVHDF is more effective than PD for rapidly eliminating elevated leucine levels caused by MSUD in the newborn and it is not associated with increased complication rates.Öğe The contribution of postnatal steroid administration to early brain damage in preterm babies with bronchopulmonary dysplasia(TÜBİTAK, 2021) Ertuğrul, Sabahattin; Darakci, Savaş Mert; Kaplan, İbrahim; Yolbaş, İlyas; Değer, İbrahim; Yılmaz, Sibel Tanrıverdi; Aktaş, ŞerafettinBackground/aim: Postnatal corticosteroids are commonly used to treat bronchopulmonary dysplasia (BPD). We aimed to show whether S100 calcium-binding B (S100B), neuron-specific enolase (NSE), Tau protein or microtubule-associated protein tau (MAPT), and glial fibrillary acid protein (GFAP) levels would provide any evidence of early neurological damage in premature infants receiving postnatal low dose dexamethasone therapy for BPD treatment. Materials and methods: In this cohort study, 136 preterm infants diagnosed with BPD at ≤32 weeks of gestation formed the study group, and 64 preterm infants formed the control group. NSE, S100B, GFAP, and MAPT levels were first measured before the postnatal corticosteroid treatment in both the patient and the control group on the 28th day and, for a second time, after treatment termination in the patient group. Results: There were significant differences between the measured GFAP, MAPT, and NSE values of the BPD and control groups on the 28th day, whereas there was no significant difference between the measured S100B values of the two groups. There were a statistically significant difference between the NSE values measured on the 28th day and after the treatment within the BPD group, whereas no significant difference existed between the GFAP, MAPT, and S100B values. Conclusion: NSE levels, which indicate brain damage in the early period, increased in preterm babies with BPD who had been administered postnatal dexamethasone.Öğe COVID-19 ve yenidoğan(Dicle Üniversitesi Tıp Fakültesi, 2021) Ertuğrul, Sabahattin; Değer, İbrahim; Yılmaz, Sibel TanrıverdiCOVID-19 pandemisi dünya çapında yayılmaya devam ederken, risk altındaki popülasyonları belirlememiz ve onları korumak için uygun klinik bakım politikaları geliştirmemiz çok önemlidir. Yenidoğan SARS-CoV-2 enfeksiyonunun insidansı ve sonuçlarına ilişkin veriler ortaya çıkmaya devam etse de, öğrenilecek daha çok şey vardır. Şimdiye kadar ki kanıtlar, yenidoğanda dikey bulaşmanın nadir olduğunu ve daha büyük bir oranın doğum sonrası solunum damlacıkları yoluyla veya enfekte anne veya bakıcılarla temas yoluyla enfeksiyon kaptığını göstermektedir. Yenidoğanların çoğunda SARS-CoV-2'ye bağlı semptom gelişmez, ancak prematüreliğe bağlı morbiditeler yoğun bakım ve destek gerektirebilir. Semptomların varlığına bakılmaksızın, COVID-19 enfeksiyonundan şüphelenilen veya teyit edilen annelerden doğan tüm yenidoğanlar test edilmelidir. Yenidoğanda COVID-19 durumu hakkında farkındalık, enfeksiyon önleme ve kontrol önlemleri uygulama yöntemleri teşvik edilmelidir.Öğe Diagnostic and prognostic value of serum NT-ProBNP in the diagnosis of neonatal sepsis(Yuzuncu Yil Universitesi Tip Fakultesi, 2022) Değer, İbrahim; Ceylan, AbdullahDespite the advances in the diagnosis and treatment of neonatal sepsis, it remains an important cause of morbidity and mortality. This study aimed to investigate the effectiveness of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) levels in the diagnosis and prognosis of neonatal sepsis. Fifty neonates diagnosed with clinical sepsis in the neonatal intensive care unit were included in the study. The control group was composed of 50 healthy neonates. As a result of the study, a statistically significant difference was observed between the groups in terms of NT-proBNP, C-reactive protein, leukocyte count, platelet count and I/M ratio(p <0.05). NT-ProBNP level was 19624.1±15027.6 pg/ml in the case group, while it was 3203.8±4506.8 pg/ml in the control group. There was a positive correlation between NT-ProBNP and neonatal sepsis in the case group. NT-ProBNP measurements were found to be significant in differentiating neonatal sepsis. In the case group, 33 patients discharged with recovery, 17 patients died, and the mean NT-ProBNP levels were 12732.2±12954.3 pg/ml and 35000 pg/ml, respectively. NT-ProBNP levels were statistically significantly higher in died patients. NT-ProBNP levels should be measured in the early diagnosis of neonatal sepsis and to determine the prognosis of patients diagnosed with neonatal sepsis. The use of NT-ProBNP with other biomarkers helps the early diagnosis of neonatal sepsis. Further multicenter, prospective studies with large samples are needed to identify NT-ProBNP levels in the diagnosis and prognosis of neonatal sepsis.Öğe Hipoksik iskemik ensefalopatide N-terminal pro brain natriüretikpeptid ve troponin I düzeylerinin önemi(Dicle Üniversitesi Tıp Fakültesi, 2021) Değer, İbrahim; Ertuğrul, Sabahattin; Yılmaz, Sibel Tanrıverdi; Türe, MehmetAmaç: Hipoksikiskemikensefalopati (HİE), perinatal dönemde hipoksiye bağlı olarak görülen ağır morbidite ve mortalite ile sonuçlanabilen klinik bir durumdur. Bu çalışmanın amacı, hipoksik iskemik ensefalopatide kardiyak biyomarkerlerden N-Terminal pro Brain Natriüretik Peptid (NTproBNP) ve Troponin I’nın rolünü değerlendirmektir. Yöntemler: Bu çalışmada, Ocak 2019 ve Mayıs 2021 tarihleri arasında Yenidoğan Yoğun Bakım Ünitesinde HİE tanısı ile takip ve tedavileri yapılmış olan hastaların Troponin I ve NTproBNP düzeyleri geriye dönük olarak incelendi. Bulgular: Bu çalışma %44,5 (45)’i kız ve %55.5(56)’sı erkek olmak üzere 101 olgudan oluştu. Normal spontan vajinal yol ile doğum oranı %57,8 (63) iken Sezaryenle doğum oranı %42,2 (46) idi. Olgularda HİE evre 1 oranı %31.7 (32), HİE evre2 oranı %31,7 (32) ve HİE evre 3 oranı%36,6 (37) olarak bulundu. Ortalama doğum ağırlığı 3139.95±499.02 g, ortalama gestasyon haftası 38.39±1.69 hafta bulundu. NTproBNP; ortalama 10099.49±12023.03 pg/mL ve Troponin I; 122.575±188.5287 ng/L bulundu. Hipoksik iskemik ensefalopatinin şiddetinin artması ile Troponin I arasında istatistiksel olarak anlamlı bir fark bulunurken, NTproBNP ile HİE’nin şiddeti arasında herhangi bir farklılık bulunmadı. Sonuç: Yenidoğan HİE’li bebeklerde NTproBNP ve Troponin I düzeylerinde artış vardır. Ayrıca, Troponin I düzeyleri ile yenidoğan hipoksik iskemik ensefalopati şiddeti arasında anlamlı ilişki olduğu bulundu.Öğe Infrequent association of two rare diseases: amniotic band syndrome and osteogenesis imperfecta(Walter de Gruyter GMBH, 2021) Darakci, Savaş Mert; Ertuğrul, Sabahattin; Yılmaz, Sibel Tanrıverdi; Ünal, Edip; Yolbaş, İlyas; Değer, İbrahimObjectives: Amniotic band syndrome and osteogenesis imperfecta are two distinct diseases that develop due to structural defects of the collagen protein. In our paper, we report the concurrence of these two diseases rarely seen in the newborn period. Case presentation: A female infant born at 33rd gestational week was found to have constrictive bands in her right lower extremity and flexion contractures in distal joints of lower and upper extremities due to amniotic bands in postnatal physical examination. While being treated for respiratory difficulty, she was diagnosed with osteogenesis imperfecta and treated with bisphosphonates upon being found to suffer bilateral humeral fractures on the sixth day of life. She received respiratory support with mechanical ventilation due to respiratory tract complications related to osteogenesis imperfecta and died on the 384th day of life. Conclusions: One should bear in mind that other collagen tissue diseases may accompany the amniotic band syndrome; this possibility should be definitely pursued if clinical suspicion exists.Öğe The measurement of neutrophil gelatinase associated lipocalin in umbilical cord blood and the assessment of its relationship with neonatal results(Dicle Üniversitesi Tıp Fakültesi, 2022) İlter, Seçkin; Ertuğrul, Sabahattin; Değer, İbrahim; Kaplan, İbrahimObjectives: In this study, the relationship of cord blood Neutrophil Gelatinase-Associated Lipocalin (NGAL) with neonatal diseases was investigated. Methods: NGAL levels were measured in the cord blood of 180 babies born between 2015 and 2016. Patients were classified according to maternal diseases, neonatal diseases and demographic characteristics. Obtained data were compared with cord blood NGAL levels. Results: In our study, the mean NGAL levels were 1283.99 ng/mL in boys and 1306.52 ng/mL in girls. Umbilical cord blood NGAL levels of infants diagnosed with intrauterine growth retardation (1913.4±2833.5 ng/mL) and prolonged premature rupture of membranes (2594.2±2037.1 ng/mL) were found to be statistically high (p<0.05). There was no statistically significant difference between NGAL levels in infants of mothers with gestational diabetes mellitus, acyanotic congenital heart diseases, meconium aspiration syndrome, infants of mothers with preeclampsia, Apgar scores and infants of mothers with oligohydramnios (p>0.05). Conclusions: Neutrophil Gelatinase-Associated Lipocalin, may be useful as a diagnostic biomarker in the evaluation of maternal and neonatal diseases. However, studies on larger patient populations are needed.Öğe Prematüre bebeklerde nekrotizan enterokolit ve mortalite ilişkisinin değerlendirilmesi(Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, 2022) Değer, İbrahim; Ertuğrul, Sabahattin; Yolbaş, İlyasGiriş: Nekrotizan enterokolit, yenidoğan yo ğun bak ım ünitelerinde en sık görülen ciddi gastrointestinal problemlerin başında gelmektedir. Bu çalışmada Nekrotizan enterokolit olguları ve mortalite ilişkisi değerlendirildi. Gereç ve Yöntem: Bu çal ışmada Haziran 2019-Haziran 2021 tarihleri aras ında Çocuk Sa ğlığı ve Hastalıkları Anabilim Dalı Yenidoğan Yoğun Bakım Ünitesi’nde evre II ve üstü Nekrotizan enterokolit tanısı ile takip ve tedavisi yapılan 157 olgu çalışmaya alındı. Bulgular: Olguların %51(80)’i kız ve %49(77)’si erkek, doğum ağırlığı 1147±436 g, gebelik haftası 27.9±3.1 hafta, Anne ya şı 29.2±7.4 ve Anne gebelik sayısı 3.59±2.2 bulundu. Doğum ağırlığına göre dağılım, ≤1000 g %41.4 (65), 1001-1500 g %40.8 (64), 1501-2000 g %13.4 (21), 2001-2500 g %3.2 (5) ve 2501 g ve üstü %1.3(2) bulundu. Olguların gebelik haftasına göre dağılımı ≤27 hafta %42.7 (67), 28-32 hafta %49 (77), 33-36 hafta %7.6 (12) ve 37 hafta ve üstü %0.6 (1) bulundu. Cinsiyet ve anne yaşı ile mortalite arasında istatistiksel olarak anlamlı ilişki bulunmadı. Do ğum a ğırlığı ve gestasyon haftası azaldıkça ve anne gebelik say ısı arttıkça mortalite ve nekrotizan enterokolit sıklığının istatistiksel olarak anlamlı şekilde arttığı bulundu (p<0.05). Sonuç: Yenidoğan dönemindeki prematüre bebeklerde, do ğum ağırlığı ve gestasyon haftas ının azalması, hem nekrotizan enterokolit sıklığında hem de nekrotizan enterokolite ba ğlı mortalite oranında ciddi artışa neden olmaktadır.Öğe The relationship between Vitamin A and Vitamin E levels and neonatal morbidities(Verduci Publisher, 2022) Değer, İbrahim; Ertuǧrul, Sabahattin; Yılmaz, Sibel Tanrıverdi; Özbey, Z. K.; Yolbaş, İlyas; Kaplan, İbrahimOBJECTIVE: In the neonatal period. diseases such as respiratory distress syndrome, necrotizing enterocolitis, bronchopulmonary dysplasia. retinopathy of prematurity. intraventricular hemorrhage. patent ductus arteriosus hypoxic-ischemic encephalopathy. and hyperbilirubinemia are frequently seen, despite being differently affected by the gestational age. This study aims to examine the relationship between morbidities in the neonatal period and serum vitamin A and vitamin E levels. PATIENTS AND METHODS: In this prospective cohort study. patients who were treated and followed up in the Neonatal Intensive Care Unit between August 2020 and September 2021 were evaluated. RESULTS: 381 patients, 202 male (53%) and 179 female (47%), were included in the study. The mean birth weight was 2642.13 +/- 835.91 g (minimum 480 g, maximum 4285 g) and the mean gestational week was 35.3 +/- 3.8 (minimum 24 weeks, maximum 42 weeks). The weight of 332 patients (87.2%) was above 1500 g in whom there was a significant increase in respiratory distress. hypoxic-ischemic encephalopathy, and hyperbilirubinemia correlated with a decrease in the vitamin E levels (p=0.001, 0.02, and 0.001. respectively). In infants over 32 weeks of age, there was a significant increase in respiratory distress. hypoxic-ischemic encephalopathy, and hyperbilirubinemia correlated with a decrease in the vitamin E levels (p=0.001, 0.02, and 0.001. respectively). No significant relationship was found between vitamin A levels and neonatal morbidities regardless of the birth weight or gestational age. CONCLUSIONS: We believe that our study may provide convenience to pediatricians and neonatologists in terms of the relationship between vitamin A and E levels and neonatal morbidities in neonates.Öğe Respiratuvar distres sendromlu preterm bebeklerde sürfaktan uygulanmasında LISA ve INSURE yöntemlerinin karşılaştırılması(Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, 2021) Aydın, Neşet; Değer, İbrahim; Başaranoğlu, Murat; Demir, Nihat; Tuncer, OğuzAmaç: Bu çalıs ma, respiratuvar distres sendromu tanısıyla sürfaktan tedavisi uygulanan prematüre bebeklerde, invaziv (entübasyon tüpü) ve daha az invaziv (ince kateter) yöntemlerle sürfaktan uygulanmasının kars ılas tırılması amacıyla yapıldı. Gereç ve yöntem: Yenidog an Yog un Bakım ünitesinde yatan; dog um haftası 32. gebelik haftası ve/veya altında olan ve sürfaktan tedavisi verilmesi gereken bebekler çalıs maya alındı. Respiratuvar distres sendromu için sürfaktan replasmanı gereken 60 olgu çalışmaya alındı. Tüm olgulara poractant alfa (200 mg/kg/doz) verildi. Olgular, LISA (Daha az invaziv sürfaktan uygulaması) ve INSURE (Entübasyon, Sürfaktan uygulaması ve Ekstübasyon) grubu olacak şekilde randomize edildi. Bulgular: Sürfaktan verilis i sırasında INSURE grubundaki hastaların %90’ında, LISA grubundaki hastaların ise %63.3’ünde komplikasyon gözlenmedi. LISA grubunda ilk 72 saatte entübasyon ihtiyacının istatistiksel olarak anlamlı oranda daha düşük olduğu saptandı. Mekanik ventilasyon ihtiyacının ve ölüm oranlarının INSURE grubunda daha yüksek olduğu saptandı. Tekrarlayan sürfaktan ihtiyacı açısından gruplar arasında anlamlı farklılık bulunmadı. Gruplar arasında Respiratuvar distres sendromu komplikasyonları (Nekrotizan enterokolit, İntrakraniyal kanama, Prematüre retinopatisi, Bronkopulmoner displazi) yönünden istatistiksel olarak anlamlı farklılık bulunmadı. Sonuç: Sürfaktan replasman tedavisinde her iki yöntem de uygulanabilir ancak ince kateter ile sürfaktan tedavisi sırasında desatürasyon daha sık görülmektedir. Kateter yönteminin uygulama zorlukları yöntemin dezavantajlarıdır. Fakat entübasyon ve pozitif basınçlı ventilasyon gerektirmemesi, mekanik ventilasyon destek ihtiyacının ve mekanik ventilasyonda kalış süresinin daha az olması nedeniyle INSURE yöntemine göre daha başarılı görünmektedir.Öğe Retrospective evaluation of inborn errors of metabolisms in the level III neonatal intensive care unit(Dicle Üniversitesi Tıp Fakültesi, 2022) Değer, İbrahim; Taş, İbrahim; Samancı, SerhatObjective: Inborn errors of metabolisms (IEMs) are a heterogeneous group of disorders that can occur as a result of inherited or spontaneous mutations, are rare when considered alone, but have many diseases as a group. Although they are generally thought of as diseases of the neonatal period, 50% of these also occur outside the neonatal period, and some are not diagnosed until adulthood. The aim of this study is to examine the frequency, clinical and laboratory features of inborn errors of metabolism in the neonatal period. Methods: The results of 60 patients who were diagnosed with IEMs as a result of the study, out of 1400 patients who were followed up and treated in the Children's Hospital Neonatal Intensive Care Unit between January 2018 and December 2020, were evaluated. Results: In this study, it consisted of 60 cases, 30 (%50) of which were girls and 30 (%50) were boys (50%). The median age of the patients included in the study was 3 (1-25) days at admission, median weight was 3100 (1000-4000) g, and gestational week was found to be median 39 (27-40) weeks at admission. The most common complaints were feeding difficulty 43(72%), tachypnea 27 (45%) and vomiting 5 (8.3%). The most common laboratory findings were metabolic acidosis 39 (65%) and 36 (60%) hypoglycemia. There was a history of consanguinity in 46 (76.6%) cases, and a history of sibling death in 30 (50%). The mother had a history of abortion in 5 (8.3%) patients who did not have a history of sibling death. The most common diagnoses were Urea cycle disorder 13 (21.7%), organic acidemia 12 (20%), galactosemia 10 (16.7%) and amino acid metabolism disorders 9 (15%). Conclusion: Inborn errors of metabolisms, which are a group of diseases that can occur in different spectrums with clinical, biochemical and genetic heterogeneity, should be kept in mind especially in regions where consanguineous marriages are high. In cases such as metabolic acidosis, which presents with nonspecific symptoms such as malnutrition, tachypnea and jaundice in the neonatal period and cannot be explained in laboratory examinations, care should be taken and they should be referred to centers for further investigation.
