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Öğe Assessment of epicardial adipose tissue thickness and the mean platelet volume in children with familial Mediterranean fever(Bmc, 2015) Uluca, Unal; Demir, Fikri; Ece, Aydin; Sen, Velat; Gunes, Ali; Aktar, Fesih; Tan, IlhanBackground: Familial Mediterranean fever (FMF) is an inflammatory disease, which is suggested to be associated with increased risk of atherosclerosis. Epicardial adipose tissue (EAT) thickness and the mean platelet volume (MPV) are parameters used in prediction of atherosclerotic risk in various conditions. These parameters were evaluated in children with FMF and compared with healthy controls. Methods: Forty-five patients with FMF and 54 age-and gender-matched healthy controls were assessed. Duration of symptoms, age at diagnosis, duration of delay in diagnosis, frequency and duration of FMF attacks, disease severity scores, response to colchicine therapy, MEditerraneanFeVer (MEFV) gene mutations, and MPV values were recorded. EAT thicknesses were measured by echocardiography. Results: Epicardial adipose tissue thicknesses of the children with FMF were found to be significantly greater than that of controls (5.1 +/- 1.4 vs. 4.5 +/- 0.9 mm, p = 0.036). FMF patients had significantly higher MPV values compared with the controls (7.8 +/- 1.1 vs. 7.3 +/- 1.4 fl, p = 0.044). Age at diagnosis, duration of delay in diagnosis, and MPV values were found to be correlated with EAT thickness in the patient group (r = 0.49, p = 0.001 for the former parameters and r = 0.32, p = 0.04 for MPV). Conclusion: Epicardial adipose tissue thickness and MPV values seem to be increased in children with FMF. These findings may indicate an increased risk of atherosclerosis in FMF patients.Öğe Brucella Infection Associated with Complete Atrioventricular Block(Galenos Publ House, 2016) Bilici, Meki; Demir, Fikri; Yilmazer, Murat Muhtar; Bozkurt, Fatma; Tuzcu, VolkanBackground: The clinical spectrum of Brucella infection is quite diverse and characterized by multi-system involvement. Patients present with myocarditis, endocarditis, or pericarditis. Infective endocarditis is the most common cardiovascular complication in patients with brucellosis. Although conduction abnormalities are seen in cases with endocarditis, they are reported very rarely in the setting of cardiac Brucella infection. Case Report: An eight and a half-year-old male patient was referred to our clinic due to inadequate response to cotrimaxazole plus streptomycin treatment at the 15th day of admission. Although local hospital records on the patient showed a heart rate of 80 bpm, we determined a heart rate of 46 bpm. The electrocardiogram showed complete atrioventricular (AV) block. The average heart rate was determined as 48 bpm with 24-hour Holter electrocardiogram (ECG) monitoring. The echocardiographic examination showed normal-sized heart chambers and the absence of valvular involvement. An agglutination test for brucellosis was found to be positive with a titer of 1/320. High fever, arthralgia, and splenomegaly regressed following doxycycline plus rifampicin therapy, but there was no improvement in the AV block. A permanent pacemaker was implanted because of the detection of an average heart rate of 48 bpm. Conclusion: Because cardiac failure and rhythm abnormalities are reported in the course of Brucella infection and may be associated with significant outcomes, cases with brucellosis should be evaluated carefully in terms of cardiac involvement. This report aims to draw attention to complete AV block as an extremely rare complication of Brucella infection.Öğe Cardiac thrombus developing after an accidental high-voltage electric shock in a child(Turkish National Pediatric Society, 2015) Akın, Alper; Bilici, Meki; Demir, Fikri; Pirinççioğlu, Ayfer Gözü; Yavuz, CelalAkın A, Bilici M, Demir F, Gözü-Pirinççioğlu A, Yavuz C. Cardiac thrombus developing after an accidental high-voltage electric shock in a child. Turk J Pediatr 2015; 57: 180-182. Electric shock is a condition that may affect various organ systems and potentially cause death. Cardiac findings vary from asymptomatic mild injury to fatal myocardial involvement. Herein we present a five-year-old boy with a cardiac thrombus developing after an accidental electrical shock. Cardiac arrhythmias and evidence of ischemia have been reported after electric shock; we were, however, unable to identify an earlier case report of intracardiac thrombosis related to electric shock. Findings such as elevated cardiac enzymes and systolic dysfunction, which indicate myocardial damage following electric shock, were present in our patient. We think that the cardiac thrombus might have resulted from the myocardial damage and the slowed intracardiac blood flow related to systolic dysfunction. As the thrombus was thought to have been formed through known mechanisms, it was treated traditionally. However, further data regarding the etiology and management of such thrombi is needed.Öğe Complete atrioventricular block associated with clozapine intoxication: case report(Turkish Journal of Pediatrics, 2019) Türe, Mehmet; Bilici, Meki; Akın, Alper; Demir, Fikri; Balık, Hasan; Darakçı, Savaş MertClozapine is one of the atypical anti-psychotic drugs used in the treatment of resistant schizophrenia. Although cardiac side-effects are rare, it has been reported that there may be development of myocarditis, dilated cardiomyopathy, postural orthostatic hypotension and prolonged QT duration. Complete atrioventricular (AV) block is characterized by the inability to transmit all of the atrial signal to the ventricles. Causes may be congenital, idiopathic or acquired which are associated with surgery, infection, or muscle disease. AV block is extremely serious and permanent pacemaker insertion is usually necessary for all patients. Complete AV block may develop due to clozapine intoxication through increase in vagal tonus, sinoatrial node (SN) and the inhibition of atrioventricular node signalling. The case presented here is of a 15-year old female patient who developed AV total cardiac block associated with the taking of clozapine in a suicide attempt.Öğe Dev sağ ventrikül fibromu olan süt çocuğu(Dicle Üniversitesi Tıp Fakültesi, 2014) Demir, Fikri; Akın, Alper; Bilici, Meki; Aktar, Fesih; Uluca, Ünal; Turan, Mehmet İbrahim; Tan, İlhanKardiyak fibrom, rabdomiyomdan sonra en sık görülen benign kardiyak tümör olmasına rağmen insidansı oldukça düşüktür. Çıkış yolu obstrüksiyonuna, aritmiye veya ciddi kapak disfonksiyonuna yol açtıklarında cerrahi müdahale gerektirirler. Bu yazıda oldukça büyük olmasına rağmen asemptomatik seyir gösteren fibromlu bir süt çocuğu sunuldu.Öğe Echocardiographic diagnosis of double-chambered left ventricle(Springer Japan Kk, 2016) Bilici, Meki; Demir, Fikri; Akin, Alper; Guzel, Abdulmenap; Akdeniz, Osman; Tan, IlhanDouble-chambered left ventricle (DCLV) is a rare congenital abnormality in which the left ventricle is divided into two separate chambers by a septum or anomalous muscular structure. The chambers are observed mostly parallel to each other without stenosis, and less frequently in a superior-inferior arrangement. An asymptomatic girl is presented here who was diagnosed with DCLV on echocardiographic examination that was performed for the evaluation of cardiac murmur detected by a pediatrician. She has been followed up without treatment.Öğe Epidemiologic Features of Type 1 Diabetic Patients between 0 and 18 Years of Age in Istanbul City(Galenos Yayincilik, 2015) Demir, Fikri; Gunoz, Hulya; Saka, Nurcin; Darendeliler, Feyza; Bundak, Ruveyde; Bas, Firdevs; Neyzi, OlcayObjective: To evaluate the epidemiologic, clinical and laboratory characteristics of a group of children with type 1 diabetes mellitus (T1DM) living in a Turkish city. Methods: The records of 395 (boys/girls: 199/196) children with newly diagnosed T1DM hospitalized in the years 1985-2004 were evaluated retrospectively. The data were assessed by gender and age subgroups (<= 5, 6-10 and >= 11 years). Results: Mean age of children at diagnosis was 8.1 +/- 4.1 years. At T1DM onset, the number of children <= 5, between 6-10 and >= 11 years old was 110 (27.9%), 147 (37.2%) and 138 (34.9%), respectively. The patients were mostly diagnosed at ages 6-8 years (24.1%), followed by cases aged 3-5 years (22.0%). Polyuria and polydipsia were the most common symptoms (94.7%). Mean duration of symptoms was 21.5 +/- 18.6 days. Although the patients mostly presented in autumn (30.7%), no season-related significant differences were found. The frequency of ketoacidosis was relatively high (48.5%). When compared to boys, the girls experienced higher rates of ketoacidosis (55.1% vs. 41.7%, p=0.042); had a higher frequency of antithyroid peroxidase antibodies (11.7% vs. 4.2%, p=0.049) and higher insulin requirement (0.89 +/- 0.41 vs. 0.77 +/- 0.36 IU/kg, p=0.005). Cases with a family history of T1DM were more likely to have anti-endomysial antibodies (42.9% vs. 8.1%, p=0.027) and higher initial blood glucose levels (510.5 +/- 145.0 vs. 436.1 +/- 156.5 mg/dL, p=0.005). Conclusion: The findings possibly indicate a decreasing age of T1DM onset. The high frequency of ketoacidosis at presentation is noteworthy. Girls had higher rates of ketoacidosis, higher frequency of anti-thyroid antibodies and higher insulin requirements as compared to boys. Patients with a family history of T1DM had higher initial glucose levels and higher frequency of antiendomysial antibodies.Öğe Epidemiologic Features of Type 1 Diabetic Patients between 0 and 18 Years of Age in İstanbul City(2015) Darendeliler, Fatma Feyza; Günöz, Hülya; Baş, Firdevs; Bundak, Rüveyde; Neyzi, Olcay; Demir, Fikri; Saka, NurçinObjective: To evaluate the epidemiologic, clinical and laboratory characteristics of a group of children with type 1 diabetes mellitus (T1DM) living in a Turkish city. Methods: The records of 395 (boys/girls: 199/196) children with newly diagnosed T1DM hospitalized in the years 1985-2004 were evaluated retrospectively. The data were assessed by gender and age subgroups (<=5, 6-10 and >=11 years).Results: Mean age of children at diagnosis was 8.1±4.1 years. At T1DM onset, the number of children <=5, between 6-10 and >=11 years old was 110 (27.9%), 147 (37.2%) and 138 (34.9%), respectively. The patients were mostly diagnosed at ages 6-8 years (24.1%), followed by cases aged 3-5 years (22.0%). Polyuria and polydipsia were the most common symptoms (94.7%). Mean duration of symptoms was 21.5±18.6 days. Although the patients mostly presented in autumn (30.7%), no season-related significant differences were found. The frequency of ketoacidosis was relatively high (48.5%). When compared to boys, the girls experienced higher rates of ketoacidosis (55.1% vs. 41.7%, p=0.042); had a higher frequency of antithyroid peroxidase antibodies (11.7% vs. 4.2%, p=0.049) and higher insulin requirement (0.89±0.41 vs. 0.77±0.36 IU/kg, p=0.005). Cases with a family history of T1DM were more likely to have anti-endomysial antibodies (42.9% vs. 8.1%, p=0.027) and higher initial blood glucose levels (510.5±145.0 vs. 436.1±156.5 mg/dL, p=0.005).Conclusion: The findings possibly indicate a decreasing age of T1DM onset. The high frequency of ketoacidosis at presentation is noteworthy. Girls had higher rates of ketoacidosis, higher frequency of anti-thyroid antibodies and higher insulin requirements as compared to boys. Patients with a family history of T1DM had higher initial glucose levels and higher frequency of antiendomysial antibodiesÖğe The evaluation of the factors that affects the smoking behaviours in a group of high school students in Turkey(European Respiratory Soc Journals Ltd, 2015) Demir, Melike; Karadeniz, Gulistan; Demir, Fikri; Karadeniz, Cem; Kaya, Halide; Yenibertiz, Derya; Aylan, Mahsuk T.[Abstract Not Available]Öğe Evaluation of vitamin D levels in patients with acute rheumatic fever(Turkish Soc Cardiology, 2017) Onan, Sertac Hanedan; Demirbilek, Huseyin; Aldudak, Bedri; Bilici, Meki; Demir, Fikri; Yilmazer, Murat Muhtar[Abstract Not Available]Öğe An extremely rare complication associated with primary varicella zoster virus infection: Cardiac tamponade(Turkish Soc Cardiology, 2014) Bilici, Meki; Yilmazer, Murat Muhtar; Demir, Fikri; Caliskan, Ahmet; Bozkurt, Fatma; Guzel, Abdulmenap; Onan, Sertac Hanedan[Abstract Not Available]Öğe Factors affecting mortality in children with dilated cardiomyopathy(Turkish Journal of Pediatrics, 2019) Sabaz, Muhammed Nurullah; Akın, Alper; Bilici, Meki; Demir, Fikri; Türe, Mehmet; Balık, HasanDilated cardiomyopathy (DCMP) is a heart disease with high mortality rates that is often seen in children. Genetic and infectious reasons are primary in the etiology. The aim of this study was to investigate the etiology of DCMP and the parameters predicting mortality. A retrospective examination was made of 37 patients diagnosed with DCMP between January 2012 and October 2016. Data were recorded from the patient files of age, gender, complaints on presentation, findings of the physical examination, laboratory test results, echocardiography and electrocardiography findings at the time of diagnosis. These parameters were then compared between the surviving and non-surviving patients. The patients comprised 21 males with a mean age of 27.50±50 months. Diagnosis was made at the age of <12 months in 67.6% patients. Within mean 8 months of diagnosis, 16.2% of the patients were lost to mortality and 83.8% of the patients survived. In 83.3% of the non-surviving patients and in 29% of the surviving patients, sinus tachycardia was present at the time of diagnosis (p=0.023). Corrected QT (QTc) at the time of diagnosis was longer in the non-surviving patients (p=0.007). On ECG, the rate of ST-T wave change was higher in the non-surviving patients (80% vs. 17.8%, p=0.012). In conclusion, a significant proportion of the patients were diagnosed below the age of one year. In the non-surviving patients, as sinus tachycardia and ischaemic changes on ECG were seen more often and the QTc was longer, these findings could be considered to be predictors of mortality.Öğe Geçirilmiş miyokarditte antikonjestif tedavi ne zaman kesilmelidir?(2016) Karabel, Duran; Uluca, Ünal; Demir, Fikri; Bilici, Meki; Akın, Alper; Yılmazer, Murat MuhtarMiyokardit miyokard dokusunun enflamasyonu ve miyokard fibrillerinin hasarı ile seyreden bir hastalıktır. Asemptomatik seyirden, kalp yetersizliği ve ani ölüme kadar değişken bulgular gösterir. Tedavinin köşe taşı, antikonjestif ilaçlar ve gerektiğinde mekanik ventilasyonu da kapsayan destekleyici tedavidir. Miyokardit düzeldikten sonra ilaç tedavisinin kesilmesi için en uygun zaman belirsizdir. Burada, izleminin beşinci ayında kalp yetersizliği bulguları düzelen ancak ilaçları kesildikten sonra kalp yetersizliği bulguları tekrarlayan hastayı sunarak antikonjestif tedavinin kesilmesi konusunda temkinli olunması gerektiğini vurgulamak istedik.Öğe The impact of anti-smoking laws on high school students in Ankara, Turkey(Soc Brasileira Pneumologia Tisiologia, 2015) Demir, Melike; Karadeniz, Gulistan; Demir, Fikri; Karadeniz, Cem; Kaya, Halide; Yenibertiz, Derya; Taylan, Mahsuk[Abstract Not Available]Öğe İnfluenza virüsü (H1N1)'ne sekonder gelişen miyokardit olgusu(2015) Çubuk, Ercan; Güneş, Ali; Aktar, Fesih; Yel, Servet; Mete, Şeymus; Demir, Fikrinfluenza, sağlıklı çocuklarda genellikle kendi kendini sı- nırlayan, akut ve komplikasyonsuz bir hastalık olsa danadiren ciddi hastalık tablosu oluşturup ölüme neden ola- bilir. Enfeksiyonun en sık komplikasyonu pnömoni olup,miyokardit influenza A ve B virüsüne bağlı olarak gelişebi- len nadir bir komplikasyondur. 32 aylık erkek hasta ateş,öksürük, kusma, halsizlik, burun akıntısı, sonrasında hızlıgelişen solunum sıkıntısı ve taşikardi şikâyetleri ile kabuledildi. Genel durumu orta, bilinci açık, hepatomegali, taşi- kardi, dispne, takipne, interkostal-subkostal çekilme ve bi- lateral ronküs mevcuttu. Kardiak enzim düzeyleri ve diğerlaboratuvar parametreler normaldi. Ekokardiyografide mi- yokardit ve ejeksiyon fraksiyonu %42 olarak bulundu. An- cak takiplerinin 24-48. saatinde belirgin solunum sıkıntısıgelişen hasta entübe edilip mekanik ventilatöre bağlandı.Hastanın nazofarinks sürüntü kültüründe takiplerinin al- tıncı gününde H1N1 üredi. Mevcut myokardit tablosununH1N1 virüsüne bağlı olabileceği düşünülerek Oseltamivirtedavisi başlandı. Tedavinin dördüncü gününde ateşi nor- male dönen hastanın dokuzuncu gününde kliniğinde dra- matik bir iyileşme görüldü. Ekokardiyografi takiplerindeise ejeksiyon fraksiyonu ve myokardit tablosunda başvuruanına göre belirgin düzelme gözlendi. Gribal enfeksiyonbulgularıyla başvurup solunum sıkıntısı ve taşikardi ge- lişen hastalarda, alt solunum yolu enfeksiyonu yanındamiyokarditin de ayırıcı tanıda düşünülmesi ve erken tanıve tedavi ile yüz güldürücü sonuçların alınabileceğini ha- tırlatmak amacıyla sunuldu.Öğe İnfluenza virüsü (H1N1)’ne sekonder gelişen miyokardit olgusu(Dicle Üniversitesi Tıp Fakültesi, 2015) Aktar, Fesih; Güneş, Ali; Yel, Servet; Çubuk, Ercan; Demir, Fikri; Mete, Şeyhmusİnfluenza, sağlıklı çocuklarda genellikle kendi kendini sınırlayan, akut ve komplikasyonsuz bir hastalık olsa da nadiren ciddi hastalık tablosu oluşturup ölüme neden olabilir. Enfeksiyonun en sık komplikasyonu pnömoni olup, miyokardit influenza A ve B virüsüne bağlı olarak gelişebilen nadir bir komplikasyondur. 32 aylık erkek hasta ateş, öksürük, kusma, halsizlik, burun akıntısı, sonrasında hızlı gelişen solunum sıkıntısı ve taşikardi şikâyetleri ile kabul edildi. Genel durumu orta, bilinci açık, hepatomegali, taşikardi, dispne, takipne, interkostal-subkostal çekilme ve bilateral ronküs mevcuttu. Kardiak enzim düzeyleri ve diğer laboratuvar parametreler normaldi. Ekokardiyografide miyokardit ve ejeksiyon fraksiyonu %42 olarak bulundu. Ancak takiplerinin 24-48. saatinde belirgin solunum sıkıntısı gelişen hasta entübe edilip mekanik ventilatöre bağlandı. Hastanın nazofarinks sürüntü kültüründe takiplerinin altıncı gününde H1N1 üredi. Mevcut myokardit tablosunun H1N1 virüsüne bağlı olabileceği düşünülerek Oseltamivir tedavisi başlandı. Tedavinin dördüncü gününde ateşi normale dönen hastanın dokuzuncu gününde kliniğinde dramatik bir iyileşme görüldü. Ekokardiyografi takiplerinde ise ejeksiyon fraksiyonu ve myokardit tablosunda başvuru anına göre belirgin düzelme gözlendi. Gribal enfeksiyon bulgularıyla başvurup solunum sıkıntısı ve taşikardi gelişen hastalarda, alt solunum yolu enfeksiyonu yanında miyokarditin de ayırıcı tanıda düşünülmesi ve erken tanı ve tedavi ile yüz güldürücü sonuçların alınabileceğini hatırlatmak amacıyla sunuldu.Öğe Myocardial infarction in an 11-year-old child with systemic lupus erythematosus(Turkish Soc Cardiology, 2016) Bilici, Meki; Demir, Fikri; Ture, Mehmet; Akin, Alper; Cil, Habip; Ece, Aydin; Polat, Nihat[Abstract Not Available]Öğe Pediatrik disritmiler(Dicle Üniversitesi, 2015) Bilici, Meki; Demir, FikriPediatrik disritmiler, pediatri poliklinik ve acillerine seyrek ancak önemli başvuru nedenleridir. Doğumsal kalp hastalıklarının başarılı cerrahi tedavisi ve tanı araçlarının gelişmesiyle beraber daha sık olarak disritmi tanısı konulmaya başlamıştır. Pediatrik disritmiler; asemptomatik olabileceği gibi, halsizlik, sersemlik hissi, efor kapasitesinde azalma, çabuk yorulma, kalp atımlarında düzensizlik, çarpıntı, bayılma şikayetleri ile kendilerini göstermekte ve bazen kardiyak arrest ilk başvuru bulgusu olabilmektedir. Sebep olabilecekleri önemli hemodinamik etkiler nedeniyle pediatristler ve aile hekimleri tarafından iyi tanınmaları, hastalar için hayatiyet arz etmektedir. Bu derlemede sık karşılaşılan pediatrik disritmilerin pediatristler ve aile hekimlerince doğru tanı ve tedavisine katkıda bulunulması amaçlanmıştır.Öğe Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization(Turkish National Pediatric Society, 2018) Akın, Alper; Bilici, Meki; Demir, Fikri; Yılmazer, Murat Muhtar; İpek, Mehmet Şah; Kara, HülyaAkın A, Bilici M, Demir F, Yılmazer MM, İpek MŞ, Kara H. Percutaneous retrieval of umbilical vein catheter fragment in an infant two months after embolization. Turk J Pediatr 2018; 60: 191-193. Umbilical vein catheterization is frequently preferred and a safe route of venous access especially in newborns. However, some cases with breaking and embolization of those catheters have been rarely reported. Herein we present a two-and-a-half-month-old infant being catheterized within first postnatal week and diagnosed to have embolization of the catheter fragment to conjunction of hepatic vein and right atrium. Percutaneous withdrawal of broken catheter was achieved despite several months after the embolization took place. We suggest that transcatheter removal of catheter fragment embolizations may be safe even in late diagnosis cases.Öğe Potential Role of Vitamin D in Pathogenesis of Acute Rheumatic Fever(Karger, 2016) Onan, Sertac Hanedan; Demirbilek, Huseyin; Aldudak, Bedri; Bilici, Meki; Demir, Fikri; Yilmazer, Murat Muhtar[Abstract Not Available]
