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    Assesment of Quality of Life in Children with Asthma
    (Derman Medical Publ, 2012) Gumus, Serhat; Kelekci, Selvi; Yolbasi, Ilyas; Gurkan, Fuat
    Aim: Bronchial asthma is among the most common chronic pediatric diseases that can result in variable restriction in the physical, emotional and social aspects of the patient's life. The aim of this study was to assess impairment on quality of life (QOL) in asthmatic children. Material and Method: Ninety seven patients aged between 7 and 15 years which followed up at Pediatric Pulmonology Department of Dicle University Hospital were included into the study, during October 2009 - January 2010. To assess the quality of life Pediatric Asthma Quality of Life questionnaire's (PAQLQ) self-applied Turkish version was used. In addition, the severity of asthma was measured using by Childhood Asthma Control Test (C-ACT). Results: The male to female ratio of asthmatic children was 2/1 and the mean age was 10.0. boxed times 2.5 years. Severity of asthma, history of steroid use and low family income were found as having negative effect on the PAQLQ scores (p < 0.001). Mother's education level also had statistically significant effect on the PAQLQ scores (P = 0.02). Father's education level; patient's age, gender, passive smoking exposure, family history of asthma or eczema and duration of disease did not have statistically significant effect on PAQLQ scores (p> 0.05). Asthma control test score had a significant correlation with PAQLQ score (p < 0.001). Discussion: Steroid use, severity of Asthma and lower socio-economical status of family had negative effects on quality of life in children with asthma.
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    A COMPARATIVE REVIEW OF PEDIATRIC AND ADULT PATIENTS WITH MILIARY TUBERCULOSIS
    (Modestum Ltd, 2007) Tanrikulu, Cetin; Gurkan, Fuat; Dagli, Canan Eren; Gozu, Ayfer; Suner, Ali
    Aim: Miliary tuberculosis (MTB) is a serious and rare form of tuberculosis. Studies comparatively reviewed children and adults with MTB are lacking. Methods: We retrospectively evaluated 56 pediatric and 26 adult MTB patients at a university hospital, between 1990 and 2003 Results: The median age at presentation was 3.5 years for children and 38 years for adults. Thirtyeight of all patients of whom 86.8% were children had family history of tuberculosis Presenting symptoms and signs of adult and pediatric patients were loss of weight (51.8% vs. 61.5%), anorexia (76.9% vs. 57.8%), dyspnea (12.5% vs. 57.8%), diarrhea/ vomiting (35.0% vs. 27.0%), fever (53.8% vs. 17.9%), hepatomegaly (30.8% vs. 51.8%), pulmonary crepitations (42.3% vs. 42.9) and cough (46.2% vs. 35.7%), respectively. The presenting symptoms/signs and laboratory abnormalities were generally more frequent in adults. Detected laboratory abnormalities were leukocytosis (73.2%), increased sedimentation rate ( 73.2%), anemia (52.4%), hypoalbuminemia (47.6%), elevated liver transaminases (36.6%), elevated lactate dehydrogenase (50.0%) and hyponatremia (25.6%) in whole study group. The diagnosis was proven microbiologically in 15 (18.3%) patients. Among 56 pediatric cases, there were 8 (14.3%) children with positive BCG scar and only 16 (28.6%) children with positive reaction to 5TU tuberculin test. Radiological findings of all patients, either on chest X-ray or high resolution computerized tomography, were characteristic for MTB. One fourth of patients had accompanying tuberculous meningitis. Predisposing factors for TB were found in 13 patients (15.9%). No patients had HIV infection. Overall 6 (7.3%) patients had died. Conclusion: High rate of history of family contact and low rate of BCG vaccination in our patients with MTB were significant public health problems. Identifying different features in children and adults may contribute to early diagnosis of MTB, which is highly relevant to its outcome.
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    Interferon-? gene+874T -: A polymorphism is associated with tuberculosis and gamma interferon response
    (Churchill Livingstone, 2007) Sallakci, Nilgun; Coskun, Mesut; Berber, Zafer; Gurkan, Fuat; Kocamaz, Halil; Uysal, Gulnar; Bhuju, Sabin
    Interferon-gamma is the most important cytokine in resistance to mycobacterial diseases and common variants of interferon-gamma gene could be related to tuberculosis susceptibility. We tested the hypothesis that the interferon-gamma+874T-A polymorphism is associated with tuberculosis disease, and affects the interferon-gamma reponse. We determined by pyrosequencing the distribution of the interferon-gamma+874T-4 polymorphism in a Turkish population of 319 patients with pulmonary tuberculosis, 42 children with severe forms of tuberculosis and 115 healthy donors. We also analysed whether any correlation exists between this polymorphism and interferon-y response to Mycobacterium tuberculosis antigens by ELISPOT in 58 pulmonary tuberculosis cases, and the results were analysed according to the genotypes. We found that the minor allele (T) frequency was significantly lower in patients with pulmonary tuberculosis when compared to controls (P = 0.024, OR = 0.7), a similarly significant decrease in the frequency of TT genotype was observed in patients with pulmonary tuberculosis, compared to the control group (P = 0.02, OR = 0.49). IFN-gamma responses to PPD antigen in TT genotype was found to be significantly higher than the AA group (P>0.001). Non-parametric correlation analysis of ELISPOT data showed significant reverse correlation in PPD, CFP10 and ESAT6 values and IFN-gamma +874 genotypes. These results show that the IFN-gamma +874T-A polymorphism is related to the IFN-gamma response and the magnitude of the response decreases during transition from TT- to TA and to AA genotypes. Our data suggest that similar to various Caucasian populations, in a Turkish population the IFN-gamma+874 T-A polymorphism is also associated with tuberculosis disease and affects the magnitude of the IFN-gamma response. (C) 2006 Elsevier Ltd. All rights reserved.
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    Intracranial hemorrhage: Clinical and demographic features of patients with late hemorrhagic disease
    (Wiley, 2011) Pirinccioglu, Ayfer Gozu; Gurkan, Fuat; Boşnak, Mehmet; Acemoglu, Hamit; Davutoglu, Mehmet
    Background: This retrospective study presents clinical, demographical features and radiological findings as well as outcomes of 31 infants with intracranial hemorrhage (ICH) due to vitamin K deficiency and hence evaluates the risk factors involved. Methods: Thirty-one cases (17 males and 14 females) having a mean age of 52.52 +/- 20.80 days with intracranial hemorrhage due to late hemorrhagic disease of the newborn (LHDN), hospitalized in our clinics were included in the study. Cranial computerized tomography (CT) was performed in all patients for the diagnosis and evaluation of ICH. Results: It was found that the most frequent presenting symptoms were pallor (77.4%), seizures (58%), altered consciousness (58%), vomiting (44%) and poor feeding (35%). Pulsatile fontanel was found in 61% and bulging in 26%. Seven (22.5%) patients had prior history of antibiotic usage. All patients (93.5%) except two were breast fed. Sixteen (51.6%) were delivered at home. Eighteen (58%) had a history of single-dose vitamin K prophylaxis on the first day of delivery. Parenchymal (44%), subdural (39%) or subarachnoidal (22.5%) bleeding was observed. Seven (22.6%) were exitus. During the follow-up period (ranging from 3 months to 18 months) neurological examination findings were recorded. Conclusion: Our results indicate that it may be questionable whether single-dose vitamin K prophlaxis at birth is adequate for the prevention of LHDN and if a different timing of this prophylaxis should be made for the exclusively breast fed infants.
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    Multicentric analysis of childhood tuberculosis in Turkey
    (Turkish J Pediatrics, 2013) Pekcan, Sevgi; Aslan, Ayse Tana; Kiper, Nural; Uysal, Gulnar; Gurkan, Fuat; Patiroglu, Turkan; Ozturk, Mustafa
    Only a few series of pediatric tuberculosis (TB) have been reported in the last 20 years. The purpose of this study was to evaluate the clinical, radiological, microbiological, and treatment characteristics of childhood TB. A total of 539 children with childhood TB diagnosed over a 12-year period (1994-2005) in 16 different centers in Turkey participated in the study. The medical records of all childhood TB patients were investigated. A total of 539 children (274 males, 265 females) with childhood TB aged 10 days-17 years participated in the study. Age distribution was nearly equal among all age groups. We detected the index case in 39.8% of the patients. More than one index case was detected in 17.3% of the patients. A minimum 15-mm induration is accepted on tuberculin skin test (TST) following Bacillus Calmette-Guerin (BCG) vaccination. The TST was positive in 55.3% of the patients. Acid-fast bacillus smear was positive in 133, and polymerase chain reaction for Mycobacterium tuberculosis was positive in 45 patients. In 75 patients (13.9%), cultures yielded M. tuberculosis. One hundred fifty-one patients (28%) did not present for follow-up, and families of 5 patients (0.9%) discontinued the treatment. Pulmonary TB (n=285) and meningeal TB (n=85) were the most frequent diseases. In 29% of the patients, there was poor adherence to treatment or patients were lost to follow-up. We have demonstrated that household contact screening procedures play a major and important role, especially considering the high ratio of cases with contact index cases. We also recommend that the positive TST values should be reviewed according to the local cut-off data and should be specified in as many countries as possible. In view of the considerably high percentages of patients lost to follow-up and treatment discontinuation observed in our study, we suggest that application of directly observed treatment, short-course (DOTS) is preferable.
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    Paraoxonase, total antioxidant activity and peroxide levels in marasmic children
    (Pergamon-Elsevier Science Ltd, 2007) Ece, Aydın; Gurkan, Fuat; Celik, Fatma; Boşnak, Mehmet; Yel, Servet; Balik, Hasan; Erel, Ozcan
    Objectives: The aim of this study was to investigate the oxidant/antioxidant status, paraoxonase (PON) activity and leptin. levels in children with marasmic malnutrition. Design and methods: Thirty marasmic children (age 14.4 +/- 10.3. months) and 28 control subjects were included; Plasma PON activity, total antioxidant activity (TAO), total peroxide (TPX) and leptin,levels were measured. Results: Malnourished children had significantly. lower leptin.(3.6 +/- 1.1. vs. 11.8 +/- 4.5 ng/mL, P < 0.001), PON. activity (66.4 +/- 28.6 vs. 2213 +/- 31.6 IU/L, P < 0.001) and. TAO (1.44 +/- 0.12 vs. 2.45 +/- 0.61 mmol Trolox equiv/L, P < 0.001); and higher TPX (15.6 +/- 6.4 vs. 5.9 +/- 1.9 mu mol/L, P < 0.001) values than,in controls. Significant negative correlation was found between PON and TPX (P=0.040) and positive correlation between TAO and BMI (P= 0.034) in patients. No significant correlation was found between leptin and oxidam/antioxidant parameters (P > 0.05). Conclusions: Children with marasmic. malnutrition had increased. pro-oxidant and decreased antioxidant status. Extent of oxidative stress increases with malnutrition severity.. Antioxidants could be given during nutritional rehabilitation., (c) 2007 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
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    Relationships between leptin, insulin, IGF-1 and IGFBP-3 in children with energy malnutrition
    (Pergamon-Elsevier Science Ltd, 2007) Haspolat, Kenan; Ece, Aydin; Gurkan, Fuat; Atamer, Yildiz; Tutanc, Murat; Yolbas, Ilyas
    Objectives: Leptin has a key role in energy homeostasis and there may be a link between leptin and insulin-like growth factor-1 (IGF-I) system. The aim of this study was to analyze the relationships between long-lasting insufficient caloric intake (marasmus), leptin and IGF-1 system. Design and methods: The study group consisted of 30 marasmic children and control group included 28 healthy children. After an overnight fasting; leptin, insulin, IGF-1 and IGFBP-3 levels were measured. Results: Marasmic children had significantly lower body weight, height, mid-arm circumference (MAC), skinfold thickness, mean serum leptin, insulin, IGF-1 and IGFBP-3 levels compared with healthy subjects (P < 0.05). Serum IGF-1 and IGFBP-3 levels were significantly correlated with insulin, MAC and height Z score in patients (P < 0.05). In controls, significant positive correlations were found between BMI, 1GF-1 and leptin (P < 0.05). Conclusions: Energy malnutrition is characterized by the important decreases in the leptin, insulin, IGF-I and IGFBP-3 levels. Understanding details of these changes may lead to new therapeutic approaches in disease states associated with malnutrition. (c) 2006 The Canadian Society of Clinical Chemists. All rights reserved.
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    Risk factors for drug resistant tuberculosis in southeast Turkey
    (Royal Soc Medicine Press Ltd, 2008) Tanrikulu, A. Cetin; Hosoglu, Salih; Ozekinci, Tuncer; Abakay, Abdurrahman; Gurkan, Fuat
    We undertook a cross-sectional survey of 116 patients at Dicle Hospital,Turkey, who had with bacteriologically confirmed tuberculosis (TB). Demographic and clinical features, including age, gender, pulmonaryTB history, associated diabetes mellitus, previousTB treatment, residential area and education, were collected from charts. Eighty-four of the strains were found to be susceptible to all drugs. The resistance to one or more drug(s) was found in 32 strains. Multi-drug resistant (MDR) TB was found in 13 strains (11.3% of the total and 40.7% of the drug resistant strains). The resistance to isoniazid was the most frequently seen (25 strains, 21.5%). In the multivariable analysis, only previousTB treatment (P = 0.000) remained a significant predictor for drug resistance; in MDR, previousTB treatments (P = 0.002) remained significant in the final model. The patient's educational status was found to be negatively correlated with the risk of MRD-TB (P = 0.035). PreviousTB treatment and low educational status were found to important risk factors for the development of MDR-TB.
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    Scorpion Sting Envenomation in Children in Southeast Turkey
    (Elsevier Science Inc, 2009) Boşnak, Mehmet; Ece, Aydın; Yolbas, Ilyas; Boşnak, Vuslat; Kaplan, Metin; Gurkan, Fuat
    Background.-Scorpion sting envenomation is a life-threatening emergency and a common public health problem in many regions of the world, particularly in children. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications. Objectives The aims of this study were to evaluate demographic, clinical, laboratory, treatment, and outcome characteristics for pediatric patients with scorpion sting envenomation in southeast Turkey and to describe features that may be predictive of the need for pediatric intensive care unit (PICU) care. Methods.-A total of 52 charts of children (mean age: 7.7 +/- 2.8 years; age range: 1.5-15 years) presenting with scorpion sting envenomation to a single hospital in southeastern Turkey were investigated. General characteristics of the children, species of the scorpions, anatomic site of the sting, clinical and laboratory findings, treatment approaches, complications, and outcomes were recorded. Results.-Twenty-four stings (46.2%) were inflicted by Androctonus crassicauda, 1 (1.9%) by Leiurus quinquestriatus, and the sources of the other stings were not known. Thirty-one patients (59.6%) were admitted from rural areas. Admission from a rural area was a significant risk factor for severe envenomation. Foot-leg was the most frequently stung part of the body (48%). The greatest number of stings occurred in the summer (78.8%). Cold extremities and tachycardia were the most frequently seen clinical findings (38.4% for both). Twenty patients (38.5%) had signs of serious envenomation and required admission to the PICU. Hemoglobin, white blood cell count, activated prothrombin time, aspartate aminotransferase, alanine aminotransferase, and creatine phosphokinase levels were higher in severely envenomed children compared to levels in those with mild-moderate stings. Antivenom was given at a primary or secondary health center before arrival to our hospital in 44 (84.6%) patients, without any apparent difference in the number of patients presenting with mild-moderate and severe envenomed stings. All patients recovered after treatment except for I child who died with severe pulmonary edema. Conclusions.-We found no clinically useful demographic or epidemiological data to guide decision making regarding the need for PICU admission for pediatric victims of scorpion sting in our area. Decisions on transfer and admission to a PICU should be based on the development of systemic findings of envenomation.