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Öğe Amitraz poisoning in children(Nature Publishing Group, 2000) Yaramis, A; Soker, M; Bilici, MAmitraz is an acaricide and insecticide indicated for the treatment of generalized demodicosis in dogs and for the control of ticks and mites in cattle and sheep. There is little information available in the human literature about the toxicology of the product. In this study, the clinical and laboratory features of amitraz poisoning in 11 children are presented. The age range of the patients was 2 -1/2 to 6 years. Accidental ingestion of an improperly stored liquid pesticide was determined in all patients. Unconsciousness (100%), drowsiness (100%), and myosis (84%) were the most common abnormal signs; 45%, 27%, and 18% of patients had bradycardia, respiratory insufficiency, and hypotension, respectively. All of the patients were treated with atropine, gastric lavage, activated charcoal, and supportive care. Although the patients had a prompt response to therapy, three patients required multiple doses of atropine during a 24-h period. This study revealed that clinical poisoning by oral route emerged within 30-90 min and that central nervous system (CNS) depression, which is the most important sign, resolved within 8-1/2-14 h. All cases were discharged.Öğe Caution about trial methodology and statistics - Reply(Amer Acad Pediatrics, 2001) Yaramis, A; Bilgin, K[Abstract Not Available]Öğe Diagnostic performance of amplified Mycobacterium tuberculosis direct test in the cerebrospinal fluid of children with tuberculosis meningitis(Amer Acad Pediatrics, 2000) Yaramis, A; Tekes, S; Bilici, M[Abstract Not Available]Öğe Diagnostic value of cytokine measurement in cerebrospinal fluid in children with central nervous system tuberculosis(Amer Acad Pediatrics, 2001) Yaramis, A; Çolpan, L; Tas, MA[Abstract Not Available]Öğe Distinguishing features of Salmonella and viral hepatitis(Lippincott Williams & Wilkins, 2000) Gürkan, F; Derman, O; Yaramis, A; Ece, A[Abstract Not Available]Öğe Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission(Elsevier Sci Ltd, 2002) Topcu, I; Cüreoglu, S; Yaramis, A; Tekin, M; Oktay, F; Osma, U; Meric, FObjective: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. Methods: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). Results: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four cars. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. Conclusion: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Neonatal tetanus in the southeast of Turkey: risk factors, and clinical and prognostic aspects - Review of 73 cases, 1990-1999(Turkish J Pediatrics, 2000) Yaramis, A; Tas, MAAlthough neonatal tetanus (NT) can be prevented by immunization of expectant mothers and by good hygiene and asepsis during delivery, it is still a common cause of neonatal mortality in developing countries. The objective of this study was to determine indicators in NT. We reviewed the clinical records of 73 neonates admitted to the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, Turkey, with the diagnosis of NT. Delivery had occurred at home by untrained traditional birth attendants in all cases. None of the mothers had immunization with tetanus toroid during pregnancy. The median age of infants at presentation was 7.3 days and the mean age at onset of symptoms was 5.6 +/- 2.8 days. The overall mortality was found to be 52 percent. Mortality was significantly associated with an incubation period of 4.3 days or less and fever. The incidence of NT in Turkey is on the decline due to widespread tetanus toroid use in pregnant women, but in some regions, especially in the so-called rural poor areas, there is still risk of preventable diseases. Hygienic deliveries and immunization of pregnant women are very important for the prevention of NT deaths, and universal prenatal care, including education programs on appropriate perinatal and cord care, can significantly reduce NT incidence and mortality in developing countries.Öğe A portable device based on the interrupter technique for measuring airway resistance in preschool children(Hogrefe & Huber Publishers, 2004) Derman, O; Yaramis, A; Kirbas, GThe interrupter technique for measuring airway resistance is a noninvasive method reported to require minimal subject cooperation. Therefore it has a good potential for use in young children who are not able to cooperate with conventional lung function tests. The interrupter method is based on transient interruption of airflow at the mouth for a brief period during which alveolar pressure equilibrates with mouth pressure. In order to investigate the compliance rate with the interrupter technique in preschool children and to look for associated baseline measures of RINT we performed a study in 214 children of ages from 3 months to 5 years. There was a significant inverse correlation between baserint and age (r = -0.672, p < 0.001), and standing height (r = -0.692, p < 0.001) in children with recurrent wheezing. However, this was not seen in healthy children. We concluded that the portable interrupter device is very useful in preschool children. The measurements showed that the a-e and standing height are inversely proportional to the baseline RINT values measured. We reported that these differences would be more apparent in children with a history of recurrent wheezing.Öğe Pulmonary alveolar microlithiasis(Karger, 2001) Senyigit, A; Yaramis, A; Gürkan, F; Kirbas, G; Büyükbayram, H; Nazaroglu, H; Alp, MNPulmonary alveolar microlithiasis (PAM) is a lung disease characterized by deposits of calcium within the alveoli. Our aim was to emphasize the familial character and the clinical features of the disease, and to draw attention to the increasing number of Turkish patients reported in the world. We detected 6 cases of PAM. Three cases had been diagnosed 4 years earlier, and 3 new cases were detected during the screening of the family members. All patients were male and the mean age was 11.5 ranging between 5 and 29 years. Five of the patients were cousins and the other one was their uncle. Radiographic studies showed a sand-like appearance in all patients. One case showed small subpleural bullae and bronchiectatic changes in both lower robes in recent high-resolution CT scans, while his CT performed 4 years ago showed only sand-like appearance. The cases were diagnosed with the demonstration of microliths by bronchoalveolar lavage in 5 patients and transbronchial biopsy in 1. Recently reported cases from Turkey have constituted a considerable percentage among all cases in the world. In conclusion, (1) our patients constitute one of the largest series of cases reported in one family in the world. The disease seems to have familial and racial characteristics. The Turkish race has to be further investigated for genetic transmission. (2) Contrary to female predominance in previous reports, all 6 cases were male and 5 of them were below 12 years of age. (3) The disorder may show rapid progression in some cases probably due to the severity of the genetic disturbance. Copyright (C) 2001 S. Karger AG, Basel.Öğe A randomized trial of granulocyte-macrophage colony-stimulating factor in neonates with sepsis and neutropenia(Amer Acad Pediatrics, 2001) Bilgin, K; Yaramis, A; Haspolat, K; Tas, A; Günbey, S; Derman, OObjectives. To determine whether adjunctive therapy with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival and to assess its safety compared with conventional therapy in a control group. Study Design. This prospective, randomized, controlled trial was performed in 60 infants with neutropenia and clinical signs of sepsis. A subcutaneous injection of rhGM-CSF (5 mug/kg/day) was administered to 30 of the patients for 7 consecutive days. Hematologic parameters (absolute neutrophil, eosinophil, monocyte, lymphocyte counts, and platelet number) and outcome were compared with 30 conventionally treated (control) patients. Results. Twenty-five patients from the GM-CSF-treated group and 24 from the conventionally treated group had early-onset sepsis (less than or equal to3 days' postnatal age), and the other 11 patients had late-onset sepsis (>3 days' postnatal age). There was no difference between groups in terms of birth weight; gestational age; gender; maturity; maternal age; and incidence of prolonged rupture of membranes, maternal hypertension, or severity of sepsis. All neonates tolerated GM-CSF well with no adverse reactions. The absolute neutrophil count on day 7 was significantly increased in the GM-CSF-treated group compared with the conventionally treated group: 8088 +/- 2822/mm(3) versus 2757 +/- 823/mm(3). The mean platelet count was significantly higher on days 14 in the GM-CSF-treated group compared with conventionally treated group: 266 867 +/- 55 102/mm(3) versus 229 200 +/- 52 317/mm(3). Hematologic parameters were otherwise similar between groups before treatment and on day 28. Twenty-seven neonates in the rh-GMCSF group and 21 in the control group survived to hospital discharge. The mortality rate in the rhGM-CSF group (10%) was significantly lower than in the conventionally treated group (30%). Conclusion. Treatment with rhGM-CSF is associated with an increase in absolute neutrophil, eosinophil, monocyte, lymphocyte, and platelet counts and decreased mortality in critically ill septic neutropenic neonates. These results suggest that rhGM-CSF may be effective in the treatment of neonatal sepsis with neutropenia, and further randomized trials are needed to confirm its beneficial effects.Öğe Severe microangiopathic hemolytic anemia and thrombocytopenia in a child with Brucella infection(Springer-Verlag, 2001) Yaramis, A; Kervancioglu, M; Yildirim, I; Soker, M; Derman, O; Tas, MAWe present a case of severe microangiopathic hemolytic anemia and thrombocytopenia with epistaxis, gross hematuria, hemoglobinuria. and skin purpura in a child with Brucella septicemia proven by culture. The patient showed the features of this illness: leukopenia, severe hemolytic anemia, thrombocytopenia, fragmentation of erythrocytes in the peripheral blood smear, increased erythropoiesis, megakaryopoiesis, and granulomata cell invasion in the bone marrow. The patient was treated with rifampin and doxycycline. Platelets and leukocyte numbers rose to normal values by the 6th day. She was discharged on the 14th day. Follow-up of the patient 1 year later showed normal bone marrow morphology. Differential diagnosis, pathogenesis, and therapy of Brucella infection are discussed.Öğe Symptomatic and asymptomatic hypohidrosis in children under topiramate treatment(Turkish J Pediatrics, 2005) Yilmaz, K; Tatli, B; Yaramis, A; Aydinli, N; Çaliskan, M; Özmen, MTopiramate (TPM) has peculiar side effects such as speech difficulties, weight loss, oligohidrosis and hyperthermia. We present the frequency and severity of hypohidrosis in our patients under TPM treatment. One hundred and two patients treated with TPM were evaluated retrospectively. Five (8 months-15 years of age) of them experienced symptomatic hypohidrosis manifested with prolonged or intermittent fever. Pilocarpine iontophoresis sweat test had been performed on the five patients before they were managed, and no sweat had been collected in 4/5 cases. Of the 102 patients, 42 who started TPM treatment when the study was established were evaluated prospectively regarding oligohidrosis. First, they were questioned about whether hypohidrosis occurred after TPM. Of 42, 11 patients complained of hypohidrosis. A sweat test was then performed on these I I patients. Sweat could not be obtained in 5/11, and increased chloride concentration was found in 4/11. However, sweat could be obtained in the patients who had no complaint of hypohidrosis. Pediatricians should be aware of this side effect of TPM to prevent nonrelevant and cumbersome investigations in patients with prolonged or intermittent fever onset during TPM treatment. Our findings suggest that 5% of patients would experience hyperthermia during TPM treatment. Hypohidrosis without hyperthermia would be more frequent. If it is possible to collect sweat in patients who get fever during TPM treatment, it would be highly probable that the fever is not due to hypohidrosis. Increased chloride concentration alone does not seem to be significant for the hyperthermia risk.
