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    Antibiotic Susceptibility of Microorganisms Grown in Tracheal Aspirate Cultures of Pediatric Intensive Care Patients
    (Cureus Inc, 2022) Orhan, Ozhan; Yilmaz, Kamil; Pirinccioglu, Ayfer Gozu; Solmaz, Murat; Karakoc, Ferhat
    Background Microorganisms proliferating in the hospital setting cause infections with high morbidity and mortality rates. In intensive care units (ICUs), the rates of antibiotic resistance and microorganisms grown in cultures may vary by time period. Antibiotic sensitivity must be known for a correct empirical treatment approach. This study aimed to investigate the distribution and antibiotic resistance profiles of pathogenic microorganisms isolated from tracheal aspirate samples in the ICU. Methodology This study enrolled 100 tracheostomized patients aged one month to 18 years, regardless of gender, who were followed in the ICU of Dicle University for more than 72 hours. Medical data were retrospectively evaluated from the medical records. Care was taken to collect samples before changing antibiotics. Antibiotherapy was continued until after culture antibiogram results were obtained, or empirical antibiotic therapy was started by giving consideration to the potential source in patients with a suspected infection. Results An analysis of the tracheal aspirate culture samples of the patients showed that Pseudomonas aeruginosa (54%), Acinetobacter baumannii (16%), and Staphylococcus aureus (8%) were the most common pathogens. An analysis of the culture antibiogram results of the tracheal aspirate samples obtained from the entire study population showed that P. aeruginosa was 100% resistant against vancomycin, clindamycin, and teicoplanin, but highly sensitive to colistin and amikacin. A. baumannii was highly resistant to almost all antibiotics but showed no resistance against colistin. Carbapenems being frequently preferred for cases where empirical therapy should be initiated for ICU infections can be one of the reasons for a high carbapenem resistance rate in our hospital. Conclusions We believe that starting empirical therapy with colistin when infections caused by Pseudomonas and Acinetobacter are suspected may be an appropriate initial therapy until culture antibiogram results become available. Microbiological data are crucial for a correct empirical treatment approach. In this way, intensive antibiotic usage and subsequent high antibiotic resistance can be adequately controlled.
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    Assessment of quality of life and psychosocial problems in children with Congenital Heart Disease
    (Cambridge Univ Press, 2024) Oztoprak, Meral Bulbul; Bilici, Meki; Dogac, Tugba; Akin, Alper; Ture, Mehmet; Balik, Hasan; Yilmaz, Kamil
    Objective: Congenital heart disease (CHD) is a condition that can significantly impact health-related quality of life due to the need for long-term follow-up and treatment. The purpose of this study was to analyse the quality of life of children diagnosed with CHD and to assess the relationship between the disease and their physical and mental well-being. Materials and Methods: The study involved 180 patients and 180 healthy controls. Both groups were divided into three age categories (5-7 years, 8-12 years, and 13-18 years), with 60 children in each age group. The researchers administered the Pediatric Quality of Life Inventory (PedsQL) to the participants, taking into account their age. Results: Comparisons between the patient and control groups showed that the patient group had significantly lower scores than the control group in terms of total quality of life scale score, physical health score, and psychosocial health score of the Pediatric Quality of Life Inventory (p < 0.001, p < 0.001, and p < 0.001). Quality of life was also compared between patients receiving and not receiving medication treatment. Patients receiving medication treatment had lower scores for total quality of life score, physical health score, and psychosocial health score of the Pediatric Quality of Life Inventory compared to the control group (p < 0.001, p = 0.005, and p < 0.001). Conclusion: Children with CHD experience a negative impact on their quality of life. Given the extended life expectancy resulting from new treatment options, it is important to monitor these children both physically and psychosocially and to implement activities aimed at improving their quality of life.
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    Diagnostic role of inflammatory markers in pediatric Brucella arthritis
    (Bmc, 2016) Aktar, Fesih; Tekin, Recep; Bektas, Mehmet Selcuk; Gunes, Ali; Kosker, Muhammet; Ertugrul, Sabahattin; Yilmaz, Kamil
    Background: As a multisystem infectious disease, there is an inflammation, which causes increase in acute phase reactants in brucellosis. The mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as markers of inflammation. The present study aimed to evaluate diagnostic values of these biomarkers in brucella arthritis (BA). Methods: The study included 64 children with BA and 66 healthy control subjects. Demographic features, joint involvement, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and hematological variables were retrospectively recorded. In addition, results of synovial fluid and serum tube agglutination test for brucella together with treatment regimens were recorded. Results: The mean age of the patients (53.1 % male) was 92.3 +/- 41.2 months. The most commonly affected joint was ankle (53.1 %). Synovial fluid puncture-brucella agglutination test was positive in 22 (34.3 %) patients. Puncture culture was positive in 9 patients. Most of the patients (57.8 %) were treated with a combination of rifampicin plus sulfamethoxazole/trimethoprim and gentamicin. Significantly higher mean PDW, RDW, MPV, NLR and PLR values were found in children with BA compared to control subjects (p < 0.05). A positive correlation was found between MPV and NLR values (R-2 = 0.192, p < 0.001). Conclusion: Our findings indicated that NLR and PLR are indirect markers of inflammation that may be observed abnormally increased in children with brucella arthritis. Further longitudinal studies are needed to investigate this topic to establish the more clear associations.
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    The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children
    (Georg Thieme Verlag Kg, 2022) Kan, Ahmet; Ture, Mehmet; Akin, Alper; Yilmaz, Kamil; Surucu, Mehmet; Unal, Edip; Sen, Velat
    Objective Multiple factors being overweight, asthmatic, or being of Asian or black ethnic origins have been reported vis-a-vis the multisystem inflammatory syndrome in children (MIS-C). There is an association between these conditions and vitamin D deficiency, which explains why MIS-C is more common in these patients. In the present study, we attempted to retrospective evaluate the 25-hydroxy vitamin D levels of patients with MIS-C, its association with acute phase reactants, its treatment, and clinical status. Methods Patients aged between 1.5 months to 18 years with MIS-C were included in the study. All of the laboratory parameters, treatment, and response to the treatment were evaluated retrospectively. Two groups were formed. Patients had 25-hydroxycholecalciferol D vitamin < 20 ng/mL in group 1 and >= 20 ng/mL in group 2. Results A total of 52 patients were included in the study. There was no statistical difference between groups in terms of acceptance of the intensive care unit treatment (p = 0.29) and response to the first-line treatment (p = 0.56). A lower median lymphocyte count (p = 0.01) and a higher median C-reactive protein (p = 0.04) and procalcitonin (p = 0.01) with N-terminal pro-B-type natriuretic peptide (p = 0.025) values were found in group 1. Conclusion Vitamin D deficiency was associated with an increased inflammatory response in children with MIS-C. More studies are required to determine the potential impact of vitamin D deficiency on the clinical outcome of MIS-C.
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    Evaluation of children and adolescent with cystic fibrosis by pancreatic elastography
    (Wiley, 2022) Yilmaz, Kamil; Hattapoglu, Salih; Sen, Velat; Karabel, Musemma; Kan, Ahmet; Yilmaz, Engin Deniz; Sen, Hadice Selimoglu
    Background Cystic fibrosis (CF) is an autosomal recessively inherited disease. Clinical findings vary by age of the patient, the organ systems involved, and the severity of the CFTR gene mutation. Pancreatic and liver involvement is prominent and exocrine pancreatic insufficiency is observed in the majority of patients. Point shear wave elastography (pSWE) is a non-invasive method that can quantitatively determine tissue elasticity and stiffness. In this study, the morphological evaluation of the pancreas was performed using the pSWE technique in pediatric patients diagnosed with CF. The effectiveness of this method for the early detection of pancreatic insufficiency was investigated. Methods Fifty-five patients with CF (24 girls, 31 boys) and 60 healthy children (29 girls, 31 boys) without any chronic diseases and who were suitable for the pSWE examination were included in the study. Results The mean value of pSWE was 1.12 +/- 0.16 in the healthy group and 0.97 +/- 0.16 in the patients with cystic fibrosis. There was a statistically significant difference between the two groups (P < 0.001). Significant negative correlations were found between pSWE and age (r = -0.319; P = 0.018), height (r = -0.293; P = 0.03), serum glucose (r = -0.346; P = 0.01), HbA1C (r = -0.592; P = 0.02), and duration of the disease (r = -0.806; P < 0.001). Conclusions Investigating pancreatic elasticity and detecting pancreatic insufficiency using pSWE (a simple, inexpensive, and non-invasive method) in the early period before overt laboratory and clinical symptoms of EPI appear can contribute positively to long-term results in young patients with CF.
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    Evaluation of depression, anxiety and posttraumatic stress response levels of children and adolescents treated with COVID-19
    (Springer, 2023) Taskesen, Bekir; Kardas, Omer; Yilmaz, Kamil
    We aimed to evaluate stress level reactions to depression, anxiety, and posttraumatic stress in paediatric patients' post-COVID-19 infection. A total of two hundred consecutive patients aged 8 to 18 years were prospectively enrolled in the study between March 2020 and June 2021. One hundred patients were diagnosed with a positive COVID-PCR test and had inpatient management. Another hundred patients had positive COVID-PCR results and completed their care and isolation for 14 days at home. We used the child posttraumatic stress reaction index (CPTS-RI), child depression inventory (CDI), and screen for child anxiety-related disorders (SCARED) to evaluate their post-COVID-19 infection mental health state. In the study population, the mean age was 13.4 years, and 50.5% were male. Sixty-seven patients were paediatric, and the rest were adolescents. Based on our scaling system, 10% of patients had depression. Forty-one percent of patients had at least one high subscale of SCARED. Forty-four percent of patients' CPTS-RI was above the normal limit, while 4% had a severe stress reaction level. In the female patient population, SCARED and CPTS-RI were significantly high (p = 0.01). There was no significant correlation between hospitalization duration and test scores. The CPTS-RI score was significantly higher in the outpatient group than in the other groups (p = 0.01). The inpatient group had significantly higher social phobia, while the outpatient group had significantly higher school phobia (p = 0.01 and p = 0.05, respectively). Conclusion: The present study showed that COVID-19 infection is a significant risk factor for psychopathology in children and adolescents.
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    Recurrent rhabdomyolysis in a child. Case presentation
    (Soc Argentina Pediatria, 2016) Ertugrul, Sabahattin; Yolbas, Ilyas; Aktar, Fesih; Yilmaz, Kamil; Tekin, Recep
    Viral myositis associated with infections rarely may cause rhabdomyolysis. There is no any pediatric case with severe recurrent rhabdomyolysis triggered by infections in the literature. We reported a two-year-old boy who was hospitalized three times due to severe rhabdomyolysis associated with viral myositis in the winter months. This is the first child case presentation with severe rhabdomyolysis triggered by infections. Prednisolone and intravenous immunoglobulin treatments were ineffective in this case.
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    Risk Factors for Health Care-Associated Bloodstream Infections in a Neonatal Intensive Care Unit
    (Kowsar Corp, 2016) Ertugrul, Sabahattin; Aktar, Fesih; Yolbas, Ilyas; Yilmaz, Ahmet; Elbey, Bilal; Yildirim, Ahmet; Yilmaz, Kamil
    Background: Healthcare-associated bloodstream infections (HCA-BSI) are a major cause of morbidity and mortality in neonatal intensive care units (NICUs). Objectives: We aimed to determine the causative organisms and risk factors of HCA-BSIs in NICUs. Methods: This study was performed between January 2011 and December 2014 in the neonatal intensive care unit of Dicle university, Turkey. The study consisted of 126 patients (infected group) with positive blood culture and 126 randomly selected patients (uninfected control group) with negative blood culture after four days of hospitalization. Results: We found that the most common causative agents isolated from nosocomial infections (NIs) were 20.7% Staphylococcus epidermidis, 26.7% Klebsiella spp., and 13.3% Acinetobacter spp. Incidences of low gestational age, low birth weight, vaginal birth type, and long length of hospitalization were higher in the infected neonates than in the uninfected neonates. In the univariate analysis, surgical operation, ventriculoperitoneal shunt, use of umbilical catheter, nasogastric or orogastric tube, urinary catheter, mechanical ventilation, surfactant treatment, erythrocyte transfusion, plasma transfusion, thrombocyte transfusion, total parenteral nutrition infusion, intracranial hemorrhage, length of hospital stay, fifth-minute Apgar score, and total parenteral nutrition time were significantly associated with NIs. In the multiple logistic regression analysis, fifth-minute Apgar, use of erythrocyte transfusion and surgical operation were found as the independent risk factors for HCA-BSI. Conclusions: This study determined the causative organisms and risk factors of HCA-BSIs in NICUs.