Organofosfatlar hala yaygin olarak tarimda, endustride, evlerde, bahcelerde ve veterinerlikte kullanilanpestisitlerdir. Organofosfatlarla zehirlenme inhalasyon, sindirim ve ciltten emilim yoluyla hizla gelisebilmektedir.Bu bilesikler... more
Organofosfatlar hala yaygin olarak tarimda, endustride, evlerde, bahcelerde ve veterinerlikte kullanilanpestisitlerdir. Organofosfatlarla zehirlenme inhalasyon, sindirim ve ciltten emilim yoluyla hizla gelisebilmektedir.Bu bilesikler asetilkolinesterazi inhibe ederek kolinerjik reseptorlerde asetilkolin birikimine neden olur. Kolinerjik sinapslarin asiri uyarilmasi organofosfat zehirlenmesinde klinik bulgularin ortaya cikmasindan sorumludur. Organofosfat zehirlenmesinde medikal tedavi atropinin yaninda pralidoksim gibi kolinesteraz reaktivatoru olan oksim bilesiklerinin intravenoz uygulanmasini icerir. Pralidoksim organofosfatlarin fosforilledigi asetilkolinesteraz enziminin yeniden uretilmesini saglayarak organofosfat toksisitesine bagli ortaya cikan nikotinik ve muskarinik etkilerin geri donusunu saglar. Enzimin ‘‘yaslanma’’ reaksiyonu gelismeden 24-36 saat icinde verilmesi gerekmektedir. Sundugumuz olguda organofosfat maruziyetinden 48 saat sonra verilen Pralidoksim etkin bulunmus ve literatur esliginde tartisilmistir.
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Introduction: Chromosomal abnormalities are mostly found in 0.5–0.8% of live-born infants with developmental and morphological defects. Paracentric inversions are structural intrachromosomal rearrangements resulting in a risk of... more
Introduction: Chromosomal abnormalities are mostly found in 0.5–0.8% of live-born infants with developmental and morphological defects. Paracentric inversions are structural intrachromosomal rearrangements resulting in a risk of chromosomally unbalanced gametes in carriers. Case Presentation: Herein, we report a patient with dicentric rearrangement of chromosome 18 due to maternal paracentric inversion of chromosome 18. The patient was a girl, aged 3 years and 11 months. She was referred due to multiple congenital abnormalities, severe intellectual disability, and motor retardation. She had microcephaly, prominent metopic suture, synophrys, epicanthic folds, telecanthus, wide-set alae nasi, wide columella, bilateral cleft lip and palate, pectus carinatum, umbilical hernia, pes planus, and anteriorly displaced anus. She had bilateral external auditory canal stenosis and mild right-sided and moderate left-sided sensorineural hearing loss. Echocardiography showed secundum-type atrial s...
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Research Interests: Medicine and Gynecology
An 11-year-old boy was admitted with mildly painful swallowing. His parents mentioned he had had bad breath for 4 months. He had presented with the same complaint several times at medical centres, and some antibiotics and analgesics were... more
An 11-year-old boy was admitted with mildly painful swallowing. His parents mentioned he had had bad breath for 4 months. He had presented with the same complaint several times at medical centres, and some antibiotics and analgesics were given. During examination, bad breath (halitosis) was noted (figure 1). There was no cervical and submandibular lymphadenopathy and fever. edpract;archdischild-2018-315509v1/F1F1F1Figure 1Oropharyngeal examination on admission. QUESTIONS What do you see on oropharyngeal examination?What is the most likely diagnosis?Tonsillitis with exudate.Tonsillolithiasis.Foreign body on tonsil.Peritonsillar abscess. How would you manage this patient?Start broad-spectrum antibiotic.Drainage.Remove by using swab.Tonsillectomy. Answers can be found on page 2.
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Research Interests: Medicine and Renal Artery
Abstract Fosfomycin trometamol (FT) has shown promising in vitro activity against multidrug-resistant (MDR) uropathogens; however, clinical data are limited in pediatric patients. We conducted a retrospective study to describe the... more
Abstract Fosfomycin trometamol (FT) has shown promising in vitro activity against multidrug-resistant (MDR) uropathogens; however, clinical data are limited in pediatric patients. We conducted a retrospective study to describe the clinical and microbiological outcomes of uncomplicated lower urinary tract infections (LUTIs) due to MDR Escherichia coli treated with oral FT in female adolescents. A total of 70 outpatients, with a median age of 13 years (range 12-16 years), were included. FT was initiated as definitive treatment of UTIs in all patients due to documented resistance against alternative oral agents. All patients received a single dose of 3 g oral FT. The post-treatment clinical and microbiological cure rates were 97% (68/70) and 94% (66/70), respectively. Only two (3%) patients reported mild, self-limited diarrhea. UTI relapse occurred in two (3%) patients. Our results suggest that oral FT might be an alternative option for outpatient treatment of uncomplicated LUTIs due to MDR E. coli in female adolescents.
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Research Interests: Medicine, Human, Cerebrospinal Fluid, Case Report, Complication, and 15 moreHumans, Child, Male, Antibiotic Prophylaxis, Hemolytic Uremic Syndrome, C reactive protein, Meningococcal disease, Letter, Bacteremia, Clinical Article, Eculizumab, Atypical Hemolytic Uremic Syndrome, fatality, leukopenia, and Fatal outcome
PURPOSE The apparent diffusion coefficient (ADC) which obtain from diffusion-weighted magnetic resonance imaging (DWI), is a quantitative parameter representing the renal function and parenchymal damage in some renal disorders. The... more
PURPOSE The apparent diffusion coefficient (ADC) which obtain from diffusion-weighted magnetic resonance imaging (DWI), is a quantitative parameter representing the renal function and parenchymal damage in some renal disorders. The primary aim of this study was to investigate whether renal tissue alterations associated with vesicoureteral reflux (VUR) can be displayed by DWI. The secondary aim was to assess how ADC values change with age in kidneys with and without VUR. MATERIALS AND METHODS This prospective study included 46 patients (8 boys, 38 girls; mean age 7.3 ± 4.2; range 1-15 years) with VUR and 54 control subjects (21 boys, 33 girls; mean age 7.7 ± 5.2; range 1-17 years). All subjects underwent DWI of the kidneys using b value of 600s/mm(2) in addition to MR urography. The ADC values of 71 kidneys with VUR were compared with those of 81 kidneys without VUR. RESULTS The mean ADC values were (1.93 ± 0.36)×10(-3)mm(2)/s, (1.97 ± 0.24)× 10(-3)mm(2)/s, (1.83 ± 0.37)× 10(-3)mm(2)/s, (1.98 ± 0.20)×10(-3)mm(2)/s and (2.08 ± 0.42)× 10(-3)mm(2)/s in normal kidneys, and in those with grade 1, grade 2, grade 3 and grade 4 VUR, respectively. There was no significant difference in ADC values between kidneys with and without VUR. There was a significant positive correlation between the age and ADC values both in kidneys with and without VUR (r=0.79, p<0.001 and r=0.82; p<0.001, respectively). CONCLUSION DWI does not reveal probable parenchymal alterations in reflux nephropathy. ADC values increase with age during childhood not only in normal kidneys but also in kidneys with VUR.
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Research Interests: Adolescent, Medicine, Human, Case Report, Male, and 15 moreIntraocular Pressure, Follow Up, Article, Occlusion, Genetic Polymorphism, Controlled Study, Optic Disk, Genetic Analysis, Pediatric Case Presentation, Clinical Article, Best Corrected Visual Acuity (BCVA), Vitreous Hemorrhage, Central retinal vein occlusion, Antinuclear antibody , and Topical treatment
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Introduction: Autosomal recessive polycystic kidney disease (ARPKD) is associated with pathogenic variants in the PKHD1 gene. Autosomal dominant polycystic kidney disease (ADPKD) is mainly associated with pathogenic variants in PKD1 or... more
Introduction: Autosomal recessive polycystic kidney disease (ARPKD) is associated with pathogenic variants in the PKHD1 gene. Autosomal dominant polycystic kidney disease (ADPKD) is mainly associated with pathogenic variants in PKD1 or PKD2. The present study aimed to identify the clinical and genetic features of Turkish pediatric ARPKD and ADPKD patients. Methods: This multicenter, retrospective cohort study included 21 genetically confirmed ARPKD and 48 genetically confirmed ADPKD patients from 7 pediatric nephrology centers. Demographic features, clinical, and laboratory findings at presentation and during 12-month intervals were recorded. Results: The median age of the ARPKD patients at diagnosis was lower than the median age of ADPKD patients (10.5 months [range: 0–15 years] vs. 5.2 years [range: 0.1–16 years], respectively, [p = 0.014]). At the time of diagnosis, the median eGFR in the ARPKD patients was lower compared to that of ADPKD patients (81.6 [IQR: 28.7–110.5] mL/min/1.73 m2 and 118 [IQR: 91.2–139.8] mL/min/1.73 m2, respectively, [p = 0.0001]). In total, 11 (52.4%) ARPKD patients had malnutrition; 7 (33.3%) patients had growth retardation at presentation; and 4 (19%) patients had both malnutrition and growth retardation. At diagnosis, 8 (16.7%) of the ADPKD patients had malnutrition, and 5 (10.4%) patients had growth retardation. The malnutrition, growth retardation, and hypertension rates at diagnosis were higher in the ARPKD patients than the ADPKD patients (p = 0.002, p = 0.02, and p = 0.0001, respectively). ARPKD patients with malnutrition and growth retardation had worse renal survival compared to the patients without (p = 0.03 and p = 0.01). Similarly, ADPKD patients with malnutrition had worse renal survival compared to the patients without (p = 0.002). ARPKD patients with truncating variants had poorer 3- and 6-year renal outcome than those carrying non-truncating variants (p = 0.017). Conclusion: Based on renal survival analysis, type of genetic variant, growth retardation, and/or malnutrition at presentation were observed to be factors associated with progression to chronic kidney disease (CKD). Differentiation of ARPKD and ADPKD, and identification of the predictors of the development of CKD are vital for optimal management of patients with ARPKD or ADPKD.
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Research Interests: Medicine and Colchicine
WOS: 000443998400089
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WOS: 000382082600484
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Research Interests: Medicine and Gynecology
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A previously healthy 3-year-old girl was admitted with fever, nonbloody diarrhea, vomiting for 3 days, and oliguria. Physical examination showed fatigue, pale appearance, hypertension, and mild periorbital edema. Laboratory examinations... more
A previously healthy 3-year-old girl was admitted with fever, nonbloody diarrhea, vomiting for 3 days, and oliguria. Physical examination showed fatigue, pale appearance, hypertension, and mild periorbital edema. Laboratory examinations revealed anemia, thrombocytopenia, acute kidney injury, high LDH, and low haptoglobin levels. Urinalysis showed proteinuria and hematuria. Schistocytes and helmet cells were detected in the peripheral blood smear. There were no electrolyte imbalance and hypocomplementemia. Direct Coombs and viral panel were negative. Blood, urine, throat, and stool cultures were negative. Norovirus GII was positive in stool PCR, while other diarrheal agents were negative. The patient was diagnosed with norovirus gastroenteritis-induced hemolytic uremic syndrome (HUS). Furosemide was started for oliguria and hypertension, and blood pressure was controlled with oral nifedipine. On the 12th day of hospitalization, he was discharged with fully recover. To date, norovirus-associated HUS has been reported in 5 cases. Two of these are adult cases and the other three and our case are pediatric patients. In this case report and literature review, we observed that norovirus can cause HUS, especially in children, with a milder course than other types of HUS. The reason why it is more complicated in adult cases may be the presence of an additional underlying kidney disease. Since it was detected coincidentally in 1 case in the literature, it may be useful to screen for mutations in the complement pathway that may cause aHUS, if possible, in diarrhea-associated HUS caused by norovirus agents, but it was not present in our case.
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OBJECTIVE By creating nephrotoxicity models with cisplatin, vancomycin, and gentamicin in HK-2 (human renal proximal tubule cell) and HEK293T (human embryonic kidney epithelial cells) cell lines, we aimed to evaluate the effect of... more
OBJECTIVE By creating nephrotoxicity models with cisplatin, vancomycin, and gentamicin in HK-2 (human renal proximal tubule cell) and HEK293T (human embryonic kidney epithelial cells) cell lines, we aimed to evaluate the effect of cilastatin on recovery of cell damage after toxicity had occurred. MATERIALS AND METHODS In the first phase of the study, the doses of cisplatin, vancomycin, and gentamicin (50% inhibitive concentration; IC50) were determined. In the second phase, the effective dose of cilastatin against these drugs was determined, and IC50 doses of nephrotoxic agents were administered simultaneously. In the third phase of our study, to evaluate the possible therapeutic effect of cilastatin after toxicity had occurred, the analyses of cell viability, apoptosis, oxidative stress, expression of kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) were performed. RESULTS In the second phase of the study, it was observed that cilastatin increased cell viability when treated simultaneously with a nephrotoxic agent. In the third phase, cilastatin provided a significant increase in cell viability. After treatment with each agent for 24 hours, we determined that adding cilastatin to the medium had an effect on the recovery of cell damage by increasing cell viability and reducing apoptosis and oxidative stress. The expression of KIM-1 and NGAL increased when nephrotoxicity occurred and decreased with the addition of cilastatin to the medium. CONCLUSIONS The findings of the study suggest that cilastatin may have a healing effect after the development of nephrotoxicity.
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The aim of the study was to describe the validity and reliability of the Turkish version of Juvenile Arthritis Functional Assessment Report (JAFAR) in children/adolescents with Juvenile Idiopathic Arthritis (JIA). Sixty-nine... more
The aim of the study was to describe the validity and reliability of the Turkish version of Juvenile Arthritis Functional Assessment Report (JAFAR) in children/adolescents with Juvenile Idiopathic Arthritis (JIA). Sixty-nine children/adolescents with JIA were included in the study. JAFAR(TR)-Child and Parent forms were applied to the patients with JIA and to their parents for test retest at one-week intervals, the patients did not receive additional treatment and his/her pharmacological treatment did not change for that week. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC), and internal consistency reliability of multi-item subscales was evaluated by calculating Cronbach's alpha coefficient. Correlations between JAFAR(TR)-Child and Parent with the Pediatric Quality of Life Inventory 3.0. Module Arthritis (PedsQL), the Childhood Health Assessment Questionnaire (CHAQ), and the Juvenile Arthritis Disease Activity Score (JADAS) were evaluated to det...