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Öğe Assessment of tuberculosis infection during treatment with biologic agents in a BCG-vaccinated pediatric population(Springer London Ltd, 2016) Atikan, Basak Yildiz; Cavusoglu, Cengiz; Dortkardesler, Merve; Sozeri, BetulBiologic therapies, such as tumor necrosis factor-alpha (TNF-alpha) blockers, are commonly used to treat rheumatological diseases in childhood. Screening patients for tuberculosis (TB) is highly recommended before starting therapy with TNF-alpha blockers. Despite appropriate screening, TB still remains a problem in patients receiving anti-TNF therapy in countries where TB is not endemic. TB in anti-TNF-treated patients is often diagnosed late due to altered presentation, and this delay results in high morbidity and mortality with a high proportion of extrapulmonary and disseminated disease. The aim of this study is to show the course of TB disease in children who are on biologic therapy, in an era where many of the children are BCG-vaccinated and TB is intermediately endemic. We recruited 71 patients with several types of inflammatory diseases. Six of them had a positive test result during TB screening and began taking isoniazid (INH) prophylactically. During the 3 years of follow-up, none of these patients developed TB disease. Biologic agents can be safely used in a BCG-vaccinated pediatric population, as long as patients are closely monitored to ensure that any cases of TB will be detected early.Öğe Assessment of vascular function in systemic onset juvenile idiopathic arthritis(Springer London Ltd, 2016) Sozeri, Betul; Atikan, Basak Yildiz; Ozdemir, Kadriye; Mir, SevgiAn increased incidence of cardiovascular disease has been found in rheumatic disorders. Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. Prolonged immunological inflammatory process leads these patients to an early onset of atherosclerosis. We aimed to assess the presence of early vascular dysfunction in patients with systemic onset juvenile idiopathic arthritis (sJIA) and investigate the role of therapy sJIA in vascular health. Thirty-three patients (22 males, 11 females) diagnosed with sJIA according to the International League of Associations for Rheumatology criteria were compared to 72 age- and sex-matched controls. None of the participants was overweight, obese, or had a history of hypertension, dyslipidemia, diabetes mellitus, or cardiovascular disease. Arterial stiffness (As) was evaluated by measurement of carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) with a Vicorder. The mean age of patients in this study was 9.96 +/- 3.71 years (range 4-16 years) and the mean age of controls was 10.9 +/- 3.52 years (range 4-19 years). These two groups were well matched for age, sex, and BMI. The mean age of patients at the onset of disease was 7.06 +/- 3.9 years (range 3-15 years). The mean duration of disease and active disease was 79 +/- 45 months (range 6-162 months) and 58 +/- 49 months (range 1-101 months), respectively. The highest levels of PWV and AIx were found in the patient group. Seven patients had had macrophage activation syndrome at presentation. In these patients, vascular changes were higher than other patients (6.30 +/- 0.42 m/s vs 5.17 +/- 0.55 m/s, p = 0.01, respectively). The corticosteroid therapy was found associated with higher PWV, (p < 0.05), while there was no difference between vascular parameters and use of non-steroid therapies (methotrexate (MTX), anti-TNF alfa agents). We also find statistically significant correlation between PWV and disease duration (p = 0.003, r = 0.45). Vascular function is impaired in patients with sJIA at a very young age. Vascular dysfunction may be partly attributed to the effects of disease-related characteristics (inflammation, disease activity, and medications).Öğe Efficacy and Maternal Comfort of Sequential versus Simultaneous Breast Expression by Mothers of Critically III Newborns(Galenos Yayincilik, 2017) Koroglu, Ozge Altun; Can, Nazmiye; Atikan, Basak Yildiz; Tanriverdi, Sema; Yalaz, Mehmet; Akisu, Mete; Kultursay, NilgunAim: Expressed breast milk is beneficial for infants in neonatal intensive care unit (NICU) when direct breastfeeding is not possible. Breast expression with manual or electric breast pumps is promoted for the initiation and maintenance of lactation in this critical period. In this study, we aimed to compare the efficacy and maternal comfort of sequential versus simultaneous breast expression in newly delivered mothers whose infants were admitted to NICU. Materials and Methods: Thirty five mothers were followed prospectively for milk expression either sequentially (n=21, group 1) or simultaneously (n=14, group 2) with breast pumps for 10 days. The total amount of milk expressed per day and per each period was recorded together with the duration of breast expression. The mothers' impressions about the easiness and comfort of the procedure, and their satisfaction with the amount of milk were evaluated with a questionnaire at the end of the study. Results: The amounts of expressed milk per day and per each expression period were similar in both groups. However, time spent for each expression period was significantly lower in the simultaneous breast expression group. Mothers in this group gave higher scores with regard to ease of use when compared to mothers in the sequential expression group (4.36 +/- 0.50 vs. 4.00 +/- 0.44, p=0.046). The mothers graded both methods with similar scores in all other parameters. Conclusion: Simultaneous breast expression is time saving while both simultaneous and sequential breast expression are similarly efficient for milk production, and both methods are helpful and tolerable in promoting breastfeeding for NICU mothers.Öğe Hematologic Malignancies in Children with Down Syndrome: Transient Myeloproliferative Disease and Acute Megakaryoblastic Leukemia(Galenos Yayincilik, 2015) Atik, Tahir; Sivis, Zuhal Onder; Karadas, Nihal; Rashnonejad, Afrooz; Atikan, Basak Yildiz; Karapinar, Deniz Yilmaz; Vardar, Fadil; Cogulu, Ozgur; Özkınay, FerdaDown Syndrome (DS) is an important genetic disease resulting from partial or total trisomy of chromosome 21 and characterized by dysmorphic facial features, intellectual disabilities and multiple congenital anomalies. Children with DS are at increased risk of developing leukemia. Specifically, 3-10% of newborns with DS are diagnosed with transient myeloproliferative disease, and children with DS are 500 times more likely to develop acute megakaryoblastic leukemia (AMKL), and 20 times more likely to develop acute lymphoblastic leukemia (ALL) than children without DS. In this study, we report two children with DS presented with transient myeloproliferative disease.Öğe Inherited and acquired immunodeficiencies underlying tuberculosis in childhood(Wiley, 2015) Boisson-Dupuis, Stephanie; Bustamante, Jacinta; El-Baghdadi, Jamila; Camcioglu, Yildiz; Parvaneh, Nima; El Azbaoui, Safaa; Agader, Aomar; Hassani, Amal; El Hafidi, Naima; Mrani, Nidal Alaoui; Jouhadi, Zineb; Ailal, Fatima; Najib, Jilali; Reisli, Ismail; Zamani, Adil; Yosunkaya, Sebnem; Gulle-Girit, Saniye; Yildiran, Alisan; Cipe, Funda Erol; Torun, Selda Hancerli; Metin, Ayse; Atikan, Basak Yildiz; Hatipoglu, Nevin; Aydogmus, Cigdem; Kilic, Sara Sebnem; Dogu, Figen; Karaca, Neslihan; Aksu, Guzide; Kutukculer, Necil; Keser-Emiroglu, Melike; Somer, Ayper; Tanir, Gonul; Aytekin, Caner; Adimi, Parisa; Mahdaviani, Seyed Alireza; Mamishi, Setareh; Bousfiha, Aziz; Sanal, Ozden; Mansouri, Davood; Casanova, Jean-Laurent; Abel, LaurentTuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb) and a few related mycobacteria, is a devastating disease, killing more than a million individuals per year worldwide. However, its pathogenesis remains largely elusive, as only a small proportion of infected individuals develop clinical disease either during primary infection or during reactivation from latency or secondary infection. Subacute, hematogenous, and extrapulmonary disease tends to be more frequent in infants, children, and teenagers than in adults. Life-threatening primary TB of childhood can result from known acquired or inherited immunodeficiencies, although the vast majority of cases remain unexplained. We review here the conditions conferring a predisposition to childhood clinical diseases caused by mycobacteria, including not only M.tb but also weakly virulent mycobacteria, such as BCG vaccines and environmental mycobacteria. Infections with weakly virulent mycobacteria are much rarer than TB, but the inherited and acquired immunodeficiencies underlying these infections are much better known. Their study has also provided genetic and immunological insights into childhood TB, as illustrated by the discovery of single-gene inborn errors of IFN- immunity underlying severe cases of TB. Novel findings are expected from ongoing and future human genetic studies of childhood TB in countries that combine a high proportion of consanguineous marriages, a high incidence of TB, and an excellent clinical care, such as Iran, Morocco, and Turkey.Öğe Perforated Appendicitis After Intravenous Immunoglobulin Therapy in a Term Neonate with Haemolytic Jaundice(Coll Physicians & Surgeons Pakistan, 2015) Atikan, Basak Yildiz; Koroglu, Ozge Altun; Yalaz, Mehmet; Ergun, Orkan; Dokumcu, Zafer; Doganavsargil, Basak; Akisu, Mete; Kultursay, NilgunNeonatal appendicitis is a rare clinical condition that may cause high morbidity and mortality if diagnosis is delayed. There is usually an underlying disease; it can also be a localized form of necrotizing enterocolitis. Here, we present a term neonate who was treated with intravenous innmunoglobulin because of severe isoimmune hemolytic jaundice. The patient developed abdominal symptoms within 10 hours of therapy, was diagnosed with acute perforated appendicitis and completely recovered after surgery.Öğe Perforated Appendicitis After Intravenous Immunoglobulin Therapy in a Term Neonate with Haemolytic Jaundice(Coll Physicians & Surgeons Pakistan, 2015) Atikan, Basak Yildiz; Koroglu, Ozge Altun; Yalaz, Mehmet; Ergun, Orkan; Dokumcu, Zafer; Doganavsargil, Basak; Akisu, Mete; Kultursay, NilgunNeonatal appendicitis is a rare clinical condition that may cause high morbidity and mortality if diagnosis is delayed. There is usually an underlying disease; it can also be a localized form of necrotizing enterocolitis. Here, we present a term neonate who was treated with intravenous innmunoglobulin because of severe isoimmune hemolytic jaundice. The patient developed abdominal symptoms within 10 hours of therapy, was diagnosed with acute perforated appendicitis and completely recovered after surgery.Öğe Perforated Appendicitis After Intravenous Immunoglobulin Therapy in a Term Neonate with Haemolytic Jaundice(Coll Physicians & Surgeons Pakistan, 2015) Atikan, Basak Yildiz; Koroglu, Ozge Altun; Yalaz, Mehmet; Ergun, Orkan; Dokumcu, Zafer; Doganavsargil, Basak; Akisu, Mete; Kultursay, NilgunNeonatal appendicitis is a rare clinical condition that may cause high morbidity and mortality if diagnosis is delayed. There is usually an underlying disease; it can also be a localized form of necrotizing enterocolitis. Here, we present a term neonate who was treated with intravenous innmunoglobulin because of severe isoimmune hemolytic jaundice. The patient developed abdominal symptoms within 10 hours of therapy, was diagnosed with acute perforated appendicitis and completely recovered after surgery.
