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    Clinical and laboratory features of hospitalized children with pandemic influenza: Is it different from the other respiratory tract infections? [Hastaneye yati{dotless}ri{dotless}lan pandemik i·nfluenza tani{dotless}li{dotless} çocuklari{dotless}n klinik ve laboratuvar özellikleri: Diger solunum yolu enfeksiyonlari{dotless}ndan farkli{dotless} mi{dotless}?]
    (2012) Bal Z.Ş.; Bal A.; Anil M.; Bayram S.N.; Arslan N.C.; Köse E.; Can F.K.; Anil A.B.; Helvaci M.
    Objective: To evaluate the clinical and laboratory findings of children hospitalized due to H1N1 virus infection with respiratory tract infection (RTI) during the last two months of 2009 and to compare patients in two groups: H1N1(+) and H1N1(-). Material and Methods: The data of 86 children with RTI, who were hospitalized between November 1 2009 and December 31 2009 at the Izmir Tepecik Training and Research Hospital Department of Pediatrics were reviewed retrospectively. Real time polymerase chain reaction (real time-PCR) was performed for all hospitalized cases. With this method, the H1N1 (+) and (-) cases were compared in terms of clinical and laboratory characteristics. Results: Forty-eight of 86 cases with RTI were H1N1(+). Older age (p=0.047) and underlying disease (p=0.043) were more frequent in H1N1(+) cases. A higher hemoglobin level (p=0.011), lower platelet count (p<0.001) and reduced incidence of a high C-reactive protein (CRP) level (>0.8 mg/dL) (p=0.004) were determined in the H1N1(+) group. Lobar infiltration determined by chest X-ray was less frequent in the H1N1(+) group (p=0.002). One patient died the in H1N1(+) group. There were no significant differences between the two groups regarding the length of hospital stay, frequency of pediatric intensive care admission and mortality rate (p>0.005). In the logistic regression analysis, hemoglobin level (p=0.033), high CRP (>0.08 mg/dL) (p=0.005) and the incidence of lobar infiltration by X-ray (p=0.036) were found to be significant parameters distinguishing the H1N1(+) and H1N1(-) groups. Conclusion: Pandemic Influenza affected children in the older age group with chronic medical conditions. The length of hospital stay, the rate of admission in the pediatric intensive care unit and the mortality rate were not different in H1N1(+) and H1N1(-) children.
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    Diagnostic accuracy of interleukin-6, interleukin-8, and interleukin-10 for predicting bacteremia in children with febrile neutropenia [Febril Nötropenili Çocuklarda Bakteriyemiyi Öngörmede İnterlökin-6, İnterlökin-8, İnterlökin-10’un Tanısal Doğruluğu]
    (Turkish Society of Hematology, 2017) Bal Z.Ş.; Özdemir N.K.; Şen S.; Karapınar D.Y.; Azarsız E.; Aydemir Ş.; Vardar F.
    Despite improvements in diagnosis and treatment, infections are still a major cause of morbidity and mortality in children with febrile neutropenia. In the majority of febrile episodes, the source of infection cannot be defined. In this study, we aimed to identify the earlier predictors of bacteremia/fungemia and a useful cytokine to identify the source of infection and to discriminate the patients with culture-confirmed bacterial/fungal infection. The most sensitive cytokine was interleukin (IL)-10 and the most specific was IL-8 in predicting culture-confirmed cases. IL-8 had greater sensitivity and specificity in determination of gram-negative bacterial infections with a higher negative predictive value; therefore, IL-8 can be used particularly to rule out gram-negative bacterial infections. IL-6, IL-8, and IL-10 circulating levels were shown to be higher in cases of infection. Further studies are needed to recommend a routine practice for predicting culture-confirmed bacterial infections. © Copyright 2017 by Turkish Society of Hematology.
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    Education of healthcare personnel working with pediatric patients during covid-19 pandemic within the framework of infection control [Covid-19 pandemisinde enfeksiyon kontrol çalışmaları çerçevesinde çocuk hastalarla çalışan sağlık personeli eğitimi]
    (AVES, 2020) Oygar P.D.; Büyükçam A.; Bal Z.Ş.; Dalgıç N.; Bozdemir Ş.E.; Karbuz A.; Uygun H.
    Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic. © 2020, AVES. All rights reserved.
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    Epidemiological, laboratory and clinical Features of childhood hydatid disease [Çocukluk çagi{dotless}nda kist hidatik hastali{dotless}gi{dotless}ni{dotless}n epidemiyolojik, laboratuvar ve klinik özellikleri]
    (2013) Yildiz B.; Şen S.; Bal Z.Ş.; Erdoan D.D.; Korkmaz M.; Vardar F.
    Objective: Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. It is an important cause of morbidity in endemic areas and can be life threatening. In our country it can occur from childhood onwards and usually requires the prolonged use of medications. Material and Methods: Twelve paediatric cases admitted to the Ege University Children's Hospital with various symptoms and diagnosed with hydatid disease between 2009 and 2011 were included in the study. Results: During a 3-year period 12 patients (5 female, 7 male; mean age 11±2 years; range 6 to 14 years) were admitted to the hospital because of fatigue, nausea, fever and cough, abdominal pain, or back pain, or were diagnosed incidentally. Complete blood count tests revealed mild eosinophilia (mean=490±158/ mm3); two cases admitted with fever (16%) had elevated C reactive protein levels and leucocytosis. All patients were treated with Albendazole (10 mg/kg/d), seven were treated surgically, four (33%) were treated with percutanous drainage (PAIR: puncture, aspiration, injection, re-aspiration) and two (16%) did not need invasive procedures and remain in follow up. Conclusion: This study presents the course of hydatid disease and emphasizes the diagnostic challenges in follow up. © 2013 by Pediatric Infectious Diseases Society.
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    Immune thrombocytopenic purpura as sole manifestation and hemophagocytic lypmhohistiocytosis as sole manifestation of hepatitis a virus infection in two children [İmmün trombositopenik purpuranın tek bulgu olduğu ve hemofagositik lenfohistiositozun tek bulgu olduğu ıki çocuk olguda hepatit a virüs enfeksiyonu]
    (AVES Ibrahim Kara, 2017) Bal Z.Ş.; Şen S.; Özdemir N.K.; Yildiz K.B.; Karapinar D.Y.; Vardar F.
    Hepatitis A virus (HAV) infection is often asymptomatic or mildly symptomatic in pediatric population, the severity of the disease increases by age. Immune-mediated extrahepatic extrahepatic manifestations and hematologic complications are mainly reported in adults with acute and chronic hepatitis B and C. However, they are relatively rare in children with HAV infection. There are few available pediatric reports in English literature about autoimmune complications of HAV infection. We reported hematologic manifestations of HAV infection including hemophagocytic lymphohistiocytosis (HLH) and immune thrombocytopenic purpura as sole manifestations of HAV infection therefore in patients with these hematologic disorders, HAV infection should be kept in mind in the differential diagnosis even if they are not jaundiced. © 2017 by Pediatric Infectious Diseases Society.
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    New generation rotavirus vaccines [Yeni nesil rotavirus aşıları]
    (AVES Ibrahim Kara, 2016) Bal Z.Ş.; Kurugöl Z.
    Rotavirus gastroenteritis (RVGE) is a vaccine-preventable disease that causes hospitalization and deaths due to severe gastroenteritis in developing countries. The World Health Organization (WHO) reported that 801000 children die annually due to gastroenteritis. Improvement in hygienic conditions is insufficient for preventing rotavirus gastroenteritis due to transmission via droplets and resistance to disinfectants; therefore, vaccination is the most effective method for prevention. At present, there are two licensed rotavirus vaccines, monovalent rotavirus vaccine (RV1, Rotarix, GlaxoSmithKline) and pentavalent rotavirus vaccine (RV5, RotaTeq, Merck). The WHO offered to integrate the rotavirus vaccine to the national vaccination programs of all countries worldwide since 2009. Current licensed vaccines have since demonstrated efficacy against severe gastroenteritis and hospitalization in developed countries. In countries with low income and high disease vaccination rate is low because of difficulties in vaccine supply and high cost of the vaccine and consideration about diminished efficacy of the other oral vaccines. Therefore, several groups are led to develop around the world, new rotavirus vaccines. In this review, we provide a summary of the new licensed vaccines with ongoing clinical trials and the locally licensed vaccines. © 2016 by Pediatric Infectious Diseases Society.
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    Review of extrapulmonary tuberculosis in children [Çocuklarda ekstrapulmoner tüberküloz hastaliginin tani ve tedavisi]
    (2014) Şen S.; Bal Z.Ş.; Vardar F.
    Tuberculosis is still a major public health problem in developing and developed countries. The immune status in children, human immunodeficiency virus (HIV) infection and age under two years increase the risk of progressive/fatal disease and extrapulmonary tuberculosis (EPTB). As EP TB may mimic malignancies and many other diseases, it should be kept in mind in the differential diagnosis. Because of the difficulty in obtaining bacteriological evidence, contact history, clinical findings, radiographs, and tuberculin skin test may help in decision-making regarding the initial treatment. If in doubt, empiric treatment can be administered while awaiting culture result. The morbidity and mortality can be reduced with early diagnosis and treatment of the disease.