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Öğe Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey(Elsevier Sci Ltd, 2018) Caglar, Ilknur; Devrim, Ilker; Ozdemir, Halil; Sahbudak, Zumrut; Sonmez, Gulsum; Buyukcam, Ayse; Gulhan, Belgin; Kara, Ahu; Aygun, Deniz F.; Bayram, Nuri; Celebi, Solmaz; Cetin, Benhur; Nepesov, Merve, I; Yilmaz, Ayse T.; Kepenekli, Eda; Ciftdogan, Dilek Yilmaz; Acar, Manolya K.; Yayla, Burcu Cura; Okumus, Canan; Ecevit, Zafer; Hatipoglu, Nevin; Kuyucu, Necdet; Kosker, Muhammed; Sen, Semra; Karbuz, Adem; Sutcu, Murat; Duramaz, Burcu Bursal; Ozen, Metehan; Ciftci, Ergin; Alabaz, Derya; Kurugol, Zafer; Kara, Ates; Kanik, Saliha; Kilic, Omer; Oncel, Selim; Somer, Ayper; Tapisiz, Anil; Belet, Nursen; Akcan, Ozge Metin; Turel, Ozden; Ozkaya, Aslinur; Tezer, Hasan; Cengiz, Ali Bulent; Ince, Erdal; Camcioglu, Yildiz; Kocabas, Emine; Arisoy, Emin S.; Salman, NuranObjectives: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey. Methods: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed. Results: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies. Conclusion: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital. (C) 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.Öğe Arterial ischemic stroke in childhood: Risk factors and outcome in old versus new era(Sage Publications Inc, 2007) Goekben, Sarenur; Tosun, Ayse; Bayram, Nuri; Serdaroglu, Gul; Polat, Muzaffer; Kavakli, Kaan; Tekgul, HasanRisk factors of children with arterial ischemic stroke were retrospectively evaluated. The children were grouped according to values on developing diagnostic tools: 13 in the old era (19871994) and 18 in the new era (1995-2004). The old era battery included 5 tests: protein C, protein S, antithrombin, lupus anticoagulants, and anticardiolipin antibodies. The new era battery added 5 more tests: homocystine level, factor VIII level, mutations for factor V Leiden and prothrombin G20210A, and lipoprotein (a) level. At least I risk factor was found in 5 of 13 children (38.5%) in the old era and in 8 of 18 (44.4%) in the new era. The extended battery for prothrombotic disorders revealed 7 risk factors in 4 children (22.2%) in the new era, whereas the limited battery identified a single risk factor in I child (7.7%) in the old era. For the correct etiologic identification, prothrombotic risk factors should be extensively evaluated in patients with arterial ischernic stroke.Öğe Birincil Derialtı Aktinomikozu: Olgu Sunumu(2017) Kara, Ahu; Çayıröz, Mehmet Umut; Bayram, Nuri; Apa, Hurşit; Yaman, Banu; Akalın, Taner; Devrim, İlkerAktinomikoz, Actinomycetaceae ailesinde yer alan türlerin neden olduğu süregen, irinli, fistül oluşumuna yol açabilen ve yayılabilen bir hastalıktır. Aktinomikoz iç kaynaklıdır, normal floradaki Actinomyces türlerinin mu-kozaya girebilmesi sonucu oluşur. Boyun-yüz, karın, göğüs, pelvis, be-yin ve deri aktinomikozu olmak üzere çeşitli biçimleri vardır. Deri biçimi oldukça seyrektir. Aktinomikoz tanısında genellikle gecikilmekte ya da yanlış tanı konulmaktadır, buna bağlı olarak da yanlış tedavi uygulan-maktadır. Birçok olguda doğru tanı ancak cerrahi işlemden sonra konu-labilmektedir. Bu yazıda, sırtındaki kitle nedeniyle getirilen, ayırıcı tanıda kötü doğalı hastalık düşünülen ve eksizyonel biyopsiyle tanı konulan, dokuz yaşındaki bir aktinomikoz olgusu sunulmuştur.Öğe Brucellosis as a Cause of Fever of Unknown Origin in Children Admitted to a Tertiary Hospital in the Aegean Region of Turkey(Mary Ann Liebert Inc, 2011) Ciftdogan, Dilek Yilmaz; Bayram, Nuri; Vardar, FadilThe aim of the study was to determine the role of brucellosis in children with fever of unknown origin (FUO) in the Aegean region of Turkey. For this purpose, the records of all children referred or admitted with diagnosis of FUO to the Department of Pediatric Infectious Diseases, Ege University Medical School, between 2003 and 2008 were scanned and 92 cases were identified retrospectively. Fifty-eight of these 92 children (63%) were diagnosed with infectious diseases, brucellosis being the most frequent cause (15.2%). Although several other infectious diseases do appear as a cause of FUO, brucellosis should be particularly considered as a differential diagnosis.Öğe A case of Mondini dysplasia with recurrent Streptococcus pneumoniae meningitis(Springer, 2009) Ciftdogan, Dilek Yilmaz; Bayram, Nuri; Ozdemir, Yasemin; Bayraktaroglu, Selen; Vardar, FadilMondini's dysplasia is a developmental anomaly of the middle ear characterized by cochlear malformation with dilation of the vestibular aquaduct, vestibule, and ampullar ends of the semicircular canals. These deformities may result in a connection between subarachnoid space and the middle ear resulting in recurrent episodes of meningitis. Additionally, it is commonly associated with hearing impairment. We describe here a boy with recurrent meningitis and unilateral sensorineural hearing loss. Mondini dysplasia was demonstrated with computed tomographic scans of the temporal bones in the search for pathogenesis of recurrent meningitis.Öğe A case of Mondini dysplasia with recurrent Streptococcus pneumoniae meningitis(Springer, 2009) Ciftdogan, Dilek Yilmaz; Bayram, Nuri; Ozdemir, Yasemin; Bayraktaroglu, Selen; Vardar, FadilMondini's dysplasia is a developmental anomaly of the middle ear characterized by cochlear malformation with dilation of the vestibular aquaduct, vestibule, and ampullar ends of the semicircular canals. These deformities may result in a connection between subarachnoid space and the middle ear resulting in recurrent episodes of meningitis. Additionally, it is commonly associated with hearing impairment. We describe here a boy with recurrent meningitis and unilateral sensorineural hearing loss. Mondini dysplasia was demonstrated with computed tomographic scans of the temporal bones in the search for pathogenesis of recurrent meningitis.Öğe A Diagnostic Challenge Is it Tuberculosis?(Lippincott Williams & Wilkins, 2022) Boncuoglu, Elif; Akaslan Kara, Aybuke; Bayram, Nuri; Devrim, Ilker; Kiymet, Elif; Caglar, Ilknur; Demirag, Bengu[No Abstract Available]Öğe Effect of zinc sulfate on common cold in children: Randomized, double blind study(Wiley, 2007) Kurugol, Zafer; Bayram, Nuri; Atik, TahirBackground: The aim of the present randomized, double-blind, placebo-controlled study was to determine the efficacy of zinc sulfate on the duration and severity of common cold in children. Methods: Children presenting at least two of 10 symptoms of common cold within the 24-48 h of the onset of illness were eligible for the study. Children were randomized to receive either oral zinc containing zinc sulfate or placebo. A diary was completed to record symptoms and adverse effects. Symptoms were scored as absent (0), mild (1), moderate (2), or severe (3). Results: One hundred and fifty children participated in the study, and 120 children were included in the final analysis. The median duration of all cold symptoms was 6 days (P = 0.20), and the median duration of nasal symptoms was 5 days in both groups (P = 0.09). However, total symptom severity scores were significantly lower in the zinc group, starting from the second day of the study. The lower scores in the zinc group were largely due to improvement of nasal symptom scores. Adverse effects were similar in both groups. Conclusion: Zinc sulfate had no effect on the duration of cold symptoms. However, it appears to be effective in reducing the severity of the cold symptoms in healthy children.Öğe Identification of Enteroviruses from Central Nervous System Infections by RT-PCR and Cell Culture Methods(Ankara Microbiology Soc, 2011) Kilic, Ilknur; Altuglu, Imre; Cicek, Candan; Pullukcu, Husnu; Bayram, Nuri; Sirin, Hadiye; Erensoy, SeldaViruses are the major causes of aseptic meningitis and encephalitis. Enteroviruses account for more than 80% of the aseptic meningitis cases for which an etiologic agent is identified. The aims of the present study were to identify agents of enteroviral meningitis by viral culture and reverse transcriptase polymerase chain reaction (RT-PCR) methods, to evaluate the appropriateness of a commercial RTPCR kit for its use in routine laboratory, and to obtain epidemiological data about enteroviral meningitis. Sixty six cerebrospinal fluid (CSF) samples from patients with suspected viral central nervous system (CNS) infection by clinical and CSF biochemical findings, sent to Ege University Faculty of Medicine, Department of Medical Microbiology were included in the study. The CSF samples were all negative for tested bacteria, mycobacteria, fungi, herpes simplex virus and cytomegalovirus. Thirty-four (51.5%) of the samples were from female and 32 (48.5%) were from male patients. Twenty-three (34.8%) patients were children (5 months-18 years) and 43 (65.2%) were adults (19-86 years). Shell vial rapid cell culture method by using Vero, HEp-2 and RD cell lines was performed for virus isolation and the results were evaluated on 48(th) hours after staining the cells with fluorescein labeled polyclonal antibodies (Pan-Enterovirus Blend, Light Diagnostics, USA). Enteroviral RNA in the samples was detected by a commercial RT-PCR kit (Enterovirus Consensus Kit, Argene, France). Sixty-one (92.4%) of 66 samples from patients with suspected viral CNS infection were found to be negative for enterovirus both with RT-PCR and shell vial cell culture methods. Three samples (4.5%) were positive by shell vial culture method. In one CSF sample that was culture positive, RT-PCR was also positive. However, the remaining two culture positive samples yielded negative result by RT-PCR. Intermediate results with RT-PCR were obtained in two samples (3%) that were identified as negative by cell culture. Two of the three positive samples in cell culture were identified as echovirus, however, the remaining sample could not be identified due to small sample amount. As a result, the commercial assay was found non-practical and labor intensive, giving indeterminant results in some cases and missing two culture positive samples. Since it didn't have an advantage over the cell culture method used, it was found inappropriate for routine diagnosis in our laboratory. On the other hand, it has been known that nucleic acid amplification tests (NAT) have markedly improved the diagnosis of enterovirus infections by increasing the sensitivity compared with cell culture methods. An alternative NAT method should be evaluated in parallel with cell culture method especially in CSF samples of children with suspected viral central nervous system infections.Öğe Mycobacterium lentiflavum Infection in a Patient With Hyper-IgE Recurrent Infection Syndrome A Case Report(Lippincott Williams & Wilkins, 2017) Duzgol, Mine; Cavusoglu, Cengiz; Kara, Ahu; Gulfidan, Gamze; Ayhan, Yuce; Bayram, Nuri; Devrim, IlkerMycobacterium lentiflavum is a recently described nontuberculous mycobacterium that has mainly clinical importance in young children with cervical lymphadenitis and in immunocompromised patients. We report here, along with a further case of diffused pulmonary nodules in a 12-year-old boy, the first isolations from bronchoalveolar lavage culture with hyper-IgE recurrent infection syndrome from Turkey.Öğe The prophylactic and therapeutic effectiveness of zinc sulphate on common cold in children(Wiley, 2006) Kurugol, Zafer; Akilli, Munevver; Bayram, Nuri; Koturoglu, GuldaneAim: To determine the efficacy of prophylactic administration of zinc sulphate in reducing the occurrence of the common cold in children, and to evaluate the efficacy of zinc sulphate in reducing the duration and severity of cold symptoms. Methods: A total of 200 healthy children were randomly assigned to receive oral zinc sulphate ( zinc group, n = 100) or placebo ( placebo group, n = 100). Zinc sulphate ( 15 mg of zinc) or placebo syrup were administered for prophylaxis once daily during a 7-mo study period. The dose was increased to two times per day ( 30 mg of zinc) at the onset of cold, until symptoms resolved. Results: The mean number of colds in the zinc group was significantly less than in the placebo group ( 1.2 vs 1.7 colds per child; p = 0.003). The mean cold-related school absence was 0.9 d per child in the zinc group versus 1.3 d in the placebo group ( p = 0.04). Compared to the placebo group, the zinc group had shorter mean duration of cold symptoms and decreased total severity scores for cold symptoms ( p < 0.0001). Adverse effects were mild and similar in both groups. Conclusion: Zinc sulphate appears to be an easily administered, safe and well-tolerated alternative for the prevention and treatment of the common cold in children.Öğe A rare complication of pulmonary tuberculosis in childhood: Rasmussen's aneurysm in a 9-year-old child with Down syndrome(Turkish J Pediatrics, 2022) Boncuoglu, Elif; Cinar, Celal; Kiymet, Elif; Caglar, Ilknur; Kara, Aybuke Akaslan; Bayram, Nuri; Devrim, IlkerBackground. As an extremely rare entity reported in children, Rasmussen???s aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of the pulmonary artery adjacent to or within a tuberculous cavity. Case. Here, we reported a 9-year-old child with Down syndrome who presented with massive hemoptysis. Endovascular coil embolization was performed for Rasmussen???s aneurysm. During the 2-year follow-up period, she had no further episodes of bleeding. Conclusions. In case of the development of massive hemoptysis in the follow-up of a patient with pulmonary tuberculosis and Down syndrome, this lethal complication should be considered.Öğe Simultaneous Detection of Respiratory Viruses and Influenza A Virus Subtypes Using Multiplex PCR(Ankara Microbiology Soc, 2014) Cicek, Candan; Bayram, Nuri; Anil, Murat; Gulen, Figen; Pullukcu, Husnu; Saz, Eylem Ulas; Telli, Canan; Cok, GurselThis study was conducted to investigate the respiratory viruses and subtyping of influenza A virus when positive by multiplex PCR in patients with flu-like symptoms, after the pandemic caused by influenza A (H1N1)pdm09. Nasopharyngeal swab samples collected from 700 patients (313 female, 387 male; age range: 24 days-94 yrs, median age: 1 yr) between December 2010 - January 2013 with flu-like symptoms including fever, headache, sore throat, rhinitis, cough, myalgia as defined by the World Health Organization were included in the study. Nucleic acid extractions (Viral DNA/RNA Extraction Kit, iNtRON, South Korea) and cDNA synthesis (RevertAid First Strand cDNA Synthesis Kits, Fermentas, USA) were performed according to the manufacturer's protocol. Multiplex amplification of nucleic acids was performed using DPO (dual priming oligonucleotide) primers and RV5 ACE Screening Kit (Seegene, South Korea) in terms of the presence of influenza A (INF-A) virus, influenza B (INF-B) virus, respiratory syncytial virus (RSV), and the other respiratory viruses. PCR products were detected by automated polyacrylamide gel electrophoresis using Screen Tape multiple detection system. Specimens which were positive for viral nucleic acids have been further studied by using specific DPO primers, FluA ACE Subtyping and RV15 Screening (Seegene, South Korea) kits. Four INF-A virus subtypes [human H1 (hH1), human H3 (hH3), swine H1 (sH1), avian H5 (aH5)] and 11 other respiratory viruses [Adenovirus, parainfluenza virus (Ply) types 1-4, human bocavirus (HBoV), human metapneumovirus (HMPV), rhinovirus types A and B, human coronaviruses (HCoV) OC43, 229E/NL63] were investigated with those tests. In the study, 53.6% (375/700) of the patients were found to be infected with at least one virus and multiple respiratory virus infections were detected in 15.7% (59/375) of the positive cases, which were mostly (49/59, 83%) in pediatric patients. RSV and rhinovirus coinfections were the most prevalent (18/29, 62.7%) dual infections. The distribution of 436 respiratory viruses identified from 375 patients were as follows; 189 (43.3%) RSV, 93 (21.4%) rhinovirus, 86 (19.8%) INF-A, seven (1.6%) INF-B, 22 (5%) PIV types 1-3, 14 (3.2%) HMPV, 11(2.5%) HCoV, nine (2%) HBoV, and five (1.2%) adenovirus. Fifty-five (64%) out of 86 INF-A viruses were subtyped as hH3, 24 (27.9%) were sH1 and seven (8.1%) were hH1. Avian 115 was not detected in any samples. The overall prevalence rates of INF-A, INF-B, RSV and other respiratory viruses were 12%, 1%, 27%, and 14.6%, respectively. RSV was the most prevalent respiratory agent in pediatric (161/313, 51%) cases, while INF-A virus in adult (24/62, 38.7%) patients. Influenza viruses were detected as responsible pathogens in 13.3% (93/700) of the patients with flu-like symptoms. Among the cases, a 1-month-old baby was infected with three virus strains (INF-A hH1+INF-A sH1+HCoV OC43) and a 82-year-old patient was infected with two INF-A virus subtypes (hH3 + sH1). INF-A viruses were mostly detected (79/86) in winter period, from December to March. INF-A virus sH1, was the most prevalent subtype in flu cases till February 2011 (22/86), after replaced by INF-A virus hH3. Beginning from February 2012, a significant increase observed in the cases infected with INF-A virus subtype hH3 (39/86). In conclusion, the identification and surveillance of influenza virus types and subtypes circulating in populations have importance both for epidemiological data and selection of vaccine strains.
