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Öğe Çocukluk çağı lösemilerinde mikroRNA ekspresyonunun lösemi tipi, tedaviye yanıt ve prognoz ile ilişkisinin değerlendirilmesi(Ege Üniversitesi, 2011) Duyu, Muhterem; Çoğulu, ÖzgürÇocukluk yaş grubunda lösemiler %30.2 oranı ile en sık görülen malign hastalıktır. Çocukluk çağı lösemilerinde bazı klinik ve laboratuvar göstergeleri kullanılarak risk gruplandırması ve buna göre tedavi planlaması yapılmaktadır. Aynı yaş ve risk grubundaki hastalarda tedaviye yanıt ve prognozda kişisel farklılıklar gözlenebilmektedir. Prognoz ve tedaviye yanıtta görülen kişisel farklılıkların altında genetik nedenler ileri sürülmektedir. Son yıllarda kanser ve genetik ilişkisine ait yapılan çalışmalarda son derece güncel ve yeni keşfedilen moleküller olan mikroRNA'lar (miRNA) karşımıza çıkmaktadır. miRNA'lar büyüklüğü 19-25 nükeotid arasında değişen, etkisini messenger RNA (mRNA) üzerinden gösteren küçük endojen RNA kümesidir. miRNA'nın en önemli fonksiyonu hedef mRNA'ların fonksiyonunu etkileyerek olmaktadır. Her özgün miRNA hedef mRNA'larını tanıdıktan sonra; translasyonun baskılanması ya da mRNA'nın parçalanması yolu ile işlev görmektedir. miRNA ekspresyonundaki bozukluklar, hedef mRNA'nın fonksiyonunu etkilediği ve dolayısıyla üretilen protein ya da gen ürünlerinin ifadesinde değişikliğe yol açmaktadır. Bu araştırmaya yeni tanı almış 60 akut lösemili çocuk olgu ve 15 kontrol olgusu alındı. Olgular Ege Üniversitesi Pediatrik Hematoloji Bilim Dalı ve Ege Üniversitesi Pediatrik Onkoloji Bilim Dalı, Dokuz Eylül Üniversitesi Hematoloji Bilim Dalı ile Dr. Behçet Uz Çocuk Hastanesi Onkoloji ve Hematoloji Kliniğinden seçildi. Çalışmaya alınan bütün gruplar içinden 3'ü (%5), yapılan RNA izolasyonu işlemi sonrasında, mikroarray çalışmasında yeterli düzeyde sinyalizasyon vermediği için çalışma dışı bırakıldı. Sonuç olarak hasta grubundan 43, kontrol grubundan 14 olgu ile çalışmaya devam edildi. CLC Main Workbech Versiyon 5.5 Softwatre® programı kullanılarak istatistiksel değerlendirme yapıldı. Mean değerine göre fold change değeri ± 2 kat ve daha fazla ekspresyon farkı gösteren miRNA`lar çalışmaya alındı. FDR correction (doğrulama) p değeri <0.05 olan miRNA'lar anlamlı kabul edildi. Hasta grubunda tanıda ortalama yaş 7.2± 4.8, kontrol grubunda ise 6.6± 5.1 olarak saptandı. Hasta grubu akut lenfoblastik lösemi (ALL) ve akut myeloblastik lösemi (AML) olmak üzere iki ana grubu ayrıldı. Hasta grubunun %74'ü (43 olgu) ALL, %26'sı ise (15 olgu) AML grubundandı. Kız erkek dağılımına bakıldığında hasta grubunda kız/erkek oranı 1 ( ALL:0.9, AML:1.1), kontrol grubunda ise 0.8 olarak saptandı. Hasta ve kontrol grubundan elde edilen her bir kemik iliği ve periferik kan örneklerinden güncel miRNA database sistemi Sanger miRBase V16 son versiyonuna baglı kalınarak 1136 çeşit miRNA değerlendirildi. Günümüze kadar miRNA hastalık ilişkisine yönelik yapılan çalışmalarda en geniş taranan miRNA profili çalışmamıza aitti. Lösemide periferik kan örneklerinin doğru miRNA profili yansıtmadığı saptandı. Lösemi tipi, subtipleri, risk grubu, prognoz (eksitus ve relaps olma) ve çeşitli sitogenetik alt tiplerle miRNA ekspresyon profillerinin ilişkisi değerlendirildi ve belirgin ayrımlar olduğu görüldü. Anlamlılık gösteren bazı miRNA'ların, lösemilerle ilişkisinin ilk kez çalışmamızda ortaya konduğu görüldü. Anlamlı miRNA'ların hedef genlerinin lösemi ile ilişkileri ortaya kondu.Öğe Detection of Human Metapneumovirus Prevalence in Pediatric Patients with Lower Respiratory Tract Infections(Ankara Microbiology Soc, 2012) Gokmen, Aysegul Aksoy; Cicek, Candan; Saz, Eylem Ulas; Ozananar, Yeliz; Duyu, MuhteremHuman metapneumovirus (hMPV) which is classified in Paramyxoviridae family has been identified in 2001 as the etiological agent of lower respiratory tract infection (LRTI) especially in children. Previous studies indicated that hMPV prevalence in LRTI is between 2-25%, being resposible for 10% of childhood LRTIs and its isolation rate is approximately 6% in hospitalized patients under age three years. The aim of this study was to investigate the hMPV prevalence in children with LRTI in our region. A total of 100 patients (41 female, 59 male) ages between 0-10 years old (median age: 4.8) and who were admitted to Pediatric Clinics of Ege University Medical Faculty Hospital with the diagnosis of LRTI between January-December 2009 were included in the study. Nasopharyngeal swab samples were taken from those patients during the first three days of their symptoms. The presence of hMPV in the samples were investigated by rapid (shell vial) cell culture method using HEp-2 cell line and by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). The methods were performed to the clinical samples simultaneously. In both methods, a standard strain of hMPV provided by Erasmus University was used as positive control and QCMD-2009 hMPV panel was used as external quality control. In our study, 11 and 2 samples were found positive with cell culture and rRT-PCR methods, respectively. Two of rRT-PCR positive samples were also positive in cell culture, while the other nine were positive by only cell culture method. Both of the methods were performed twice due to inconsistent results, however, the same results were obtained in both runs. Studies with QCMD-2009 panel yielded compatible results for five samples, however a positive standard sample (hMPV A subtype, Ct value: 37.31) was found as negative by rRT-PCR test used in this study (RealAccurateTM, Pathofinder, The Netherlands). Our data showed that the prevalence of hMPV detected by rapid cell culture method was 11% in pediatric patients with LRTIs, the age range of hMPV positive cases was 6 months to 7 years old (median age: 20 months), the majority of the admissions was in winter season and the main clinical picture was bronchiolitis. In addition, rRT-PCR assay used in this study was thought to be insufficient to detect the viral RNA in the event of low levels of hMPV A subtypes. Thereby the cell culture method should be used in addition to the new developing molecular methods for the detection of hMPV until standardization is achieved.Öğe Difficult diagnosis of invasive fungal infection predominantly involving the lower gastrointestinal tract in acute lymphoblastic leukaemia(Elsevier Science Bv, 2016) Avcu, Gulhadiye; Karapinar, Deniz Yilmaz; Yazici, Pinar; Duyu, Muhterem; Polat, Suleyha Hilmioglu; Atabay, Berna; Doganavsargil, Basak; Karapinar, BulentInvasive fungal infections are most commonly seen in immunocompromised patients and usually affect the respiratory system. Gastrointestinal system involvement of mucormycosis and invasive aspergillosis is rarely reported in childhood. Here we describe a 5 year old boy with acute lymphoblastic leukaemia who developed invasive fungal infection particularly affecting the lower gastrointestinal system to emphasise the difficulties in diagnosis and management of invasive fungal infections in immunocompromised patients. (C) 2016 The Authors. International Society for Human and Animal Mycology. Published by Elsevier B.V.Öğe Early extracorporeal life support experiences in 2 tertiary pediatric intensive care units in Turkey(Tubitak Scientific & Technical Research Council Turkey, 2014) Ozturk, Makbule Nilufer; Ak, Koray; Erkek, Nilgun; Yesil, Edanur; Duyu, Muhterem; Yazici, Pinar; Engin, Aysen Yaprak; Karapinar, BulentBackground/aim: Extracorporeal membrane oxygenation (ECMO) is a unique life-support modality offered to patients unresponsive to optimal medical therapy. The aim of this study was to evaluate early experiences with ECMO support in 2 tertiary Turkish pediatric intensive care units (PICUs). Materials and methods: We retrospectively evaluated a total of 10 ECMO-supported patients between March 2012 and March 2013 in Marmara and Ege University Hospital PICUs. We reported data regarding demographics, laboratory and diagnostic information, and the clinical course of the patients. Results: The study consisted of 6 males and 4 females from 5 months to 14 years of age (mean age: 0.5 +/- 5.01 years) supported with ECMO. Out of the 10 patients, 8 were on venovenous ECMO for respiratory failure and 2 received venoarterial ECMO for cardiac failure. Mean ECMO and intensive care duration was 11.1 +/- 7.3 days and 23.5 +/- 17.8 days, respectively. Bleeding was the most common complication (60%). Forty percent of the patients were weaned from ECMO, among which 50% were discharged in good health without sequelae. Conclusion: Initial experiences build the learning curve of institutions, and our early results are encouraging. Giving time to heal to the right patient at the right time is the key to success.Öğe The Effect of Aminoglycosides on Colistin-Containing Regimens in the Treatment of Carbapenem-Resistant Gram-Negative Infections in Pediatric Intensive Care Units: A Two-Center Experience(2019) Bal, Zümrüt Şahbudak; Kamit, Fulya; Duyu, Muhterem; Yazıcı, Pınar; Anıl, Ayşe Berna; Yılmaz, Dilek Çiftdoğan; Çilli, FerihaObjective: This study aimed to assess the outcomes including morbidity and mortality of carbapenem-resistant gram-negative (CRGN) infections in pediatric critical care setting. the second aim was to investigate the impact of aminoglycosides on colistin-containing regimen in CRGN-infected pediatric critical care patients. Materials and Methods: We retrospectively evaluated medical records of 82 patients who had received colistin in combination with an aminoglycoside (CA group) or another antibiotic (CO group) at two reference pediatric intensive care units (PICUs) between February 2011 and February 2016. Results: We enrolled 82 CRGN-infected patients who were admitted to PICUs of two hospitals. the median age of the patients was 24 (25th–75th percentile; 8–78.75) months, and the median duration of hospital stay was 30 days (25th–75th percentile; 16.7–57.7). No statistical difference was observed in the variables, including microbiological response, attributable mortality, crude mortality, and the duration of achieving first negative culture (p>0.05). Clinical response was significantly more observed in the CA group (85.5% vs. 63.2; p=0.048), and attributable mortality was higher in the CO group (12.7% vs. 31.6%; p=0.055). Nephrotoxicity did not show statistical difference between groups (p=0.357), and neurotoxicity was not observed. Conclusion: Colistin-containing regimen in combination with an aminoglycoside may be an effective and safe antimicrobial agent without a significant increase in side effects.Öğe The Effect of Aminoglycosides on Colistin-Containing Regimens in the Treatment of Carbapenem-Resistant Gram-Negative Infections in Pediatric Intensive Care Units: A Two-Center Experience(Erciyes Univ Sch Medicine, 2019) Bal, Zumrut Sahbudak; Kamit, Fulya; Duyu, Muhterem; Yazici, Pinar; Anil, Ayse Berna; Yilmaz, Dilek Ciftdogan; Yilmaz, Nisel Ozkalay; Cilli, Feriha; Karapinar, BulentObjective: This study aimed to assess the outcomes including morbidity and mortality of carbapenem-resistant gram-negative (CRGN) infections in pediatric critical care setting. The second aim was to investigate the impact of aminoglycosides on colistin-containing regimen in CRGN-infected pediatric critical care patients. Materials and Methods: We retrospectively evaluated medical records of 82 patients who had received colistin in combination with an aminoglycoside (CA group) or another antibiotic (CO group) at two reference pediatric intensive care units (PICUs) between February 2011 and February 2016. Results: We enrolled 82 CRGN-infected patients who were admitted to PICUs of two hospitals. The median age of the patients was 24 (25th-75th percentile; 8-78.75) months, and the median duration of hospital stay was 30 days (25th-75th percentile; 16.7-57.7). No statistical difference was observed in the variables, including microbiological response, attributable mortality, crude mortality, and the duration of achieving first negative culture (p>0.05). Clinical response was significantly more observed in the CA group (85.5% vs. 63.2; p=0.048), and attributable mortality was higher in the CO group (12.7% vs. 31.6%; p=0.055). Nephrotoxicity did not show statistical difference between groups (p=0.357), and neurotoxicity was not observed. Conclusion: Colistin-containing regimen in combination with an aminoglycoside may be an effective and safe antimicrobial agent without a significant increase in side effects.Öğe The evaluation of safety and efficacy of colistin use in pediatric intensive care unit: Results from two reference hospitals and review of literature(Elsevier Science Bv, 2018) Bal, Zumrut Sahbudak; Can, Fulya Kamit; Yazici, Pinar; Anil, Ayse Berna; Duyu, Muhterem; Ciftdogan, Dilek Yilmaz; Yilmaz, Ozkalay Nisel; Cilli, Feriha; Karapinar, BulentColistin, an old cationic polypeptide antibiotic, have been reused due to rising incidence of infections caused by multi-drug resistant (MDR) Gram-negative microorganisms and the lack of new antibiotics. Therefore, we evaluated safety and efficacy of colistin in treatment of these infections. This study included 104 critically ill children with a median age of 55,9 months between January 2011 and January 2016. Nephrotoxicity occurred in 11 (10.5%) patients. Nephrotoxicity occurred between the third and seventh day of treatment in 63% of colistin induced nephrotoxicity episodes. The subgroup analysis between the patients who developed nephrotoxicity during colistin treatment and those that did not, showed no significant difference in terms of age, underlying disease, cause for PICU admission and type of infection required colistin treatment, P values were 0.615, 0.762, 0.621, 0.803, respectively. All patients were receiving a concomitant nephrotoxic agent (P = 0,355). The majority of the patients (52%) were having primary or secondary immune deficiency in treatment failure group and the most common cause of PICU admission was sepsis in treatment failure group, P values were 0.007 and 0.045, respectively. Mortality attributed to colistin failure and crude mortality were 14.4% and 29.8%, respectively. In conclusion, colistin may have a role in the treatment of infections caused by multidrug-resistant Gram-negative bacteria in critically ill children. However, the patients have to be followed for side effects throughout colistin treatment, not for only early stage. And the clinicians should be aware of increase in the rate of nephrotoxicity in patients those have been receiving a concomitant nephrotoxic agent. (C) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Öğe Inferior Petrosal Sinus Thrombosis in a Child due to Malposition of Central Venous Catheter: A Case Report(Karger, 2017) Akinci, Burcu; Duyu, Muhterem; Alkilic, Liya; Karapinar, Deniz Yilmaz; Karapinar, BulentObjective: To report a case of inferior petrosal sinus thrombosis associated with malposition of central venous catheterization (CVC). Clinical Presentation and Intervention: A 5-month-old boy was admitted to Sifa University Hospital because of pneumonia. When exophthalmos occurred in the right eye, he was referred to Ege University Hospital. Cranial magnetic resonance imaging and magnetic resonance venography confirmed that the catheter in the right inferior petrosal sinus caused the thrombosis. The catheter was extracted and anticoagulant treatment was started. Conclusion: In this case report, malpositioning of the CVC was the cause of the thrombosis. To minimize such complications, catheterization should be done with the supervision of an expert and postprocedure radiography should also be performed. (C) 2017 The Author(s) Published by S. Karger AG, BaselÖğe Leukapheresis in Childhood Acute Leukemias: Single-Center Experience(Informa Healthcare, 2014) Yilmaz, Deniz; Karapinar, Bulent; Karadas, Nihal; Duyu, Muhterem; Yazici, Pinar; Ay, Yilmaz; Balkan, Can; Aydinok, Yesim; Kavakli, KaanHyperleukocytosis in patients with leukemia is associated with early mortality, especially due to the pulmonary and neurological complications of leukostasis. The prompt use of leukapheresis may improve patients' survival in the initial treatment period. The medical records of all previously untreated acute leukemia patients were reviewed to determine whether there was hyperleukocytosis at presentation. This study summarizes a single-center experience of leukapheresis that was applied to 12 children with acute leukemia and hyperleukocytosis. The median leukocyte count at diagnosis was 589,000/mm(3) (range: 389,000-942,000/mm(3)) for ALL patients and 232,000/mm(3) (range: 200,000-282,000/mm(3)) for AML patients. A central venous catheter (CVC) was inserted, and leukapheresis procedures were repeated at 12-hour intervals. A total of 29 leukapheresis cycles were performed on 12 children. The median number of cycles of leukapheresis required by each patient was two (range: 1-4). The median absolute and percentage reductions in white blood cell (WBC) count after the first cycle of leukapheresis were 113,000/mm(3) (range: 55,000-442,000/mm(3)) and 36% (range: 16-57.4%), respectively. As a laboratory finding, mild hypocalcemia was the most frequently observed complication. No patients developed any other problem related to the procedure. Our results showed that leukapheresis is a safe and effective procedure if performed by experienced staff.Öğe Noninvasive ventilation in cancer children with acute respiratory failure(Elsevier Science Bv, 2017) Yilmaz, Sema; Yildizdas, Riza Dincer; Dursun, Oguz; Karapinar, Bulent; Kendirli, Tanil; Demirkol, Demet; Citak, Agop; Kupesiz, Alphan; Tekguc, Hakan; Duyu, Muhterem; Yazici, Pinar; Yukselmis, Ufuk; Odek, Caglar; Yaman, Ayhan; Bayraktar, Suleyman; Sik, Guntulu; Cakir, Fatma BetulObjective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/ FiO2 ratios were (164.22 +/- 37.24) and (126.80 +/- 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.Öğe Politravma ile izlenen çocuklarda surveyi etkileyen faktörlerin değerlendirilmesi(Ege Üniversitesi, 2015) Duyu, Muhterem; Karapınar, Bülent; Kılınç, Mehmet ArdaPolitravma, intraserebral basınç ölçümü, glaskow sonuç skorıf.;Çocukluk çağında travma , bu yaş grubunda mortalite ve morbiditenin en önemli sebeplerinden biridir. Politravma ile başvuran çocuklarda yaş gruplarına göre travma şekli, travma bölgesi ve mortalite oranları değişmektedir. Kafa travması çocukluk yaş grubunda önemlibir sağlık sorunudur. Bu yaş grubunda sağlık kuruluşlarınabaşvuran kafa travması olgularının yıllık insidansı % 12 olarak bildirilmektedir. Yatarak tedavi gören olguların yıllık insidansı ise yaklaşık binde 2-3 olup, erkek çocuklarda iki kat fazla sıklıkta görülmektedir. Mortalite oranı çeşitli kaynaklara göre değişmekle birlikte % 2-15 arasında bildirilmektedir. Bu hastaların erken hospitalizasyon sırasında yakın monitörize edilerek izlenmesi, sekonder hasarlanma açısından özellikle kafa travmalı olgularda rehbere dayalı hedefe yönelik tedavinin düzenlenmesi prognoz açısından oldukça önemlidir. Bu çalışmada da yakın hemodinamik monitörizasyon ve hızlı tedavi uygulamaları ile politravma ile izlenen çocuklarda prognozu etkileyen faktörlerin değerlendirilmesi, epidemiyolojik özellikler ile ilişkisinin değerlendirilmesi amaçlanmıştır. Çocukluk çağı kafa travmalarının yarıya yakınının nedeni düşmeydi ve bu olguların prognozu iyi bulundu. Okul çağında ise ilk sırayı trafik kazaları aldı. Trafik kazaları gerek giriş GKS gerekse prognoz açısından en ağır travma tipiydi. Hastanın politravmalı oluşu, subdural hematom, serebral kontüzyon, subaraknoid kanama, intraserebral hematom, serebral ödem, diffüz aksonal varalaı maya sahip olması ve ameliyat gerektiren bir kranyal hasar bulunması kötü prognozla ilişkili bulundu.;Politrauma, intracerebral pressure measurement, glaskow coma score.Öğe Prospective Evaluation of Whole Genome MicroRNA Expression Profiling in Childhood Acute Lymphoblastic Leukemia(Hindawi Publishing Corporation, 2014) Duyu, Muhterem; Durmaz, Burak; Gunduz, Cumhur; Vergin, Canan; Karapinar, Deniz Yilmaz; Aksoylar, Serap; Kavakli, Kaan; Cetingul, Nazan; Irken, Gulersu; Yaman, Yontem; Özkınay, Ferda; Cogulu, OzgurDysregulation of microRNA (miRNA) expression contributes to the pathogenesis of several clinical conditions. The aim of this study is to evaluate the associations between miRNAs and childhood acute lymphoblastic leukemia (ALL) to discover their role in the course of the disease. Forty-three children with ALL and 14 age-matched healthy controls were included in the study. MicroRNA microarray expression profiling was used for peripheral blood and bone marrow samples. Aberrant miRNA expressions associated with the diagnosis and outcome were prospectively evaluated. Confirmation analysis was performed by real time RT-PCR. miR-128, miR-146a, miR-155, miR-181a, and miR-195 were significantly dysregulated in ALL patients at day 0. Following a six-month treatment period, the change in miRNA levels was determined by real time RT-PCR and expression of miR-146a, miR-155, miR-181a, and miR-195 significantly decreased. To conclude, these miRNAs not only may be used as biomarkers in diagnosis of ALL and monitoring the disease but also provide new insights into the potential roles of them in leukemogenesis.Öğe Risk Factors of Bloodstream Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Pediatric Critical Care Settings(2019) Bal, Zümrüt Şahbudak; Duyu, Muhterem; Kamit, Fulya; Yazıcı, Pınar; Anıl, Ayşe Berna; Çiftdoğan, Dilek Yılmaz; Çilli, FerihaAim: Infections and sepsis are the leading causes of death in non-cardiac intensive care units (ICUs) and account for 40 percent of all ICU expenditures. Data regarding bloodstream infections (BSIs) due to a carbapenem-resistant gram negative (CRGN) microorganisms in pediatric ICUs still remain limited. Materials and Methods: This study was conducted retrospectively in patients who were admitted to two pediatric critical care units between January 2011 and December 2017. Patients were assigned to two groups. Patients with BSI caused by a CRGN microorganism and infections were assigned to the BSI group and those other than BSI were assigned to the non-BSI group. Results: This study included 89 critically ill children with a mean age of 52.1 (±65.1) months. the requirements for invasive procedures including tracheostomy, Foley catheter and central venous catheter were not statistically different among the groups, p values were 0.159, 0.291 and 0.803, respectively. the majority of the patients admitted to pediatric intensive care unit were due to sepsis/septic shock in the BSI group (n=18, 58%) and in the non-BSI group, this figure was 37.9% (n=24). Prior third/fourth generation cephalosporin exposure was significantly more common in the BSI group (51.6% vs 15.5%, p<0.001), carbapenem exposure was not significantly different among the groups (35.5% vs 56.9%, p=0.054). Neutropenia (<500/mm3) and thrombocytopenia (150x103/mm3) were significantly more common in the BSI group (p=0.011 and p=0.010) and the C-reactive protein level was significantly higher (p=0.018). Crude and attributable mortality did not show any significance between the groups, p values were 0.578 and 0.955, respectively. Conclusion: CRGN infections are still a major cause of morbidity, mortality and healthcare associated infections. in this study, we evaluated patients with BSI due to a CRGN microorganism and compared them with other infection types. the risk factors and outcomes were similar except for prior cephalosporin exposure. As a conclusion, we have to enhance infection control programs and prevent patients from redundant antibiotic exposure.Öğe Soft tissue infection caused by Burkholderia cepacia in a child with polyarteritis nodosa(Turkish J Pediatrics, 2012) Yildiz, Basak; Duyu, Muhterem; Sozeri, Betul; Karapinar, BulentBurkholderia cepacia belongs to a family of Burkholderia species previously described as Pseudomonas cepacia, especially in patients suffering from cystic fibrosis. There are also many studies about this agent in the last decade due to their life-threatening infections and ability to invade mucosal and cellular surfaces. Here, we report a case of soft tissue infection caused by B. cepacia in a child with an underlying condition of polyarteritis nodosa. Her complaints started at two months of age and she was on cyclosporine therapy. She was treated several times because of soft tissue infections especially in her extremities. The most common causative agents were Pseudomonas spp. and Escherichia coli, but recently, another soft tissue infection accompanied by fever and signs of sepsis had developed. All blood, urine and tissue (debrided from the necrotic area) specimens were incubated. Empirical antibiotherapy with clindamycin was started and cyclosporine therapy was discontinued. B. cepacia was grown in the tissue specimen culture and was only susceptible to carbapenems. Meropenem therapy was administered throughout 14 days with a daily dosage of 60 mg/kg, and she was treated successfully at least in this attack of soft tissue infection, which caused more severe sepsis and tissue damage than the previous infections with other agents.Öğe Thanks to Trauma A Delayed Diagnosis of Pott Disease(Lippincott Williams & Wilkins, 2015) Avcu, Gulhadiye; Bal, Zumrut Sahbudak; Duyu, Muhterem; Akkus, Eser; Karapinar, Bulent; Vardar, FadilÖğe The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department(Turkish Soc Gastroenterology, 2010) Saz, Eylem Ulas; Arikan, Cigdem; Ozgenc, Funda; Duyu, Muhterem; Ozananar, YelizBackground/aims: We aimed to identify the presence of ingested metallic foreign bodies with handheld metal detector in the pediatric population. Methods: All children (n=40) known or suspected to have ingested a MFB and who presented to the Emergency Department of the Children's Hospital of Ege University were prospectively ascertained. All patients underwent both radiographic evaluation and handheld metal detector scanning of the chest and abdomen on their presentation. In the present prospective study, we compared handheld metal detector scanning with plain radiography. Results: The end point of the study compared metallic foreign body findings with handheld metal detector vs radiological findings during an eight-month period. Forty subjects with possible metallic foreign body ingestion were enrolled into the study. The principle investigator scanned all subjects. Disease was defined by the presence of a foreign body in the gastrointestinal tract on radiograph. Radiographically, 35 foreign bodies were found, and handheld metal detector revealed 31 of them. The sensitivity of handheld metal detector was 88.6% (95% confidence interval [CV: 72.1%-96.5%), specificity 100% (95% CI: 61.8%-100%), positive predictive value (PPV) 100% (95% CI: 85.8%-100%), and negative predictive value 55.5% (95% CI: 34.3%-84.6%). Handheld metal detector revealed that 2 metallic foreign bodies (1 pushpin, I coin) were localized to the chest, which was confirmed by radiography, and urgent removal was performed with endoscopy. Conclusions: Handheld metal detector scanning is an accurate, inexpensive, radiation-free screening tool and should be used for evaluation of patients suspected of ingesting metallic foreign bodies.Öğe The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department(2010) Saz, Eylem Ulaş; Arıkan, Çiğdem; Özgenç, Funda; Duyu, Muhterem; Ozananar, YelizMetalik yabancı cisim yutan çocuklarda metal dedektör kullanımının cismi saptamadaki duyarlılığını saptamak. Yöntem: Çalışma periyodu içinde metalik yabancı cisim yutan ya da yutma şüphesi olan 40 çocuk, Ege Üniversitesi Tıp Fakültesi Hastanesi Çocuk Acil servisine başvurdu. Tüm hasta verileri prospektif olarak daha önceden hazırlanmış formlara işlendi. Hastalar hem grafi hem de dedektörle yabancı cisim açısından tarandı. Dedektörle göğüs kafesi, abdomen ve inguinal bölge tarandı. Sonuçlar radyolojik bulgularla karşılaştırıldı. Bulgular: Sekiz aylık çalışma periyodu içinde metalik yabancı cisim yutan ya da şüphesi olan toplam 40 çocuk çalışmaya alındı. Hastalık gastorintestinal sistemde radyolojik olarak yabancı cisim varlığı olarak tanımlandı. Toplamda 35 çocukta yabancı cisim radyolojik olarak saptanırken dedektör bunlardan 31 tanesini tanıyabildi. Dedektör sensitivitesi %88.6 (95% güvenlik aralığı [CI], 72.1%-96.5%), spesifisitesi %100 (95% CI, 61.8%100%), pozitif prediktif değer 100% (95% CI, 85.8%-100%), ve negatif prediktif değer % 55.5 (95% CI, 34.3%-84.6%). Dedektör ile göğüs kafesi taramasından 1 i toplu iğne diğeri de para olmak üzere 2 yabancı cisim saptandı. Bunlar radyolojik olarak özefagusta tespit edildi ve endoskopik olarak acilen çıkartıldı. Sonuç: Metalik yabancı cisim yutan çocuklarda dedektör kullanımı güvenilir, ucuz ve radyasyon yaymayan bir yöntemdir. Tarama testi olarak kullanıma uygun olduğu tespit edilmiştir.Öğe Whole Genome microRNA Expression Data in Childhood Acute Lymphoblastic Leukemia and Evaluation of microRNA Pathways Using Fuzzy C-means(2021) Özgür, Su; Orman, Mehmet Nurullah; Çoğulu, Özgür; Duyu, Muhterem; Bağca, Bakiye GökerObjective: Hard clustering approaches may cause some of the relationships to be overlooked due to their nature of algorithms especially in genetic datasets. But hidden relationships can be revealed by fuzzy approaches. Purpose of this study was evaluating effect of microRNAs (miRNA) on children with acute lymphoblastic leukaemia (ALL) by using miRNA expression data obtained from bone marrow samples with sets containing different numbers of elements of fuzzy Cmeans (FCM). Material and Methods: miRNA expression levels of 43 newly diagnosed ALL patients and 14 healthy subjects were analysed via FCM. Clusters containing different numbers of miRNAs were evaluated, common properties in messenger RNA (mRNA) pathways were investigated and new pathways associated with ALL and cancer were described via miRNA target prediction tools. Results: Significant miRNA profile was compared to control cases. Only 46 out of 108 miRNAs were found to be significantly upregulated or downregulated. Of forty six miRNAs: 8 miRNAs were labelled as tumour suppressor (17.4%), 17 miRNAs were labelled as onco-miR (37.0%) and 21 miRNAs could not be labelled (45.6%) for hematological malignancy. Fourteen (%30.4) miRNAs were found to be apoptosis-related, 27 miRNAs were in leukemia-related (58.7%) and 15 labelled miRNAs were related with cancer pathways (32.6%). hsa-miR-181b, hsa-miR- 146a, hsa-miR-155, hsa-miR-181c-5p, hsa-miR-7-1-3p, hsa-miR-708- 5p onco-miRs constituted a set. These miRNAs targeted 801 common mRNAs (p<0.05). When this sub-cluster was searched in the literature and miRNA target prediction tools system, it was found to be involved in cancer-related pathways except ALL. Conclusion: Hidden relationships can be defined by fuzzy approaches and those pathways may provide guidance to open up new horizons in the field of miRNA studies.
