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Öğe Asthma-like symptom or “cystic fibrosis asthma”?(2021) Öztürk, Gökçen; Gülen, Figen; Demir, Esen; Eşki, AykutIntroduction: The diagnosis of asthma is still a difficult problem in cystic fibrosis. There is no consensus on how to define “CF asthma”. The aim of this study was to determine the role of bronchodilator response and laboratory evidence of allergy in “CF asthma”. Materials and Methods: Patients aged ?6 years with evaluated bronchodilator response and characteristics of atopy were included in the study. Patients diagnosed with Allergic Bronchopulmonary Aspergillosis or pulmonary exacerbation were excluded. Results: A total of 204 CF patients were evaluated, and 40 who met the criteria were included. Asthma had been diagnosed in ten patients. A positive bronchodilator response was present in 47.3% of the patients tested. Aeroallergen sensitization was present in 52.5% of the patients. While the frequency of recurrent/history of wheezing, family history of atopy and elevated total immunoglobulin E were similar (p> 0.05), the frequencies of inhaled medication use and coexistence of asthma were statistically higher in the group with positive allergen sensitization (p< 0.05). The frequencies of positive bronchodilator response (77.7% versus 37.9%) and a family history of asthma/atopy (40% versus. 23%) were found to be similar in CF asthma and CF. There were significant increases in total IgE and allergen-specific IgE and an increase in the frequency of aeroallergen sensitization in CF asthma compared to CF (p< 0.05). Conclusion: Although not routinely used in the evaluation of patients, allergen specific-IgE and skin prick test for aeroallergen sensitization may be used as an adjunctive test in patients with suspected clinical findings. The recognition of CF asthma may facilitate the development of targeted therapiesÖğe Atelectasis: An Uncommon Sign of Achalasia inChildhood(2021) Alper, Hüdaver; Öztürk, Gökçen; Gülen, Figen; Demir, Esen; Eşki, Aykut; Şakul, Gözde; Divarcı, EmreAn 11-year-old boy presented to our pediatric pulmonology clinic with a 3-month history of atelectasis evident onhis chest radiography. Breath sounds revealed fine crackles in the right lower zone and rhonchi in the upper zones.His initial pulmonary function test was compatible with restrictive pulmonary disease. Chest tomography revealedthat the trachea, right intermediate, and middle lobe bronchi were narrowed by megaesophagus. Esophagogramdetermined dilatation of the esophagus and “bird-beak” sign in the esophagogastric junction but it was not suffi cient to diagnose. Esophageal manometry which is the gold standard test for achalasia was performed and type 2achalasia was diagnosed. His symptoms improved following Heller myotomy conducted together with Dor fun doplication. Although respiratory problems are more common in infants and younger children, atypical respiratorypresentations may also occur during adolescence. Achalasia should be one of the rare differential diagnoses ofpediatric restrictive pulmonary disease.Öğe Bronşektazili çocuklarda kapsamlı göğüs fizyoterapi programına ilave edilen osilatuar pozitif ekspriratuar basınç (OPEP) cihazının etkinliğinin araştırılması(Ege Üniversitesi, 2022) Gülen, Figen; Demir, Esen; Barlık, Meral; Zeren, Melih; Tosun, Beyza NurArkaplan: Bronşektazili hastalarda havayollarındaki balgamı uzaklaştırmak ve akciğer ventilasyonunu geliştirmek adına havayolu temizleme tekniklerin uygulanması önerilmektedir. Osilatuar (titreşimli) Pozitif Ekspiratuar Basınç (OPEP) cihazları, hastalara öğretilmesi ve kullanımı kolay oldukları için klinik pratikte yaygın olarak kullanılan bir havayolu temizleme tekniğidir. Ancak bu cihazlar ülkemizde geri ödeme kapsamında değildir. Amaç: Bu projenin amacı, klasik göğüs fizyoterapi programına eklenen OPEP cihazının hastalara sağlayacağı ilave faydayı araştırmaktır. Böylece, havayolu temizliğinin sağlanması amacıyla hastaları mali bir yük altına sokmanın gerekliliği incelenecektir. Gereç ve yöntem: Bronşektazi tanısı ile takip edilen 42 çocuk hasta randomize şekilde göğüs fizyoterapisi grubu (FTR grubu) ve göğüs fizyoterapisi + OPEP cihazı grubu (FTR+OPEP grubu) olmak üzere 2'ye ayrıldı. Hastalar egzersizlerini ev temelli olarak günde 2 kez, haftanın her günü, 8 hafta süre ile gerçekleştirdi. Egzersiz kapasitesi, solunum fonksiyonları, efora gösterilen ventilatuar yanıtlar, kas kuvveti ve yaşam kalitesi çalışmanın başında ve sonunda değerlendirildi. Bulgular: Solunum fonksiyon testi parametrelerinden FVC (%pred), FEV1 (%pred), FEF25-75 (%pred), 6-dk yürüme testi mesafesi, efor sırasındaki dinamik hiperinflasyonu gösteren ?IC, efor sırasındaki en düşük SpO2 (%) ve quadriceps kas kuvveti iki grupta da istatistiksel olarak anlamlı şekilde gelişti (p<0, 05). Meydana gelen gelişmeler açısından gruplar arasında fark saptanmadı (p>0, 05). Sonuç: Solunum egzersizleri, postural drenaj ve öksürüğü geliştirme tekniklerini içeren kapsamlı bir göğüs fizyoterapisi programına OPEP cihazlarının eklenmesi ilave bir fayda sağlamamaktadır. Kapsamlı bir göğüs fizyoterapi programı ile hastalar herhangi bir mali yük altına sokulmadan solunum fonksiyonları, egzersiz kapasitesi ve kas kuvveti geliştirilebilir. Ancak, fizyoterapi programlarına erişemeyen ya da bu programlara bağlılığı düşük olan hastalarda OPEP cihazları kullanılması düşünülebilir.;Bronşektazi, sekresyon, fizyoterapi, solunum fonksiyonları, egzersiz kapasitesi.;Bronchiectasis, secretion, physiotherapy, pulmonary function, exercise capacity.Öğe Early diagnosis effects the prognosis in children with atypical wheeze(2020) Severcan, Ezgi Ulusoy; Demir, Esen; Gülen, Figen; Bilgin, Raziye Burcu Güven; Tanaç, RemziyeAim: Recurrent wheezing is a common problem in preschool children. It is classified into two groups because there can be many reasons for wheeze: typical and atypical. The aim of this study was to identify the general features of atypical wheezy children. Material and Methods: Three hundred two children who presented to our clinic between 2000 and 2015 for three or more wheezing attacks and were diagnosed as having an underlying disease such as bronchiectasis, foreign body aspiration, recurrent aspiration pneumonia, cystic fibrosis, bronchopulmonary dysplasia, congenital anomalies, and tuberculosis, were included in the study. Results: In this study, 127 (42.1%) girls and 175 (57.9%) boys were evaluated. The diagnostic distribution of the patients was as follows: bronchopulmonary dysplasia (21.9%), bronchiolitis obliterans (16.6%), bronchiectasis (14.5%), bronchiolitis obliterans + primary immunodeficiency (12.3%), cystic fibrosis (10.3%), bronchiectasis + primary immunodeficiency (7.9%), recurrent aspiration pneumonia (3.6%) and foreign body aspiration (3.3%), and other diseases (9.6%). Mosaic oligemia, bronchiectasis, atelectasis, bronchiolectasis, and small airway disease were the most distinct findings on high-resolution lung tomography. When the patients were evaluated clinically, radiologically, and according to pulmonary functions after an average period of 40 months, it was seen that 9.2% deteriorated, 33.9% regressed, and 56.7% remained stable. Presentation to hospital after the first attack occurred earlier in patients with bronchopulmonary dysplasia, bronchiolitis obliterans and bronchiolitis obliterans + primary immunodeficiency compared with patients with bronchiectasis, bronchiectasis + primary immunodeficiency, and cystic fibrosis. When presentation time and outcomes were evaluated, it was found that 63.4% of patients who presented to hospital early (0–6 months) and 7.5% of patients who presented late (after 5 years) had regression. Conclusion: Recurrent wheezy children must be promptly evaluated for an underlying disease. Early diagnosis and treatment influence the prognosis.Öğe Ege bölgesinde alerjik hastalıkların prevalansında son sekiz yıldaki değişiklikler(Ege Üniversitesi, 2004) Gülen, Figen; Demir, EsenÖZET: Ege Bölgesinde Alerjik Hastalıkların Prevalansında Son Sekiz Yıldaki Değişiklikler Ege bölgesinin 7 ilinde 1993-1994 yıllan arasında yapılan çalışmada astım, alerjik rinit, alerjik konjunktivit ve alerjik deri hastalığı sıklığım sırasıyla %3.8, %4.6, %12,6 ve %19.4 olarak belirlenmişti. Son yıllarda tüm dünyada prevalansın artmasına paralel olarak, bölgemizde de prevalansın arttığı düşünülerek aynı yöntemle bölgede araştırma yapılması planlandı. AMAÇ: Bu çalışmada önceki araştırmadaki yöntem kullanılarak son 8 yılda Ege Bölgesi okul çocuklarında alerjik hastalıkların prevalansı ve bu prevalansı etkileyen faktörlerdeki değişikliklerin araştırılması amaçlanmıştır. HASTALAR VE YÖNTEM: Bu çalışmaya 2001-2002 öğretim yılında İzmir, Manisa, Uşak, Kütahya, Afyon, Denizli, Muğla ve Aydm illerindeki ilköğretim okullarına devam eden, yaşlan 6-18 yaş arasında değişen, %51.8'i erkek, %48.2'si kız olmak üzere 3370 çocuk randomize olarak alınmıştır. Çocuklara anket çalışması, fizik muayene, sp IgE ve PEF ölçümleri uygulanmıştır. BULGULAR: Çocukların %21,2'si en az bir kez hışıltı atağı geçirmişken astım oranı %6,4 bulunmuştur. Alerjik rinit, alerjik konjunktivit, alerjik deri hastalığı sırasıyla %13,6, %13,2 ve %23,7 olarak saptanmıştır. Alerjik konjunktivit ve alerjik deri hastalığı sıklığı, önceki çalışmamızla benzer 64şekilde Muğla ilinde en yüksek oranlarda iken, astım Aydın'da, alerjik rinit ise Kütahya illerinde en sık bulunmuştur. Ege Bölgesi genelinde astım %2.6, alerjik rinit %9, alerjik konjunktivit %0,6 oranında artış göstermiştir. Astımda cinsiyet farkı gözlenmezken alerjik rinit, alerjik konjunktivit ve alerjik deri hastalıkları anlamlı olarak kızlarda yüksek oranda bulunmuştur. Alerjik hastalıkların sıklığını etkileyen faktörler araştırıldığında astım ile geçirilmiş hışıltı atağı, ailede astım öyküsü arasında anlamlı ilişki gösterilirken parazitoz, düşük sosyoekonomik durum, pasif sigara içimi ile anlamlı ilişki gösterilememiştir (p>0,05). PEF değerleri, hışıltı atağı geçiren çocuklarda anlamlı olarak düşük saptanmıştır (p<0,05). Çocukların 396'sında spigE araştırılmış ve %17,6 oranında pozitif bulunmuştur. SONUÇ: Ege bölgesi okul çocuklarında alerjik hastalıkların, özellikle solunum yolu alerjik hastalıklarının prevalansı artmıştır. Solunum yolu alerjilerinin artmasına neden olan çevresel faktörleri inceleyen geniş çaplı araştırmalara ihtiyaç olduğu düşünülmüştür. 65Öğe Investigation of Short and Long-TermComplications of Respiratory System AfterEsophageal Atresia and/or TracheoesophagealFistular Surgery(2020) Öztürk, Gökçen; Gülen, Figen; Demir, Esen; Eşki, AykutObjective: Esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) is one of the common developmental anomalies of the foregut. Despite advances in surgical techniques and postoperative care, respiratory system complications affect the quality of life of patients. We planned to evaluate our patients in terms of the general features, the risk factors for respiratory morbidity and short- and long-term respiratory complications after corrective surgical treatment. Method: Thirty-six patients with the diagnosis of EA and/or TEF and followed after surgical treatment between 2002 and 2019 were retrospectively enrolled in the study.Results: The most common symptom was chronic cough (77.7%) and wheezing (41.6%). Recurrent pulmonary infections were present in the great majority of the patients. The frequency of pulmonary infections was higher in patients who had undergone dilatation due to stricture (N=14) and in patients with recurrent TEF (N=6) and malacia (N=10). Bronchiectasis was present in eight patients and hospital admission due to infections was highly frequent. Aeroallergen sensitivity was detected in four and food allergy in five patients. Scoliosis was present in 33.3% of the patients all of whom had recurrent pulmonary infections. Pulmonary function tests were performed in 10 patients. Five patients had impaired pulmonary function. Medical treatment for reflux was given to the majority of patients (N=30), while fundoplication was performed in 10 patients. Most of the patients had a significant decrease in the frequency of pulmonary infections after the procedure. Conclusion: The etiology of pulmonary complications is multifactorial and many factors affect each other. Evaluation and management of the patients for each complication will improve the quality of life and comfort of the patientsÖğe Nasal fluid sample as a reliable matrix for determination of cytokine levels in childhood asthma(Walter De Gruyter Gmbh, 2023) Doulatpanah, Mojtaba; Kocamanoglu, Meltem; Yıldırım Sözmen, Eser; Kartal Öztürk, Gökçen; Demir, Esen; Gülen, Figen; Akçay, YaseminObjectives: Childhood asthma is a chronic disease with high incidence worldwide. As a lifelong disease, asthma has episodes. Inflammation continues to occur in the clinical remission of asthma. It can be difficult to diagnose childhood asthma, especially in clinical remission. We hypothesized that some cytokines secreted to nasal fluid from the airway during inflammation might help diagnose clinical remission of asthma. Moreover, sampling nasal fluid is an easy and non-invasive procedure, so it may be a preferable sampling method.Methods: We measured levels of some interleukins (ILs), which are IL-4, IL-5, IL-6, IL-12p70, IL-13, IL-33, granulocyte-macrophage colony-stimulating factor (GM-CSF), periostin and thymic stromal lymphopoietin (TSLP) by Luminex magnetic bead-based immunoassay in nasal fluid and in serum of asthmatic children in clinical remission.Results: We found that IL-5, IL-6, IL-33, and periostin had elevated levels in nasal fluid. IL-5 and IL-33 had increased levels in the nasal fluid of the patients with immunoglobulin E (IgE) high and low phenotypes. While the nasal fluid TSLP levels were positively correlated with most of the increased serum cytokine levels of non-allergic asthmatic children, the nasal fluid GM-CSF levels were positively correlated with most of the increased serum cytokine levels of the allergic asthmatic children.Conclusions: IL-5, IL-6, IL-33, and periostin had elevated levels in the nasal fluid of the patients in clinical remission. The nasal fluid GM-CSF levels of the allergic patients and nasal fluid TSLP levels of the non-allergic patients had a positive correlation with most of the serum cytokine levels. Thus, our results showed that nasal fluid might be a preferable biological sample to diagnose asthma in children.Öğe Optimal Skin Prick Test Panel for Detecting Respiratory Allergens in Children: A Retrospective Study(2023) Kartal Öztürk, Gökçen; Demir, Esen; Eşki, Aykut; Gülen, FigenAim: The skin prick test (SPT) is the standard tool for determining respiratory allergen sensitizations. Different allergen sensitization patterns have been observed within countries and regions according to geographical and seasonal variations. This study aims to identify the sensitization pattern of children in different age groups and to define the minimum number and type of allergen extracts in an SPT to detect a sensitized child. Materials and Methods: This retrospective study was conducted in the Outpatient Clinic of the Pediatric Allergy, Immunology, and Pulmonology Unit of a tertiary Children’s Hospital from October 2019 to December 2020. Children aged between 2 and 18 years suspected of inhalant allergy with the presence of clinically relevant symptoms were included. The results of SPT were collected from medical records to determine the optimal panel to cover 95% of the sensitized children. Results: A total of 1821 patients with SPT results were evaluated. Forty-three patients (2.4%) were excluded from the study because some allergen extracts did not apply. Consequently, 1778 children (male/female ratio of 1.33) were included in the study. The median age (interquartile range) was 8 years (2-18). The most common sensitizations were to grasses (Lolium perenne and Poa pratensis), trees (Olea europaea and Fraxinus excelsior), cereals (Avena sativa and Hordeum vulgare), animal dander (cat and dog), and weeds (Plantago lanceolata and Ambrosia artemisiifolia). The rate of sensitization tended to increase with age. Applying an SPT that included six allergen extracts for 2-5 years, five for 6-11 years, and four for 12-18 years was sufficient to identify 95% of sensitized children. Conclusion: A test panel with six allergen extracts was sufficient to identify most of the sensitized children and adolescents suspected of allergy and had clinically relevant symptoms. An SPT with fewer allergen sources was required to detect older sensitized children than younger children.Öğe Prospective evaluation of vascular changes in acute respiratory infections in children with cystic fibrosis(2020) Öztürk, Gökçen; Eşki, Aykut; Çelik, Figen; Conkar, Seçil; Gülen, Figen; Demir, Esen; Keskinoğlu, AhmetBackground/aim: Acute exacerbations and chronic inflammation are risk factors for cardiovascular disease (CVD) in cystic fibrosis (CF) patients. the aim of this study was to investigate the effects of acute exacerbation therapy on arterial stiffness in children with CF. Materials and methods: Augmentation index (Aix) and pulse wave velocity (PWV) were measured before and after treatment and 1 month after the end of treatment in patients with acute exacerbation. the relationship between hemodynamic measurements and c-reactive protein (CRP) and pulmonary function tests (PFTs) was investigated. Results: Measurements before and after treatment were evaluated in 27 patients and were repeated in 21 patients who were clinically stable 1 month following acute exacerbation. There was a significant decrease in CRP and an increase in spirometry parameters after treatment. While no significant difference was found between PWV (P = 0.33), a significant difference for Aix before (41.95 ± 12.96%) and after (30.95 ± 11.47%) treatment and before treatment and stable clinical condition (34.19 ± 14.36%) was obtained (P =0.00, and P =0.01, respectively). No significant difference in heart rate and other hemodynamic measurements was found. Pretreatment Aix is associated with poor clinical condition (PFTs, BMI, and clinical score) and systemic inflammation (CRP) (P <0.05). Conclusion: the decrease of arterial stiffness (Aix) with acute exacerbation treatment in children with CF has been demonstrated. This result shows that systemic inflammation in CF may cause an increase in arterial stiffness and recurrent exacerbations may increase the risk of CVD.Öğe Prospective evaluation of vascular changes in acute respiratory infections in children with cystic fibrosis(2020) Öztürk, Gökçen; Eşki, Aykut; Çelik, Figen; Conkar, Seçil; Gülen, Figen; Demir, Esen; Keskinoğlu, AhmetBackground/aim: Acute exacerbations and chronic inflammation are risk factors for cardiovascular disease (CVD) in cystic fibrosis (CF) patients. The aim of this study was to investigate the effects of acute exacerbation therapy on arterial stiffness in children with CF. Materials and methods: Augmentation index (Aix) and pulse wave velocity (PWV) were measured before and after treatment and 1 month after the end of treatment in patients with acute exacerbation. The relationship between hemodynamic measurements and c-reactive protein (CRP) and pulmonary function tests (PFTs) was investigated. Results: Measurements before and after treatment were evaluated in 27 patients and were repeated in 21 patients who were clinically stable 1 month following acute exacerbation. There was a significant decrease in CRP and an increase in spirometry parameters after treatment. While no significant difference was found between PWV (P = 0.33), a significant difference for Aix before (41.95 ± 12.96%) and after (30.95 ± 11.47%) treatment and before treatment and stable clinical condition (34.19 ± 14.36%) was obtained (P =0.00, and P =0.01, respectively). No significant difference in heart rate and other hemodynamic measurements was found. Pretreatment Aix is associated with poor clinical condition (PFTs, BMI, and clinical score) and systemic inflammation (CRP) (P <0.05). Conclusion: The decrease of arterial stiffness (Aix) with acute exacerbation treatment in children with CF has been demonstrated. This result shows that systemic inflammation in CF may cause an increase in arterial stiffness and recurrent exacerbations may increase the risk of CVD.Öğe Pseudo-Bartter Syndrome in Patients with Cystic Fibrosis and Clinical Features(Galenos Publ House, 2023) Ozaslan, Mehmet Mustafa; Senol, Handan Duman; Barlık, Meral; Coksuer, Fevziye; Dindar, Bahar; Demir, Esen; Gülen, FigenObjective: Pseudo-Bartter syndrome (PBS) is a complication of cystic fibrosis (CF) accompanied by electrolyte disorders. We aimed to compare the clinical features of patients diagnosed with CF with or without PBS in our clinic.Method: One hundred twenty-eight patients with the diagnosis CF data was recorded. Clinical features, diagnostic test results, colonization status, complications and genetic test results were compared in patients with and without PBS.Results: Totally 128 patients who were regularly followed diagnosis CF January 2017 and May 2022 and 18 of them (14%) developed PBS. Median age of CF diagnosis was significantly lower in patients with PBS (p<0.003). There was a significant difference between the two groups in terms of colonization. In the group with PBS, the chronic respiratory tract colonization was detected more. There were no significant differences for age, gender, weight, height, sweat test. The most common genetic mutation was c1521_1523delCTT (p. F508Del).Conclusion: PBS was the most common finding in our patients with CF. It may be exacerbated by the warm weather conditions in our country. It may be a clue for early diagnosis of CF.Öğe Successful treatment of post-pericardiotomy syndrome via C1 inhibitor replacement therapy in a hereditary angioedema patient with Marfan syndrome (vol 65, page 338, 2023)(Turkish J Pediatrics, 2023) Topyıldız, Ezgi; Duman Şenol, Handan; Gülen, Figen; Demir, Esen; Gokmen, Nihal Mete[No abstract available]
