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Öğe Abdominal aortic stiffness as a marker of atherosclerosis in childhood-onset asthma: a case-control study(Clinics Cardive Publ Pty Ltd, 2015) Ulger, Zulal; Gulen, Figen; Ozyurek, Arif RuhiBackground: Asthma is one of the chronic inflammatory diseases. It is known that chronic inflammation accelerates atherosclerosis. Abdominal aortic stiffness parameters can be used to detect the early development of atherosclerosis. Aim: In this study, we aimed to evaluate abdominal aortic stiffness parameters in childhood-onset asthma compared with a control group. Methods: In this cross-sectional, case-control study, we evaluated 50 patients with childhood-onset asthma, and 57 healthy children as controls. Patients with a diagnosis of asthma of at least three years' duration were included in the study. Children with hypertension, hyperlipidaemia, diabetes, a history of smoking contact, or systemic disease were excluded. The study and control groups were evaluated with transthoracic echocardiography, and abdominal aorta diameters were measured. Using the measured data, abdominal aortic stiffness parameters (aortic distensibility: DIS, aortic strain: S, pressure strain elastic modulus: Ep, and pressure strain normalised by diastolic pressure: Ep*) were calculated. Statistical evaluation was done with the Student's t-test, chi-squared test and Pearson's correlation test. Results: The study group consisted of 50 children (24 female, 26 male) with asthma. According to the GINA guidelines, 26 of the patients had mild intermittant asthma, six had mild persistent asthma and 18 had intermediate persistent asthma. None of the patients had severe asthma. In 37 of the asthma patients, spIgE was positive and these patients were accepted as having atopic asthma; 27 of these patients received immunotherapy. We did not detect any differences between the study and control groups in terms of gender, age and body mass index. No differences were evident between the groups with regard to systolic and diastolic blood pressure, heart rate, blood cholesterol levels and respiratory function test parameters. There was no difference between the asthma and control groups in the measurement of abdominal aortic stiffness parameters. There was no significant correlation between aortic stiffness parameters and high-sensitivity C-reactive protein, blood total cholesterol, LDL cholesterol and HDL cholesterol levels. Conclusion: We did not find any difference between the asthma patients and control group with regard to aortic stiffness parameters (DIS, S, Ep and Ep*) and there was no difference in these parameters when we compared patients with mild asthma with those with moderate asthma. These results may be due to the anti-inflamatory effect of inhaled steroids. Further studies are needed to validate these results.Öğe Approach to Common Cold in Children(Galenos Yayincilik, 2015) Sahin, Ozlem Naciye Atan; Gulen, FigenInfections of the upper respiratory tract are very common in children. Clinical features and patterns of disease are different from those in adults. Although infections of the upper respiratory tract often resolve completely without complications, treatment is indicated where it can achieve more rapid resolution of symptoms and prevent the complications. Vast amounts of money are wasted on over-the-counter products for colds. Clinical trials have confirmed their lack of efficacy. This review summarizes the epidemiology, pathogenesis, clinical features, diagnosis and treatment of common cold in children.Öğe Asthma-like symptomcystic fibrosis asthma?(Turkish Assoc Tuberculosis & Thorax, 2021) Ozturk, Gokcen Kartal; Eski, Aykut; Demir, Esen; Gulen, FigenIntroduction: 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 therapies.Öğe The comparison of microscopy and real time polymerase chain reaction methods for the diagnosis of Pneumocystis Jirovecii pneumonia: evaluation of clinical parameters(Turkish Assoc Tuberculosis & Thorax, 2017) Toz, Seray; Gunduz, Cumhur; Tetik, Asli; Tasbakan, Meltem; Pullukcu, Husnu; Bacakoglu, Feza; Tasbakan, Mehmet Sezai; Gulen, Figen; Unver, Aysegul; Turgay, NevinIntroduction: Pneumocystis jirovecii pneumonia (PCP) causes serious infections, especially in patients with immunosuppressive diseases. In this study, it was aimed to evaluate the results of samples obtained from PCP suspected patients using two different methods together with clinical data. Materials and Methods: Microscopy and real time polymerase chain reaction (real time PCR) methods were performed with bronchoalveolar lavage (BAL) samples sended to Ege University Medical Faculty Direct Parasitology Diagnostic Laboratory between March 2009 and June 2010. Demographic characteristics, clinical and laboratory data were also recorded retrospectively. The data were evaluated using the SPSS 16.0 program. Results: A total of 42 BAL samples collected from patients (24 males, mean age: 31.49 +/- 26.14) were included. There were totally 16 P. jirovecii positives either one of the tests. Sixteen and three samples were detected positive by real time PCR and microscopy, respectively. Trimethoprim-sulfamethoxazole was prescribed in 11 PCP diagnosed cases and 6 of them died. Conclusion: Today, despite the growing opportunities in diagnosis and treatment, PCP pneumonia is associated with high mortality. Careful examination of clinical data and immune status of the patients are important. Multidisciplinary approach is required for early PCP diagnosis.Öğe Comparison of the "ProDect BCS RV CHIP" assay with the combination of shell vial cell culture and immunofluorescence antibody test for the detection of respiratory viruses(Elsevier Science Bv, 2007) Cicek, Candan; Gulen, Figen; Karatas, Eylem; Demir, Esen; Tanac, Remziye; Bacakoglu, Feza; Bilgic, AltinayIn the present study, a multiplex reverse transcriptase polymerase chain reaction combined with a chip hybridization assay (ProDect BCS RV CHIP) was evaluated as an alternative to the combination of immunofluorescent antibody test and shell vial cell culture considered as gold standard for the detection of respiratory viruses. Among 100 specimens, 40 were positive using the combination of immunofluorescent antibody test and shell vial cell culture assay in which 9 of them were infected by two different viruses (27 parainfluenza virus type 3, 10 adenovirus, 9 respiratory, syncytial virus. 2 influenza type B, and 1 influenza type A). ProDect BCS RV CHIP detected only 10 positive specimens in which one of them was infected by two different viruses (5 respiratory syncytial virus, 3 parainfluenza virus type 3, 2 adenovirus, and I influenza virus type B). The sensitivity. specificity, PPV. NPV and diagnostic accuracy of ProDect BCS RV CHIP were 25.0%, 100%, 100%, 66.6%, and 70.0%, respectively, compared to the combination of shell vial cell culture and immunofluorescent antibody test. As a result, the specificity of ProDect BCS RV CHIP is high. however. the sensitivity (25%) of the assay is not sufficient for routine laboratory use. (C) 2007 Elsevier B.V. All rights reserved.Öğe Could Age and Oral Challenge Outcomes Identify High-Risk Patients During Cow's Milk Oral Immunotherapy?(Mary Ann Liebert, Inc, 2022) Senol, Handan Duman; Topyildiz, Ezgi; Severcan, Ezgi Ulusoy; Akercan, Sanem Eren; Gunaydin, Nursen Cigerci; Gulen, Figen; Demir, EsenObjective: Severe immunglobuline E (IgE)-mediated reactions during oral immunotherapy (OIT) are major obstacles to treatment. The present study aimed to evaluate and identify clinical and laboratory biomarkers of adverse events during OIT among children with cow's milk (CM) allergy.Study Design: Eighty-six children older than 36 months who had undergone OIT with milk were enrolled. Clinical data, oral food challenge (OFC) test results, and laboratory data were recorded retrospectively.Results: The median duration of the build-up phase of OIT was 19 weeks (min 10-max 40) and the duration of the maintenance phase was 86.5 (min 1-max 132) months. A total of 11,767 CM doses were administered during the build-up phase and adverse reactions were seen in 62 (73.8%) patients with reactions registered for 157 doses among 11,767 (1/75 doses). The number of reactions during the maintenance phase was 41 (47.6%) in 24 (27.9%) patients. There was a significant reduction in the number of reactions (P = 0.000) between the build-up phase and maintenance phase. Adverse reactions and anaphylaxis were higher for patients who had cough during OFC (P = 0.003, P = 0.002, respectively) during the build-up phase and also during the maintenance phase too (P = 0.000). Evaluation for all reactions and anaphylaxis (during build-up and maintenance) with Kaplan-Meier and Cox regression analysis showed class IV-VI of CM-specific immunoglobulin E (sIgE), casein-sIgE and cough during OFC were significantly associated with increased probability of reaction and anaphylaxis. Younger age at onset of OIT was associated with risk reduction (0.017).Conclusion: Laboratory data and reactions during the OFC (especially cough) can help to identify high-risk patients during OIT.Öğe Cut-Off Values of Specific IgE and Skin Prick Test to Predict Oral Food Challenge Positivity in Children with Cow's Milk Allergy(AVES, 2022) Gunaydin, Nursen Cigerci; Akarcan, Sanem Eren; Gulen, Figen; Bal, Cem Murat; Tanac, Remziye; Atasever, Mesude; Demir, EsenObjective: The cut-off values for the skin prick test diameters and cow's milk-specific IgE measurements are used to predict the result of the oral food challenge test for the diagnosis of cow's milk allergy. This study aimed to determine the diagnostic values of skin prick test and cow's milk-specific IgE according to age groups and compare the diagnostic powers of these 2 methods. Materials and Methods: In total, 153 children who had a preliminary diagnosis of cow's milk allergy were evaluated. Group A (n = 90) consisted of cow's milk allergy patients whose diagnosis was confirmed by a positive oral food challenge or a history of anaphylaxis. Group B (n = 63) was composed of patients with a negative oral food challenge. The demographic, clinical, and laboratory findings of 2 groups were compared. Results: The cut-off points for cow's milk-specific IgE and cow's milk-skin prick test were determined as >2.12 kUA/L and >5 mm, respectively. The area under the curve was 0.844 for cow's milk-skin prick test (sensitivity 73%, specificity 84%) and 0.745 for cow's milk-specific IgE (sensitivity 67%, specificity 86%). The diagnostic power of skin prick test was determined to be higher when compared to cow's milk-specific IgE (P=.02). According to the predicted probability curves, decision points for cow's milk-specific IgE and cow's milk-skin prick test with 95% probability were determined as follows, respectively: for <= 24 months: 22 kUA/L, 11.3 mm; for >24 months: 44.1 kUA/, 15.1 mm. The lowest cut-off value with a positive predictive value of 95% and a specificity of 96% was found in patients <1-year-old (>3.3 kUA/L) Conclusion: The use of high probability diagnostic values of communities for specific IgE and skin prick test along with a significant clinical history may provide accurate and rapid diagnosis of cow's milk allergy and facilitate patient follow-up.Öğe Development of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy(Allergy Immunol Soc Thailand,, 2007) Gulen, Figen; Zeyrek, Dost; Can, Demet; Altinoz, Serdar; Koksoy, Huseyin; Demir, Esen; Tanac, RernziyeIt has been hypothesized that specific immunotherapy (SIT) significantly decreases the development of new allergen sensitizations in mono-sensitized patients. In this study, we evaluated the effect of SIT on the development of new allergen sensitizations in 129 asthmatic children mono-sensitized to house dust mite. SIT was accepted by only 70 of them (SIT group). The remaining 59 children were treated only with medication (control group). At the end of the study we found that 33% of all patients developed new sensitizations. Surprisingly, the prevalence of new sensitizations was significantly higher in the SIT group (45.5%) than in the control group (18.1 %). Ash tree (Fraxinus excelsior), Olive and Meadow fescue (Festuca elatior) were the most common allergens responsible for the new sensitizations. We conclude that SIT did not prevent the onset of new sensitizations in asthmatic children mono-sensitized to house dust mite.Öğe Does the quality of life in autism spectrum disorder differ from other chronic disorders and healthy children?(Cumhuriyet Univ Tip Fak Psikiyatri Anabilim Dali, 2016) Ozturk, Onder; Erermis, Serpil; Ercan, Eyup Sabri; Gulen, Figen; Kabukcu Basay, Burge; Basay, Omer; Kose, Sezen; Ozgun Ozturk, Fatma; Alacam, Huseyin; Aydin, CahideObjective: Autism spectrum disorder (ASD) is characterized by deficits in social interaction, communication, restricted interests, and repetitive patterns of behavior. This study examined quality of life (QoL) and related clinical factors in children with ASD, compared to children with Attention Deficit Hyperactivity Disorder (ADHD), children with asthma, and healthy controls (HC). Methods: QoL was assessed by the Pediatric Quality of Life Inventory 4.0 (PedsQLTM 4.0). Additionally, parents of the children provided sociodemographic information and filled out an evaluation questionnaire, child behavior check list (CBCL), and Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S). Results: The physical health, psychosocial health, social functioning, and scale total score of the ASD group were significantly lower than those of the three comparison groups. The school functioning score domain was lower in the ASD group than in the asthma and HC groups. In contrast, the emotional functioning domain assessments did not reveal statistically significant differences between the ASD group and the comparison groups. In the ASD group, the total problem score, inattention, and hyperactivity scores were significantly higher than both the asthma and HC groups, and the internalizing scores were higher than the healthy group. Conclusion: The poor QoL is most likely due to functional losses and problem behaviors related to ASD and may negatively affect not only children with ASD but also the whole life of the family.Öğe Early diagnosis effects the prognosis in children with atypical wheeze(Turkish Pediatrics Assoc, 2020) Severcan, Ezgi Ulusoy; Demir, Esen; Gulen, Figen; Bilgin, Raziye Burcu Guven; Tanac, 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 Effectiveness and adverse reactions to subcutaneous immunotherapy in children with allergic rhinitis/asthma(Elsevier Ireland Ltd, 2022) Senol, Handan Duman; Topyildiz, Ezgi; Ekici, Betul; Gulen, Figen; Demir, EsenObjective: Adverse reactions, which are mostly local and rarely systemic, can be seen during subcutaneous immunotherapy (SCIT). It was not possible to continue SCIT at times due to systemic reactions. The purpose of the present study was to identify the incidence and risk factors associated with adverse reactions during subcutaneous allergen-specific immunotherapy (AIT).Methods: A total number of 344 patients under 18 years old with allergic rhinitis and/or asthma who underwent SCIT between 2005 and 2021 were included in the study. Demographic characteristics of the patients, laboratory findings [Total Immunglobulin E(IgE), aeroallergen prick test, inhaler, and allergen specific IgE(sIgE) and eosinophil counts], and adverse events observed during AIT were recorded retrospectively. Descriptive and univariate/multivariate logistic regression analyses were used to identify risk factors for adverse events.Results: Among 344 patients, 33.4% (n = 115) were female, mean age was 133.1 +/- 41.0 months, and 42.2% (n = 145) were >12 years old. One hundred-thirty eight (40.1%) of the patients were mono-sensitized, 47 (13.7%) had asthma, 207 (60.2%) allergic rhinitis, and 90 (26.2%) asthma and allergic rhinitis. Single allergen content was administered to 187 (54.4%) patients (62 mite, 114 grass mix, 11 olea), and multiple allergens to 157 (45.6%) patients (121 pollen mix, 36 other (mite/alternaria)]. A total number of 33.008 injections were administered. 840 adverse reactions (262 (31.1%) at up-dosing phase, 578 (68.8%) at maintenance phase) in 195 (56.7%) patients were observed. Among the adverse reactions, 632 (75.2%) were local, 160 (19%) large local, and 48 (5.7%) (39 at maintenance, 9 at up-dosing) (in 31 patients) were systemic (28 Grade 1, 12 Grade 2, 8 Grade 3). Adrenalin was administered to 8 patients with Grade 3 systemic reaction (8/33008; %0.024). Adverse reactions, especially local ones, were seen more frequently in children under 12 years old (p < 0.001). Patients sensitized with grass pollen (p:0.01) and mite (p:0.004), and those who had received SCIT with pollen mixture had more adverse reactions than the others. More adverse reactions were observed in SCIT containing calcium-phosphate as adjuvant (p: 0.01). Local reactions were risk factors for large local (OR = 3.591, %95 CI:2.064-6.247, p < 0.001) and systemic (OR = 2.190, %95 CI:1.005-4.722 p = 0.046) reactions at univariate analyses. Total nasal symptom scores, Visual Analog Scale and asthma symptom control test decreased after one year of treatment (p < 0.01).Conclusion: SCIT is a safe and effective treatment method in childhood that leads to improvements in all nasal symptoms and asthma after one year of treatment.Öğe Effects of Cow's Milk Components, Goat's Milk and Sheep's Milk Sensitivities on Clinical Findings, and Tolerance Development in Cow's Milk Allergy(Kare Publ, 2021) Gunaydin, Nursen Cigerci; Severcan, Ezgi Ulusoy; Akarcan, Sanem Eren; Bal, Cem Murat; Gulen, Figen; Tanac, Remziye; Demir, EsenObjective: Cow's milk (CM) contains some proteins capable of causing an allergic reaction in a sensitized individual and one of the most common causes of food allergy in childhood. Most of the patients will develop tolerance by the age of 3. In this study, we aimed to evaluate sensitivity to CM allergen components as well as goat's milk (GM) and sheep's milk (SM) cross reactions in cow's milk allergic (CMA) patients and to figure out the risk factors for tolerance non-development. Methods: This is a retrospective cross-sectional study including 66 patients for IgE-mediated CMA with mean age of 38 months. We evaluated the patients in two groups: Group 1 (n=50): Patients who have no tolerance in oral food challenge test; Group 2 (n= 16): Patients who were found tolerant to CM after elimination diet. CM-sIgE, alpha-lactalbumin (ALA)-sIgE, beta-Lactoglobulin (BLG)-sIgE, casein (CAS)-sIgE, GM-sIgE, and SM-sIgE, skin prick tests with CM and GM, and eosinophils in peripheral blood were all compared between two groups. Results: In the whole group, GM-sIgE and SM-sIgE were positive in 84.8% and ALA-sIgE, BLG-sIgE, and CAS-sIgE were positive in, respectively, 69.7%, 62.7%, and 77.3% of the patients. Two groups were similar in terms of age at onset and diagnosis, gender, median elimination period, total IgE levels, CM-sIgE, and eosinophilia (p>0.05). Mean wheal diameters of CM and GM in SPT (p<0.001), GM-sIgE (p=0.03), and SM-sIgE (p=0.01) were significantly higher in Group 1. There was a positive correlation between CM-sIgE and total IgE (p=0.001), eosinophilia percentage (p=0.04), CM wheal diameter in SPT (p=0.001), CAS-sIgE (p<0.001), GM-sIgE (p<0.001), and SM-sIgE (p<0.001) in Group 1. Patients with respiratory symptoms and history of anaphylaxis had higher CM-SPT, CM-sIgE, CAS-sIgE, GM-sIgE, and SM-sIgE (p<0.05) levels. Gastrointestinal and skin symptoms showed no relation with laboratory findings. Tolerance was not developed in any patient with a history of anaphylaxis. Conclusions: As with CM-sIgE levels and high induration diameters in SPT, high CAS-sIgE, SM-sIgE, and GM-sIgE levels are also risk factors for persistence of CMA; anaphylaxis, as a first reaction, may also be a risk factor. High CM-sIgE, CAS-sIgE, SM-sIgE, and GM-sIgE levels are associated with respiratory symptoms.Öğe Effects of volatile substance abuse on the respiratory system in adolescents(Novamedia, 2011) Buker, Halime S. C.; Demir, Esen; Yuncu, Zeki; Gulen, Figen; Midyat, Levent; Tanac, RemziyeAim: Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents. Chronic inhalant abuse can damage respiratory, cardiac, renal, hepatic, and neurologic systems. This study aims to determine the physiologic effects of inhaling solvents on the respiratory functions. Methods: The general health status of the subjects was assessed by history taking, physical examination and a questionnaire which was designed to show the severity of respiratory symptoms. Spirometry, ventilation/perfusion scintigraphy, and high resolution computed tomography (HRCT) were performed to assess pulmonary functions and anatomy. Results: Thirty-one male volatile substance abusers and 19 control subjects were included in the study. The mean age of onset of inhalant use was 14.6 +/- 2.2 (9-18) years and duration of drug use was 3.7 +/- 1.7 years. The most common respiratory symptoms in volatile substance abusers were nasal congestion (45.2%), sputum (38.7%), exercise intolerance (32.3%) and cough (22.6%). Results of spirometric studies showed 12 (41.4%) subjects with low FVC values < 80% of predicted, indicative of restrictive ventilatory pattern in the study group. Although the difference was not statistically significant, restrictive ventilatory pattern was higher in the study group. There was no statistically significant correlation between restrictive ventilatory pattern and the age of onset/duration/frequency of inhalant abuse, respiratory symptoms and scintigraphic abnormalities. Subjects who had restrictive pattern in their pulmonary function tests were more likely to have abnormal findings at HRCT (p < 0.01). Conclusion: This study has shown a positive correlation between volatile substance abuse and the development of restrictive ventilatory pattern, but more comprehensive studies are needed for more precise conclusions.Öğe Efficacy of pollen immunotherapy in seasonal allergic rhinitis(Wiley, 2007) Can, Demet; Tanac, Remziye; Demir, Esen; Gulen, Figen; Veral, AliBackground:The efficacy of subcutaneous pollen immunotherapy has been documented in published double-blind, placebo-controlled studies related to treatment of seasonal allergic rhinitis. In the present study, subjective (symptom scores) and objective (nasal peak inspiratory flow, nasal smear, nasal biopsy) parameters were used to study the efficacy of pollen immunotherapy. Methods: Forty-eight patients (32 male), mean +/- SE age 13.6 +/- 2.8 years allergic to grass-pollen participated in the present study. Patients were divided into three groups: group I, 24 patients who did not receive pollen immunotherapy; group II, 12 patients who received the build-up phase of pollen immunotherapy; and group III, 12 patients who had just finished pollen immunotherapy. With regard to objective and subjective parameters these three groups were compared. Results:When group I was compared to groups II and III, the patients who had not received any immunotherapy were found to have a high daytime nasal symptoms score (P < 0.01), high daytime eye symptoms score(P < 0.01) and high night-time symptoms score (P < 0.01). In objective parameters, it was found that group I had low nasal peak inspiratory flow (P < 0.05), and a high eosinophil count in nasal smears (P < 0.05) and peripheral blood (P < 0.05). It was also demonstrated that there was an increased eosinophil infiltration (P < 0.01) and mast cell infiltration (P < 0.05) in nasal biopsy in group I. There was no significant difference between group II and group III according to these results (P > 0.05). Conclusions: Immunotherapy leads to a better clinical and histopathological prognosis in children with seasonal allergic rhinitis.Öğe Eponym - Scimitar syndrome(Springer, 2010) Midyat, Levent; Demir, Esen; Askin, Memnune; Gulen, Figen; Ulger, Zulal; Tanac, Remziye; Bayraktaroglu, SelenScimitar syndrome is a rare congenital anomaly, characterized by partial or complete anomalous pulmonary venous drainage of the right or left lung into the inferior vena cava. The syndrome is commonly associated with hypoplasia of the right lung, pulmonary sequestration, persisting left superior vena cava, and dextroposition of the heart. The pathogenesis of the syndrome is unclear, but it seems to originate from a basic developmental disorder of the entire lung bud early in embryogenesis. Two main forms of scimitar syndrome have been described. Signs and symptoms can start during infancy (infantile form) or beyond (childhood/adult form). The infantile form generally presents within the first 2 months of life with tachypnea, recurrent pneumonia, failure to thrive, and signs of heart failure. The diagnosis of scimitar syndrome is usually made based on the characteristic chest X-ray films and can be confirmed by angiography; however, it is now done mostly by transthoracic or transesophageal echocardiography, noninvasive computed tomography, or magnetic resonance angiography. Fetal echocardiography using three-dimensional power Doppler imaging permits prenatal diagnosis. Most frequently, patients are asymptomatic in the absence of associated abnormalities and can be followed conservatively. For patients with congestive heart failure, repeated pneumonia, or pulmonary-to-systemic blood flow ratios greater than 1.5 and pulmonary hypertension, it is important to reroute the anomalous right pulmonary veins and repair the associated cardiac defects in order to avoid progression to right ventricular failure. The triad of respiratory distress, right lung hypoplasia, and dextroposition of the heart should alert the clinician to think of scimitar syndrome.Öğe Evaluation of increased arterial stiffness in pediatric patients with cystic fibrosis by augmentation index and pulse wave velocity analysis(Wiley, 2020) Ozturk, Gokcen Kartal; Conkar, Secil; Eski, Aykut; Gulen, Figen; Keskinoglu, Ahmet; Demir, EsenWith the increase in life expectancy, cardiovascular complications of cystic fibrosis (CF) have come to the forefront. Increased arterial stiffness is a marker of increased cardiovascular risk. the aim of this study was to compare both pulse wave velocity (PWV) and augmentation index (Aix) measurements in children with CF and to compare them with healthy controls. We hypothesized that children with CF had increased arterial stiffness, although traditional risk factors for CVD were not observed. Forty-four patients and age and sex-matched 30 healthy controls were included in the study. Hemodynamic measurements were compared in both groups, together with traditional risk factors. Peripheral blood pressure parameters of CF and control groups were similar (P > .05). Bodyweight and BMI were significantly lower in the CF group (P < .001). Serum cholesterol, HDL, and LDL levels were significantly lower in the CF group, whereas fasting blood glucose and triglyceride levels were significantly higher than the control group (P < .05). Mean +/- SD Aix was significantly higher in the CF group (33.22 +/- 13.87%) compared with the control group (24.93 +/- 10.58%), respectively (P < .05), while PWV was similar. No significant correlation between PWV and Aix and fasting blood glucose and lipid profile in both groups (P > .05). Children with CF have been shown to have increased arterial stiffness compared to healthy children. Although there are not many traditional risk factors, increased arterial stiffness have been demonstrated in children with CF. the effects of this process starting from childhood on the development of CVD in adulthood are not known. Therefore, further studies are needed.Öğe Evaluation of Long Term Respiratory Complications in Childhood and Adolescent Cancer Survivors(Galenos Publ House, 2023) Ergin, Firat; Cetingul, Nazan; Demir, Esen; Sayiner, Abdullah; Alper, Hudaver; Gulen, FigenAim: In addition to increased survival rates, systemic complications which can impair the quality of life have been seen in 25-30% of childhood and adolescent cancer cases. The respiratory system is one of the severely affected systems. We aimed to evaluate late respiratory complications and risk factors in pediatric and adolescent cancers.Materials and Methods: We examined the pulmonary complications of 50 cancer patients and 40 control cases. We asked about environmental exposures, physical examinations performed, and pulmonary function tests (PFT) spirometry, diffusing capacity of the lungs for carbon). X-ray was performed on all patients in the patient group and on patients with indications in the control group.Results: In the patient group, there was impairment of pulmonary function in 52%, [24% small airway disease (SAD)], 14% diffusion disorders (DD) and 14% combined disorders (CD) compared to 22.5% in the control group (p=0.007). There was a higher risk of restrictive disorder and/ or SAD in those cancer patients who were diagnosed prior to 2 years of age. Additionally, there was a higher rate of SAD in those patients with soft tissue sarcomas and a higher rate of restrictive disease in those patients who had received high-dose alkylating agents. No significant PFT impairment was observed in the other patient groups.Conclusion: There is a high incidence of respiratory impairment in childhood and adolescent cancer survivors. They need to be followed up by a multidisciplinary team and be informed about the additional risk factors which may cause lung function loss.Öğe Factors effecting natural course of egg allergy(Edra Spa, 2024) Senol, Handan Duman; Geyik, Mehmet; Topyldz, Ezgi; Aygun, Ayse; Gulen, Figen; Demir, EsenBackground. There is limited data about the natural course of egg allergy in the literature. We aimed to analyze the factors that can affect the tolerance or persistence of egg allergy. Methods. A total number of 126 IgE-mediated egg allergic patient who had data about tolerance gaining were included in the study. Demographic and laboratory data were recorded retrospectively. Kaplan -Meier curves was used for estimation of resolution and the factors related to resolution by Cox regression model. Results. Among 126 patients, 81 (64.2%) had gained tolerance with a median survival time of 48 months (min: 12 -max: 121). Tolerance was gained in 22.2% (n = 28) of these patients in the first 2 years of life, in 46.8% (n = 49) in 2-6 years, 3.1% (n = 4) between 7-12 years. In univariate analysis, baseline sIgE level was < 8.2 (Hazard ratio: 2.193; 95%CI 1.309-3.674; p = 0.003), no history of anaphylaxis (at initiation or during OFC) (Hazard ratio: 11.292; 95%CI 2.766-46.090; p = 0.001) and baseline egg SPT < 11 mm (Hazard ratio: 2.906; 95%CI 1.424-5.930, p = 0.003) were found to be related to earlier resolution of egg allergy. In multivariate analysis, only anaphylaxis was significantly related to later resolution (Hazard ratio: 6.547; 95%CI 15.8027.434; p = 0.01). Conclusions. Higher levels of egg sIgE, skin prick test induration and anaphylaxis at onset or during oral food challenge, can give hint about persistence of egg allergy.Öğe The Fc gamma RIIa polymorphism in Turkish children with asthma bronchial and allergic rhinitis(Pergamon-Elsevier Science Ltd, 2007) Gulen, Figen; Tanac, Remziye; Altinoz, Serdar; Berdeli, Afig; Zeyrek, Dost; Koksoy, Huseyin; Demir, EsenObjective: The aim of the present study was to evaluate the Fc gamma RIIa polymorphism in Turkish children with atopic asthma and allergic rhinitis. Design and methods: In this study, 372 atopic children (192 asthma bronchial, 180 allergic rhinitis) between ages of 5 and 16 years old (11.3 +/- 2.9) who were followed at Aegean University Paediatric Allergy and Pulmonology Outpatient Clinics and 234 healthy subjects as the control group were included. The evaluation of subjects included routine biochemical blood analysis and allergic workup based on the following laboratory determinants. The Fc gamma RIIa polymorphism was determined using the polymerase chain reaction method. Results: Distribution of RI 3 1 R genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 2.64 95%CI: 1.22-5.79, p=0.006; for allergic rhinitis OR: 2.58 95%CI: 1.18-5.71, p=0.009). Frequency of 131R allele was significantly different among patient groups compared to controls (for asthmatic children OR: 1.66 95%CI: 1.22-2.26, p=0.0007; for allergic rhinitis OR: 1.93 95%CI: 1.42-2.63, p=0.00001). Conclusion: This study shows that Fc gamma RIIa gene 131R allele represents an important genetic risk factor for bronchial asthma and allergic rhinitis susceptibility. (c) 2007 Published by The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.Öğe Fc gamma RIIIa-V/F 158 polymorphism in Turkish children with asthma bronchiale and allergic rhinitis(Blackwell Publishing, 2008) Zeyrek, Dost; Tanac, Remziye; Altinoz, Serdar; Berdeli, Afig; Gulen, Figen; Koksoy, Huseyin; Demir, EsenFc receptors (FcR) play an important role in immune regulation. This might be linked to the variability in immune response, therefore relating to the pathogenesis of atopic diseases. The aim of the present study was to evaluate the Fc gamma RIIIa gene polymorphism in Turkish children with asthma and allergic rhinitis. The study included 364 atopic children (184 bronchial asthma, 180 allergic rhinitis) and 234 healthy subjects as the control group, aged between 5 to 16 years. Patients were recruited from outpatient clinics of allergy and general pediatric care. Plasma IgE concentrations were measured by immunoassays and skin prick test was done in children with atopic diseases. The Fc gamma RIIIa gene polymorphism was determined using the polymerase chain reaction method. Distribution of V158V genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 5.33, 95% CI: 2.80-10.23, p < 0.001; for allergic rhinitis OR: 3.25, 95% CI: 1.75-6.07, p = 0.001). Distribution of 158 V allele was significantly different among asthmatic children (OR: 2.20, 95% CI: 1.65-2.92, p < 0.001) and allergic rhinitis patients (OR: 1.77, 95% CI: 1.32-2.35, p < 0.001) compared to healthy controls. Our study shows that the V158V genotype in Fc gamma RIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.
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