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Öğe Can increased intra-abdominal pressure (IAP) be treated more effectively with intravesical pressure measurement in high-risk patients? [kari{dotless}niçi basi{dotless}nç arti{dotless}şi{dotless}na yol a öç abilen hastali{dotless}klari{dotless}n tedavisi intravezikal basi{dotless}nç lümü kontrolü alti{dotless}nda daha güvenle yapi{dotless}labilir mi?](2013) Divarci E.; Ergün O.; Karapinar B.; Yalaz M.; Çelik A.BACKGROUND: Increased intra-abdominal pressure (IAP) can result in multiorgan failure. Trauma, mechanical bowel obstruction (MBO), abdominal wall defects (AWD) and fluid resuscitation in septic shock are conditions associated with a high risk of increased IAP in children. It may be possible to treat these conditions more effectively using intravesical pressure measurement. MEHTOHDS: This prospective study was performed between December 2009 and October 2010. Intravesical pressure (IVP) measurement was used to determine IAP. The presence of Intra-abdominal hypertension (IAP >12 mmHg) and abdominal compartment syndrome (IAP >15 mmHg + new organ dysfunction) was evaluated in all clinical decisions. RESULTS: IVP monitoring was applied in all patients with abdominal trauma (14), AWD (8), fluid resuscitation for septic shock (7), and MBO (6). A diagnosis of ACS was determined in 14% of trauma patients and required surgery. IAH/ACS occurred in 38% of AWD cases, which required closure. IAH occurred in 43% of patients undergoing fluid resuscitation for septic shock, requiring decompressive intervention. IAH/ACS occurred in 50% of MBO patients, all of whom required surgery. DISCUSSION: IVP measurement is a useful method to identify candidates for surgical treatment in cases of trauma and MBO. Similarly, IVP monitoring can facilitate the closure of abdominal wall defects and the application of fluid resuscitation in septic shock. © 2013 TJTES.Öğe A case of herpes simplex encephalitis revealed by decompressive craniectomy(2008) Bayram N.; Ciftdogan D.Y.; Karapinar B.; Ozgiray E.; Polat M.; Cagliyan E.; Vardar F.A 15-year-old girl was referred to our hospital due to fever, headache, and vomiting of 7 days duration and focal motor convulsion at the day of referral. Her clinical signs and cerebral imaging findings were found to be compatible with herpes simplex encephalitis. In spite of prompt acyclovir administration, her consciousness deteriorated gradually. Emergent cranial magnetic resonance imaging demonstrated a shift of midline intracranial structures. Decompressive surgery resulted in partial improvement in the shift of midline intracranial structures and potentially saved the patient's life. This case report stresses the importance of proper management of increased intracranial pressure in patients with herpes simplex encephalitis. © 2007 Springer-Verlag.Öğe Cutaneous leukocytoclastic vasculitis in a child with interleukin-12 receptor beta-1 deficiency(2006) Kutukculer N.; Genel F.; Aksu G.; Karapinar B.; Ozturk C.; Cavusoglu C.; Casanova J.-L.; Fieschi C.We report a patient with complete interleukin-12 receptor beta-1 deficiency associated with cutaneous leukocytoclastic vasculitis. The patient experienced Bacille Calmette Guérin, Mycobacterium chelonae, and Salmonella enteritidis infection. Vasculitis affecting both small arteries and postcapillary venules due to deposition of immune complexes was probably caused by S. enteritidis and/or M. chelonae infection. © 2006 Elsevier Inc. All rights reserved.Öğe Disseminated invasive vertebral aspergillosis with a 7 year latent period in an immunocompetent girl (Pediatrics International (2007) 49, (516-518))(2008) Kutukculer N.; Karapinar B.[No abstract available]Öğe Evaluation of anticoagulant system in Turkish children with Perthes disease(2005) Yilmaz D.; Karapinar L.; Karapinar B.; Ozturk H.; Kavakli K.Background: Perthes Disease (PD) is generally a self-limiting disease of childhood but it causes severe pain and may lead to deformity of the femoral head. Intravascular thrombosis seems to form the main mechanism in the pathogenesis of the disease. The aim of this study was to determine hereditary thrombotic risk factors in Turkish children with PD. Methods: In 46 Perthes patients (35 male, 11 female), family history of thrombotic events was investigated, Protein C (PC), free-Protein S (f-PS), antithrombin (AT) activities, fibrinogen level, and resistance to activated Protein C (APC) were measured. The results were compared with a healthy control group of 79 children matched by age and sex. The relationship between the severity of disease and coagulation system abnormalities was evaluated. Results: While the mean PC and AT activities were significantly lower in the patients than those of the controls, the proprotions of patients with low AT activity, resistance to APC, and a history of hereditary thrombophilia were significantly higher than those of the controls. No difference was observed in coagulation system disorders relative to severity of the disease and bilateral or unilateral disease involvement. Conclusions: This study shows that a possible association between PD and inherited hypercoagulability. Determination of thrombotic risk factors in these patients may bring a new approach to the treatment. Most importantly, this may be a stimulant to take precautions for other thrombotic events, which patients may face later in life.Öğe Imatinib treatment alone in philadelphia-positive acute lymphoblastic leukemia: Is it enough?(2011) Ay Y.; Yilmaz D.; Balkan C.; Karapinar B.; Karadas N.; Kavakli K.BCR-ABL fusion gene t(9;22)(q34;q11) occurs in only 3% of pediatric acute lymphoblastic leukemia (ALL) cases. Previously, less than 40% of Philadelphia-positive ALL patients were cured with intensive chemotherapy. The use of imatinib (340 mg/m2/day) added to an intensive chemotherapy regimen has improved the outcome in this population at 3 years to an event-free survival of 80%. Imatinib treatment alone was administered after remission induction chemotherapy to a patient with Philadelphia-positive ALL who presented with serious chemotherapy toxicity, so that intensive chemotherapy could not be maintained. This is the only patient in the literature who survived remission for more than 2.5 years with imatinib treatment only. Copyright © 2011 S. Karger AG, Basel.Öğe Intense myelofibrosis in a child: Unusual result of EBV-associated hemophagocytic lymphohistiocytosis(2007) Karapinar B.; Yilmaz D.; Aydinok Y.; Türkoglu E.; Hekimgil M.; Kavakli K.A previously healthy 12-year-old girl was admitted to the intensive care unit with severe pulmonary bleeding. Her history revealed that she had suffered from high fever, fatigue, sore throat, myalgia and generalized rash for two weeks. Physical examination revealed hepatosplenomegaly. Laboratory investigation showed pancytopenia associated with unusual high levels of serum ferritin, triglyceride and lactate dehydrogenase (LDH) and low fibrinogen levels. Apparent hemophagocytosis was seen in bone marrow aspiration. Bone marrow biopsy revealed myelofibrosis, and confirmed hemophagocytosis. IgM for Epstein-Barr virus (EBV) viral capsid antigen was found to be positive. She received chemotherapy for 10 days according to hemophagocytic lymphohistiocytosis (HLH)-2004 treatment protocol, since the symptoms persisted despite supportive therapy and intravenous immunoglobulin (IVIG) administration. However, the clinical status and laboratory findings did not respond to treatment and she died from severe pulmonary bleeding associated with prolonged ventilator support and sepsis. Intense myelofibrosis, which is reported rarely, particularly in patients with EBV-related HLH, contributed to this fatal prognosis. © Turkish Society of Hematology.Öğe Mothers' attitudes towards their own presence during invasive procedures on their children(2005) Karapinar B.; Yilmaz D.; Egemen A.This study assessed of the preferences 742 mothers regarding their own presence during invasive procedures performed on their children. The relationships between socio-demographical characteristics and preferences of the mothers and disease characteristics of the children were examined. A mother's desire to be present was found to increase with decreasing invasiveness of the procedure as well as with increasing analgesia and sedation provided. The desire to be present was higher in young mothers with higher socio-economic levels and educational backgrounds, with younger children and with children who had undergone prior recurrent interventions. This study demonstrated that most of the mothers preferred to be present during the procedure, and that the ratio of mothers willing to do so increased significantly if the children were sedated. The results suggested that pediatricians can improve the quality of service and physician-patient-family relationship by taking mothers' preferences into consideration.Öğe Parental presence during invasive procedures and resuscitation: Attitudes of health care professionals in Turkey(2006) Egemen A.; Ikizoglu T.; Karapinar B.; Coşar H.; Karapinar D.Objectives: An agreement among physician, nurse, and family on the issue and a solution developed by all will improve the quality of work. The aims of this study were to determine health care professionals' (physicians and nurses) attitude toward parental presence during invasive procedures and toward parental participation in this decision and to investigate the difference between the approach of physicians and nurses. Methods: This study was performed on the physicians and nurses of the Medical Faculty of the Department of Pediatrics of Ege University between December 2003 and March 2004. The questionnaire delivered was completed by 49 (94%) of 52 nurses and 51 (89%) of 57 physicians. Results: Parental presence during blood sampling, simple wound repair/suture, lumbar puncture, and bone marrow aspiration/biopsy was approved by 72.5%, 27.5%, 66.7%, and 82.4% of the physicians and 53.1%, 57.1%, 81.6%, and 85.7% of the nurses, respectively. None of the health care professionals preferred parents to attend during any kind of resuscitation. Attitudes of the nurses and physicians were found to be similar between the 2 groups except for simple wound repair. Major determinants of the decision about the agreement for parental presence were procedural invasiveness for physicians (reported by 82.5%) and level of sedation for nurses (reported by 75.5%). The mean ages of both groups of health care professionals who did not approve parental presence during invasive procedures were lower than that of the ones who approved for all procedures. Conclusions: The physicians and nurses in the study population tended to prefer parents not to be present during procedures as the level of invasiveness increased. An agreement between the attitudes of physicians and nurses toward parental presence during invasive procedures is essential for improving quality of service, especially in the dynamic environment of the emergency department. Copyright © 2006 by Lippincott Williams & Wilkins.Öğe Pediatric bedside tracheostomy in the pediatric intensive care unit: Six-year experience(2008) Karapinar B.; Arslan M.T.; Özcan C.In this study, we evaluated the experience of a single center pediatric intensive care unit in pediatric bedside tracheostomies performed during a six-year period. Thirty-one bedside tracheostomies were performed on 31 patients aged 2 months to 18 years. The major indication for tracheostomy was prolonged ventilator dependence. Twenty-two complications, 6 major and 16 minor, were observed in 18 patients. Early complications were observed in 5 patients and all were managed immediately without serious outcomes. Ten patients died during the study period and only one death was directly related to the tracheostomy; the remaining 9 patients died due to their underlying disease. Eleven patients were successfully decannulated, 12 patients were discharged home with their tracheostomies and 5 of these 12 patients required home ventilation. Although children who required tracheostomy had a high overall mortality (32.3%), the prognosis of these patients depends primarily on the underlying medical condition.Öğe Pediatric nosocomial infections; incidence, risk factors [Hastane enfeksiyonlar?; s?kl?g? ve risk faktörleri](2009) Özçtin M.; Saz E.U.; Karapinar B.; Özen S.; Aydemir Ş.; Vardar F.Aim: This study aimed to determine the prevalence and type of nosocomial infections, etiologic distrubition of organism in hospitalized children at Ege University School of Medicine, Department of Pediatrics for a 12 month period. It also investigated the duration of hospitalization. Material and Method: Patients diagnosed with nosocomial infection between January 2002-December 2002 at the inpatient unit of pedidtrics were included in the study. Neonatal cases were excluded from the analysis. Diagnosis of nosocomoial infection was made based on CDC criteria. Statistical analysis was made by using SPSS 10.1 for Windows packet and p<0.05 was accepted as significant. Results: During the study period, 1811 patients were investigated and 96 nosocomial infection determined (5.3%). The majority were female at 52% (n=50). The most common infections in our study were bacteriemia and urinary tract infections, 50% and 40% respectively. Although bacteriemia was the commonest infection type in the intensive care unit, urinary tract infections were the most common infections in inpatient services. Enterobacteriaceae was the most common cause with 37.5% (n=36), coagulase negative staphylococci found in 16.4% (n=16), and yeast infection was isolated in 12.5% (n=12). The majority of patients (59.3% n=57) had one or more invasive procedures which make the patients susceptible to contracting nosocomial infections. Children who are hospitalized more than 7 days are more likely to have nosocomial infections (P<0.0001). Another predisposing factor for developing nosocomial infections was increased patient numbers receiving medical care by each nurse. Conclusion: Nosocomial infections have been increasing in pediatric patients. Long hospital stays and increased patient numbers needing medical care by each nurse were associated with nosocomial infections. They are estimated to more than double the mortality and morbidity risks of any admitted patient.Öğe Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia(Elsevier Editora Ltda, 2015) Yilmaz Karapinar D.; Karadaş N.; Önder Siviş Z.; Yazici P.; Duyu M.; Metin D.; Karapinar B.; Aydinok Y.Empirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19) days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture). Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely. © 2015 Elsevier Editora Ltda.Öğe Septic pulmonary emboli secondary to disseminated, community-acquired, methicillin-resistant Staphylococcus aureus infection(2009) Karapinar B.; Yilmaz Çiftdogan D.; Bayram N.; Aydogdu S.; Vardar F.Community-associated strains of methicillin-resistant Staphylococcus aureus have recently emerged as a major cause of serious infections with rarely observed serious complication, such as deep vein thrombosis (DVT) and septic pulmonary embolism (SPE), among children. SPE, DVT and bone or joint infections are a triad which is rarely seen in children. This clinical syndrome is a life-threatening disorder, which requires prompt diagnosis and aggressive treatment. We report a 14-year-old boy who was diagnosed with SPE, DVT and disseminated, community-acquired, methicillin-resistant S. aureus. © 2009 IOS Press. All rights reserved.Öğe Thanks to Trauma: A Delayed Diagnosis of Pott Disease(Lippincott Williams and Wilkins, 2015) Avcu G.; Sahbudak Bal Z.; Duyu M.; Akkus E.; Karapinar B.; Vardar F.[No abstract available]Öğe Validity and reliability study of sedation diagnosis method comfort scale [Sedasyon tanilama yöntemi-konfor skalasinin geçerlik güvenirlik çalişmasi](Turkish Society of Algology, 2016) Beytut D.; Başbakkal Z.; Karapinar B.Objectives: The aim of the present methodological descriptive study was to test the validity and reliability of the COMFORT scale. Methods: The study was conducted at a pediatric critical care unit at a university hospital between February 2009 and June 2010. Study sample included 84 pediatric patients (n=37) receiving mechanical ventilation. Data were collected via child information form, COMFORT scale, and visual analog scale (VAS). Having been assured of the language and context validity of the scale, researchers conducted reliability tests (Cronbach's alpha coefficient, item analysis), inter- and intra-observer reliability tests, and correlation analyses based on the data obtained during their own observations. Results: Cronbach's alpha coefficient was 0.77. Results of the item analysis indicated that item-total correlations were satisfactorily high. Significance of inter-observer agreement was analyzed for each item, and it was found that weighted kappa values varied between 0.703 and 0.888. Convergent validity tests demonstrated a positive strong correlation between COMFORT scale scores of the primary researcher and the assistant researchers (r= 0.961, p<0.000), and between the scores of the COMFORT scale and the VAS (r= 0.775, p<0.000; r=0.786, p<0.000). Conclusion: It was concluded that the COMFORT scale was a valid and reliable method of measuring sedation levels of children receiving mechanical ventilation and being sedated in a pediatric critical care unit. © 2016 Türk Algoloji Dernegi.Öğe Zygomycosis in a child with severe aplastic anemia who has invasive pulmonary aspergillosis: Hypersensitivity reaction to liposomal amphotericin B and successful challenge [Invaziv pulmoner aspergillozis enfeksiyonu si{dotless}rasi{dotless}nda zigomikoz gelişen agi{dotless}r aplastik anemili olguda lipozomal amfoterisin B allerjisi ve desensitizasyon](2011) Ay Y.; Yilmaz D.; Balkan C.; Karapinar B.; Midyat L.; Akin M.; Kavakli K.Invasive pulmonary aspergillosis and zygomycosis are fungal opportunistic diseases with a high morbidity and mortality rate, predominantly affecting immunosuppressed patients. In patients with severe aplastic anemia (SAA) more than one invasive mycotic infection should be considered and early diagnosis with adequate treatment is crucial. We present a patient with treatment resistant SAA who developed zygomycosis while under caspofungin + voriconazole combined antifungal therapy for invasive pulmonary aspergillosis. A 13.5 year old boy with SAA developed invasive pulmonary aspergillosis. Liposomal amphotericin B (L-AmB) was started, but he developed an anaphylactic type hypersensitivity reaction with L-AmB. Therefore treatment was changed to voriconazole treatment, and at the 3rd month of this treatment, caspofungin was added as a salvage therapy. However, he did no respond to immunosuppressive treatment for SAA. No clinical or laboratory improvement of invasive fungal infection was seen in spite of antifungal therapy. Clinical nasal/ paranasal zygomycosis occurred and showed a very rapid spread to most parts of the face under this intensive antifungal therapy. Although no destruction of the bones was seen on tomography at first, a fungal infection was suspected and histopathologic/ micologic cultures proved the diagnosis. L-AmB was given with a protocol allowing desensitization since the patient had a history of anaphylactic reaction. This case report is presented in order to illustrate the possibility of more than one fungal infection in an immuncompromised patient in spite of antifungal therapy and documenty a successful L-AmB challenge and possible desensitization in a patient with SAA who had a prior anaphylactic reaction associated with L-AmB.
