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Öğe Demographic and clinical features of child abuse and neglect cases: One-year experience of The Hospital-Based Child Protection Team of Ege University, Turkey [Çocuk istismari{dotless} ve ihmali olgulari{dotless}mi{dotless}zi{dotless}n demografik ve klinik özellikleri: Ege Üniversitesi Çocuk Koruma Birimi'nin bir yi{dotless}lli{dotless}k deneyimi](2012) Koç F.; Aksit S.; Tomba A.; Aydin C.; Koturoglu G.; Çetin S.K.; Aslan A.; Halicioglu O.; Erşahin Y.; Turhan T.; Çelik A.; Şenol E.; Kara S.; Solak U.Aim: Cases of child abuse and neglect (CAN) should be ideally managed by a multidisciplinary team. In the present study, our aim was to review the demographic and clinical features of cases of child abuse and neglect followed-up by the Child Protection Team of Ege University, Izmir, Turkey. Material and Method: The data of the cases of CAN referred to the multidisciplinary team of Ege University between August 2009 and 2010 were retrospectively reviewed. The demographic and clinical characteristics of the cases were summarized. Results: There were a total of 89 CAN cases evaluated by the team in our hospital during the last 12 months. The age of the cases ranged from 1 to 17 years, and 43 (48.3%) of them were male, while 46 (51.7%) were female. The sexual, physical and emotional abuse rates were 49%, 25% and 11% respectively, while 14% of them were diagnosed as pure neglect cases. The fathers were offenders in 67% of cases of physical abuse and in 9% of cases of sexual abuse. However, an extra-familial person was the perpetrator in 59% of the cases of sexual abuse. Conclusions: Recently, the number of reported CAN cases in our country has increased after the increase in the awareness of the public about this subject and multidisciplinary child protection teams have been established within hospitals. However, there is a long way to go, although remarkable improvements have been observed in the last decade.Öğe Detection of Bordetella pertussis infection by culture, real-time polymerase chain reaction and serologic tests among children with prolonged cough [Uzamrş öksürügü olan çocuklarda kültür, gerçek zamanli polimeraz zincir reaksiyonu ve seroloji ile Bordetella pertussis enfeksiyonunun araştirilmasi](2012) Gürsel D.; Asian A.; Sönmez C.; Koturoglu G.; Çöplü N.; Kurugöl Z.; Aydemlr S.Pertussis is a respiratory infection caused by Bordetella pertussis. It attacks all age groups. It has significantly higher mortality and morbidity among newborns and children. Adolescents and adults with symptomatic but unrecognized pertussis are often the source of the infection for pediatric cases. Therefore, it is suggested to perform laboratory diagnostic tests for B.pertussis infection in children and adolescents with prolonged cough of more than two weeks. In this study, it was aimed to identify B.pertussis infection by culture, real-time polymerase chain reaction (Rt-PCR) and serological methods among children with prolonged cough. Nasopharyngeal swab samples were obtained from 51 children (19 female, 32 male; age between 2 months-14 years; median age: 7.0), who attended the outpatient clinic of Ege University Medical Faculty Department of Pediatrics, Izmir, Turkey with prolonged cough (> 14 days) during December 2009-August 2010. While pertussis vaccination had been completed in 48 (94%) of the cases, three cases had not been vaccinated. Previous antibiotic treatment was reported for 38 (75%) of the cases. Cultivation was done by using 7% horse blood and charcoal containing Bordetella Agar (Becton Dickinson, Germany) and Rt-PCR targeting 15481 sequence (Roche Applied Science, Germany) was used to detect B.pertussis. In addition, in house ELISA was performed to detect titers of anti-pertussis toxin (anti-PT) IgG and anti-filamentous hemagglutinin (anti-FHA) IgG antibodies in paired sera collected in 2-4 week intervals. Fourfold titer increase of antibodies or anti-PT IgG levels of at least 100 EU/ml in one serum were evaluated as serological confirmation of B.pertussis infection. In our study, B.pertussis was isolated from one nasopharyngeal swab samples culture among the 51 patients, and IS487 Rt-PCR yielded positive results for B.pertussis in 6 (11.8%) samples. Nine (17.6%) patients were diagnosed as B.pertussis infection by serological tests. Totally 12 patients were evaluated as positive using at least one method. Among them only one had positive results with three of the tests used and two were positive with IS487 Rt-PCR assay and serologic tests. Three patients were found positive with only IS487 Rt-PCR and six were identified only with serologic diagnosis. In this study, 23.5% (12/51) of children with persistant cough were evaluated as having B.pertussis infection. The age range of these cases (5 female, 7 male) was 2 months-11 years and one case had not been vaccinated at all while four cases had not completed the vaccination schedule. It was concluded that since B.pertussis can be detected as the etiologic agent of persistant cough in a significant number of children by culture, PCR and serologic tests, diagnostic tests must be applied to evaluate B.pertussis infection. However, standardized serological methods and PCR protocols are needed for accurate and reliable diagnosis.Öğe Doctor's knowledge levels about for cervical cancer [Serviks kanseri hakkinda hekimlerin bilgi düzeyleri](2010) Koç F.; Akşit S.; Kurugöl Z.; Koturoglu G.; Halicioglu O.; Aslan A.Objective: Human papillomavirus (HPV), Human immunodeficiency virus (HIV) and Chlamydia infections, long-term oral contraceptive use, poor diet, multiple pregnancies, low socioeconomic status and family history are major risk factors for cervical cancer. The aim of the study was to evaluate doctors' knowledge about HPV vaccine and the risk factors for the development of cervical cancer. Material and Methods: Before the HPV vaccine license approval in our country, we were asked to complete a self-administered questionnaire regarding cervical cancer and HPV vaccine. A total of 188 doctors filled the questionnaires. Results: The mean age of the participant doctors was 38 ± 10 years. Eighty percent of them were pediatricians. HPV infection, early sexual activity, multiple pregnancies, HIV infection and oral contraceptive use were defined as very important risk factors for cervical cancer by 85%, 73%, 21%, 41% and 13% of the doctors, respectively. About 80% of the doctors were aware of the use of HPV vaccine in the prevention of cervical cancer. Conclusion: Doctors' knowledge especially on the association of HPV and cervical cancer seems to be satisfactory. However, more information on the development and prevention of cervical cancer should be given to physicians. Copyright © 2010 by Türkiye Klinikleri.Öğe The effects of atypical antipsychotics on woman's fertility and pregnancy: Case report [Atipik antipsikotiklerin kadin fertilitesi ve gebelik üzerine etkileri: Olgu sunumu](2005) Altintoprak A.E.; Erol A.; Koturoglu G.; Gönül A.S.Clinical reports indicate that atypical antipsychotics are associated with a lower incidence of adverse events such as dose-related increases in prolactin concentrations than conventional antipsychotics. It has been shown that olanzapine causes less extrapyramidal movement disorder, hyperprolactinemia and sexual disfunction. Clinicians are confronted with challenging situations when working with women who are pregnant and have a co-existing mental illness. It is well known that potential consequences of an untreated psychotic episode may be severe and may lead to the mother attempting suicide and/or infanticide. For these reasons, clinicians need to help mothers weigh both fetal and neonatal risks of exposure to drugs against the potential risk they and their infant may incur if the psychiatric illness is not treated. Although data regarding conventional antipsychotics and pregnancy are available, reports about the course of pregnancy in women treated with atypical agents are insufficient. Understanding the risk of prenatal antipsychotic exposure can be of benefit in selecting therapies. Here we present a woman who was treated with olanzapine before and during her pregnancy and her baby.Öğe Effects of Saccharomyces boulardii in children with acute diarrhoea(2005) Kurugöl Z.; Koturoglu G.Aim: Certain probiotic agents, e.g. Lactobacillus GG, have shown efficacy in clinical trials for the treatment of acute childhood diarrhoea, but few studies have examined the effect of Saccharomyces boulardii. We evaluated the effect of S. boulardii in children with acute diarrhoea. Methods: Two hundred children were randomized to receive S. boulardii in a granulated form in a daily dose of 250 mg (S. boulardii group) or placebo (placebo group) for 5 d. Clinical and demographic characteristics on admission were similar between the study groups. Results: The medians of the average stool frequency after the second day of the treatment were significantly lower in the S. boulardii group than in the placebo group (p = 0.003). The duration of diarrhoea significantly reduced in the S. boulardii group compared with the placebo group (4.7 vs 5.5 d, p = 0.03). The effect of S. boulardii on watery diarrhoea became apparent after the second day of the treatment. The duration of hospital stay was shorter in the S. boulardii group than in the placebo group (2.9 vs 3.9 d, p < 0.001). Four children from the placebo group versus only one child from the S. boulardii group had persisting diarrhoea. Conclusion: The placebo-controlled study suggested that S. boulardii significantly reduced the duration of acute diarrhoea and the duration of hospital stay. S. boulardii seems to be a promising agent for the amelioration of the course of acute diarrhoea in children when used therapeutically.Öğe Fears of fever and fever management in Turkish families [Türk ailelerinin ateş yönetimi i·le i·lgili bilinç düzeyi ve korkulari](2009) Saz E.U.; Koturoglu G.; Duyu M.; Ozananar Y.; Kurugöl Z.; Sever M.Objective: Fever is one of the most common reasons for parents to bring their children to the emergency departments. Most parents believe that fever is not a sign of illness, they have numerous misconceptions about it as well as its management.The objectives of this study were to explore knowledge and management of childhood fever and to evaluate factors associated with correctly identifying a temperature which is within the normal range and one which is a fever. Methods: Between January and July 2008, a crosssectional 30-item questionnaire was distributed to caregivers whose children were enrolled in an urban hospital-based pediatric clinic in Ege University Hosoital, Izmir. This questionnaire was conducted in a division of the emergency and ambulatory pediatrics department of Ege University School of Medicine. We included all parents who approached for examination regardless of the chief complaint. All parents were asked about definition of fever, concerns about fever, and fever management. Additional information including home fever reduction techniques, frequency of temperature monitoring was also sought. Results: A total of 200 parents agreed to join the study and were interviewed. Approximately half of the participitants had completed highschool and college. Of the parents surveyed, 85%stated that they owned a thermometer and 70%preferred the axillarymethod of temperature measurement. Forty precent of caregivers believed their children had a fever if the temperature was between 30-37 C and half of them would give medicines for management. According to 73%of responders, if the fever remained untreated febrile seizure, %18 brain damage could occur. For 45%of caregivers the 1st choice of medicine was acetaminophen, and ibuprofen for 40%. Conclusion: This study demonstrates that numerous misconceptions exist regarding fever and its role in illness among well educated caregivers. Providing parents with a thermometer and educating them about its proper use may lead to an increase in appropriate monitoring and medical treatment of the febrile child.Öğe Human soluble tumor necrosis factor receptor I (sTNF-RI) and interleukin-I receptor antagonist (IL-I Ra) in different stages of acute rheumatic fever(2008) Kütükçüler N.; Karaca N.E.; Sözeri B.Y.; Koturoglu G.; Kurugöl Z.; Özyürek R.A.; Aksu G.Objective: Acute rheumatic fever (ARF) results from an autoimmune response to infection with group A streptococci. Serum concentrations of two anti-inflammatory cytakines, interleukin-I receptor antagonist (IL-IRa) and human soluble tumor necrosis factor receptor I (sTNF-RI) were determined in patients with ARF at the time of admission and 3 months after treatment in order to evaluate changes in cytokine concentrations occurring during different stages of the disease. Methods: Serum concentrations of two anti-inflammatory cytokines, IL-I Re and sTNF-RI , were investigated in children with ARF atthe time of admission (n=21) and after 3 months following the cessation of treatment (n=15). The sTNF-RI and sIL-IRa were measured quantitatively in serum using enzyme-linked immunosorbent assay (ELISA). Results: Levels of IL-1 Re and sTNF-RI were found to be significantly higher during acute phase and remission period of ARF when compared to age-matched healthy controls (p=0.001 and p=0.0001, respectively). Conclusion: Our study demonstrated that two anti-inflammatory cytokines, serum sTNFRI and IL-1 Ra, are increased in acute and remission stages of ARF reflecting activation of the cellular immune response. We suggest this increase might probably be generated in an effort to counteract the already increased concentrations of proinflammatory cytokines.Öğe Hypohidrotic ectodermal dysplasia: a multidisciplinary approach.(2012) Bildik T.; Ozbaran B.; Kose S.; Koturoglu G.; Gokce B.; Gunaydin A.; Altintas I.Hypohidrotic ectodermal dysplasia (HED; Christ-Siemens-Touraine syndrome) is a genetic disorder characterized by sparse hair, oligodontia with peg-shaped teeth, reduced sweating, and defects in a number of other ectodermal organs. A partial or complete absence of eccrine glands can lead to recurrent severe overheating that may cause seizures and neurological deficits. This clinical report presents a 14-year-old male patient with hypohidrotic ectodermal dysplasia, including the clinical and radiographic findings, and multidisciplinary treatment. The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) was administered to patient along with mother to assess for any psychiatric disorders. The screening and rating scales completed by mother and two teachers to evaluate the severity of attention deficit hyperactivity disorder (ADHD) symptoms, and other behavioral problems. Patient's academic performance, adaptive functioning, and problem behavior was evaluated using. The Teacher Report Form. Mental capacity was assessed with the Wechsler Intelligence Scale for Children (WISC-R). Illness Perception Questionnaire Revised was used to systematically assess illness representation attributes and emotional representations of illness. On the psychiatric diagnosis assessment using K-SADS-PL sub-threshold attention deficits and anxiety symptoms were determined. In this case we established a multidisciplinary approach in his treatment with pediatric, dermatological, and dental examinations, beside his psychiatric evaluation. The prosthetic rehabilitation included restoring upper teeth with copings and fabrication of upper and lower complete dentures. Metal framework was not incorporated in the partial denture design allowing modifications as the oral and maxillofacial development continued. Removable complete or partial dentures without metal framework is a treatment of choice until the completion of facial growth at which definitive treatment is considered.Öğe Mothers' approach to feverish child and fever phobia [Annelerin ateşli çocuga yaklaşimi ve ateş korkusu](2007) Esenay F.I.; Işler A.; Kurugöl Z.; Conk Z.; Koturoglu G.Aim: This study was planned to determine mother's knowledge, thoughts and attitudes about fever, fever phobia (fear) situations and related factors. Material and Method: The study was carried out with 426 mothers who had a child aged between 0 to 6 years and who were admitted to the pediatric policlinic of Ege University Hospital, in a four- month period. Data was collected using a questionnaire form that included 17 open ended and multiple choiced questions; (the results were) evaluated using the number, percentage and chi-square tests. Results: Thirty-six percent of the mothers accepted temperatures less than 37?C as fever, 83% of the mothers thought that fever could be dangerous for their children and 92.3% were afraid and worried when their children were febrile. Seizure was the principle phobia source. Even 12% of the mothers worried that their children would die due to high fever. Mothers fear of fever decreased when their educational level increased. When their children were febrile, mothers performed inaccurate practices; 28.9% of the mothers gave antipyretics without asking to their doctors, 19% of the mothers administered cold water and 7.7% administered alcohol or vinegar. Conclusions: The majority of the mothers had fever phobia. The effecting factors were the mother's educational status, their working situation and (the presence of) febrile seizure history.Öğe Pemphigus vulgaris in childhood. A case report(2008) Koturoglu G.; Demir E.; Kumbaraci B.S.; Kandiloglu G.; Yurtsever S.N.An 11-year-old girl with vesicles and eroded lesions on her oral mucosa and tongue was diagnosed as having pemphigus vulgaris. The diagnosis was confirmed by histopathologic and immunofluorescence studies. The patient was succesfully treated with methylprednisolone and azathioprine. After two months maintenance therapy was started. She is still taking methylprednisolone and azathioprine as maintenance therapy and no recurrence has been observed.Öğe QT prolongation and minor head trauma: A report of two cases(2006) Koturoglu G.; Kurugol Z.; Levent E.QT prolongation is rarely seen after acute stress reactions such as burn injury and severe head trauma. Although pathophysiologic mechanism is not entirely clear, acute stress is thought to contribute to the inhomogeneity of ventricular repolarization and it is hypothesized that QTc dispersion increases with severity of acute stress conditions. In the present study, we report long QT syndrome in 2 patients with minor head trauma. Their QTc intervals, i.e. QT intervals corrected for heart rate by the standard Bazett formula, were found to be prolonged (545 and 450 ms, respectively) without creatine phosphokinase - MB elevation. These findings suggest that myocardial effects may occur as a result of probable catecholamine discharge, even if they are not at a level to affect creatine phosphokinase - MB values in minor head trauma. But these findings have not been supported by experimental data, for this reason we need a lot of study in order to confirm this hypothesis.Öğe Seroprevalence of hepatitis a infection in the Turkish Republic of Northern Cyprus(2009) Kurugöl Z.; Koturoglu G.; Akşit S.; Özacar T.This study was conducted to determine the seroprevalence of hepatitis A virus (HAV) infection in the Turkish Republic of Northern Cyprus. Materials and Methods: A total of 660 unvaccinated persons 1 to 30 years old were selected for the study with cluster sampling. Information on sociodemographic characteristics was gathered for each participant and, in 641 of them, anti-HAV antibodies were assayed using an enzyme immune assay. Results: Anti-HAV prevalence in the Turkish population under the age of 30 in Northern Cyprus was 23.9%. For the age groups 1-5, 6-10 and 11-15 years, seroprevalence rates were relatively low (11.4, 9.4 and 12%, respectively). For age groups 16 years and over, HAV seroprevalence gradually increased with age, rising to 30.4% in 16 to 20 years and to 52.5% in 21 to 30 years of age. In addition to age, other variables significantly associated with HAV seroprevalence included low family income, family size, waste water sewage, and the education level of parents. Conclusions: Anti-HAV seroprevalence in the Turkish Republic of Northern Cyprus shows an intermediate prevalence. As well as expanding health education and improving sanitation, a hepatitis A universal mass vaccination program would be logical for the population. © TÜBITAK.Öğe Severe hemolytic anemia associated with mild pneumonia caused by Mycoplasma pneumonia(Hindawi Limited, 2012) Kurugol Z.; Onen S.S.; Koturoglu G.We report a case of M. pneumoniae infection presenting with severe hemolytic anemia in a 4-year-old girl, with a ten-day history of paleness, weakness, and nonproductive cough. She was very pale and tachycardic. However, she was not tachypneic. Chest examination showed normal breath sounds. No rhoncus or whistling was heard. As the erythrocyte sedimentation rate was excessively elevated, the differential diagnosis primarily comprised hematological malignancies. Direct Coombs' test was positive. Diagnosis of M. pneumoniae infection was confirmed by elevated levels of M. pneumoniae IgG and IgM antibodies and a chest X-ray suggestive of atypical pneumonia. The patient was treated with clarithromycin and packed red cell transfusion and showed a favorable recovery within ten days after admission. In conclusion, this case demonstrates that severe hemolytic anemia caused by M. pneumoniae is not always associated with severe pulmonary involvement, even when the respiratory infection is very mild, M. pneumoniae may be the cause of severe anemia. © 2012 Zafer Kurugol et al.Öğe Shaken baby syndrome: Case report [Sarsi{dotless}lmi{dotless}ş bebek sendromu](Turkiye Klinikleri, 2012) Koç F.; Akşit S.; Turhan T.; Erşahin Y.; Tomba A.; Halicioglu O.; Aslan A.; Koturoglu G.; Aydin C.; Çetin S.; Şenol E.; Çelik A.; Kara S.Shaken baby syndrome (SBS) is a serious type of physical abuse characterized by subdural hematoma and retinal hemorrhage. This syndrome is frequently seen in children younger than 2 years of age. Most of the time it results in death or severe neurological damage. In these cases, external visible injuries are generally absent; often there no history of shaking or trauma. Clinical symptoms and findings are nonspecific. Therefore, most of the cases are missed when SBS is not considered in the differential diagnosis. In this article, we reported two SBS cases admitted to our hospital with a history of head trauma and convulsions, resulting in death in one case. © 2012 by Türkiye Klinikleri.Öğe Two cases of Guillain-Barré syndrome during measles elimination campaign in Izmir(2008) Koturoglu G.; Kurugol Z.; Tekgul H.; Ozcan T.; Dizdarer C.The authors report two cases of Guillain-Barré Syndrome (GBS) occurred during a national measles vaccination campaign in Izmir, Turkey. Among more than 325 000 vaccine recipients, only 2 cases of GBS were observed within the 10-week risk period. These cases yielded an incidence of 0.615 per 100 000 vaccine doses. The authors think that association between measles vaccination and GBS is coincidental, rather than causal. However, an epidemiological evaluation in Turkey is needed to clearly show that there is no causal association between measles vaccination and GBS.
