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Öğe Acquired hemophilia in pediatric population(2002) Kavakli K.; Nişli G.; Aydinok Y.; Çetingül N.; Yilmaz D.; Kavakli T.The development of acquired inhibitors against the factor VIII protein in childhood period, is a very rare disorder in nonhemophiliac persons but may be clinically important condition due to potential serious bleedings. We have investigated acquired hemophilia development frequency in children with potential high risk groups. Totally 483 nonhemophiliac children including healthy controls were enrolled the study. Age range was 2 to 20 years and mean age was 11 ± 5.4 years. Risk groups for acquired hemophilia were selected among sick children with transfusion dependent ß- thalassemia major (n= 75), children with malignancy (n= 55), asthma bronchiale (n= 65), type I insulin dependent diabetes mellitus (n= 63), collagen tissue disorders (n= 35). Age-matched 190 healthy children were selected as for healthy control group. Inhibitor tests were performed by the method of Bethesda assay. We have found only two patients who had acquired factor VIII inhibitor among 483 children. These two patients were solid tumor (osteosarcoma) and type I insulin dependent diabetes mellitus. Other risk groups and healthy controls have not inhibitor positivity. As a conclusion, acquired inhibitors should be considered for the differential diagnosis of unusual bleeding episodes in patients who had risk factors of all age groups including childhood period.Öğe Analysis on the condition of women in post menopausal period on their application of breast self-examination and having mammography and pap smear screening [Menapoz sonrasi dönemdeki· kadinlarin kendi· kendi·ne meme muayenesi·ni· uygulama, mamografi· çekti·rme ve pap smear yaptirma durumlarinin i·ncelenmesi·](2009) Oyur Çelik G.; Malak A.T.; Öztürk Z.; Yilmaz D.This study was done in order to define application of pap smear screeing test and early diagnosis of breast cancer on women in post menopausal period. This study was conducted among 45 women who applied to Çanakkale Central Health Center and accepted the research between November 15-December 15 2008. The data obtained from this study is evaluated as percentage and it is a defining research. 51,1 % of the women who apply breast self-examination knows the process. 24,4 % of them obtained the information from friends, 37,7 % from a midwife or nurse. 20% apply breast self-examination regularly but 44,4 % of them do irregularly in every three months, 40 % does not remember applying it. 44,4 % of women do not apply self breast-examination since they think that they will not have breast cancer.71,1 % of them have never had mammography screening, 20 % of them had it done once in their lives as suggested by health staff. 26% of them know that mammography screening should be done. The percentage of women who have knowledge on pap smear is 42,2 %. 55,6 % of these women received this information through TV. Until now 53,3% of them had pap smear test done once or twice, 28,9% of them had never had the test. 46,6 % of women were shy and uncomfortable of male health staff, %42,2 of them were afraid of the test, and hence did not have it. The behaviour of women in post menopausal period who had self breast-examination, mammography and pap smear screening have been found inadequate. Lack of knowledge and cultural factors have been important determinants in conducting such behaviour on their health.Öğe Antioxidant defense systems in newborns undergoing phototherapy(The Indian Journal of Pediatrics, 1999) Akisü M.; Yilmaz D.; Tüzün S.; Kültürsay N.This paper was designed to investigate whether phototherapy is an oxidative stress in newborn infants undergoing phototherapy. A day-light continuous phototherapy was given to jaundiced 20 term and 16 preterm newborns for 72 hours. We measured serum vitamin E and the activities of red blood cell anti-oxidation enzymes (superoxide dismutase, catalase and glutathione peroxidase) before and after 72 h of phototherapy. Serum vitamin E levels were not different before and after 72 h of phototherapy in both preterm and term infants. In several studies, antioxidant enzyme activities have been shown to increase in response to oxidative stresses. In this study, however, the antioxidant enzyme activities in the hemolysate were similar before and at the end of the phototherapy in both preterm and full term. In conclusion, the results of our in vivo study do not confirm the thesis that phototherapy is an oxidative stress in newborn infants. Therefore, phototherapy would preferably seem to be safe and efficient method of treatment for all neonates presenting with hyperbilirubinemia. (Indian J Pediatr 1999; 66 : 651-655).Öğe A cost evaluation of treatment alternatives in mild-to-moderate bleeding episodes in haemophilia patients with inhibitors in Turkey(2005) Dundar S.; Zülfikar B.; Kavakli K.; Gönen C.; Zülfikar H.; Yilmaz D.; Hart W.M.; Sümen A.; Tuna S.; Karamalis M.A decision-analysis model was constructed to assess total direct health care costs of four current first-line treatment options for mild-to-moderate bleeding episodes in haemophilia patients with inhibitors in Turkey: recombinant activated Factor VII (rFVIIa); high-dose Factor VIII; prothrombin complex concentrate (PCC); and activated PCC (aPCC). Resource utilisation was based on a retrospective analysis of 105 bleeding episodes treated during the period January 1996 to December 2002. Clinical outcomes were derived from a combination of the retrospective patient data and literature review, both validated by an expert panel of Turkish haematologists. rFVIIa was more effective and resolved bleeds more quickly than any of the alternatives. rFVIIa and PCC were associated with similar direct treatment costs that were relatively lower than those compared with the other options. Given the better efficacy, rFVIIa should be considered the preferred treatment option in the management of haemophilia patients with inhibitors in Turkey. © 2005 T&F Informa UK Ltd.Öğe The effect of the z-track technique on pain and drug leakage in intramuscular injections(Lippincott Williams and Wilkins, 2016) Yilmaz D.; Khorshid L.; Dedeoglu Y.Purpose/Aims: The aim of this study was to investigate the effects of the Z-track technique in the administration of intramuscular diclofenac, a nonsteroidal anti-inflammatory drug, on pain and drug leakage. Design: This is a semiexperimental and randomized controlled study. Methods: It was felt necessary to conduct this study to compare the effects on pain and drug leakage of the standard intramuscular injection method and the "Z-track technique," which is claimed to be helpful in this regard. The study was conducted in a government hospital in the Marmara region of Turkey. The research sample consisted of 60 patients, 26 female and 34 male, whose ages varied from 18 to 65 years. Sixty patients were randomly divided into 2 equal groups - the experimental group and the control group. The Z-track technique was used for intramuscular injection with the experimental group, whereas, with the control group, the standard technique of intramuscular injection was used. The patients of both groups were injected with 3-mL diclofenac sodium as prescribed by their doctor. Immediately after the procedure was finished and the needle was withdrawn, a different researcher used a 7 × 7-cm pre-prepared and sterilized standard drying paper to press on the needle entry point. The diameter of leakage was measured with a millimetric ruler and recorded on a data collection form. During this procedure, another nurse who was blind to the injection technique assessed the pain felt during the injection by means of the Visual Analog Scale. Results: In the experimental group, mean pain severity was found to be 28.30 ± 23.0, and mean drug leakage was 6.93 ± 4.62 mm, whereas, in the control group, these values were 36.40 ± 28.40 and 10.03 ± 3.69 mm, respectively. Conclusions: Drug leakage was reduced when administering intramuscular diclofenac sodium by the Z technique, but pain severity was not significantly reduced. © 2016 Wolters Kluwer Health, Inc.Öğe Effects of iron(ii) salts and iron(iii) complexes on trace element status in children with iron-deficiency anemia(2003) Sözmen E.Y.; Kavakli K.; Çetinkaya B.; Akçay Y.D.; Yilmaz D.; Aydinok Y.Iron-deficiency anemia (IDA) is the most common nutritional deficiency in childhood throughout the world. Although it has been shown that IRA is associated with elevated plasma copper and depleted zinc levels in children, there are conflicting results on the effect of iron supplementation on the absorption of these elements. The aim of this study was to investigate the effects of ferrous and ferric iron supplementation on the trace element status in children (n=25, aged 8-168 mo) with IDA. Fourteen of them were treated with ferric hydroxide-polymaltose complex (Ferrum, Vifor, Switzerland) (6 mg/d in the first 3 mo for initial therapy and 3 mg/kg for 3 mo as maintenance); the others were treated with a ferrous sulfate complex (FerroSanol, Schwarz, Germany) (6 mg/d in the first 3 mo for initial therapy and 3 mg/kg for 3 mo as maintenance). Plasma copper, zinc, and ceruloplasmin levels as well as hematological parameters were determined at baseline and the first, third, and sixth month of the treatment period. The hemoglobin and iron levels of patients in both groups were higher in the first and sixth months compared to baseline. Although the ceruloplasmin levels were depleted (48.9 mg/dL vs 41.4 mg/dL, p=0.035) during ferrous iron treatment, the copper and zinc levels remained unchanged. On the other hand, ferric iron supplementation led to an increase in zinc levels in the sixth month of treatment (0.77 mg/L vs 1.0 mg/L, p=0.021). The plasma copper levels were lower in the ferrous iron-treated group at the end of the first month of treatment than in the ferric iron-treated group (1.06 mg/L vs 1.29 mg/L, p=0.008). In conclusion, our data showed that copper and ceruloplasmin metabolisms were affected by ferrous iron supplementation, whereas ferric iron kept them to normal levels of zinc, possibly by affecting their absorption. We conclude that the copper and zinc status of patients with IDA should be taken into consideration before and after iron therapy.Öğe The elevated markers of hypercoagulability in children with Henoch-Schönlein purpura(2005) Yilmaz D.; Kavakli K.; Ozkayin N.Twenty-eight children with HSP and 79 healthy children were entered into study. Activities of protein C, free-protein S and antithrombin, activated protein C resistance, levels of fibrinogen. D-dimer, thrombin-antithrombin complex (TAT), prothrombin fragments 1+2 (PF1+2), and von Willebrand factor antigen (vWAg) and its activity (RiCof) were investigated in acute and recovery phases of HSP and controls. Fibrinogen, D-dimer, TAT, PF1+2, vWAg, and RiCof levels in patients with HSP during the acute phase were significantly higher than those of recovery phase and of the controls. A significant correlation was detected between severity of disease and TAT, PF1+2, vWAg, and D-dimer levels.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 Examination of factors affecting health school student's health promotion behavior [Saglik yüksekokulu ögrenci·leri·ni·n sagligi geli·şti·rme davranişlarini etki·leyen etmenleri·n i·ncelenmesi·](2009) Oyur Çelik G.; Malak A.T.; Bektaş M.; Yilmaz D.; Sami Yümer A.; Öztürk Z.; Demir E.This semi-experimental study was conducted at examining of factors affecting health school student's health promotion behaviour. The study sample consist of 156 first and second grade students Çanakkale Onsekiz Mart University School of Health. The data were collected by socio-demographic data collection form and Healthy Lifestyles Behavior Scale (HLBS) between October and December 2008. The data were analyzed using percentage, independent t-test, Paired sample t-test, kruskal wallis and bonferroni adjusted mann-whitney U statistical methods. The researcher gave education the student who participate the study about self-breast examination, testicular examination, gynecologic cancer prevention, nutrition, smoking, the importance of exercise. The average age of students participating in the study 19.4 + 1.3, 67.9 % of women and 32.1% of the male. 40.4 % of the students' live in the city, 79.5 % of the nuclear family and 51.9 % in order to graduate high school. Healthy lifestyle behaviors scale pre-education scores average was 122.1 ± 19.8. No significant difference was found between HLBS scores according to gender, graduate school, department, family type and family's economic level. After three months of education, student's HLBS score was 125.3 ± 17.4. There was a significant difference between the pre- post education HLBS scores (p <0.05). After three months of education, the average HLBS score of the students at the middle level were found. Students are required to improve positive health behaviors.Öğe Glutamate dehydrogenase gene mutation and hyperinsulinemia hyperammonemia syndrome: A case report [Glutamat dehidrogenaz gen mutasyonu ve hipoglisemi hiperamonemi sendromu: Bir vaka takdimi](2003) Çoker M.; Darcan S.; Gökşen D.; Orbak Z.; Yilmaz D.; Özkayin N.Congenital hyperinsulinism characterized by over-secretion of insulin is the most common cause of recurrent hypoglycemia in the neonatal period and can cause irreversible brain damage. In this case hyperinsulinemia was diagnosed by inappropriately elevated insulin levels during hypoglycemia, with negative ketone bodies in the urine and increased glucose levels to glucagon. Hyperammonemia persisted with sodium benzoate therapy and was not affected by protein restriction. Serum and urine amino acids and organic acid levels in urine were not consistent with urea cycle defects or with other hyperammonemia syndromes. A410T mutation was detected in the child and she was diagnosed as hyperinsulinemia hyperammonemia syndrome.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 Long-term ongoing coagulopathy in premature infants with respiratory distress syndrome(2013) Buyukinan M.; Yilmaz D.; Yalaz M.; Koroglu O.A.; Akisu M.; Kavakli K.; Kultursay N.The previously reported activated intravascular coagulation system in the acute phase of respiratory distress syndrome (RDS) has not been evaluated in the long term. We assessed the activities of coagulation system of a cohort of premature infants with RDS in comparison with healthy premature infants (HPIs), healthy mature infants (HMIs), and pediatric laboratory controls over a 6-month period. Cord and venous blood samples were taken at birth, at the first month and sixth month. Protein C (PC), free protein S (f-PS), and antithrombin (AT) activities, thrombin-antithrombin (TAT) complex, prothrombin fragment 1 + 2 (PF1 + 2), and fibrinogen levels were measured. Mean PC, f-PS, d-dimer, and fibrinogen values were similar at all periods for HPI and RDS groups. Low neonatal anticoagulant proteins increased within 6 months in HMI and HPI groups. However, in RDS group, the AT activity remained significantly lower together with significantly higher TAT and PF1 + 2 levels both at the first month and at sixth month, suggesting a long-term consumption coagulopathy. © 2013 The Author(s).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 A novel mutation in the DIA1 gene in a patient with methemoglobinemia type II [2](2005) Çogulu Ö.; Yilmaz D.; Özkınay F.; Kavakli K.; Roos D.[No abstract available]Öğe Outcome of joint functions in hemophilic patients: A twelve year retrospective study(2010) Çapaci K.; Balkan C.; Yilmaz D.; Yilmaz A.Y.; Kirazli Y.; Durmaz B.; Kavakli K.In hemophilic patients, recurrent intra-articular bleeding results in hemophilic arthropathy. The frequently affected joints are knee, elbow, and ankle. Prevention of recurrent joint bleedings is of great significance in avoiding hemophilic arthropathy. Bleedings may occur as a result of minor traumas or spontaneously in severe hemophilic patients. In this study, data belonging to 31 hemophilic patients were analyzed after a 12-year retrospective observation. Joints of knee, elbow, and ankle were assessed with Gilbert score and swelling, atrophy, axial deformity, crepitus, range of motion, and flexion contracture were assessed in terms of instability. Patients were grouped based on the severity of hemophilia. Severe hemophiliacs were grouped depending on whether they received long term prophylaxis or on-demand therapy. As a conclusion, it was observed that joint assessment results of severe hemophiliacs who received on-demand therapy were rather poor compared to those of mild or moderate hemophiliacs. Joint assessment results obtained from hemophilia patients who received prophylaxis, on the other hand, were almost as good as those of mild hemophiliacs. Based on swelling, atrophy, axial deformity, crepitus, flexion contracture and loss of full range of motion, there was a significant difference between the on-demand and prophylaxis groups in severe hemophiliacs (p< 0.05). In the on-demand group there was a significant difference between the baseline and final evaluations based on all parameters (p< 0.05). Consequently, it was determined that prophylactic treatment has a crucial role in the prevention of arthropathy in severe hemophiliacs. Copyright © 2010 by Türk Tibbi Rehabilitasyon Kurumu Dernegi.Öğe Relations between breast and cervical cancer prevention behaviour of female students at a School of Health and their healthy life style(Asian Pacific Organization for Cancer Prevention, 2010) Malak A.T.; Yilmaz D.; Tuna A.; Gümüs A.B.; Turgay A.S.Regular breast self-examination (BSE) and pap-smear tests are the two of the positive heath behaviors for improving, promoting and protecting the health of adolescent girls. The present quasi-experimental research was carried out with the purpose of analyzing the relations between breast and cervical cancer prevention behavior of female students at a School of Health and their health lifestyle. The research was conducted at Çanakkale Onsekiz Mart University School of Health between November 2008 and February 2009. A total of 77 female students attending the first and second grades were included in the sample. Education pertinent to the matter was provided and evaluation was made three months later. A knowledge evaluation form for breast and gynecological examination, the Healthy Life-Style Behavior Scale (HPLP), was used in data collection. Number percentages, the McNemar Bowker test, the t test and the Mann Whitney U test were used in the evaluation. Despite the information they had received, not all of the students performed regular breast self-examination (BSE) prior to the education. For 24.7% (n=19) the reason for not ding regular BSE was their having no symptoms and for 29.9% (n=23) it was due to thinking that they would not have breast cancer. The reason for not having pap smear test was a virgin status. Three months after the education, knowledge level scores of the students increased approximately three and a half times (from 23.8±9.8) to 81.2±8.0). The rate of having regular BSE was 88.3% after three months, however; there was no pap smear test probably due to the fact that it was a taboo. When the rate of having regular BSE three months after the education and HLPL scores were compared, the scores of those having it regularly and the scores of those not having it regularly were found to be close and no statistically significant difference was detected (p>0.05). In conclusion, consultancy service units should be established to comprehend the barriers perceived by adolescent girls who do not have regular health screening, to make appropriate strategic planning in order to eradicate the hindrances in Muslim societies and to enhance the motivation of youth with continuous education.Öğe Serum malondialdehyde levels in preterm and fullterm infants undergoing phototherapy [2](1998) Akisu M.; Coker C.; Tuzun S.; Yilmaz D.; Kultursay N.[No abstract available]Öğe Severe neutropenia in children: A single institutional experience(2007) Yilmaz D.; Ritchey A.K.Severe neutropenia (SN) is a rare disorder in childhood. This study aimed to document the approach to diagnosis and treatment of children with SN in a single university-based children's hospital, determine the types of SN seen in a 4-year period, and determine outcomes of the subtypes of SN. Forty-five children with SN were identified between 2000 and 2004. Two patients had autoimmune, 3 congenital, 3 familial, 6 cyclic, and 31 idiopathic SN. The median age of the patients with idiopathic SN was 15 months (3 mo to 17 y). Thirteen patients with idiopathic SN received filgrastim and 18 were observed. The history of severe infection and hospitalization at presentation was significantly more common among the patients who received filgrastim than those observed, but was not different between the 2 groups during the follow-up period. SN resolved in 16 patients and persisted in 14 patients. One patient with idiopathic SN did not respond to filgrastim and died of sepsis while she was still neutropenic. In summary, the majority of patients with SN had idiopathic SN, the infection risk was variable, treatment was based on clinical judgment rather than absolute neutrophil count, and approximately half of the patients had complete recovery. © 2007 Lippincott Williams & Wilkins, Inc.Öğe Valproic acid and lamotrigine treatment during pregnancy: The risk of chromosomal abnormality(2003) Özkınay F.; Cogulu O.; Gunduz C.; Yilmaz D.; Kultursay N.A baby born to an epileptic mother had dysmorphological features associated with 47,XXX karyotype. The mother had been treated with valproic acid (1800mg per day) and lamotrigine (100mg per day) throughout pregnancy. Dysmorphological features detected in baby were intrauterine growth retardation, hypertelorism, flattened nasal bridge, low set malformed auriculas, micrognathia, very small an bow-shaped mouth with thin upper lip, cleft palate, arachnodactyly, camptodactyly, secundum atrial septal defect, bilateral hammer toes and decreased creases on the soles. At 6 months old she showed motor retardation. The molecular analysis of parents revealed that extra X chromosome was inherited from the mother. In this case whether the dysmorphological features and 47,XXX karyotype were caused by lamotrigine and valproic acid treatment during pregnancy or coincidence is in question. © 2002 Elsevier Science B.V. All rights reserved.
