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    Clinical Picture at Attendance and Response to Flexible Family-Based Low-Carb Life Style Change in Children With Obesity
    (Lifescience Global, 2021) Cakmak, Hatice Mine; Arslanoglu, Ilknur; Sungur, Mehmet Ali; Bolu, Semih
    Aim: The study aims 1) to determine the clinical status of obese children at the admittance to the pediatric endocrinology referral center 2) to investigate the efficiency and compliance of the low-carb diet in a pediatric population with or without exercise, metformin Material and Methods: All subjects with the complaint of obesity and BMI percentile >95 were recruited from January 2012-August 2014. We evaluated basal retrospectively, recommended low carbohydrate family-wide eating practice and exercise to all, and metformin to selected cases, and recorded Self- reported adherence at first, third, sixth, and twelfth months. Results: Thirty-six subjects used metformin with a higher ratio of weight loss (90.0%, p=0.010) without a difference in the number of lost kilograms. In 160 cases without metformin; diet only, exercise only, and both diet and exercise groups lost weight significantly according to neither diet nor exercise group (OR:12.08, 95% CI 3.93-41.66, p<0.001; OR:3.04, 95% CI 1.18-7.84, p=0.022 and OR:32.80, 95% CI 7.14-150.77, p<0.001 respectively). Exercise plus diet (95.3%, p=0,002) and only diet (88.9%, p=0,023) were even more efficient than exercise alone (65.5%). In the twelfth month, 13.8% were on follow-up. Conclusion: Obesity gives rise to metabolic complications in the very early stages. A low carbohydrate diet proved to be acceptable and useful. Long-term consistency remains a challenge.
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    Heightened Serum Mitochondrial Biomarkers; FGF21 and NOS in Pediatric Anemia and a Negative Correlation between GDF15 and Serum Ferritin
    (Mdpi, 2024) Cakmak, Hatice Mine; Alpay, Merve; Mahdizadeh, Cansu; Ozalp, Seray Cevikel; Turay, Sevim; Ozde, Sukriye; Kocabay, Kenan
    Objective: Mitochondrial dysfunction is closely linked to chronic disorders. This study aims to explore the correlation between pediatric anemia and mitochondrial markers, specifically fibroblast growth factor 21 (FGF21), growth/differentiation factor 15 (GDF-15), and nitric oxide synthase (eNOS). Method: This study included 66 children, with 34 diagnosed with anemia and 32 in the healthy control group. Statistically significant biomarkers were determined through cutoff levels. Results: Among the participants, 34 children were classified as anemic, while 32 were categorized as healthy. The study revealed that FGF21 levels >= 0.745 pg/mL and eNOS levels >= 1.265 mu g/mL predicted anemia. Hemoglobin levels exhibited a negative correlation with FGF21 (r = -0.381; p = 0.002) and eNOS levels (r = -0.462; p < 0.001). Furthermore, a significant negative correlation was observed between GDF-15 and ferritin (r = -0.311; p = 0.019), while eNOS levels correlated positively with folate (r = 0.313; p = 0.019). Conclusions: Anemia induced elevated mitochondrial biomarkers; FGF21 and eNOS levels. The findings suggest that the long-term ramifications of anemia in childhood may be associated with mitochondrial dysfunction.
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    Long-term Outcomes of Children with Myelomeningocele and the Quality of Life in Survivors
    (Duzce Univ, Fac Medicine, 2024) Cakmak, Hatice Mine; Onbas, Omer; Tuncer, Cengiz; Kocabay, Kenan; Kilic, Guven; Zamur, Cagatay; Sav, Nadide Melike
    Objective: Myelomeningocele, a condition that causes chronic health conditions and diminished quality of life, affects not just the children but also their families. Therefore, we comprehensively evaluated the data of 101 children with MMC (myelomeningocele) and aimed to compare the quality of life between children with MMC and their siblings. It is crucial to understand that children with MMS have a diminished quality of life with social and behavioral aspects and health issues, which can be emotionally challenging for them and their families. Methods: In this retrospective study, we collected data from electronic files, ensuring a comprehensive and accurate representation of the participants' medical history. To measure the quality of life, we used the KIDSCREEN 10 instrument, a widely recognized and validated tool in pediatric research. Results: Of the 101 children, 93 were survivors. Comparing the survivors (n=93) with their siblings, survivors had lower HRQoL (health-related quality of life) scores in subdimensions of physical well-being (p<0.001), relationships with family (p<0.001) Aand friends (p<0.001), Aschool performance and attention (p<0.001). On the other hand, the psychological wellness score was higher in survivors than in siblings (p<0.001). Most 44 (43.5%) had average mental capacity. The HRQoL score, a measure of the impact of health conditions on a person's overall well-being, was lower in the Chiari type 2 group than in the other survivors (p=0.035). Serum and folic acid levels did not correlate with HRQoL measures. Conclusions: This study illuminates the quality of life measures in MMC survivors and the Chiari type 2 group and utilizes new MRI findings, which provide groundbreaking insights into the health conditions and well-being of these populations. These findings are of utmost importance for medical professionals, researchers, and healthcare providers specializing in pediatric care and neurology, as they can significantly impact the treatment and care of these patients.
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    Multidrug-Resistant Gram-Negative Bacteria Rate and Risk Factors in the Neonatal Intensive Care Unit: A Single-Center Ten- Year Experience
    (Duzce Univ, Fac Medicine, 2023) Cakmak, Hatice Mine; Yekenkurul, Dilek; Sengun, Zehra; Yener, Selvi; Duran, Pelin Kamuran; Davran, Fatih; Kocabay, Kenan
    Objective: Multidrug resistance (MDR) in gram-negative neonatal infections is difficult to manage, and the risk factors differ among different studies. Therefore, we aim to investigate the demographics, mortality, MDR status of gram-negative isolates, and risk factors for MDR gram-negative infections.Methods: We conducted a retrospective single-center study about MDR gram-negative infections in neonates between January 2012-January 2022 at Duzce University Hospital in Turkey. This study evaluates neonates with MDR gram-negative infections' risk factors and clinical features. All analyses were performed using IBM SPSS V23. In addition, univariate analyses and multivariate logistic regression models were studied to determine MDR's risk factors.Results: Of 107 gram-negative bacteria, 41 (38.3%) accounted for Enterobacter, 30 (28%) for Klebsiella pneumonia, and 22 (20.6%) for Escherichia coli. Additionally, 61 (56.5%) were MDR microorganisms. Among the susceptibility tests performed for selected isolates, 41 (77.4%) had resistance to piperacillin, 57 (75%) showed resistance to amoxiclav, and 16 (72.7%) had cefoxitin resistance. In addition, carbapenemase resistance was found in 24 (43.6%) and meropenem resistance in 13 (36.1%). Colistin, aztreonam, and tigecycline resistances were the least frequent. In addition, the following dependent risk factors increased the multidrug resistance risk in gram-negative infections; late-onset sepsis 3.547 fold (p=0.005), use of mechanical ventilation 3.143 fold (p=0.007), blood transfusion 3.587 fold (p=0.013), bronchopulmonary dysplasia 6.702 fold, (p= 0.015) and total parenteral nutrition 5.591 fold (p=0.001), lower gestational age 1.122 (1/0.891) fold (p=0.026), and birth weight 1.001 (1/0.999) fold, (p=0.013). Similarly, antibiotherapy duration was significantly higher in the MDR group than in the non-MDR group.Conclusions: The reported risk factors for MDR in gram-negative neonatal infections are all dependent risk factors. Hence clinicians must be alert to all potential risk factors.
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    Refugee and asylum-seeker children and health problems in the city of Duzce, Turkiye
    (Wiley, 2024) Cakmak, Hatice Mine; Kocabay, Kenan; Temizkan, Ramazan Cahit; Turay, Sevim; Ozde, Sukriye; Kurt, Fatih; Sav, Nadide Melike
    Introduction: This study examines the health problems and healthcare needs of refugee and asylum-seeker children and aims to develop strategies for improvement. Methods: Based on quantitative data from 448 refugee and asylum-seeker children and 222 non-refugee local children, this study was conducted at D & uuml;zce University, Department of Paediatrics, between 2010 and 2021. The refugee children originated from three countries: Iraq (n = 304), Syria (n = 101) and Afghanistan (n = 43). The data were analysed using the SPSS data analysis program. Ethical clearance was obtained from the Ethics Committee of Duzce University. Results: The results suggest that refugee and asylum-seeker children have significantly higher rates of acute illness or infection, malnutrition (p < 0.001) and anaemia (p < 0.001) than local children as a result of living in overcrowded families (p = 0.017) and unhealthy conditions. Adolescent pregnancy (p = 0.049) emerges as an important social problem as a result of child marriage among refugee children, mostly in the form of consanguineous marriages (p < 0.001). The rate of having at least two adolescent pregnancies (under 18) was highest among Syrian refugee girls (p = 0.01). Although refugee and asylum-seeker children have higher rates of health insurance (between 74% and 95%), they have lower rates of insurance compared to local children. This research also compares the data from three nationalities, including Syria, Afghanistan and Iraq children; Iraqi and Afghan children under the international protection (IP) system with limited social support and rights had worse health conditions compared to other groups. Although Iraqi children had the highest rates of health insurance on admission (p < 0.001), they also had higher rates of chronic diseases (p = 0.001), infections (p = 0.004), allergic rhinitis (p = 0.001) and malnutrition (p < 0.001). The youngest age of admission (p = 0.006) and the shortest length of stay (p = 0.004) were for Afghan children who also had higher rates of upper respiratory infections (p = 0.021). Conclusions: This study highlights the urgent need for improved screening programmes and the importance of collaborative efforts to address the specific health needs of these populations. Addressing the health status of child refugees is a complex and multifaceted task that requires the active participation of healthcare professionals, policymakers and researchers, each of whom has a crucial role to play.