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Adolesan Çocuklarda Hepatit B Belirteçlerinin İncelenmesi-Düzce Üniversitesi Hastanesi 5 Yıllık Sonuçlar
(2021) Kılıçaslan, Önder; Sav, Nadide Melike; Karaca, Seda Erişen; Sungur, Mehmet Ali; Öztürk, Cihadiye Elif; Kocabay, Kenan
Amaç: Hepatit B virüsü (HBV), akut ve kronik karaciğer hastalığının ve bunlara bağlı morbidite ve mortalitenin başlıca nedenidir. Ülkemizde 1998 yılında Hepatit B aşısı rutin aşı takvimine alındı. Bu çalışmada, ülkemizde Hepatit B aşısı uygulanmaya başlandıktan sonra doğan çocuklardaki Hepatit B belirteçlerinin değerlendirilmesini amaçladık.Gereç ve Yöntemler: Düzce Üniversitesi Tıp Fakültesi Çocuk Polikliniklerine başvurup HBV seroloji testleri yapılan, rutin aşı takviminde aksama olmayan ve yaşları 10-19 arasında olan 310 çocuğun Hepatit B belirteçleri değerlendirildi. Çocukların tam aşılı sayılabilmeleri için 1999 ve sonrası doğumlu olanlar çalışmaya dahil edildi. Aynı hastanın farklı zamanlarda yapılan değerlendirmeleri çalışma dışı bırakıldı.Bulgular: Çalışmaya 166 (%53,5) erkek ve 144 (%46,5) kız toplam 310 çocuk alındı. Çocukların 192’sinde anti-HBs pozitif (%61,9), 118’inde (%38,1) negatif saptandı. Cinsiyetler açısından anti-HBs ve HBsAg pozitifliği karşılaştırıldığında anlamlı fark bulunmadı. Sonuç: Hepatit B aşısı sonrası bireylerin seropozitiflik durumları üzerine günümüzde fazla araştırma yapılmıyor olsa da çalışmamızda saptanan anti-HBs pozitiflik oranları; geniş bir popülasyonda yeni bir çalışma planlanarak aşılama sonrası anti-HBs düzeyinin değerlendirilmesinin tekrar gündeme gelmesini, belki de kişiden kaynaklanan sigara içme, fazla kilo problemi veya aşıların uygulanması yönünden kaynaklanan aşı transportu, saklama ve uygulama problemleri gibi sorunların ortaya çıkmasını sağlayarak, toplumda saptanan pozitif anti-HBs yüzdesinin istenilen düzeye gelmesini sağlayacaktır.
Antibiotic Resistance in Pyelonephritis Episode in Children with Recurrent Urinary Tract Infections
(2021) Sav, Nadide Melike; Çetin, Nuran; Çalışkan, Emel; Yıldız, Bilal
Objective: Bacterial resistance is a major problem in recurrent urinary tract infections. These infections are seen commonly in children with urinary tract anomalies. In this study, we aimed to determine the bacterial resistance patterns ofantibiotics in pyelonephritis.Methods: One hundred two patients were reviewed with recurrent UTI during a pyelonephritis episode retrospectively.The patients were using some antibiotics at different times as prophylaxis. Routine biochemical parameters and ultrasonographic results were also evaluated.Results: Escherichia coli was detected as the main bacterial pathogen. Bacterial isolates were significantly found moreresistant to trimethoprim-sulfamethoxazole in children with the risk factor. On the other hand, the causative microorganisms were significantly found more resistant to some antibiotics in patients under prophylaxis.Conclusion: Frequent use of antibiotics due to recurrent infections might be a factor in the development of antibiotic resistance in children. However, drug selection should be made by considering antibiotic resistance rates.
COVID-19 Disease in Children: Clinical Course, Diagnosis and Treatment Overview and Literature Data Compilation
(2020) Kılıçaslan, Önder; Sav, Nadide Melike; Karaca, Seda Erişen; Kocabay, Kenan
The novel Coronavirus is named as SARS-CoV-2 is a highly contagious infection agentcompared to the previous human coronaviruses. Each previous outbreak had distinctivedanger. The high potential of infectiousness is the primary danger of novel coronavirus.While MERS-CoV infection is known to have higher mortality rate, SARS-CoV-2 hasspread to many people all over the world in a concise time. SARS-CoV-2 (like SARS-CoVand MERS) infects fewer children and results in milder clinical symptoms than in adults.The primary pathogenesis of it is not known; the difference in children’s immunities, lesslikelihood of exposure to the agent may be the reasons. Nevertheless, along with beingmostly asymptomatic, the child population is a potential source for infection spread.
Decreased Uric Acid and Phosphorus Levels in Active Juvenile Systemic Lupus Erythematosus
(2022) Sav, Nadide Melike; Bilal, Yıldız; Çetin, Nuran
Introduction: The aim of the present study was to investigate serum phosphate and uric acid levels (UA) in juvenile sys- temic lupus erythematosus (jSLE) and to ascertain their relationship, if any, with disease activity and lupus nephritis. Methods: Included in the study were 18 children with jSLE who were investigated retrospectively during the active phase (AP) and remission phase (RP) of jSLE. Results: Serum phosphate and UA levels were found to be significantly lower in AP than in the RP (2.5±0.3/4.2±0.08 mg/dL, p=0.0001 and 2.9±0.3/5±0.2 mg/dL, p=0.0001, respectively). Serum phosphate levels were strongly correlated with serum albumin levels (r=0.772, p=0.0001) and platelet count (r=0.735, p=0.001) and negative associated with D-dimer (r=?0.750, p=0.0001) in AP. No correlation was identified between serum phosphate and UA or creatinine levels in patients with AP, while serum phosphate and UA levels were similar in children with and without nephritis (p>0.05). Serum phosphate lev- els were correlated with platelet count and UA levels and were inversely related with D-dimer levels in jSLE patients with nephritis (p<0.05). Discussion and Conclusion: Serum phosphate and UA levels can reflect the activation and low serum levels may be useful biomarkers for the detection of AP in jSLE patients with and without nephritis.
Evaluation of cardiovascular risk in children with solitary functioning kidney
(Springer, 2022) Sav, Nadide Melike; Kosger, Pelin; Can, Betül; Çetin, Nuran; Uçar, Birsen; Alataş, Özkan; Akyüz, Fahrettin
Background The present study investigates cardiovascular risk and kidney damage in patients with solitary kidneys. Methods Included in the study were 40 children with a unilateral functioning kidney and 60 healthy controls, all of whom were evaluated for carotid intima-media thickness, ischemia-modified albumin and oxidative stress parameters, and 24-h ambulatory blood pressure monitoring. Results Serum creatinine and urine microalbumin levels were higher and creatinine clearance was lower in the patient group than in the control group, and serum ischemia-modified albumin, carotid intima-media thickness, aldosterone, plasma renin activity and blood pressure were all higher in the patient group than in the control group. In addition, the patient group was showed a non-dipper pattern. Conclusion Children with a normal functioning solitary kidney are likely at higher risk of developing cardiovascular disease and such patients should be followed closely before marked kidney impairment occurs.
Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19
(Duzce University Medical School, 2022) Sav, Nadide Melike; Türay, S.; Özde, Ş.; Öksüz, Ş.
Aim: The epidemiological characteristics and modes of transmission of coronavirus disease 2019 (COVID-19) in children are not yet fully understood. In this study, it was aimed to evaluate clinical, laboratory, and radiological findings and treatment approaches in patients with negative and positive PCR tests among those with suspected COVID-19 retrospectively. Material and Methods: This study was conducted with 317 patients under 18 years of age, who received outpatient or inpatient treatment with a pre-diagnosis of COVID-19. All patients were assessed for clinical course, disease severity, comorbidity, demographic characteristics, laboratory and radiodiagnostic tests, treatment characteristics, and outcomes. Results: The PCR test was positive in 133 (42%) and negative in 184 (58%) of the patients with suspected COVID-19. There was a history of contact in 78 (58.6%) and 51 (27.7%) of the PCR-positive and negative patients, respectively (p<0.001). While the PCR-negative group had a higher rate of hospitalization (p=0.020), hospital stay was longer in PCR-positive cases (p=0.037). The white blood cell count (p=0.001), platelet count (p=0.037), neutrophil count (p=0.015), and lactate level (p=0.025) were significantly lower in the PCR-positive group. Conclusion: Early detection and isolation of children with symptoms suggestive of COVID-19 are important to limit the spread of the disease. It can be challenging initially to clinically understand whether the case has COVID-19, especially in pediatric patients. PCR test is the gold standard in the diagnosis of COVID-19. Considering the prevalence, severity, and complications of the outbreak, it would be a proper approach to initially evaluate suspected patients as COVID-19 patients. © 2022, Duzce University Medical School. All rights reserved.
Foreign Body Aspiration in Children; Duzce University Five-Years Results
(Duzce Univ, Fac Medicine, 2021) Sav, Nadide Melike; Kilicaslan, Onder; Karaca, Seda Erisen; Tamturk, Cansu; Kabaklioglu, Murat
Objective: Foreign body aspiration is a preventable cause of mortality and morbidity especially in younger than three years old children. The aim of this study is to determine the risk factors, causes and prognosis in patients with foreign body aspiration. Methods: In this study, laboratory and examination findings of 35 patients who underwent bronchoscopy, because of suspected foreign body aspiration, were retrospectively analyzed. Results: Of the 35 patients included in the study, 19 were boys and 16 were girls. The mean age was 3,2. The most causes of application were cough, and wheezing. Foreign body was detected in the right main bronchus in 62,8%, in the left main bronchus in 25,7%, in the trachea in 5,7% and in both bronchi in 5,7% of the patients. Conclusions: Early diagnosis and intervention significantly reduce the mortality and morbidity in foreign body aspirations. Prevention of foreign body aspirations is possible with the education of babysitters and family members.
Hemodialysis-related headache
(Wiley, 2014) Sav, Murat Yusuf; Sav, Tansu; Şenocak, Elif; Sav, Nadide Melike
Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis.
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.
Obez Çocuklarda Alt Üriner Sistem Semptomları
(2022) Çetin, Nuran; Sav, Nadide Melike; Kılıç Yıldırım, Gonca
Alt üriner sistem semptomları (AÜSS) çocukluk çağında oldukça yaygındır. Biz Akbal ve arkadaşları tarafından Türk çocukları için valide edilmiş işeme disfonksiyonu semptom skorunu kullanarak obez, fazla ve normal kilolu çocuklarda AÜSS sıklığını araştırmayı amaçladık. Çocuk Beslenme ve Metabolizma Polikliniği'nde takip edilen beş yaş üstü çocuklar çalışmaya dahil edildi. Vücut kitle indeksi 95 persentilin üzerinde olan çocuklar obez olarak sınıflandırıldı. Semptom skoru her çocuğa ve annesine yüz yüze birlikte uygulandı. Semptom skoru ?9 olması alt üriner sistem disfonksiyonu (AÜSD) olarak tanımlandı. Çalışmaya 164 çocuk (62 obez, 52 kilolu, 50 normal) dahil edildi. Obez çocuklarda semptom skoru, aşırı kilolu ve normal kilolu çocuklara göre anlamlı olarak daha yüksekti (sırasıyla p=0,004, p=000). Fazla kilolu çocukların semptom skoru normal kilolu çocuklara göre daha fazla idi (p=0.037). Obezlerde günlük idrar kaçırma sıklığı fazla kilolu ve normal kilolu çocuklara göre daha yaygındı (sırasıyla p=0,041, p=0,000). Hem obez hem de fazla kilolu çocuklarda normal kilolu çocuklara göre daha yüksek aciliyet sıklığı ve artmış idrar sıklığı vardı (sırasıyla, aciliyet için p=0,002, p=0,021, idrar sıklığı artışı için p=0,000, p=0,037). İşemeyi erteleme ve kabızlık sıklıkları obez çocuklarda fazla kilolu ve normal kilolu çocuklara göre daha yüksek bulundu (sırasıyla p=0.000, p=0.000 işemeyi erteleme, p=0.031, p=0.028 kabızlık). Obezite AÜSD için önemli bir risk faktörüdür. Obez çocuklarda Akbal ve arkadaşları tarafından doğrulanan anket kullanılarak AÜSS'nin sorgulanması AÜSD'nin erken teşhisine yardımcı olabilir.
Obez Çocuklarda Uyku Kalitesi ve İşeme Fonksiyonunun Değerlendirilmesi
(2022) Karaca, Seda Erişen; Sav, Nadide Melike; Kılıçaslan, Önder; Sungur, Mehmet Ali
Amaç: Çocuklarda obezite ikincil hastalıklara yol açabilen önemli bir sağlık sorunudur. Bu hastalarda artan intraabdominal ve intravezikal basınç işeme fizyolojisinde değişikliklere yol açar. Ayrıca insülin ve glukoz metabolizma bozukluğu da alt üriner sistem fonksiyonlarını etkileyebilmektedir. Bununla birlikte obezitenin uyku bozuklukları ile ilişkisi de bilinmektedir.Materyal ve Metot: İşeme ve uyku bozukluklarını belirlemek için hazırlanan anket, yaşları 9 ile 18 arasında olan, 100 obez çocuk hasta ile benzer yaş grubundaki 100 normal kilolu sağlıklı bireye uygulandı.Bulgular: Hasta grubunun %17’sinde kontrol grubunun %2’sinde gündüz idrar kaçırma şikayeti varken, nokturnal enürezis hasta grubunun %25’inde, kontrol grubunun ise %2’sinde gözlendi. Hasta grubunda sağlıklı kontrollere göre aşırı aktif mesane sıklığı da daha fazla idi (sırasıyla %15 ve %5; p<0,05). Ayrıca hasta grubunun daha yüksek oranda gece huzursuz uyuduğu, horladığı ve gün içinde yorgun göründüğü ve yine bu grupta belirgin artmış davranış bozukluğu ve öğrenme güçlüğü olduğu belirlendi.Sonuç: Bu çalışma obez çocuklarda azalmış uyku kalitesi ve işeme bozukluğunun sağlıklı gruba göre yüksek prevalansını gösteren ilk çalışmadır. Obezitenin bir çok sistemi olumsuz etkilemesine bağlı olarak ortaya çıkan patolojiler çocukluk çağında da hastalığın bir sendrom olarak değerlendirilmesinin gerekliliğini ortaya koymaktadır. Bu hastalarda multidisipliner yaklaşım tedavi başarısını artıracaktır.
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.
The Relationship Between Clinical Phenotypes and Chromosomal Microdeletions/Duplications in Pediatric Neurology
(2021) Türay, Sevim; Eröz, Recep; Habiloğlu, Esra; Sav, Nadide Melike
Aim: The aim of this study was to determine the diagnostic utility of chromosomal microarrayanalysis (CMA) in daily pediatric neurology practice and to identify the guiding clinicalparameters for patients requiring this test.Material and Methods: The CMA results for 91 patients with global developmentaldelay/intellectual disability (GDD/ID) admitted to our pediatric neurology clinic for variousreasons between 2018 and 2020 were examined. Demographical and clinical data for 34patients (37.4%) in whom del/dup was determined at CMA and 57 patients (62.6%) withnormal CMA were compared.Results: There was no statistically significant difference between two groups in terms ofdemographic characteristics such as age, gender, type of delivery, gestational age, etc.Dysmorphisms, hypotonia, myelination abnormalities were significantly more frequent inpatients with del/dup than in patients with normal result. The frequency of macrocephaly andobesity was higher in the normal group, and that of generalized seizures was higher amongepileptic patients in this group. Nineteen (55.9%) of the 34 cases who have del/dup detected atanalysis were regarded as pathogenic, 15 (44.1%) as uncertain clinical significance (likelypathogenic, likely benign and no subclassification).Conclusion: Since CMA is an expensive, laborious, and time-consuming test, consideringclinical parameters when requesting CMA will yield high diagnostic efficiency. A highpossibility of copy number variants may be predicted in GDD/ID patients with dysmorphisms,hypotonia, and myelination delay. CMA should represent the genetic analysis of choice inpediatric neurology practice in case of no finding suggesting a different etiology in these patients.
Yenidoğan Yoğun Bakım Ünitesinde Respiratuvar Distres Sendromu Tanısıyla Takip Edilen Prematüre Yenidoğanların Surfaktan Cevabının Retrospektif Değerlendirilmesi
(2023) Özde, Sukriye; Ünal, Nurcan; Sav, Nadide Melike; Çakmak, Hatice Mine; Türay, Sevim
Amaç: Preterm doğum yenidoğan ölümlerinin önde gelen nedenidir. Bu ölümlerin arasında en yüksek oran solunum sıkıntısı sendromu’ na (RDS) aittir. Bu çalışmanın amacı, yenidoğanlarda RDS yönetiminin en uygun ve etkin hale getirilmesine yardımcı olmak için; RDS’nin risk faktörlerini, klinik özelliklerini ve komplikasyonlarını belirlemektir. Gereç ve Yöntemler: Çalışmaya ikinci düzey yenidoğan yoğun bakım servisimizdeki Ocak 2016 ile Haziran 2021 tarihleri arasında düşük doğum ağırlıklı bebekler alındı. Olgular geriye dönük incelenerek, demografik özellikleri, verilmiş olan tedaviler (mekanik ventilasyon, surfaktan), ve erken ve geç komplikasyonları; ölüm oranları ve sebepleri belirlendi. Bulgular: Toplam 130 olgu çalışmaya alındı. Yüzde altmış ikisi erkek, %38’i kızdı.Yüzde 85’i sezaryen doğum, % 15’inde normal vajinal yoldu. Ortalama doğum ağırlığı 2043±372 gr, ortalama gebelik haftası 32±5 hafta bulundu. Antenatal steroid (ACS), %67,6' sında uygulanmıştı.Yüzde otuzüçünde erken membran rüptürü (EMR) saptandı. Erken ve geç komplikasyonlar; %3,8’inde ventilatöre bağlı pnömoni ve %3’ünde pnömotoraks idi.Yüzde 4,6’ında ise sepsis saptandı. Bronkopulmoner displazi (BPD) %2,3, Prematür Retinopatisi (ROP) %1,5, periventriküler lökomalazi %1,7 ile intrakraniyal kanama (IKK evre III-IV) %2 olarak görüldü. Ölüm oranı %10’du. Sonuç: Ölüm oranlarımız; ülkemizden yayınlanan verilerle benzer olarak bulundu. Doğum öncesi izlemin iyileştirilmesi, gebe takiplerinin düzenli yapılması, sık görülen ölüm nedenleri için risklerin tespit edilip bunlara karşı yeterli ve etkin önlemlerin alınması durumunda ölüm oranlarımızın azalacağını düşünmekteyiz.

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