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Öğe 99mTc-HMPAO brain perfusion single-photon emission computed tomography in children with Down syndrome(Sage Publications Inc, 2006) Altiay, Suriye; Kaya, Meryem; Karasalihoglu, Serap; Gultekin, Aziz; Oner, Naci; Biner, BetulIn recent years, it has been possible for patients with Down syndrome to live longer with advanced medical treatment and social support. As a result, the problems of these patients, such as thyroid diseases, leukemia, and Alzheimer disease, would be encountered more frequently. In this study, we aimed to perform the brain perfusion of children with Down syndrome by technetium 99m hexamethylpropylene amine oxime (Tc-99m-HMPAO) single-photon emission computed tomography (SPECT) and to determine the relationship between brain perfusion and epilepsy, thyroid function tests, congenital heart disease, and level of mental and motor development. Thirty patients with Down syndrome, aged between 1 and 15 years, were included in our study. Demographic data, the existence of epilepsy and congenital heart defects, the level of mental and motor development, serum. levels of thyroid hormones, and autoantibodies were determined. All patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI). Cerebral SPECT was per-formed in all cases to evaluate the brain perfusion pattern. According to the visual evaluation of cerebral SPECT results, hypoperfusion was detected in 11 cases (37%). Patients with cerebral hypoperfusion (group 1) and patients with normal cerebral perfusion (group 2) were compared. There was no difference between group 1 and group 2 in terms of demographic data, congenital heart defects, IQ levels, thyroid hormones, and autoantibodies, but the incidence of epilepsy was significantly higher in group 1 (P < .001). When motor and mental development levels were compared, it was found that cases in group 1 were significantly more retarded in personal-social and fine motor skills (P < .05). The present study showed that cerebral hypoperfusion in children with Down syndrome is mostly related to epilepsy and the other coexisting conditions, congenital heart disease and hypothyroidism. Patients with cerebral hypoperfusion also have more retarded developmental levels, especially in personal-social and fine motor skills.Öğe Assessment of diastolic function in children and adolescents with beta-thalassemia major by tissue Doppler imaging(Aves, 2011) Yavuz, Taner; Nisli, Kemal; Oner, Naci; Ertugrul, Turkan; Salcioglu, Zafer; Aydogan, Gonul; Karakas, ZeynepAim: The purpose of this study was to analyze myocardial diastolic function in patients with beta-thalassemia major before development of overt cardiomyopathy using pulsed wave tissue Doppler imaging, and compare data with conventional Doppler echocardiography. Material and Method: The study included 61 beta-thalassemia major subjects (age 4 to 20 years; mean age, 10.7 +/- 4.1 years; 32 females and 29 males) with normal left ventricular function and 52 healthy control subjects, matched for age and sex. All participants underwent M-mode echocardiography and left ventricular systolic function was measured; diastolic functions of the right and left ventricul were analysed using tissue Doppler imaging and conventional Doppler echocardiography. SPSS for Windows 13.0 software programme was used for statistical analysis, and the student's t-test was used to compare data. This study was approved by the ethics committee of the Istanbul Medical Faculty. Results: Body surface area was significantly smaller in the patients than in the controls (1.0 +/- 0.2 vs. 1.2 +/- 0.3 m(2), p < 0.01). Transmitral early peak velocity and ratio were found to be significantly increased in patients compared with the controls (p < 0.01 and p=0.039, respectively). Late peak velocity of mitral valve and all Doppler velocities across the tricuspid valve did not differ between groups (p > 0.05). In patients with beta-thalassemia major, the early diastolic velocities of the myocardium at the base of the left and right ventricle, at the middle segment of the left and right ventricle, and the interventricular septum were found to be higher than controls (p < 0.05). We also found significantly higher late diastolic velocities at the base and middle segments of right ventricle, early and late diastolic velocities ratio at the base of the right ventricle and at the middle segment of the left and right ventricle, and the interventricular septum compared with controls (p < 0.05). Conclusions: These findings acquired from the young aged beta-thalassemia major patients with normal ventricular systolic function were believed to be results from high preload and hyperdynamic response to chronic anemia rather than true ventricular restriction. We suggest that long-term follow-up studies should be carried out in patients with beta-thalassemia major using tissue Doppler in order to evaluate the diagnostic accuracy of this imaging technique in diagnosis of early stages of cardiac involvement. (Turk Arch Ped 2011; 46: 26-32)Öğe The comparison of single-dose ceftriaxone, five-day azithromycin, and ten-day amoxicillin/clavulanate for the treatment of children with acute otitis media(Turkish J Pediatrics, 2007) Biner, Betuel; Celtik, Coskun; Oner, Naci; Kucukugurluoglu, Yasemin; Guzel, Ahmet; Yildirim, Cetin; Adali, Mustafa KemalThe aim of the study was to evaluate the efficacy of short-course antimicrobial therapies [single intramuscular dose of ceftriaxone (50 mg/kg, not exceeding 1 g), 5 days of azithromycin (10 mg/kg on day 1, then 5 mg/kg daily on days 2-5) and the traditional 10-day course of amoxicillin/clavulanate (90/6.4 mg/kg/day in 2 doses)] in children with acute otitis media (AOM). The study was conducted as a prospective, comparative, open randomized trial between February 2001 and April 2003, and 104 children were enrolled, with a mean age of 3.8 (2.3) years. The clinical and otoscopic assessments of the children were made on days 0, 3, 11 and 30 after admission, and tympanometry was performed on day 30. The patients were diagnosed and followed with a scoring system. Clinical success was achieved in 29/34 patients (85.3%) in the ceftriaxone group, 27/31 patients (87.1%) in the azithromycin group and 34/39 children (87.2%) in the arnoxicillin/clavulanate group. The rate of persistence of middle-ear fluid did not differ between the three groups (p>0.05). During the one-month period, no recurrent case was observed. The most common drug-related adverse effects were associated with the gastrointestinal system. In conclusion, for the treatment of children with AOM, the clinical success of single-dose intramuscular ceftriaxone and of five-day azithromycin treatments was comparable to that of the traditional 10-day therapy with high-dose arnoxicillin/clavulanate.Öğe Dietary Intakes of Adolescents Living in Edirne, Turkey(Routledge Journals, Taylor & Francis Ltd, 2008) Garipagaoglu, Muazzez; Oner, Naci; Vatansever, Ulfet; Inan, Mustafa; Kucukugurluoglu, Yasemin; Turan, CagriObjective: To assess the dietary intakes of the adolescents in the area of Edirne, Turkey. Design: Cross-sectional, prospective, epidemiological study. Settings and Subjects: Our study group consists of 1944 adolescents aged between 12 to 17 years; 940 females and 1004 males. Interventions: Three-day self-reported food records were collected from the subjects and evaluated by a nutrient database pro.-ram. Reported nutrient intake data were analyzed for gender differences. Minitab statistical program was used to compare nutritional data of subjects. Results: Energy, calcium, magnesium, folic acid, vitamins A, E, thiamine. and fiber intakes of whole adolescents, and also iron intakes of female adolescents were most likely to be inadequate compared with the recommendations. Iron, calcium, folic acid, thiamine, and fiber intakes were below two thirds of RDA/DRI in a large proportion of the adolescents. The intakes of protein, riboflavin, vitamin C, phosphorus and zinc were found to be adequate in a large percentage of the subjects. Forty eight percent of females and 60.1 % of males were below 2/3 of the RDA for energy. Conclusion: Pediatricians and dietitians should train the adolescents living in our region and our country on practical strategies for making healthy food choices rich in nutrient content relative to energy value to ensure intakes that approach the recommendations.Öğe Evaluation of Cardiac Autonomic Dysfunction in Patients With Duchenne-type Muscular Dystrophy(Journal Neurological Sciences, 2010) Yilmazer, Murat Muhtar; Omeroglu, Rukiye Eker; Bornaun, Helen; Oner, Naci; Nisli, KemalObjective: The aim of this study was to investigate the presence of cardiac autonomic dysfunction by time-domain heart rate variability analysis in patients with Duchenne Muscular Dystrophy (DMD). Methods: We evaluated cardiac autonomic function by time-domain heart rate variability analysis on 24-hour Holter ECG recordings in 43 patients with DMD and 34 healthy male controls. The variability of the heart rate and its circadian rhythm were assessed. The results of time-domain analyses were compared between study and control group. In addition left ventricular end-diastolic diameter, left ventricular ejection fraction and fractional shortening were measured by 2-dimensional echocardiography. Results: The mean age of study group was 8.79 +/- 3.0 years (range, 3 to 17 years), and control group was 9.52 +/- 3.1 years (range, 4 to 16 years). All of the time-domain parameters (NN, SDNN, SDANN, SDNN-i, RMSSD, pNN50) of the study group were significantly lower than control group. However no significant difference was found in left ventricular end-diastolic diameter on echocardiographic examination between study and control groups. Conclusion: The time-domain parameters were found to be decreased significantly in DMD patients. Our data showed a marked impairment of cardiac autonomic function in patinets with DMD, which reflect to mainly involve the parasympathetic activity. We concluded that autonomic dysfunction has developed in the earlier period in DMD before the development of mechanical cardiac dysfunctionÖğe Long term follow-up results of 139 Turkish children and adolescents with rheumatic heart disease(Springer, 2008) Yavuz, Taner; Nisli, Kemal; Oner, Naci; Dindar, Aygun; Aydogan, Umrah; Omeroglu, Rukiye Eker; Ertugrul, TurkanWe aimed to evaluate the predictors of the severity of chronic rheumatic valvar disease. The long term follow-up records of 139 patients with chronic rheumatic carditis were reviewed. Children were followed-up on an outpatient basis for a period ranging from 1-16 years (5.0 +/- 3.7 years). Mitral regurgitation either isolated (51%, n=71) or combined with aortic regurgitation (AR) (49%, n = 68) was observed in all cases of the initial attack of rheumatic carditis. AR at initial attack of the rheumatic carditis was found to be affected by gender (AR was more associated with males, p = 0.032), combined mitral and aortic regurgitation (CMAR), and presence of MR at initial attack (p = 0.000 and p = 0.012, respectively) with univariate analysis. The effect of CMAR on AR at initial attack was also significant by multivariate analysis (p = 0.000). CMAR, MR, and AR at initial attack had significant effects on CMAR at final evaluation (p = 0.000, p = 0.020, and p = 0.000, respectively) in univariate analysis. Multivariate analysis revealed the significant effects of CMAR and MR at initial attack on CMAR at final evaluation (p = 0.000 and p = 0.005, respectively). Univariate analysis showed that MR and AR at initial attack, and CMAR at final evaluation, had significant effects on MR at final evaluation (p = 0.000, p = 0.029, and p = 0.000, respectively). MR at initial attack and CMAR at final evaluation had significant effects on MR at final evaluation with multivariate analysis (p = 0.001 and p = 0.003, respectively). AR at final evaluation was affected by CMAR and AR at initial attack (p = 0.000 and p = 0.000, respectively), and CMAR and MR at final evaluation (p = 0.000 and p = 0.000, respectively) with both univariate and multivariate analysis. Mitral valve prolapsus was more common in patients with a longer duration (37.5%, 6 out of 16) than those with a shorter duration (11%, 14 out of 123) and the difference was significant (p = 0.020). In conclusion, the initial severity of valve involvement and the presence of CMAR at initial attack were found to be the best predictors for the severity of chronic rheumatic valvar disease in this study.Öğe Personal characteristics of enuretic children: An epidemiological study from south-east Europe(Karger, 2008) Inan, Mustafa; Tokuc, Burcu; Aydiner, Cagatay Y.; Aksu, Burhan; Oner, Naci; Basaran, Umit NusretIntroduction: This study examined the personal characteristics of enuretic children and investigated the risk factors of nocturnal enuresis among schoolchildren. Methods: It was a cross-sectional and descriptive questionnaire study and 2,000 children were stratified according to school population, age and gender. The questionnaire was designed for parents to collect information about the prevalence and associated factors as well. Results: Nocturnal enuresis was reported in 159 cases (9.8%). The parameters of bladder control after 2 years of age, urination more than 5 times a day, urinary infection history, history of psychological or physical trauma, siblings with health problems, large family size, lack of a private bedroom, and constipation were more frequent in enuretics ( p < 0.05). The parameters of having fecal incontinence, parents and siblings with nocturnal enuresis, low educational level of the mother and poor school performance seem to be risk factors for nocturnal enuresis. However, the parental concern level was high, approximately half of the enuretic children did not visit a physician for management of the problem. Conclusion: Nocturnal enuresis could be a multifactorial problem originating from bladder dysfunction, deranged sleep patterns and psychological and hereditary predisposition. Hereditary disposition and having fecal incontinence may be important risk factors for enuresis. Copyright (c) 2008 S. Karger AG, Basel.Öğe Post-Operative Malignant Hyperthermia in a Child after Colon Interposition(Aves, 2015) Sahin, Sevtap Hekimoglu; Inan, Mustafa; Aksu, Burhan; Oner, Naci; Colak, Alkin; Guzel, AhmetMalignant hyperthermia (MH) is a rare and potentially life threatening fatal complication of anaesthesia. We present a 2-year-old boy with late onset MH after colon interposition to replace the oesophagus under sevoflurane anaesthesia. The patient was treated with intravenous dantrolene sodium as well as cooling and controlled ventilation. Despite treatment, the patient developed cardiopulmonary arrest at 21 hours after the operation and died. It should be kept in mind that post-operative MH may develop during these types of operations with ischaemia-reperfusion injuries.Öğe The Reasons of Elevated Serum Transaminases in Childhood(Turkish Biochem Soc, 2008) Celtik, Coskun; Erbas, Hakan; Kursun, Oemer Serhat; Bostancioglu, Musa; Inan, Mustafa; Oner, Naci; Acunas, Betuel AysePurpose: To determine the reasons of high serum serum transaminases levels and show the differences according to age and aetiology. Method: During the three years period, 250 cases with elevated serum transaminase levels among the children who hospitalized with various reasons were included to this study. The aetiological factors which caused high serum transaminase levels were classified according to the age groups (newborn, infants and older children). The mean serum transaminase levels were also determined according to aetiological factors. Results: In newborn period, most of the hipertransaminasemia causes were idiopathic. The most frequent pathological causes were perinatal asphyxia, haemolytic diseases and non-hepatitis infections, respectively. The most frequent causes of hipertransaminasemia were drug usage and non-hepatic infections in infancy period, while infectious hepatitis and drug usage were in older children. Among all of the groups, maximum transaminase levels were observed in the patients with infectious hepatitis. Interestingly, in some cases with abdominal blunt trauma, hypertransaminasemia were determined without hepatic injury. Conclusion: The ages and enzyme levels are important for the differential diagnosis of hipertransaminasemia and it should be taken into consideration that high serum transaminase levels could be obtained, even direct hepatic damage had not been observed.Öğe Repolarization abnormalities in Duchenne-type muscular dystrophy(Turkish Soc Cardiology, 2009) Yilmazer, Murat Muhtar; Omeroglu, Rukiye Eker; Bornaun, Helen; Oner, Naci; Nisli, Kemal; Ertugrul, TurkanObjectives: Duchenne-type muscular dystrophy (DMD) is an X-linked recessive inherited disease affecting mainly the skeletal and cardiac muscles. We aimed to seek associations between the incidence of ventricular arrhythmias and corrected QT (QTc) dispersion and its component, corrected JT (JTc) dispersion in patients with DMD. Study design: The study included 43 consecutive male patients (mean age 8.8 +/- 3.0 years; range 3 to 17 years) with DMD. On standard 12-lead electrocardiograms (ECG) the QT and JT intervals and the corrected QT (QTc) and JTc dispersions were calculated. Ventricular extrasysto-les were assessed on 24-hour Holter ECG recordings. Ventricular dysrhythmic patterns were evaluated according to the Lown-Wolf classification. The results were compared with those of a control group of 34 healthy children (mean age 9.5 +/- 3.1 years). Results: The mean QTc and JTc dispersion values were significantly higher in DMD patients compared to controls (QTc: 78.0 +/- 20.6 msec vs. 50.9 +/- 16.5 msec; JTc: 77.6 +/- 20.5 msec vs. 50.8 +/- 17.7 msec; p<0.05). The results of Holter monitoring were evaluated in 36 patients and in 33 controls. Ventricular extrasystoles were found in six patients (16.7%) and in one (grade I) control subject (3%). The incidence of pathological findings was significantly higher in the study group (p<0.05), including grade I pathology in four patients, grade II pathology in one patient, and grade IV in one patient. QTc and JTc dispersion values of the patients with and without ventricular extrasystoles showed no statistically significant difference (p>0.05). Conclusion: Similar QTc and JTc dispersion values detected in patients with and without ventricular extrasystoles may suggest that ventricular repolarization abnormalities occur in early life and may predispose to the development of ventricular arrhythmias in the long-term.Öğe Seroprevalence of autoimmune thyroiditis and celiac disease in children with insulin-dependent diabetes mellitus in the Thrace region of Turkey(Turkish Soc Gastroenterology, 2010) Soyucen, Erdogan; Yilmaz, Sema; Celtik, Coskun; Vatansever, Ulfet; Oner, Naci; Karasalihoglu, SerapBackground/aims: We aimed to estimate the seroprevalence of celiac disease, a gluten-sensitive enteropathy, and autoimmune thyroiditis in children with insulin-dependent diabetes mellitus in the Thrace region of Turkey. Methods: The population studied consisted of 33 children with insulin-dependent diabetes mellitus and 41 healthy children with demographic features similar to the study subjects. Free triiodothyronine, free thyroxine, thyroid-stimulating hormone, anti-thyroid peroxidase antibody, anti-thyroglobulin antibody, IgA, anti-endomysium IgA, and anti-gliadin IgA were measured in all cases and controls. Results: The serum levels of free triiodothyronine and free thyroxine were within the normal range in all cases. However, in one patient who had anti-thyroid peroxidase and anti-thyroglobulin antibodies, the thyroid-stimulating hormone level was high despite a normal free triiodothyronine and free thyroxine value. Ultrasonographic findings confirmed thyroiditis in this patient. Anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies, anti-endomysium IgA and anti-gliadin IgA were detected in 15.4%, 6%, 9.1% and 3% of the diabetic cases, respectively. None of these antibodies was detected in the control group. In the diabetic group, the seroprevalences of the antithyroid peroxidase antibodies and the anti-endomysium IgA were statistically higher than in the control group (p<0.05). Conclusions: Children with insulin-dependent diabetes mellitus in our region should undergo periodic screenings for autoimmune thyroiditis and celiac disease.
