Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Evaluation of Nutritional Status in Pediatric İntensive Care Unit Patients: The Results of A Multicenter, Prospective Study in Turkey(2023) Ozkale, Murat; 37601138; A-7806-2016IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.Item Hematologic and Bone Marrow Changes in Children with Protein-Energy Malnutrition(2014) Ozkale, Murat; Sipahi, Tansu; https://orcid.org/0000-0003-0625-1057; 23987917; A-7806-2016Background: All systems in an organism are affected by protein-energy malnutrition (PEM), but one of the worst affected is the hematopoietic system. Today PEM remains a very serious problem in developing countries. We examined the relationships between clinical features, hematological, and bone marrow changes with severe PEM from Turkey. Method: We evaluated 34 (11 females and 23 males) consecutive cases of severe PEM, with no underlying diseases aged 3-20 months. The clinical nutritional conditions of the patients were determined using the Wellcome-Trust PEM classification. Ten of the patients were in the Marasmic-Kwashiorkor (M-K) group, 10 were in the Kwashiorkor (KW) group, and 14 were in the Marasmic (M) group. Full blood count, protein, albumin, serum iron (SI), iron-binding capacity (TIBC), ferritin, vitamin B12, folic acid, complement-3 (C3), complement-4 (C4), and bone marrow were investigated in all groups. Results: Anemia was detected in 97% of patients. We determined serum iron levels were low in 67.6% of the patients, TS levels were low in 76.4% of the patients and ferritin levels were low in 20.5%. The level of vitamin B12 was normal in all patients. Bone marrow analysis showed erythroid series hypoplasia in 28.5% of patients in the M group, 50% in the KW group, and 30% in the M-K group. Marrow iron was absent in 58.8% of patients. Conclusion: The most common hematologic change in the children with PEM was anemia and major cause of anemia was iron deficiency in this study. Patients with severe PEM have normal Vit B12 and serum folate levels. Most of the patients with severe PEM had normal cellularity with megaloblastic and dysplastic changes in bone marrow due to the inadequate and imbalanced intake of protein and energy.Item Long-Term Accidental Overdose of Levetiracetam in an Infant(2014) Ozkale, Yasemin; Ozkale, Murat; Saygi, Semra; Erol, Ilknur; https://orcid.org/0000-0003-3009-336X; https://orcid.org/0000-0003-0625-1057; https://orcid.org/0000-0002-8522-5078; https://orcid.org/0000-0002-3530-0463; 23520362; AAL-6136-2021; A-7806-2016; AAB-1203-2021; AAK-4825-2021Levetiracetam is one of the new anticonvulsant drugs that has a high therapeutic index and potential antiepileptogenic effects. Herein, we report a patient with multidrug refractory epilepsy and Ohtahara syndrome who was accidentally administered 300 mg/kg/d for 35 days by her mother. To our knowledge, there are only a few cases of accidental overdose of levetiracetam in pediatric patients reported in the literature, and this case study is the first to report such a high and long-term dose in an infant who showed no adverse effects.Item Serum Vitamin B12, Folic Acid, and Homocysteine Levels in Children with Febrile Seizure(2015) Ozkale, Yasemin; Erol, Ilknur; Kilicarslan, Buket; Ozkale, Murat; Saygi, Semra; Sariturk, Cagla; Sezgin, Nurzen; 0000-0002-3530-0463; 0000-0002-8522-5078; 0000-0003-0625-1057; 0000-0003-3009-336X; 0000-0002-4130-1059; 27186696; AAK-4825-2021; AAB-1203-2021; A-7806-2016; AAL-6136-2021; AAS-7129-2021The aim of this study is to investigate the associations between febrile seizure and serum levels of vitamin B-12, folic acid, and homocysteine. One hundred and four children who presented with febrile seizure and 75 controls who presented with febrile illness unaccompanied by seizure were enrolled into the study. Mean levels of vitamin B-12, folic acid and homocysteine were compared between two groups. Mean vitamin B-12 level in the febrile seizure group was significantly lower than the control group. The febrile seizure patients with 3 or more had significantly lower serum folic acid than the subgroups with two or one episode only. Serum concentrations of folic acid were significantly lower in the febrile seizure subgroup with body temperature 37.5-39.0 degrees C at time of convulsion. Low serum vitamin B-12 may reduce a child's threshold for seizure and may be a risk factor for febrile seizure. Low serum folic acid level may be predisposed to recurrent febrile seizure.Item Toxic Reaction due to Multiple Wasp Stings in a Child: A Case Report(2022) Ozkale, Yasemin; Ozkale, MuratBackground: Poisoning caused by wasp and bee stings is the most common type of poisoning caused by insects in Turkiye. The wasp belongs to the family Vespidae, a subgroup of the class Hymenoptera (membrane-winged insects). While mild symptoms are frequently observed in response to a single wasp sting, multiple wasp stings can cause severe poisoning and toxic reactions. Case Report: We present a case of a 7-year-old male patient who died after developing rhabdomyolysis, acute kidney injury (AKI), and multiple organ failure as a result of multiple wasp stings. Conclusion: The case report of our patient revealed that poisoning from multiple wasp stings can show a fatal course in children. When the number of wasp stings is 20-200 and when stings occur in the head-and-neck regions, AKI and mortality are high. Therefore, these patients should be hospitalized in the pediatric intensive care unit and monitored closely for toxic reactions.Item Overview of Therapeutic Plasma Exchange in Pediatric Neurology: A Single-Center Experience(2018) Ozkale, Murat; Erol, Ilknur; Ozkale, Yasemin; Kozanoglu, Ilknur; https://orcid.org/0000-0003-0625-1057; https://orcid.org/0000-0002-3530-0463; https://orcid.org/0000-0003-3009-336X; https://orcid.org/0000-0002-5268-1210; 29882008; A-7806-2016; AAK-4825-2021; AAL-6136-2021; AAE-1241-2021Therapeutic plasma exchange (TPE) is used in the treatment of neurological, hematological, renal and autoimmune diseases with known or suspected immune pathogenesis. In comparison with neurological diseases of adults, knowledge about the use of TPE in children is incomplete. We report our experience on TPE in children with neurological diseases in a single institution and describe the underlying etiology, clinical course, treatment and outcome. We retrospectively evaluated 22 consecutive children (12 girls, 10 boys, aged 2-16 years) who underwent TPE in the pediatric intensive care unit between January 2010 and January 2017. There were 135 TPE procedures with median 6 TPE sessions per patient. Fresh frozen plasma was used as a replacement fluid in all cases. Most common indications were inflammatory polyneuropathy followed by acquired demyelinating diseases of the central nervous system. Other indications were autoimmune encephalitis and paraneoplastic limbic encephalitis. No mortality was recorded during TPE. The complication rate was 2.2% and consisted of transient events like hypotension and allergic reactions. Therapetic plasma exchange is one of the safe methods of treatment for neuroimmunological disorders in children, with Guillain-Barr, syndrome as the most common indication.Item FCN2 c.772G > T Polymorphism Is Associated With Chronic Adenoiditis And/Or Tonsillitis, But Not-4 A > G and-602 G > A(2016) Erkan, Alper N.; Oz, Isilay; Terzi, Yunus K.; Aydin, Erdinc; Ozkale, Murat; Babakurban, Seda Turkoglu; Koycu, Alper; Sahin, Feride Iffet; 0000-0003-0625-1057; 0000-0001-5612-9696; 0000-0001-7138-1400; 0000-0003-1290-3509; 0000-0002-7380-4566; 0000-0001-5067-4044; 0000-0001-7308-9673; 0000-0001-6864-7378; 27368434; A-7806-2016; B-4372-2018; H-1063-2019; AAF-3650-2021; AAJ-1452-2021; AAI-8856-2021; AAC-7232-2020; AAJ-2379-2021Objective: Ficolins are complement activating peptides that play a role in the initial host defense against infectious pathogens. In the present study, we investigated the relationship between single nucleotide polymorphisms (SNPs) in the ficolin 2 gene (FCN2) and chronic adenotonsillitis in pediatric cases. Study Design: Case-control study. Methods: A total of 101 pediatric patients diagnosed with chronic adenotonsillitis and 100 healthy children were enrolled in the study. Genotypes of FCN2 promoter SNPs -602 G>A and -4 A>G, and the exonic SNP c.772G>T were determined by light SNP assay after realtime PCR analysis using genomic DNA samples obtained from peripheral blood samples of all participants. Results: Of the 101 chronic tonsillitis patients, 38 were girls and 63 were boys; the mean age was 5.2 +/- 2.3 years. The c.772G>T SNP frequency was significantly higher in chronic adenotonsillitis cases compared to the control group (p = 0.00); however, no significant difference was determined at positions -602 G>A or -4 A>G (p > 0.05). Conclusions: The FCN2 c.772G>T genotype appears to be associated with predisposition to chronic adenotonsillitis in the pediatric age group. This nucleotide change is likely to influence the level of gene expression and contribute to the development of disease. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Item Neuromyelitis Optica Mimics the Morphology of Spinal Cord Tumors(2016) Erol, Ilknur; Ozkale, Murat; Savas, Tulin; Alkan, Ozlem; Cekinmez, Melih; Erbay, Ayse; 0000-0002-3530-0463; 0000-0003-0625-1057; 0000-0001-9658-9005; 0000-0001-7526-3460; 28266199; AAK-4825-2021; A-7806-2016; AAM-4169-2021Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system, that predominantly affects the spinal cord and the optic nerve. Its key features include transverse myelitis, commonly associated with extensive inflammation spanning three or more consecutive vertebral segments. Longitudinal extensive spinal cord lesions can also occur in systemic autoimmune diseases, infections, vascular and metabolic disorders, subsequent to irradiation, intramedullary tumors and paraneoplastic myelopathies. We present a case study of an 8-year-old girl seropositive for antibodies against the aquaporin 4 who displayed longitudinal extensive spinal cord lesions, that was initially misdiagnosed as an intramedullary tumor.Item Role Of Automated Red Blood Cell Exchange In The Treatment Of Aluminum Phosphide Poisoning: A Case Report And Review Of The Literature(2022) Ozkale, Murat; Ozkale, Yasemin; Kozanoglu, Ilknur; https://orcid.org/0000-0002-5268-1210; 35104018; AAE-1241-2021Aluminum phosphide (AIP) is a fumigant commonly used in agricultural areas. AIP is frequently misused for suicidal purposes because it is easily accessible. AIP poisoning causes severe metabolic acidosis, resistant hypotension, acute respiratory distress syndrome, and multiorgan failure with cardiogenic shock. Despite supportive management and intensive care, most patients die following AIP ingestion because there is no specific antidote. In this case report we present a 15-year-old female who presented with vomiting, coma and epigastric pain. She developed resistant metabolic acidosis and hypotension due to AIP poisoning. Although supportive treatment did not result in clinical improvement, she was successfully treated with automated red blood cell exchange. Automated red blood cell exchange is a procedure which is used to exchange the patient erythrocyte mass with donor red blood cell. Although automated red blood cell exchange is a preferred treatment method in the complications of sickle cell anemia, some blood diseases and infectious diseases such as malaria and babesiosis, there is little information about its use in poisoning. To the best of our knowledge, this is the first child with AIP poisoning who was treated with automated red blood cell exchange.Item Plasma Exchange in the Treatment of A Child with West Nile Virus Encephalitis: A Case Report(2022) Ozkale, Yasemin; Ozkale, Murat; Ceylan, Ozgur; Erol, IlknurBackground: West Nile virus (WNV) is a member of the Japanese encephalitis antigenic complex of the family Flaviviridae that can cause a wide range of clinical symptoms, from asymptomatic disease to severe meningitis, encephalitis flaccid paralysis, and death. In immunocompetent children, WNV infection is usually benign and self-limiting. However, this virus is also associated with severe neurological disease in some patients, especially those who are older, have a chronic disease, have undergone organ transplantation, or are immunocompromised. Case Report: A 12-year-old boy with selective immunoglobulin A-deficiency (SIgAD) and refractory seizures due to WNV encephalitis (WNE) was successfully treated with therapeutic plasma exchange (TPE) in conjunction with other immunomodulatory therapies. Conclusion: WNV can progress like autoimmune encephalitis. TPE appears to be safe and effective for treating children with WNE. To our knowledge, this report is the first of a child with WNV infection and SIgAD.