Scopus İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Anocutaneous Reflex Revisited: How Valuable Is Its Determination in Children with Spina Bifida? A Descriptive Study in A Cohort of 217 Patients(2022) Ozel, Kerem; Canmemis, Arzu; Goknar, Nilufer; Candan, Cengiz; Alizada, Orkhan; Alatas, Ibrahim; 35147971AIM: To determine the clinical value of anocutaneous reflex (AR) in children with neurogenic bladder due to spina bifida (SB). MATERIAL and METHODS: Patients who were diagnosed with SB were prospectively evaluated; moreover, AR and bulbocavernous reflex were examined. Patients were divided into those with and without AR. Age, gender, diagnosis, ventriculoperitoneal shunt presence, symptomatic urinary tract infections, leg movements, clean intermittent catheterization and anticholinergic therapy, lesion level, urodynamic detrusor, and sphincter activity were evaluated. Chi-square test and univariate regression analysis were done. The AR value was evaluated by two by two contingency table. RESULTS: This study evaluated 217 patients (109 boys and 108 girls). AR was present and absent in 53 and 164 patients, respectively. Anticholinergic therapy was necessary in 37.7% and 23.8% of patients with and without AR (p=0.015), respectively. Patients with AR had higher lesion level (p=0.005), more detrusor overactivity, and less detrusor underactivity (p=0.007). Less detrusor sphincter dyssynergia (DSD) was noted in patients with AR (p=0.029). AR specificity was 83%, and positive predictive value in predicting detrusor overactivity and DSD was 76% and 80, respectively. CONCLUSION: AR determination is a valuable and simple tool in neurogenic bladder. This report delineates the clinical significance of this reflex and is the largest cohort describing this significance. This simple examination should not be skipped in the initial evaluation and follow-up of these patientsItem Association Of Pediatric Vasculitis Activity Score With Immunoglobulin A Vasculitis With Nephritis(2023) Avci, Begum; Kurt, Tuba; Aydin, Fatma; Celikel, Elif; Tekin, Zahide Ekinci; Sezer, Muge; Tekgoz, Nilufer; Karagol, Cuneyt; Coskun, Serkan; Kaplan, Melike Mehves; Bayrakci, Umut Selda; Acar, Banu; https://orcid.org/0000-0002-5375-379X; 35895124Background Immunoglobulin A vasculitis with nephritis (IgAVN) is the most serious complication affecting long-term prognosis. Understanding the risk factors and markers for the development of IgAVN is essential. The aim of this study is to identify IgAVN-associated factors and to evaluate the usability of Pediatric Vasculitis Activity Score (PVAS) at diagnosis as an early marker for the development of IgAVN. Methods We conducted a retrospective case-control study of 314 patients divided into two groups: those with nephritis (IgAVN) and without nephritis (non-IgAVN). The groups were compared in terms of clinical symptoms, laboratory values, and PVAS values. Results In total, 18.5% of the patients had IgAVN; they were older than the non-IgAVN patients (median age was 8.8, p < 0.05). Arthritis/arthralgia, abdominal pain, and intestinal bleeding were more common, systolic and diastolic BP were higher in IgAVN (p < 0.05). CRP, serum creatinine, and urine protein/Cr, PVAS were higher, while serum albumin was lower in IgAVN (p < 0.05). The receiver operator characteristic curve (ROC) analysis showed that IgAV patients with a determined cut-off PVAS value greater than 3 had 70.7% sensitivity in predicting whether or not they would develop IgAVN. Logistic regression analysis found that PVAS > 3 and low serum albumin at the time of diagnosis were independent risk factors for IgAVN. Conclusion Our study revealed that PVAS > 3 at diagnosis is an independent predictor of IgAVN. Patients with PVAS > 3 should be followed more closely to ensure early diagnosis and management of IgAVN.Item Respiratory problems and associated factors following endoscopic balloon dilatation procedure in children with acquired subglottic stenosis(2022) Tuzuner, Arzu; Bas, Ceren; Jafarov, Sabuhi; Bahcecitapar, Melike; Aydin, Erdinc; 0000-0002-7302-4199; 35037169; AAI-8044-2021Objectives Endoscopic balloon dilatation (EBD) offers a safe and non-invasive surgical option for the treatment of subglottic stenosis. Patient selection is important to achieve good results and to detect which patients are more prone to the development of complications. The aim of this study was to determine predictors of postoperative problems and early complications in primary EBD surgeries. Methods A retrospective analysis was made of patients with acquired subglottic stenosis who were operated on with the EBD technique between January 2010 and December 2019 in the Otolaryngology-Head and Neck Surgery Department of Baskent University Hospital. Demographic data including the age and sex of the patients were collected together with etiology, presence of chromosomal or craniofacial anomaly (C/CA), duration of prolonged intubation (DPI), and extubation dilatation timeframe (EDT). Intra and postoperative follow-up data were recorded of the need for intubation or tracheotomy, development of desaturation, and grade and type of stenosis. Results The male to female ratio was 2:1. The patients comprised 42 males and 22 females with a mean age of 296.52 +/- 551.93 days. The cause of prolonged intubation was surgery for congenital heart disease in 50 (78.1%) patients and prematurity in 14 (21.9%). The type of lesion was acute granulation in 44 (72.1%) and chronic granulation in 17 (27.9%) patients. C/CA was determined in 13 patients, the mean grade of stenosis was 76.33 +/- 15.21%, mean DPI was 25.25 +/- 35.49 days, and mean EDT was calculated as 78.23 +/- 373.82 days. Desaturation following endoscopic balloon dilatation developed in 26 (40.6%), orotracheal intubation was required in 10 (15.6%), tracheotomy in 10 (15.6%), and cardiopulmonary arrest occurred in 4 (6.25%). Prematurity, a longer duration of preoperative intubation, longer time from extubation to dilatation, older age, and higher grade of stenosis were determined as factors associated with postoperative early respiratory complications. Conclusion EBD indication should be carefully considered in children with acquired subglottic stenosis. To achieve better results and minimise complications, EBD should be performed without delay.Item How important urolithiasis is under 2 years of age?(2021) Yilmaz, Aysun Cetik; Unal, Necla; Tayfur, Asli Celebi; Buyukkaragoz, Bahar; 0000-0003-0774-4419; 34842953; AAD-1877-2021Urolithiasis (UL) is a common health problem in the world and the observed incidence of this disease is increasing in the infantile period. The study included cases of UL diagnosed before the age of two who had a comprehensive analysis for possible etiologic variables and were followed for a minimum of 6 months. Of the 60 patients included in the study, 37 were male, and the male/female ratio was 1.6. The average age at diagnosis is 8.5 +/- 4.5 months. Of the cases diagnosed 41 (68.3%) were before than 1 year of age. The average time for follow-up is 28.9 +/- 22.6 months. There was a family history of stone disease in 41 (68.3%) cases. Twenty-four (40%) patients were treated for dehydration at least once before stone disease was identified. The number of patients presenting with symptoms is 43 (71.7%). Restlessness was noted as the main symptom. In 17 (28.3%) patients, stone disease was found incidentally. Metabolic causes (n: 19, 31.6%) were determined to be the most common underlying cause, followed by UTI-related causes (n: 12, 20%). During the follow-up, 57 (64%) of the stones spontaneously disappeared. The size of 16 (18%) stones reduced, while the size of eleven remained same (13%). Following their absence, nine (15%) of the stones reappeared. The essential strategy is to identify high-risk groups, to closely monitor them, and to take preventative interventions against modifiable conditions such as dehydration if possible.Item Risk Factors for Postoperative Prolonged Mechanical Ventilation After Pediatric Liver Transplantation(2021) Sahinturk, Helin; Ozdemirkan, Aycan; Zeyneloglu, Pinar; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-0159-4771; 31084587; AAJ-8097-2021; AAJ-1419-2021Objectives: Duration of postoperative mechanical ventilation after pediatric liver transplant may influence pulmonary functions, and postoperative prolonged mechanical ventilation is associated with higher morbidity and mortality. Here, we determined its incidence and risk factors after pediatric liver transplant at our center. Materials and Methods: We retrospectively analyzed the records of 121 children who underwent liver transplant between April 2007 and April 2017 ( 305 total liver transplant procedures were performed during this period). Prolonged mechanical ventilation was defined as postoperative tracheal extubation after 24 hours. Results: Mean age at transplant was 6.2 +/- 5.4 years and 71/121 children (58.7%) were male. Immediate tracheal extubation was achieved in 68 children (56.2%). Postoperative prolonged mechanical ventilation was needed in 12 children (9.9%), with mean extubation time of 78.0 +/- 83.4 hours. Reintubation was required in 13.4%. Logistic regression analysis revealed that presence of preoperative hepatic encephalopathy (odds ratio of 0.130; 95% confidence interval, 0.027-0.615; P =.01), high aspartate amino transferase levels (odds ratio of 1.001; 95% confidence interval, 1.000-1.002; P =.02), intraoperative usage of more packed red blood cells (odds ratio of 1.001; 95% confidence interval, 1.000-1.002; P =.04), and longer surgery duration (odds ratio of 0.723; 95% confidence interval, 0.555-0.940, P =.01) were independent risk factors for postoperative prolonged mechanical ventilation. Although mean length of intensive care unit stay was significantly longer (12.6 +/- 13.6 vs 6.0 +/- 0.6 days; P =.001), mortality was similar in children with and without postoperative prolonged mechanical ventilation. Conclusions: Our results indicate that postoperative prolonged mechanical ventilation was needed in 9.9% of our children. Predictors of postoperative prolonged mechanical ventilation after pediatric liver transplant at our center were preoperative presence of hepatic encephalopathy, high aspartate amino transferase levels, intraoperative usage of more packed red blood cells, and longer surgery duration.