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Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19
(Bayrakol Medical Publisher, 2022) Alpcan, Aysegul; Tursun, Serkan; Kandur, Yasar
Aim: Coronavirus disease 2019 (COVID-19) has become a public health threat to people all over the world in 2020 and 2021. The Centers for Disease Control and Prevention (CDC) and WHO (World Health Organization) have named a novel disease multisystem inflammatory syndrome in children (MIS-C). Herein we aimed to present a group of pediatric patients with MIS-C, who were followed up in our clinic. Material and Methods: We retrospectively reviewed the medical records of patients who were followed up at our University Hospital with the diagnosis of MIS-C between January 2021 and May 2021. Results: The mean age of 9 patients was 87.4 +/- 17.8 years (range 6-161 months); six of the patients were male. All patients had fever at admission. The duration of the fever was between 3 and 7 days. Four patients (44.4%) had terminal ileitis on ultrasonic examination. The laboratory tests of the patients revealed leukocytosis in 4 (44.4%) patients, anemia in 5 (55.5%) patients, thrombocytopenia in 1 (11.1%) patient, and a high CRP level in 8 (88.8%) patients. All patients had high sedimentation rates and procalcitonin levels. One (11.1%) patient was operated on for terminal ileitis. All patients were treated with steroids (1-2 mg/kg prednisolone) and IVIG (2gr/kg). Patients who needed ICU admission were also treated with vasoactive drug infusion (intravenous dopamine). Discussion: There is a need for increased awareness among pediatricians that MIS-C should come to mind, especially in patients with long-lasting fever and signs and symptoms that resemble Kawasaki disease.
Clinical Patterns and Seasonal Distribution of Urinary Tract Infection Caused by Extended-spectrum Beta-lactamase-producing Bacteria in Children
(Bilimsel Tip Yayinevi, 2021) Tursun, Serkan; Arslan, Zeynep; Alpcan, Aysegul; Gul, Serdar; Kandur, Yasar
Introduction: Extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae infections in the pediatric age group are mostly nosocomial infections. This study aimed to investigate the clinical pattern of extended-spectrum beta-lactamase positive urinary tract infection and its seasonal distribution. Materials and Methods: We retrospectively reviewed the medical records of pediatric patients with extended-spectrum beta-lactamases-positive UTI, who were followed-up in our clinic between lune 2015 and lune 2020. Results: One hundred-and-ten patients with ESBL-positive UTI and 231 with non-ESBL UTI were enrolled in this study. The rate of male sex in the ESBL group was significantly lower than that in the non-ESBL group (10.9% vs 27.2%, p= 0.001). The patients with ESBL were older than those in the non-ESBL group (81.3 +/- 49.0 months vs 56.0 +/- 47.2 months, p= 0.001). E. coli was the most iso- lated bacteria in both groups (68% and 70.5%, respectively). The rate of Klebsiella isolation in urine culture was significantly greater in the ESBL group than in the non-ESBL group (p= 0.04). The seasonal distribution of ESBL-positive patients was as follows: spring (18/16.4%), summer (25/22.7%), autumn (25/22.7%), and winter (42/38.2%). Conclusion: There is a substantially high rate of antibiotic resistance among patients with urinary tract infection in developing countries like Turkey. Moreover, we should be aware of the risk of ESBL-positive UTIs, especially in winter.
Clinical significance of MEFV gene variation R202Q
(Springer London Ltd, 2022) Kandur, Yasar; Kocakap, Derya Beyza Sayin; Alpcan, Aysegul; Tursun, Serkan
Background The aim of this study was to evaluate the phenotypic features and the clinical significance of the R202Q mutation of the MEFV gene. Methods We retrospectively reviewed the medical records of Familial Mediterranean Fever patients with M694V/- and M694V/R202Q mutations. We compared the patients regarding disease severity, symptoms, age at the onset of symptoms, gender, consanguinity, and family history. Results Twenty-one patients (9 males, 12 females) had compound heterozygote mutation (M694V/R202Q), and 37 patients (23 males, 14 females) had M694V/- mutation. The mean age of the patients at the time of diagnosis was 7.3 +/- 4.3 and 9.2 +/- 3.7 years. The rate of arthritis was significantly higher in patients with M694V/R202Q heterozygote mutation than those with M694V/- heterozygote mutation (76.2% vs 32.4%; p= < 0.001). The mean severity score was higher in M694V/R202Q heterozygote group although it did not reach statistical significance (8.43 +/- 1.69 vs 7.49 +/- 1.50; p= 0.082). However, the rate of having a high severity score was significantly higher in the M694V/R202Q mutation group than in the other group (47.6% vs 21.6%, respectively; p= 0.039). The rate of arthritis was significantly higher in patients with M694V/R202Q heterozygote mutation than those with M694V/- heterozygote mutation (76.2% vs 32.4%; p= < 0.001). Conclusion Our finding supports the possibility that R202Q may be pathogenic rather than a variation. We found that the R202Q mutation is associated with the inflammatory phenotype of FMF; hence, the typical clinical findings of FMF especially arthritis can be observed in patients with compound mutation including R202Q.
The comparison of the resistivity index values in the ultrasonographic evaluation of a unilateral atrophic/hypoplastic kidney
(Taylor & Francis Ltd, 2020) Dalkiran, Tahir; Kandur, Yasar; Dagoglu, Besra; Saki, Hatice; Gungor, Sukru; Ipek, Sevcan
Background: In the study, we aimed to determine the sensitivity of the renal resistivity index (RI) in differentiating hypoplastic and atrophic kidneys in patients with small-sized kidneys, and to evaluate its capacity to predict the renal involvement confirmed by the DMSA scintigraphy. Material and methods: We retrospectively reviewed the ultrasonography (US) and DMSA findings, and medical records of pediatric patients with unilateral diminutive kidneys followed between January 2017 and June 2018. The RI measurements were performed twice, and the mean RI was calculated for each kidney of all patients. Results: Sixty-three (male/female, m/f = 28/35) pediatric patients aged 107.2 +/- 49.4 months (range 14-206 months) were included in this study. The DMSA scintigraphy revealed abnormal changes to atrophic kidneys in 38 patients and hypoplastic kidneys in 25. There were no differences between the groups with atrophy and hypoplasia by age, gender, urine density, and creatinine. The patient group with atrophic kidneys had a mean RI of 0.55 +/- 0.21, and patients with hypoplastic kidneys had a mean RI of 0.67 +/- 0.03. The mean RI and systolic/diastolic rates of the patients with atrophy were significantly lower than of the patients with hypoplastic kidneys (p = 0.042 and p = 0.048, respectively). There was a positive correlation between RI and DFR in the group with atrophy (r = 0.461, p = 0.016), but this was not the case for the group with hypoplastic kidneys (r= -0.066, p = 0.889). Conclusions: The resistivity index might be very useful for differentiating atrophy and hypoplasia in patients with unilateral small kidneys and can be used instead of scintigraphic evaluation.
Diagnostic Value of Plasma Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Children with Urinary Tract Infections
(Georg Thieme Verlag Kg, 2021) Tursun, Serkan; Alpcan, Aysegul; Ozsoy, Metin; Badem, Nermin Dindar; Kandur, Yasar; Acar, Banu Celikel
Objective The aim of the present study was to evaluate the diagnostic value of soluble triggering receptor on myeloid cells-1 as a novel marker for diagnosis of childhood urinary tract infections (UTI). Methods This study enrolled 30 pediatric patients diagnosed with acute febrile UTIs; 30 healthy children were included as the control group. The blood samples from the patients and healthy controls were collected for a soluble triggering receptor on myeloid cells-1 (sTREM-1) test. Results The study group was composed of 9 males and 21 females, and the mean age of the study population was 6.63.2 (range=1-14) years. sTREM-1 levels were significantly higher in UTI patients than in the controls (592 +/- 323 vs. 490 +/- 299 pg/mL, p=0.04). The receiver operating curve analysis revealed a cut-off value of soluble triggering receptor expressed on myeloid cells-1 of 514 ng/mL (area under the curve=0.562). When the cut-off value was taken 514 pg/mL, soluble triggering receptor expressed on myeloid cells-1 had a sensitivity of 57% and a specificity of 50% for the diagnosis of UTI. Conclusion The present study revealed that plasma sTREM-1 level may be elevated in UTI and may therefore serve as a useful predictive tool for the diagnosis of UTI.
Early outcome findings of treatment for transperitoneal laparoscopy-assisted pyeloplasty
(Springer, 2021) Guler, Ahmet Gokhan; Karakaya, Ali Erdal; Dogan, Ahmet Burak; Kandur, Yasar
Background We retrospectively analyzed the initial results of laparoscopic pyeloplasty, among pediatric patients undergoing the procedure by transperitoneal access. Methods We retrospectively reviewed the medical records of patients who were operated with transperitoneal laparoscopy-assisted pyeloplasty at our institution between 2015 and 2020. Results The mean age of the 51 patients (M/F = 36/15) was 59 +/- 49.8 months. The mean preoperative renal pelvis anterior-posterior diameter was 32.9 +/- 13.4 mm, and the relative renal function was 42 +/- 12.1% on the operation side. Forty-three (84.3%) patients had no excretion on MAG3 examination preop. The number of patients with no excretion decreased to 10 (19.7%) after surgery. One of them underwent a successful endopyelotomy; eight of them underwent a successful laparoscopic re-pyeloplasty. There was nothing to do in only one patient whose DRF decreased to 11%. The mean anterior posterior diameter decreased significantly to 16.7 +/- 11.2 mm after surgery (p < 0.001). Conclusion Preoperative increased renal pelvis anterior-posterior diameter detected in our study was found to be a risk factor in the failure of transperitoneal laparoscopy-assisted pyeloplasty procedure.
Evaluation of oxidative stress biomarkers in acute mercury intoxication
(NLM (Medline), 2021) Dalkiran, Tahir; Carman, Kursat Bora; Unsal, Velid; Belge Kurutas, Ergul; Kandur, Yasar; Dilber, Cengiz
INTRODUCTION: Very few studies have evaluated the association between mercury exposure and oxidative stress in humans, particularly in children. AIM: This is the first report where we aimed to determine the oxidative stress status of children who were accidentally exposed to elemental mercury. MATERIALS AND METHODS: In the present study, the study group was composed of 86 randomly selected children poisoned by mercury; the control group was composed of 78 children who had no history of mercury exposure. At admission, blood samples were collected. Blood superoxide dismutase activity, catalase enzyme activity, and glutathione peroxidase activity were measured by Fridovich, Beutler, and Lawrence Burk methods respectively, and the results were given as U/g Hb. Malondialdehyde level was measured by Ohkawa methods, and the results were given as mmol/ml. RESULTS: Catalase activity was significantly lower in the patient group compared to the control group (1.28±0.62 vs. 3.90±0.86 U/g Hb, p=0.010). In exposed children, SOD activity was significantly higher than the controls (5936±810 vs. 2226±464 U/g Hb, p=0.03), while the GSH-Px activity was significantly lower (13.01±3.21 vs. 34.97±7.32 U/g Hb, p=0.013). The MDA levels of the mercury group were significantly higher than the MDA levels of the control group (2.85±0.84 vs. 2.05±0.79 mmol/ml, p=0.04). CONCLUSIONS: The results of the present study showed that acute mercury poisoning causes an alteration of oxidative stress status in children exposed to elemental mercury. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Evaluation of Oxidative Stress Biomarkers in Patients with Henoch-Schönlein Purpura
(NLM (Medline), 2021) Soylemez, Kadir; Temiz, Fatih; Dalkiran, Tahir; Kandur, Yasar; Belge Kurutas, Ergul; Unsal, Velid; Oner, Erkan
INTRODUCTION: Henoch-Schönlein Purpura (HSP) is a systemic vasculitic syndrome characterized by non-thrombocytopenic purpura, arthritis/arthralgia, abdominal pain, and glomerulonephritis. The pathogenesis of HSP has not been clearly identified. Oxidative damage has a role in the pathogenesis of most cases. AIM: This study aimed to evaluate changes of oxidative stress by studying parameters like superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA) in an attempt to identify the role of oxidative stress in HSP from another perspective. MATERIALS AND METHODS: This study enrolled 23 pediatric patients (ten girls and thirteen boys) diagnosed with HSP who were under follow-up at Sutcu Imam University School of Medicine Department of Pediatrics between 2014 and 2016 and twenty healthy children as the control group. The parents of all subjects gave informed consent to participate in the study. In the HSP group, the beginning season of the illness and the systemic involvement during follow-up were determined. Blood specimens were obtained at presentation before any treatment was started. SOD, CAT activities, and MDA values in erythrocyte and plasma samples were compared between the patient group and the healthy children. RESULTS: Twenty-three patients with HSP (13 males, 10 females) and 20 healthy children participated in this study. The mean age of the HSP cases was 8.21±3.78 years (range 2-16 years) and of the controls was 8.6±4.2 (range 3-14 years). The mean MDA value was 2.95±0.71 nmol/ml in the patient group and 2.67±0.66 nmol/ml in the control group (p=0.787). The mean level of the CAT enzyme was 1.32±0.35 U/g Hb in the patient group and 7.8±1.74 U/g Hb in the control group (p=0.001). The mean levels of the SOD enzyme were 3.06±0.85 U/g Hb in the patient group and 0.97±0.36 U/g Hb in the control group (p=0.001). CONCLUSIONS: Although high MDA levels support the role of lipid peroxidation in the pathogenesis of HSP, statistical significance was not reached owing to a limited number of our patients. The reduced CAT enzyme activity is consistent with the findings of previous reports. This finding supports the notion that oxidative stress can play a role in the pathogenesis of HSP. KEYPOINTS: Our findings support the notion that oxidative stress can play a role in the pathogenesis of HSP. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
EVALUATION OF THE CLINICAL FINDINGS OF PEDIATRIC PATIENTS WITH VESICOURETERAL REFLUX TO ASSESS DISEASE SEVERITY
(Springer, 2022) Kandur, Yasar; Alpcan, Aysegul; Tursun, Serkan
[Abstract No tAvailable]
Maternal Blood Group Is a Possible Predictor for Developing Congenital Heart Disease in Turkish Children with Down's Syndrome
(Georg Thieme Verlag Kg, 2024) Kandur, Yasar; Kocakap, Derya Beyza Sayin; Alpcan, Aysegul; Sanli, Cihat; Sayan, Cemile Dayangan; Koyuncu, Omer Lutfi
We aimed to evaluate the clinical characteristics and the risk factors for the anomalies of Down's syndrome (DS) patients and reviewed the relation of blood groups of the patients and the mothers with these anomalies. Pediatric patients who were diagnosed with trisomy 21 between 2010 and 2022 were enrolled in this study. The medical records of the DS patients and their parents were retrospectively reviewed. A total of 48 patients applied to our clinic. 24 (50%) patients were diagnosed with congenital heart disease. 21 (43.75%) patients had hypothyroidism. The distribution of individual congenital heart defects (CHDs) was as follows: ventricular septal defect in eight (33.3%) patients, one of which also had patent ductus arteriosus (PDA); atrioventricular septal defects in seven (29.1%) patients; atrial septal defects in four (16.6%) patients, one of which also had patent ducus arteriosus; and PDA in five (20.8%) patients. One (4.2%) patient had tetralogy of Fallot. The incidence of CHD in patients with maternal blood group A was significantly higher than those without CHD, with a prevalence of 63.6 and 21.1%, respectively ( p = 0.020). Binary logistic regression analysis showed that maternal blood group A was a risk factor for CHDs (odds ratio = 6.563; 95% confidence interval: 1.259-34.204; p = 0.025). Although we found that the rate of advanced father age was high in hypothyroidism type, the regression analysis showed that it was not a risk factor. We found that maternal blood group A increased the likelihood of being born with CHDs in DS.
MINI URETERORENOSCOPY TREATMENT OF UROLITHIASIS IN CHILDREN IN AN ENDEMIC REGION
(Springer, 2021) Guler, Ahmet Gokhan; Karakaya, Ali Erdal; Dogan, Ahmet Burak; Kandur, Yasar
[Abstract No tAvailable]
POLYCYTHEMIA IN A PEDIATRIC PATIENT WITH CHRONIC KIDNEY DISEASE: OVERUSE OF ERYTHROPOERIN DURING COVID-19 ISOLATION
(Springer, 2021) Kandur, Yasar; Alpcan, Aysegul; Yozgat, Mehmet; Tursun, Serkan
[Abstract No tAvailable]
The clinical and laboratory differences between monosymptomatic and nonmonosymptomatic enuresis
(Springer, 2022) Kandur, Yasar; Arslan, Zeynep; Alpcan, Aysegul
[Abstract No tAvailable]
The comparison of clinical outcomes of unilateral atrophic / hypoplastic / nephrectomized and solitary kidney
(Springer, 2024) Koyuncu, Omer; Kandur, Yasar
[Abstract No tAvailable]
The Effects of Colchicine on the Histopathological Findings of Celiac Disease During Familial Mediterranean Fever Treatment
(Sage Publications Inc, 2022) Alpcan, Aysegul; Gulerman, Hacer Fulya; Kandur, Yasar; Tursun, Serkan; Zengin, Mehmet
Familial mediterranean fever (FMF) and Celiac Disease (CD) are both autoinflammatory and autoimmune diseases with common clinical features affecting the gastrointestinal system. Familial mediterranean fever may coexist with CD. Inflammatory cells and cytokines are up-regulated within the intestinal mucosa of patients with CD. In this perspective, lymphocyte infiltration to the lamina propria of the small intestinal mucosa is a critical pathological sign. In the present study, we aimed to find out whether the treatment of an FMF patient with colchicine affects the pathological signs of concomitant developed CD on the same patient. We retrospectively reviewed the medical records of 147 patients with FMF who were followed up in our center between 2015 and 2020. Of the 147 patients with FMF, 3 patients also had CD. In this report, we presented these 3 cases. The findings obtained in this study suggest that pathological findings may be misinterpreted in autoimmune diseases, such as CD, when patients administer anti-inflammatory treatments, such as colchicine.
Therapeutic Plasma Exchange in Pediatric Patients: Results from a Single Center
(Georg Thieme Verlag Kg, 2024) Dalkiran, Tahir; Mercan, Mehmet; Ipek, Sevcan; Gullu, Ufuk Utku; Kandur, Yasar; Acipayam, Can; Dilber, Cengiz
Therapeutic plasma exchange (TPE) can be applied as an effective therapeutic option in children with hematological, neurological, nephrological, and autoimmune/rheumatic disorders. We aimed to report our TPE experience in pediatric patients. In this article, we retrospectively reviewed the records of pediatric patients who underwent TPE between 2019 and 2021. A total of 128 TPE sessions were performed in 25 patients (13 males,12 females; mean age 59.6 +/- 11.7 [3-198] months). The TPE indications were sepsis with/without multiorgan dysfunction syndrome in five patients, acute liver failure, hemolytic uremic syndrome caused by Shiga toxin, and autoimmune hemolytic anemia in three patients, respectively, multiple sclerosis, autoimmune encephalitis, and multisystem inflammatory syndrome in children (MIS-C) in two patients each, and myasthenia gravis crisis, meningococcemia, hemolytic uremic syndrome caused by coronavirus disease 2019, hemophagocytic lymphohistiocytosis, autoimmune encephalitis, and metabolic disease (fatty acid oxidation defect, liver failure) in one patient each. Based on our findings, we proposed that the American Society for Apheresis criteria should be updated according to newly described clinical conditions such as MIS-C.
THROMBOTIC MICROANGIOPATHY IN A SEVERE PAEDIATRIC CASE OF COVID-19
(Springer, 2021) Dalkiran, Tahir; Kandur, Yasar; Dagoglu, Besra; Taner, Sevgin; Oncu, Dogan
[Abstract No tAvailable]
Thrombotic Microangiopathy in a Severe Pediatric Case of COVID-19
(Sage Publications Ltd, 2021) Dalkiran, Tahir; Kandur, Yasar; Kara, Emine Manolya; Dagoglu, Besra; Taner, Sevgin; Oncu, Dogan
In this case report, we report a pediatric patient with COVID-19 and atypical hemolytic uremic syndrome (aHUS). A 3-year-old girl with fever and respiratory distress was admitted to the hospital. The patient tested positive for COVID-19 by a PCR test. As her respiratory distress increased and blood gas indicated deep respiratory acidosis on the third day of the pediatric intensive care unit follow-up, the patient was intubated and ventilated. Thorax computerized tomography (CT) showed bilateral effusion and atelectasis. During her follow-up, the pleural effusion resolved but there were marked consolidation areas and ground glass opacities compatible with COVID-19 on the follow-up CT. On the 10th day, she became anuric and developed progressive thrombocytopenia and persistent microangiopathic hemolytic anemia, which were suggestive of HUS given a high creatinine level (1.9 mg/dl), an undetectable haptoglobin level, reticulocytosis (8%), and an LDH level of 2540 U/l. Direct Coombs test returned negative. Examination of a peripheral blood smear revealed schistocytes. Disseminated intravascular coagulation was ruled out by normal INR and PTT. In the light of the available findings, we considered the patient to have thrombotic microangiopathy (TMA) triggered by COVID-19. It was not a TTP-form of TMA but rather an aHUS type, based on an ADAMTS13 activity level >5%. Hence, plasmapheresis was performed with fresh frozen plasma (FFP). After 4 weeks, she became completely asymptomatic, and her hemodynamic parameters normalized. COVID-19 induced uncontrolled complement activation leading to the development of aHUS. Early diagnosis and treatment may reduce morbidity and mortality since its treatment options.
Vitamin D levels in children with COVID-19: a report from Turkey
(Cambridge Univ Press, 2021) Alpcan, Aysegul; Tursun, Serkan; Kandur, Yasar
Several studies have demonstrated that higher levels of vitamin D are associated with better prognosis and outcomes in infectious diseases. We aimed to compare the vitamin D levels of paediatric patients with mild/moderate coronavirus disease 2019 (COVID-19) disease and a healthy control group. We retrospectively reviewed the medical records of patients who were hospitalised at our university hospital with the diagnosis of COVID-19 during the period between 25 May 2020 and 24 December 2020. The mean age of the COVID-19 patients was 10.7 +/- 5.5 years (range 1-18 years); 43 (57.3%) COVID-19 patients were male. The mean serum vitamin D level was significantly lower in the COVID-19 group than the control group (21.5 +/- 10.0 vs. 28.0 +/- 11.0 IU, P < 0.001). The proportion of patients with vitamin D deficiency was significantly higher in the COVID-19 group than the control group (44% vs. 17.5%, P < 0.001). Patients with low vitamin D levels were older than the patients with normal vitamin D levels (11.6 +/- 4.9 vs. 6.2 +/- 1.8 years, P = 0.016). There was a significant male preponderance in the normal vitamin D group compared with the low vitamin D group (91.7% vs. 50.8%, P = 0.03). C-reactive protein level was higher in the low vitamin D group, although the difference did not reach statistical significance (9.6 +/- 2.2 vs. 4.5 +/- 1.6 mg/l, P = 0.074). Our study provides an insight into the relationship between vitamin D deficiency and COVID-19 for future studies. Empiric intervention with vitamin D can be justified by low serum vitamin D levels.

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