Browsing by Author "Demir, Nihat"

Now showing 1 - 20 of 28

Blepharophimosis, Ptosis, and Epicanthus Inversus Syndrome: Expanding the Phenotype
(Alliance Communications Group Division Allen Press, 2016) Kaba, Sultan; Dogan, Murat; Bulan, Keziban; Demir, Nihat; Uner, Abdurrahman; Bulut, Mehmet Deniz; Kocaman, Selami
We present a 3-month-old girl who displayed typical clinical characteristics of blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). She was referred to our clinic with an initial diagnosis of Down syndrome. Clinical features of elevated follicle stimulating hormone and low estradiol levels in the case were diagnosed as BPES syndrome and were consistent with BPES type 2. To date, there are no cases of BPES with cleft palate and cardiomyopathy, suggesting that these novel findings can be part of this condition.
Characteristics of Deep Neck Infection in Children According To Weight Percentile
(Korean Soc Otorhinolaryngol, 2014) Garca, Mehmet Fatih; Budak, Ali; Demir, Nihat; Cankaya, Hakan; Kiroglu, Ahnnet Faruk
Objectives. To evaluate the effect of weight percentile on deep neck infections in children. Methods. A retrospective evaluation of 79 patients who were treated for deep neck infections. The patients were divided into six groups according to weight percentile. Patients who had systemic and/or congenital disease were excluded. Their demographics, etiology, localization, laboratory, and treatment results were reviewed. Results. In total, 79 pediatric patients were recorded: 48.1% were females and 51.9% were males, with a mean age of 7.3. years. In total, 60 patients were under the 50th percentile according to their weight versus all children. The anteroposterior triangle (29.1%) and submandibular (26.5%) spaces were most commonly involved with deep neck infection. However, the anteroposterior triangle space was the highest in the group below the 3rd percentile (44.4%). In the blood analysis, white blood cell levels in patients with at percentile values of 75-50 were higher than other groups (P < 0.05). Significant differences were found between C-reactive protein and hemoglobin levels and diameter of abscesses. The need for surgical drainage in patients in lower percentiles was higher. The patients who needed surgical drainage consisted of 56 patients (93.3%) below the 50th percentile and 9 patients (100%) below the 3rd percentile. Conclusion. Deep neck infection is more insidious and dangerous in low-weight-percentile children, especially those having low white blood cell counts, low hemoglobin levels, and high C-reactive protein in laboratory results.
A Confusing Coincidence: Neonatal Hypoglycemic Seizures and Hyperekplexia
(Hindawi Ltd, 2014) Demir, Nihat; Dogan, Murat; Yilmaz, Sanem; Peker, Erdal; Bulan, Keziban; Tuncer, Oguz
Hyperekplexia is a rare, nonepileptic, genetic, or sporadic neurologic disorder characterized by startle responses to acoustic, optic, or tactile stimuli. Genetic defects in glycine receptors as well as encephalitis, tumors, inflammation, and disgenesis are among the etiologic causes of the disease. The main problem in hyperekplexia is the incomplete development of inhibitory mechanisms or exaggerated stimulation of excitatory mediators. Hyperekplexia is often confused with epileptic seizures. Here we present a case with hypoglycemic convulsions coexisting with hyperekplexia, causing diagnostic difficulty.
Congenital Hyperinsulinism: a Novel Mutation in the Kcnj11 Gene
(E S Burioni Ricerche Bibliografiche, 2017) Bala, Keziban Asli; Demir, Nihat; Tuncer, Oguz; Kocaman, Selami; Flanagan, Sarah E.
Introduction Hyperinsulinism is the most common cause of both transient and persistent hypoglycemia in the neonatal period. Hyperinsulinism due to mutations in the ATP-sensitive potassium channel encoded by the KCNJ11 and ABCC8 genes cause the most common and severe form of hyperinsulinism. Herein, we present a case of congenital hyperinsulinism in which a novel KCNJ11 mutation was identified. Case report An eight-day-old boy with a birth weight of 4,550 g born to a 32-year-old female with diabetes mellitus was transferred to our clinic with the diagnoses of respiratory distress syndrome, congenital heart disease and hypoglycemia. A diagnosis of congenital hyperinsulinism was made based on the presence of elevated serum insulin levels (109 mu IU/mL [2.6-24]) during hypoglycemia. Levels of serum growth hormone, cortisol, ammonium, and lactate were normal. Metabolic screening tests for blood and urine ketones and fatty acid oxidation defects were found to be normal. Glucose infusion (14 mg/kg/min), glucagon infusion, and diazoxide were initiated based on the diagnosis of hyperinsulinemic hypoglycemia; however, glycemic control was only achieved after the addition of octreotide and nifedipine. There were no abnormal findings in sonography and abdominal magnetic resonance imaging. Molecular diagnosis ABCC8 and KCNJ11 mutation analyses was performed on the genomic DNA extracted from peripheral blood. A novel homozygous missense mutation (p.E126K) was detected in KCNJ11 confirming the diagnosis of congenital hyperinsulinism. Conclusion A novel homozygous missense mutation (p.E126K) was detected in our case, which resulted in hyperinsulinism.
Dermatological Findings of Vitamin B12 Deficiency and Resolving Time of These Symptoms
(Taylor & Francis Ltd, 2014) Demir, Nihat; Dogan, Murat; Koc, Ahmet; Kaba, Sultan; Bulan, Keziban; Ozkol, Hatice Uce; Dogan, Sekibe Zehra
Aim: The mucocutaneous changes observed during vitamin B12 deficiency in children have been published only as case studies and small case series. In this study, we aimed to demonstrate the frequency of mucocutaneous changes (particularly hyperpigmentation) seen during vitamin B12 deficiency and resolving time of these symptoms with vitamin B12 treatment. Material and methods: This prospective study was conducted at the pediatrics outpatient clinic of Harran and Yuzuncu Yil University Faculty of Medicine, among 57 patients, aged between 6 and 24 months, who were diagnosed with vitamin B12 deficiency following various examinations and tests. A detailed examination was performed in respect to skin and mucosal findings. Patients with vitamin B12 deficiency were administered intramuscular cyanocobalamin. Prospective examination was continued, and resolving time of symptoms after treatment was recorded. Results: The mean age of the patients enrolled in the study was found to be 12.75 +/- 4.75. Hyperpigmentation was reported in 49 (85.96%) patients enrolled in the study; atrophic glossitis in 40 (70.17%), brittle and matt hair in 13 (22.80%), skin lesions (particularly diaper dermatitis) in eight (15.78%) and cheilosis in four (7.01%) patients. Three months after the treatment initiation, hyperpigmentation improved in 87.75%, atrophic glossitis in 97.5% and brittle and matt hair in 92.3% of the patients. Five patients (8.77%) with continuing pigmentation by the end of sixth months were considered as nonresponsive to the treatment. Conclusion: Deficiency of vitamin B12 should be considered in the differential diagnosis of infants who present with skin and mucosal lesions.
Efficacy and Safety of Rectal Ibuprofen for Patent Ductus Arteriosus Closure in Very Low Birth Weight Preterm Infants
(Taylor & Francis Ltd, 2017) Demir, Nihat; Peker, Erdal; Ece, Ibrahim; Balahoroglu, Ragip; Tuncer, Oguz
Background: To compare rectal ibuprofen with oral ibuprofen for the closure of hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) preterm infants.Study design and subjects: In a prospective, randomized study, 72 VLBW infants who had hsPDA received either rectal or oral ibuprofen. The plasma concentration of ibuprofen and renal functions were determined in both groups by the high-performance liquid chromatography (HPLC) method and cystatin-C (cys-C), respectively.Results: The hsPDA closure rate of the group that received rectal ibuprofen was similar to oral ibuprofen (86.1% versus 83.3%) after the first course of the treatment (p=0.745). A statistically significant difference was identified between the mean plasma cys-C levels before and after treatment in both the rectal and oral ibuprofen groups (p=0.004 and p<0.001, respectively). The mean plasma ibuprofen concentration was similar in both groups after the first dose (rectal 44.0612.4; oral, 48.28 +/- 22.8) and the third dose (rectal, 45.34 +/- 24.3; oral, 48.94 +/- 24.8) (p>0.05 for all values).Conclusions: Rectal ibuprofen is as effective as oral ibuprofen for hsPDA closure in VLBW infants. The rise in the cys-C level with rectal and oral treatment shows that patients with borderline renal function should be evaluated and followed closely.
Efficiency of Topical Rifampin on Infection in Open Neural Tube Defects: a Randomized Controlled Trial
(Taylor & Francis Ltd, 2021) Deger, Ibrahim; Basaranoglu, Murat; Demir, Nihat; Aycan, Abdurrahman; Tuncer, Oguz
Objectives Neural tube defects are the second most common congenital malformation in humans. Despite significant decreases in neural tube defects and related mortality and morbidity with recent developments, infections remain an important problem. Research on the role of topical therapy for managing neural tube defects and associated infections in the neonatal period has been limited. This randomized controlled trial aimed to investigate the efficiency of topical Rifampin on infection control in paraplegic newborns with open neural tube defects. Methods Thirty-seven patients who underwent an operation for neural tube defects were included. Topical Rifampin and cefotaxime were administered to 19 patients constituting the case group and local saline and cefotaxime were administered to a control group. Patients were examined for ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, and sepsis. Results None of the patients using topical rifampin had ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, or sepsis. In the control group, ventriculoperitoneal shunt infection/dysfunction was found in 4 (22.2%) cases, surgical site infection in 3 (27.7%), urinary tract infection in 3 (27.7%), and sepsis in 5 (27.7%), with statistically significant differences between the groups (p = 0.01, p = 0.032, p = 0.032, and p = 0.002, respectively). No local or systemic side effect was observed regarding rifampin use. Conclusion Topical Rifampin is effective in minimizing complications like sepsis, surgical site infection, urinary tract infection, and ventriculoperitoneal shunt infection due to neural tube defect operations. Further research with larger numbers of cases is needed to implement this practice routinely.
An Evaluation of Oxidative Status in Serum and Breast Milk of Mothers Giving Birth Prematurely and at Full-Term
(Kowsar Corp, 2015) Abuhandan, Mahmut; Demir, Nihat; Guzel, Bulent; Almaz, Veysi; Koca, Bulent; Tuncer, Oguz; Cakmak, Alpay
Background: Burning fat and carbohydrates to provide energy in biological systems causes the formation of free oxygen species. Objectives: This study aimed to evaluate the oxidative status of serum and breast milk of mothers giving birth prematurely and at fullterm. Materials and Methods: The study comprised 50 mothers who gave birth at full-term at more than 38 weeks and 43 mothers who gave birth pre-term at below 32 weeks. On the postnatal 5th day, samples of the mother's milk and serum were taken and stored at -80 degrees C until the study day. On the study day, the total oxidant and total antioxidant levels were measured using the Erel method and the oxidative stress index (OSI) was calculated. Results: While the total oxidant level and total antioxidant level values of the milk of the premature birth mothers were found to be significantly high compared to those of the full-term birth mothers (P = 0.001), no statistically significant difference was found in the oxidative stress index values (P > 0.05). No statistically significant difference was found in the total oxidant level and oxidative stress index values of the serum of the premature birth mothers compared to those of the full-term birth mothers, while the total antioxidant level was found to be significantly low (P = 0.04). Conclusions: The oxidants and antioxidants in the milk of mothers giving birth prematurely were found to be significantly higher than those of full-term birth mothers. This can be evaluated as the milk of the premature birth mothers providing increased antioxidant defense to protect the infant.
An Extraordinary Cause of the Sucking Difficulty: Ecthyma Gangrenosum
(Hindawi Ltd, 2016) Ceylan, Nesrin; Demir, Nihat; Kocaman, Selami; Peker, Erdal; Tuncer, Oguz
Ecthyma gangrenosum is a cutaneous lesion often associated with pseudomonas aeruginosa bacteremia, even though it may develop without bacteremia and may originate from other bacterial and fungal organisms. Pseudomonas aeruginosa bacteremia or sepsis, which mainly affects immunocompromised patients, frequently occurs in hospitals. This lesion typically occurs on the extremities and gluteal and perineal regions. In this report we present a case of ecthyma gangrenosum in a premature newborn occurring secondary to pseudomonas sepsis causing sucking dysfunction due to tissue loss in the lip, soft palate, and tongue.
Factors Affecting Infection Development After Meningomyelocele Repair in Newborns and the Efficacy of Antibiotic Prophylaxis
(Springer, 2015) Demir, Nihat; Peker, Erdal; Gulsen, Ismail; Agengin, Kemal; Tuncer, Oguz
The purpose of this study was to evaluate the clinical and surgical variables that may be associated with wound infection and meningitis/ventriculoperitoneal (VP) shunt infection in newborns diagnosed with meningomyelocele (MMC), as well as the efficacy of antibiotic prophylaxis in reducing these complications. The data of 91 neonates diagnosed with MMC, who underwent surgical intervention between May 2012 and December 2014, were retrospectively evaluated. Multivariant logistic regression analysis was used to determine the possible clinical and neurosurgical variables associated with meningitis/VP shunt infection and surgical wound infection. Spearman's test was performed for the correlation analysis. Following MMC closure, of the 91 neonates, 18 (16.4 %) developed meningitis/shunt infection and 12 (11 %) developed surgical wound infection. The operation time was not a significant independent risk factor for the development of meningitis (RR 0.618 [0.199-1.922], p = 0.406). Open neural placodes that were not covered by any pseudomembrane (myeloschisis), external ventricular drainage (EVD) use, and flap transposition were determined as significant relative risk factors for the development of meningitis (RR 8.655 [2.329-32.157], p = 0.001; RR 9.404 [1.183-74.743], p = 0.034; RR 8.125 [2.496-26.448], p = 0.001; and RR 3.150 [1.963-10.308], p = 0.048, respectively). Deep surgical wound infection was not correlated with the operation time or wound surface area. However, there was an intermediate but very significant positive correlation between meningitis and cerebrospinal fluid (CSF) leakage, length of hospitalization, and flap transposition (r = 0.377, 0.420, 0.357, and 0.503, respectively; for all values, p < 0.001). There was no association between MMC closure and development of infection. Since it carries a high risk for the development of meningitis, the EVD system should be avoided unless necessary. Routine prophylactic antibiotic use did not reduce the infection risk in MMC repair surgery. Thus, antibiotics should not be used if there are no risk factors predisposing to infection.
Fetal Ekokardiyografi Yapılan Hastalarımızın Özellikleri ve Postnatal Ekokardiyografi ile Prenatal Tanı Doğruluğunun Araştırılması
(2015) Ece, İbrahim; Ceylan, Nesrin; Demir, Nihat; Üner, Abdurrahman; Aydın, İlyas; Epçaçan, Serdar
Amaç: Bu çalışmada, kliniğimizde fetal ekokardiyografi yapılan gebelerin; başvuru nedenleri, fetal ekokardiyografi ve postanal ekokardiyografi sonuçları değerlendirilmiştir. Yöntem: Çalışmaya Ocak 2013 ile Şubat 2014 arasında herhangi bir nedenle fetal ekokardiyografi yapılan 326 olgu alındı. Bulgular: En sık başvuru nedeni obstetrik USG de konjenital kalp hastalığı şüphesi idi (%30.6). Gebelerin ortalama yaşları 27.8±6.1 , ortalama gebelik haftası 26.03±5.02 idi. Fetal ekokradiyografi ile hastaların %62.3' ü normal saptandı. Ventriküler septal defekt (%12.2) en sık saptanan fetal kardiyak anomali iken ikinci sıklıkta ise %7.4 ile hidrops fetalis izlemekteydi. Postnatal ekokardiyografi 192 (%58.9) yenidoğana yapılabildi. Bu hastaların %64.1'i normal bulunurken, en sık saptanan konjenital kalp hastalığı ventriküler septal defekt (%8.3) idi. Çalışmamızda doğumsal kalp hastalığı prevelansı %37.7 olarak tespit edilmiştir. Sonuç: Doğumsal kalp hastalıklarının erken tanınması gerekli tıbbi veya cerrahi tedavi yöntemlerinin önceden belirlenmesi açısından büyük önem taşımaktadır. Günümüzde doğumsal kalp hastalıklarının prenatal tanısında fetal ekokardiyografi giderek artan sıklıkta kullanılmaktadır. Fetal ekokardiyografi ile tespit edilen doğumsal kalp hastalığı varlığında gerekli tedavi, aileye gerekli danışmanlık verilebilmekte ve doğum sonrası kardiyak açıdan yapılabilecekler için önceden tedbirler alınabilmektedir
Glanzmann Thrombasthenia Mimicking Early Neonatal Sepsis
(2015) Demir, Nihat; Peker, Erdal; Kaba, Sultan; Tuncer, Oğuz; Garipardıç, Mesut
Glanzmann trombastenisi pıhtı oluşumunun ilk basamağındaki anormalikten kaynaklanan otozomal resesif geçişli kalıtsal bir hastalıktır. Ekimotik mukokütenöz leziyonlarla ve kana diateziyle ilişkili olgularda, eğer trombosit sayısı normal, kanama zamanı uzun ise Glanzamann trombastenisi ayırıcı tanıda düşünülmelidir. Burada ikiz eşi olarak doğan, diğer ikizi intauterin exitus olan ve yaygın intravasküler koagulopati ve sepsis tablosuyla gelen ardından GT tanısı konan bir olgu sunuldu.
How Frequently External Ventricular Drainage Device Should Be Changed in Children With Ventriculoperitonel Shunt Infection
(Professional Medical Publications, 2015) Gulsen, Ismail; Ak, Hakan; Demir, Nihat; Sosuncu, Enver; Arslan, Mehmet
Objective: The purpose of the presenting study was to determine how frequently external ventricular drainage (EVD) device should be changed in children with ventriculopertienal shunt (VPS) infection during prolonged intravenous antimicrobial therapy. Methods: In this retrospective study, 25 children with VPS infection were evaluated between January 2012 and December 2013. In these children VPS was surgically removed and appropriate antimicrobial therapy was administered according to cerebrospinal culture results. Data noted about how frequently EVD device had been changed, the number of cells on direct observation of cerebrospinal fluid (CSF), glucose and protein levels of CSF, and CSF culture results were obtained from patients' records. Results: Total 25 children were included in the study. The median age was three months (1 and 65 months). In 44% of children, Staphylococcus epidermidis was isolated. During treatment period, EVD catheter has changed one to six times. A total of 68 EVD catheters were changed in these patients. When the duration of ventriculostomy catheter and leukocyte count in CSF were evaluated on daily basis, leukocyte count was decreased 5 units per day in children whose catheter remained less than 10 days. However, in children whose catheter remained more than 10 days leukocyte count was decreased 2.21 units per day. Conclusions: In children with VPS infection, EVD device should be changed at every 10 days for the rapid resolution of the infection.
The Importance of Administration of Early Surfactant and Nasal Continuous Positive Airway Pressure in Newborns With Respiratory Distress Syndrome
(Aves, 2014) Ceylan, Abdullah; Gezer, Suat; Demir, Nihat; Tuncer, Oguz; Peker, Erdal; Kirimi, Ercan
Aim: Mechanical ventilation is an invasive method and causes to important problems in the respiratory tract and lung parenchyma. The objective of our study was to investigate if administration of early surfactant and nasal continuous positive airway pressure (nCPAP) was superior to delayed surfactant administration and mechanical ventilation. Material and Methods: The study was conducted in the Van 100th Year University, Medical Faculty Hospital, Neonatal Intensive Care Unit. One hundred and nine infants with respiratory distrss syndrome (RDS) with a gestational age of 32 weeks and/or below were included in the study. Surfactant was given to 61 infants in the delivery room or intensive care unit and subsequently nCPAP was administered. Surfactant was administered in 48 infants in the control group and mechanical ventilation was inititated subsequently. Informed consent was obtained from the relatives of all patients and ethics committee approval was also obtained (Approval number: 03.02.2011/15). Results: There was no statistically significant difference between the two groups in terms of gestational age, birth weight, gender, height and head circumference measurements (p > 0.05). The mean hospitalization time in the patients in the study group was 24.4 +/- 17.8 days, whereas the mean time of nCPAP was 28.4 (4-120) hours. In the study group, intracranial hemorrhage was found with a rate of 27.85%, bronchopulmonary dysplasia was found with a rate of 4.91%, pneumothorax was found with a rate of 3.27%, necrotizing enterocolitis was found with a rate of 3.27%, patent ductus arteriosus was found with a rate of 16.39, sepsis was found with a rate of 22.95% and retinopathy of prematurity was found with a rate of 1.63%. No statistically significant difference was found between the study and control groups in terms of the rates of complications. During the follow-up period, 17 (27.86%) patients were lost. The length of stay on mechanical ventilation in the study group was found to be statistically significantly shorter compared to the control group (p < 0.05). Conclusions: In our study, it was observed that administration of early surfactant and nCPAP in treatment of preterm newborns with a diagnosis of RDS markedly decreased the lenght of stay on mechanical ventilation, but had no significant impact on morbidity and mortality.
Investigation of the Effect of the Efficiency of Noise at Different Intensities on the Dna of the Newborns
(Medknow Publications & Media Pvt Ltd, 2016) Ceylan, Nesrin; Kaba, Sultan; Karaman, Kamuran; Celiker, Metin; Basbugan, Yildiray; Demir, Nihat
Hearing loss can occur in newborns exposed to high-level noise; noise exposure can cause more physiological stress and can lead to DNA damage. This study was designed to determine DNA damage in newborn rats exposed to sound at different concentrations. For this purpose, 28 newborn (3-6 days old) rats were divided into four groups of 7 rats in each group (Control and Groups of 40 decibel (dB), 70 dB, and 110 dB]. In the experimental groups, 40 dB, 70 dB, and 110 dB (7.5-15 kHz) of sound was applied to the experimental groups for 30 min a day for 7 days. DNA damage levels in the serums obtained from this study were determined by the enzyme-linked immunosorbent assay (ELISA) method. According to this, it was determined that DNA damage in the group exposed to 110 dB showed a statistically significant increase (P < 0.05) compared to the compared to the control, 40 dB, and 70 dB groups. Related to the subject, it was concluded that DNA damage may occur in newborns exposed to 110 dB or higher sound in neonatal units, wards, and home environments with newborn babies. Mothers should be warned about this situation and noise should be kept under 110 dB volume in the environments with the newborns.
Is Platelet Mass a More Significant Indicator Than Platelet Count of Closure of Patent Ductus Arteriosus
(Taylor & Francis Ltd, 2016) Demir, Nihat; Peker, Erdal; Ece, Ibrahim; Agengin, Kemal; Bulan, Keziban Asli; Tuncer, Oguz
Background: The purpose of this study was to evaluate whether or not platelet mass contributes to closure of patent ductus arteriosus (PDA) in premature newborns.Study design and subjects: This retrospective study included 115 preterm newborns with hemodynamically significant PDA (hPDA) and 120 newborns without PDA. The newborns' platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) were noted from their files and the platelet mass (platelet count plus MPV/10(3)) was calculated. Patients with congenital abnormality, persistent pulmonary hypertension or sepsis were not included in the study.Results: Platelet count and PDW were found to not be risk factors for closure of hPDA (p>0.05), but both high platelet mass (OR 1.25; 95% CI 1.12-1.41) and MPV (OR 1.87; 95% CI 2.52-3.85) were determined to be independent risk factors for hPDA.Conclusions: Platelet mass may be a more significant indicator than platelet count of closure of hPDA in preterm newborns.
The Levels of Vitamin B12, Folate and Homocysteine in Mothers and Their Babies With Neural Tube Defects
(Taylor & Francis Ltd, 2016) Peker, Erdal; Demir, Nihat; Tuncer, Oguz; Ustyol, Lokman; Balahoroglu, Ragip; Kaba, Sultan; Karaman, Kamuran
The aim of the present study was to determine the serum levels of vitamin B-12, folate, and homocysteine (Hcy) in mothers and their babies, and to assess the association between these levels and neural tube defect (NTD). The study group included 92 baby-mother pairs, where the babies had NTD, and the control group included 102 pairs, where the babies had no NTD, from May 2012 to May 2015. Plasma vitamin B-12, folate, and Hcy levels of the babies and mothers were measured, and compared with each other. NTD was diagnosed in 2.6% of our babies. The vitamin B-12 levels in the mothers and the babies in the study group were determined as 166.2 +/- 63.7 pg/mL and 240.3 +/- 120.3 pg/mL, and in the control group as 1 9 0 +/- 80.2 pg/mL and 299.5 +/- 151.4 pg/mL, respectively. There was a significant difference between the two groups in terms of both the mothers' and the babies' vitamin B-12 levels (p = 0.024 and p = 0.003, respectively). The plasma folate levels of the mothers in the study group (5.2 +/- 3 ng/mL) were significantly lower than control group (6.4 +/- 4.3 ng/mL, p = 0.032). The plasma Hcy level of the mothers in the study group (9.3 +/- 3.8 mu mol/L) was significantly higher than the control group (7 +/- 3.8 mu mol/L, p<0.001). High plasma Hcy levels and low plasma folate and vitamin B-12 levels are risk factors for NTD. Our results show that the risk for NTD can be decreased by fortification of mothers-to-be, particularly in rural areas with folate and vitamin B-12 deficiency, which would lower the plasma Hcy level.
Powder Topical Rifampin for Reducing Infections After Neural Tube Defect Surgery in Infants
(Elsevier Science inc, 2016) Demir, Nihat; Peker, Erdal; Gulsen, Ismail; Kocaman, Selami; Tuncer, Oguz; Kirimi, Ercan
OBJECTIVE: The correct timing and technique of neural tube defect (NTD) repairs significantly decrease the morbidity and mortality of NTD cases. However, infections related to the surgery are still common. We investigated the effects of topical rifampin combined with routine prophylaxis in newborns with open NTDs. METHODS: This retrospective study included 86 patients who had undergone NTD surgery. The experimental group comprised 30 patients who were started on topical rifampin before surgery, and the control group comprised 56 patients who were not administered topical rifampin. Surgical site infections (SSIs) and meningitis/ventriculoperitoneal (VP) shunt infections that developed within 6 months after the surgical intervention were evaluated. RESULTS: In the postoperative period, meningitis/VP shunt infections and SSIs were observed in 6.7% and 3.3%, respectively, of the experimental group treated with topical rifampin. Meningitis/VP shunt infections and SSIs were observed in 37.5% and 21.4%, respectively, of the control group. External ventricular drainage and not using topical rifampin were identified as important relative risk (RR) factors for meningitis/VP shunt infections (RR 19.28, 95% confidence interval [CI] [3.53, 105.33], P = 0.001; RR 18.10, 95% CI [2.38, 137.68], P = 0.005). A flap transposition, cerebrospinal fluid leaks, and not using topical rifampin were identified as RR factors for SSIs (RR 22.21, 95% CI [4.81, 102.47], P < 0.001; RR 13.04, 95% CI [1.22, 139.33], P = 0.034; RR 7.09, 95% CI [1.12, 53.99], P = 0.042). We did not observe any local or systemic side effects resulting from the use of rifampin. CONCLUSIONS: The use of topical rifampin is an easy and effective method for reducing SSIs and meningitis/VP shunt infections related to NTD surgery.
The Relationship Between Mother and Infant Plasma Trace Element and Heavy Metal Levels and the Risk of Neural Tube Defect in Infants
(Taylor & Francis Ltd, 2019) Demir, Nihat; Basaranoglu, Murat; Huyut, Zubeyir; Deger, Ibrahim; Karaman, Kamuran; Sekeroglu, M. Ramazan; Tuncer, Oguz
Objective: To determine levels of trace elements [copper (Cu), zinc (Zn), selenium (Se), and cobalt (Co)] and heavy metals [arsenic (As), mercury (Hg), lead (Pb), and cadmium (Cd)] in the plasma of mothers and infants and investigate the relationship between those levels and neural tube defects (NTD). Methods: A total of 100 neonates diagnosed with NTD and placed in the Neonatal Intensive Care Unit of Yuzuncu Yil University, Turkey between May 2013 and December 2016 comprised the study group. The control group consisted of 70 healthy neonates not diagnosed with NTD or any other congenital anomalies. For both the groups, mother and infant plasma levels of Cu, Zn, Co, Cd, Se, Hg, As, and Pb were measured and compared. Plasma levels of Cu, Zn, Co, Cd, Se, Hg, As, and Pb were measured and compared between two groups of mothers and infants. Findings: Mother and infant plasma levels of trace elements Zn and Se were determined to be significantly lower in the study group compared with the control group, while Cu levels were significant elevated in the study group (all p values < .05). Plasma levels of heavy metals As, Pb, and Cd were found to be significantly higher in the NTD control group (p < .05 for all). There was no association between maternal infection, maternal smoking status, history of miscarriage, or history of NTD with the development of NTD (p > .05). Differences in maternal age, birth weight, length of gestation, and infant gender for the two groups were also determined not to be statistically significant. Results: High plasma levels of heavy metals As, Pb, and Cd and trace element Cu were identified as risk factors for the development of NTD. At the same time, low plasma levels of trace elements Zn and Se were also found to be risk factors for NTD. However, no association between Hg and Co plasma levels and increased risk for the development of NTD was observed. This study, while being the most comprehensive case study to date investigating the relationship between heavy metals and trace element levels and increased risk of NTD, nonetheless highlights the need for further research in order to make definite statements regarding this relationship.
Respiratuvar Distres Sendromlu Preterm Bebeklerde Sürfaktan Uygulanmasında Lısa ve Insure Yöntemlerinin Karşılaştırılması
(2021) Başaranoğlu, Murat; Demir, Nihat; Deger, İbrahim; Tuncer, Oğuz; Aydın, Neşet
Amaç: Bu çalıs ma, respiratuvar distres sendromu tanısıyla sürfaktan tedavisi uygulanan prematüre bebeklerde, invaziv (entübasyon tüpü) ve daha az invaziv (ince kateter) yöntemlerle sürfaktan uygulanmasının kars ılas tırılması amacıyla yapıldı. Gereç ve yöntem: Yenidog an Yog un Bakım ünitesinde yatan; dog um haftası 32. gebelik haftası ve/veya altında olan ve sürfaktan tedavisi verilmesi gereken bebekler çalıs maya alındı. Respiratuvar distres sendromu için sürfaktan replasmanı gereken 60 olgu çalışmaya alındı. Tüm olgulara poractant alfa (200 mg/kg/doz) verildi. Olgular, LISA (Daha az invaziv sürfaktan uygulaması) ve INSURE (Entübasyon, Sürfaktan uygulaması ve Ekstübasyon) grubu olacak şekilde randomize edildi. Bulgular: Sürfaktan verilis i sırasında INSURE grubundaki hastaların %90’ında, LISA grubundaki hastaların ise %63.3’ünde komplikasyon gözlenmedi. LISA grubunda ilk 72 saatte entübasyon ihtiyacının istatistiksel olarak anlamlı oranda daha düşük olduğu saptandı. Mekanik ventilasyon ihtiyacının ve ölüm oranlarının INSURE grubunda daha yüksek olduğu saptandı. Tekrarlayan sürfaktan ihtiyacı açısından gruplar arasında anlamlı farklılık bulunmadı. Gruplar arasında Respiratuvar distres sendromu komplikasyonları (Nekrotizan enterokolit, İntrakraniyal kanama, Prematüre retinopatisi, Bronkopulmoner displazi) yönünden istatistiksel olarak anlamlı farklılık bulunmadı. Sonuç: Sürfaktan replasman tedavisinde her iki yöntem de uygulanabilir ancak ince kateter ile sürfaktan tedavisi sırasında desatürasyon daha sık görülmektedir. Kateter yönteminin uygulama zorlukları yöntemin dezavantajlarıdır. Fakat entübasyon ve pozitif basınçlı ventilasyon gerektirmemesi, mekanik ventilasyon destek ihtiyacının ve mekanik ventilasyonda kalış süresinin daha az olması nedeniyle INSURE yöntemine göre daha başarılı görünmektedir.