Browsing by Author "Uner, Abdurrahman"

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Acute Intoxications Among Turkish Children
(Edizioni Minerva Medica, 2018) Kizilyildiz, Baran S.; Karaman, Kamuran; Ozen, Selvi; Uner, Abdurrahman
BACKGROUND: The aim of this study was to investigate characteristics, outcomes and clinical features of acute intoxications among children in Van region of Turkey. METHODS: All cases with a diagnosis of acute intoxication admitted to the Pediatric Emergency Department of the Yuzuncu Yil University of Van from June 1, 2010 to November 30, 2011 were evaluated. We retrospectively examined the medical records for demographical and etiological characteristics of patients below 17 years of age. RESULTS: A total of 239 intoxications were recorded. The majority of patients were under 5 years of age. Pharmaceutical agents were identified in 137 (57.3%) patients. Antidepressants with a majority of tricyclic antidepressants were the most common drugs (29.9%). Non-pharmaceutical agents were identified in 102 (42.6%) patients, 38.2% of which were insecticides-pesticides following by plants (25.4%) and carbon monoxide (17.6%). The majority (93.8%) of cases were accidental poisonings. Fourteen cases of intoxications occurred as suicide attempts and 85.7% (N.=12) of those patients were girls. Of all cases, gastric lavage was performed in 36.4% and activated charcoal administration in 53%. After hospitalization, only 23 (9.6%) of all patients received specific treatment besides symptomatic treatment. Specific treatments involved hemodialysis and antidotes such as biperiden, ethanol, atropine, neostigmine and pralidoxime. During the study period, one patient died due to acute intoxication of pesticide. The mortality rate was 0.4%. CONCLUSIONS: Our study revealed that pharmaceuticals were the most common cause of acute intoxications. While, insecticides-pesticides and plants were the leading non-pharmaceutic agents. Our data is important because it is one of few original reports on children with intoxication in Eastern Turkey.
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.
The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children
(Korean Soc Otorhinolaryngol, 2016) Acar, Onur Caglar; Uner, Abdurrahman; Garca, Mehmet Fatih; Ece, Ibrahim; Epcacan, Serdar; Turan, Mahfuz; Kalkan, Ferhat
Objectives. The purpose of the present study is to emphasize the efficacy of the myocardial performance index and tricuspid annular plane systolic excursion (TAPSE) in the determination of impaired cardiac functions and recovery period following the treatment in children with adenoid and/or tonsillar hypertrophy. Methods. Fifty-three healthy children after routine laboratory, imaging and clinical examinations, with adenoid and/or tonsillar hypertrophy were evaluated before and 3 months after adenotonsillectomy for cardiac functions using M mode and Doppler echocardiography. Results. The mean age of cases was 6.4 +/- 3.0 years, 34 (65%) were male, and 19 (35%) were female. Pulmonary hypertension was observed to be mild in 3 patients and moderate in 1 patient preoperatively. When the preoperative and postoperative echocardiographic measurements of the patients were compared, the tricuspid valve E wave velocity, the E/A ratio (E, early diastolic flow rate; A, late diastolic flow rate), and the TAPSE values were determined to be significantly higher postoperatively (P < 0.05). The tricuspid valve deceleration time, the isovolumetric relaxation time and the systolic pulmonary artery pressure were found to be significantly lower compared to the preoperative values (P < 0.05). Conclusion. Adenoidectomy and/or tonsillectomy may prevent cardiac dysfunctions that can develop in the later periods due to adenoid and/or tonsil hypertrophy in children, before the appearance of the clinical findings of cardiac failure.
The Effects of Pre-Pregnancy Obesity on Fetal Cardiac Functions
(Springer, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Kibar, Ayse Esin; Oflaz, Mehmet Burhan; Kurdoglu, Mertihan
Obesity is a substantial public health problem with a rapidly increasing prevalence in numerous industrialized nations. The objective of this study was to evaluate the effects of maternal pre-pregnancy obesity on fetal cardiac functions. We studied 55 fetuses of obese mothers and 44 fetuses of healthy mothers at 26-38 weeks of gestation. Cardiac functions were evaluated by M-mode, pulsed-wave, and tissue Doppler echocardiography. The two groups were similar in terms of maternal age, gravidity, parity, gestational age, estimated birth weight, serum lipids, and systolic-diastolic blood pressure. Fetal heart rate, diameters of the aortic and pulmonary valve annulus, aortic and pulmonary peak systolic velocities, ventricular systolic function, and cardiothoracic ratio were similar in the two groups. Pulsed-wave Doppler-derived E/A ratios in the mitral and tricuspid valves were similar in the two groups. The deceleration time of early mitral inflow was prolonged in the fetuses of the obese mothers. In the interventricular septum, left ventricle posterior wall, and right ventricle free wall, the E (a) and A (a) were higher, and E (a)/A (a) ratios were significantly lower in the study group than in the control group. The E/E (a) ratio was higher in the obese group than in the control group. The isovolumic relaxation time and the right and left ventricle myocardial performance indices were higher in the fetuses of the obese mothers than in the fetuses of the healthy mothers. We believe that maternal obesity has an important influence on fetal cardiac diastolic functions.
Epidemiology and Burden of Rhinitis and Rhinoconjunctivitis in 9-To 11-Year Children
(Sage Publications inc, 2010) Civelek, Ersoy; Yavuz, Suleyman Tolga; Boz, Aysen Bingol; Orhan, Fazil; Yuksel, Hasan; Uner, Abdurrahman; Sekerel, Bulent E.
Background: Rhinoconjunctivitis (RC) is regarded as the most common chronic disease of childhood; however, the currently available epidemiological studies on prevalence, burden, and risk factors of RC are insufficient. This analysis aimed to investigate potential risk factors, symptom frequency, and burden of RC. Methods: Using the International Study of Asthma and Allergies in Childhood Phase II questionnaires, 6963 elementary school children aged 9-11 years were surveyed in five different city centers of Turkey. All participants were skin-prick tested with common aeroallergens. Results: The prevalence of ever rhinitis, physician-diagnosed rhinitis, current rhinitis, and current RC were 51.6, 31.0, 43.5, and 23.1%, respectively; 19.8% of children with RC symptoms were atopic to at least one allergen. Among students with RC symptoms, 42.2, 23.9, 35.8, and 28.2% reported moderate severe interference of daily activities, at least 1 day of absence from school, visit to a health care professional, and any drug usage for rhinitis, respectively. Nasal decongestants and oral antihistamines were the most frequently used treatment. Approximately 70% of RC patients reported perennial symptoms and 42.8% were classified as mild to intermittent. Multivariate logistic regression analysis revealed family history of asthma and/or allergic rhinitis (odds ratio [OR] = 1.863; confidence interval, [CI] = 1.583-2.191; p < 0.001), living in a house with mold and dampness in the 1st year of life (OR = 1.651; CI = 1.356-2.01; p < 0.001), maternal smoking in pregnancy (OR = 1.425; CI = 1.089-1.864; p = 0.011), low monthly income (OR = 1.685; CI = 1.422-1.998; p = 0.001), current wheezing (OR = 2.543; CI = 2.151-3.006; p = 0.001), and current atopic eczema (OR = 2.503; CI = 1.96-3.196; p = 0.001) as significant risk factors for current RC. Conclusion: Along with the high prevalence of RC in childhood, underdiagnosis and undertreatment of the disease are also frequent. The socioeconomic burden of the disease can be reduced by increasing awareness and proper diagnosis/treatment. (Am J Rhinol Allergy 24, 364-370, 2010; doi: 10.2500/ajra.2010.24.3484)
Evaluation of Left and Right Ventricular Functions Using Conventional and Tissue Doppler Echocardiography in Children With Type 1 Diabetes Mellitus
(Walter de Gruyter Gmbh, 2016) Acar, Onur Caglar; Epcacan, Serdar; Uner, Abdurrahman; Ece, Ibrahim; Dogan, Murat
Background: The aim of the study was the evaluation of the effects of glycemic control in children and adolescents with type 1 diabetes on cardiac functions. Methods: Diabetic patients were divided into two groups as well-controlled and poorly controlled patients. All patients underwent M-mode, two-dimensions (2D), pulsed wave (PW) Doppler, and tissue Doppler (TDI) echocardiography to evaluate systolic and diastolic functions. Results: Early diastolic mitral flow velocity ( Em) and the ratio of early to late diastolic mitral flow velocity (Em/Am) obtained with TDI were found to be significantly lower in the well-controlled then the control group and significantly lower in the poorly-controlled group than the well-controlled group. Am, isovolumetric relaxation time (IVRT) and myocardial performance index (MPI) were significantly higher in the poorly controlled group. The ratio of early mitral diastolic flow velocity obtained with PW Doppler (E) to Em (E/Em) was significantly higher in the diabetic group. According to the mitral valve PW Doppler results, 13.6% of the well-controlled group and 31% of the poorly-controlled group had type 1 diastolic dysfunction. According to the mitral TDI results, 18% of the well-controlled group and 40.4% of poorly-controlled group had type 1 diastolic dysfunction. Conclusions: Conventional and TDI echocardiography revealed impairment in left ventricular functions in some patients. Tissue Doppler echocardiography also revealed diastolic impairment in some patients who appeared normal with PW Doppler echocardiography. The present study found that impairment in left ventricular diastolic functions is directly related to glycemic control and the rate of diabetic cardiomyopathy was higher in children with poor metabolic control.
Investigation of Oxidant and Antioxidant Pathway Changes in Acute Rheumatic Fever
(Taylor & Francis Ltd, 2010) Uner, Abdurrahman; Sal, Ertan; Dogan, Murat; Sanli, Fatih M.; Acikgoz, Mehmet; Cemek, Mustafa; Cagan, Eren
Aim - The purpose of this study was to investigate the role of oxidant stress in the clinical process and pathogenesis of acute rheumatic fever (ARF). Material and methods - The study included 33 children with ARF and 20 healthy control subjects. The diagnosis of ARF was established according to the Jones Criteria. Malondialdehyde (MDA), reduced glutathione (GSH), alpha-tocopherol, ascorbic acid, retinol and beta-carotene levels were measured as markers of oxidative stress together with some antioxidant markers. Results - Our study includes 33 (19 male, 14 female) children with ARF and 20 (11 male, 9 female) healthy control subjects. The mean age ranged between 5-16 years and 5-15 years in the study and control groups, respectively. MDA was measured as 2.1 +/- 0.9 nmol/mL in the control group, 3.3 +/- 2.7 nmol/mL in the study group before treatment, and 2.1 +/- 1.2 nmol/mL after treatment. Blood GSH levels were 48.2 +/- 12.7 mg/dL in the control group, 24.7 +/- 16 mg/dL in the study group before treatment, and 40.6 +/- 21.3 mg/dL in the study group after treatment. MDA and GSH levels prior to the treatment were found to be significantly high and low as compared with the levels of the control group, respectively (P < 0.05, P < 0.001). After treatment, statistically important decrements and increments were determined in the levels of MDA (P < 0.05) and GSH (P < 0.01), respectively. Furthermore, alpha-tocopherol, retinol and beta-carotene levels prior to treatment in the study group, were significantly lower in comparison with control group levels (P = 0.05, P < 0.05, P < 0.01, respectively). Conclusion - We suggested that tissue damage in ARF may not only occur in the presence of increased oxidative stress, but also as a consequence of decreased antioxidant markers.
Myocarditis With Hypotonic-Hyporesponsive Episode After Multiple Vaccination
(All india inst Medical Sciences, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Kibar, Ayse Esin
P-Wave and Qt Interval Dispersion Analysis in Children With Eisenmenger Syndrome
(Turkish Soc Cardiology, 2014) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Oflaz, Mehmet Burhan; Kibar, Ayse Esin; Sal, Ertan
Objectives: P-wave and QT dispersion are increased and associated with atrial and ventricular arrhythmia and an increase in sudden death in a variety of diseases. This study aimed to investigate P-wave and QT dispersion in children with Eisenmenger syndrome (ES). Study design: The study group included 27 children (15 females, 12 males) with both congenital heart disease (CHD) and ES. The control group consisted of 30 children with CHD without pulmonary arterial hypertension. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. 24-hour (h) rhythm Holter was fitted in all patients. Atrial volumes, ventricular dimensions and tricuspid annular plane systolic excursion (TAPSE) were measured by echocardiography Results: There was no difference between groups with regard to age, sex, weight, and body surface area (p>0.05). Right atrial volume was significantly larger in the ES group than in the control group. P-wave, QT and QTc dispersions were higher in the patients with ES (50.10 +/- 11.12 vs. 26.32 +/- 8.90, p<0.001; 57.40 +/- 24.21 vs. 38.20 +/- 8.92 ms, p<0.001; and 78.20 +/- 16.02 vs. 56.52 +/- 13.92 ms, p<0.001, respectively). Ventricular and supraventricular ectopy were significantly more frequent in the ES group. Four patients (14.8%) in the study group had tachyarrhythmias during 24-h Holter monitoring. Conclusion: In our study, P-wave and QT dispersion were found to be greater in children with ES than in the healthy control subjects.
Paroxysmal Supraventricular Tachycardia Following Dtp and Poliomyelitis Immunization
(Georg Thieme verlag Kg, 2006) Yilmaz, Cahide; Uner, Abdurrahman; Erol, Mehmet; Guven, Ahmet Sami; Caksen, Huseyin
A Rare Cause of Neonatal Bradycardia: Blocked Atrial Bigeminal Beat
(Dr Behcet Uz Cocuk Hastaliklari ve Cerrahisi, 2013) Ece, Ibrahim; Uner, Abdurrahman; Balli, Sevket; Oflaz, Mehmet Burhan
Risk Factors for Current Wheezing and Its Phenotypes Among Elementary School Children
(Wiley, 2011) Civelek, Ersoy; Cakir, Banu; Orhan, Fazil; Yuksel, Hasan; Boz, Aysen B.; Uner, Abdurrahman; Sekerel, Bulent E.
Background Accumulating evidence suggests, asthma includes many phenotypes with varying clinical and prognostic features. Epidemiological surveys documented a number of environmental risk factors for the development of asthma and interestingly these differ between and within countries, suggesting that the differences may be related with the different distribution of asthma phenotypes. This study aimed to investigate risk factors of current wheezing (CW) and different wheezing phenotypes in elementary school children. Methods Six thousand nine hundred sixty-three 9- to 11-year-old children of a previous multicenter survey where the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase-II was used were analyzed. Wheezing phenotypes were defined as wheezing with rhinitis (RW), wheezing with rhinoconjunctivitis (RCW), atopic wheezing (AW), non-atopic wheezing (NAW), and frequent wheezing (FW) (>= 4/year wheezing episodes). Results The prevalence of CW was 15.8% and among these, 22.4%, 67.3%, 45.9%, 20.5%, and 79.5% were classified as FW, RW, RCW, AW, and NAW, respectively. History of parental asthma/allergic rhinitis, coexistence of other allergic diseases, presence of mold and dampness in the house lived during the first year of life and maternal smoking in pregnancy were found to be risk factors for most phenotypes (odds ratio (OR) ranged from 1.43 to 3.56). Number of household in the last year (OR = 1.14), prematurity (OR = 2.08), and duration of breastfeeding (OR = 1.02) per additional month were found to be risk factor for FW, AVV, and RCW, respectively. Conclusion Beside common risk factors for the development of asthma and its phenotypes, certain risk factors appeared to play a role in the development of phenotypic characteristics of asthma. These findings support our hypothesis that each phenotype has not only different clinical characteristics but also has different roots. Pediatr Pulmonol. 2011; 46:166-174. (C) 2011 Wiley-Liss, Inc.
Stroke and Recurrent Peripheral Embolism in Left Atrial Myxoma
(Taylor & Francis Ltd, 2010) Uner, Abdurrahman; Dogan, Murat; Sal, Ertan; Peker, Erdal
Primary cardiac tumours are uncommon, with an estimated incidence between 0.0017% and 0.19%. Cardiac myxoma is a rare cause of cerebrovascular disease, especially in children. This case report emphasizes the importance of cardiac evaluation, especially echocardiographic examination in cases with stroke and peripheral embolism.
Successful Closure of Coronary Artery Fistula With an Amplatzer Duct Occluder Ii Device
(Baycinar Medical Publ-baycinar Tibbi Yayincilik, 2016) Ece, Ibrahim; Ture, Mehmet; Uner, Abdurrahman; Sahin, Musa
Coronary artery fistulas localized between the coronary arteries and heart chambers are rare congenital abnormalities of the heart. Although surgery is the conventional treatment of these fistulas, transcatheter closure is feasible in selected cases. Herein, we present a case in whom the fistula was localized between the coronary artery and right atrium and successfully closed with an Amplatzer Duct Occluder II. An 11-month-old patient was admitted to our clinic with a continuous murmur. His physical examination revealed no other pathology. Transthoracic echocardiography showed a fistula localized between the coronary artery and right atrium. The fistula was closed antegradely with an Amplatzer Duct Occluder II device. Post-procedural echocardiography revealed no continuous flow across the fistulous tract.
Tarka® Overdose in a Young Child
(Sage Publications Ltd, 2011) Dogan, Murat; Basaranoglu, Murat; Peker, Erdal; Akbayram, Sinan; Sahin, Musa; Uner, Abdurrahman; Caksen, Huseyin
Tarka (R) is a combination antihypertensive medication composed of verapamil hydrochloride and trandolapril. A 3.5-year-old female was brought to our hospital due to a sleepy condition 7 hours after an accidental ingestion of six tablets of Tarka (R) containing 240 mg verapamil hydrochloride and 4 mg trandolapril in each tablet. Five hours after hospitalization, her condition deteriorated and arterial pressure progressively decreased despite the treatment. Finally, a temporary pacemaker was implanted, after which the vital findings began to return to normal values. The pacemaker was removed 13 hours after implantation as normal heart rhythm was observed. There are no reports of intoxication with fixed-dose combination products, especially Tarka (R), in young children in the literature. Therefore, we believe that our report can provide an insight on the toxic dose of this drug in younger children. Clinicians should keep in mind that lethargy can be the first symptom of a possible clinical deterioration, even in normotensive and normorhythmic individuals.
Transcatheter Closure of Tortuous Aorto-Right Atrial Fistula
(Springer Japan Kk, 2015) Ece, Ibrahim; Uner, Abdurrahman; Cuce, Ferhat; Sahin, Musa
Congenital fistula between the aorta and right atrium is a rare congenital anomaly of the heart. We report a new case of this unusual communication, which was successfully closed by transcatheter embolisation using an Amplatzer duct occluder II. A 7-year-old asymptomatic girl was referred to our institute for evaluation of a murmur. Echocardiography revealed intact septae and the right coronary sinus was dilated with a fistulous tract arising from the sinus and opening into the right atrium with continuous flow into the right atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy. Cardiac catheterization performed confirmed the presence of a markedly tortuous and dilated aorto-right atrial fistula. Coronary angiography demonstrated normal coronary arteries arising from the respective sinuses. The fistula was closed antegradely using an Amplatzer duct occluder II (AGA Medical Corporation, Plymouth, MN, USA). The continuous murmur had disappeared after the procedure and an echocardiogram revealed no continuous flow across the fistulous tract. The patient remained well at follow-up 3 months later.
Transcathether Closure of a Right Pulmonary Artery-To Atrial Fistula Using Amplatzer Muscular Ventricular Septal Defect Occluder
(Springer Japan Kk, 2014) Ece, Ibrahim; Uner, Abdurrahman; Cuce, Ferhat; Balli, Sevket
A right pulmonary artery-to-left atrial fistula is a very rare cyanotic congenital heart defect and is characterized by cyanosis and normal auscultation of the heart. Interventional closure of the fistula using occluder devices and coils has been rarely reported. We report the successful closure of a RPA-to-left atrial fistula using an Amplatzer muscular ventricular septal defect occluder in a child with cyanosis. The two-dimensional echocardiogram with bubble contrast study demonstrated the communication between right pulmonary artery and left atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy.
Treatment of Chronic Immune Thrombocytopenic Purpura With Rituximab in Children
(Springer india, 2009) Dogan, Murat; Oner, Ahmet F.; Acikgoz, Mehmet; Uner, Abdurrahman
To evaluate the rituximab treatment in children with chronic immune thrombocytopenic purpura This study included ten children with chronic immune thrombocytopenic purpura, which were nonresponsive to Steroid (S), IVIG and anti-D treatments. Rituximab was given with a dosage of 375 mg/m2 weekly for 4-6 weeks. Initial platelet count was less than 30x109/L and responses were assessed in follow-up. The patients' groups were categorized as complete remission (CR);a platelet count a parts per thousand yen150x10(9)/L,partial remission (PR);a platelet count ranging from 50x10(9)/L to 150x10(9)/L, minimal remission (MR); a platelet count ranging from 30x10(9)/L to 50x10(9)/L and no response (NR); a platelet count less than 30x10(9)/L. Of our patients, four female and six male, their ages ranged from 39 mth to 13 yr and the mean age was 83.4 +/- 44.58 mth. None of the patients was splenectomized. The follow-up period after rituximab treatment ranged between 12 to 42 mth and the mean follow-up period was 25.10 +/- 13.03 months. While on this treatment, we had a CR in two patients, a PR in one, a MR in three, but no response in four. The patients in CR/PR are still being followed as in remission and they have 40 mth of mean follow-up period. The three patients in MR had a decrease in values of platelets earliest in one mth and the latest in four mth. Adverse effects of rituximab, such as itching and scraps that were not clinically significant were observed in three patients during rituximab infusion. There were no increase in infections after rituximab in any patient. CR was found in 20% of our patients, PR in 10% and MR in 30% with rituximab. On this treatment, while some series had good outcomes with this treatment (72%-100%, remission ratios), but many series, such as ours, had a poor response rate contrast to many reported case series in the literature. This condition may be associated with the age of our most patients who were young at the time of commenced rituximab. However, we believe that more studies are required to elucidate the reasons for different results in different case series reported in literature.
Use of Rituximab in Chronic Childhood Immune Thrombocytopenic Purpura
(Blackwell Publishing, 2006) Bay, Ali; Oner, Ahmet Faik; Uner, Abdurrahman; Dogan, Murat