Ates Kara | Hacettepe University (original) (raw)

Papers by Ates Kara

Research paper thumbnail of Hematological consequences of pandemic influenza H1N1 infection: a single center experience

Turkish Journal of Pediatrics, Nov 1, 2010

Since its identification in April 2009, pandemic influenza H1N1 virus has affected thousands of p... more Since its identification in April 2009, pandemic influenza H1N1 virus has affected thousands of people worldwide. Viruses, particularly Epstein-Barr virus, cytomegalovirus and parvovirus B19, may have diverse hematological consequences, including anemia, neutropenia, thrombocytopenia, lymphocytosis, hemophagocytic lymphohistiocytosis, and coagulation abnormalities. In this study, a total of 31 consecutive pediatric patients, with and without chronic diseases, who had flu symptoms and were confirmed to have pandemic influenza, were evaluated for hematological consequences upon presentation to hospital. Eight (25.8%) patients had leukopenia and six (19.4%) had thrombocytopenia at the time of diagnosis of H1N1 infection. Pandemic influenza H1N1 infection may cause diverse hematological findings, including cytopenias and hemophagocytosis.

Research paper thumbnail of 830 The Value of Mean Platelet Volume in the Determination of Community Acquired Pneumonia in Children

Archives of Disease in Childhood, Oct 1, 2012

hospitalization, while the remaining 57 (41.4%) were followed-up as outpatients. The control grou... more hospitalization, while the remaining 57 (41.4%) were followed-up as outpatients. The control group consisted of 61 healthy children. Patients with CAP had lower MPV values than their healthy counterparts (7.14±0.70 vs. 8.35±1.26 fL; p<0.001). Following ROC analysis, the cutoff value established for MPV was 8.05, which had a sensitivity of 91% and a specificity of 51% for making a diagnosis of CAP. Patients with severe CAP that required hospitalization had significantly higher CRP levels than those who were followed-up on an outpatient basis (p<0.001). Conclusions Our findings suggest that MPV could be used for the diagnosis of CAP in children.

Research paper thumbnail of Semptomatik hepatit A ve hepatit A komplikasyonu olarak kolestatik hepatit

Çocuk Enfeksiyon Dergisi, 2009

Research paper thumbnail of The use of serum endothelial adhesion molecules in pediatric patients with leukemia with febrile neutropenia to predict bacteremia

Cytokine, Dec 1, 2021

OBJECTIVE Febrile neutropenia (FN) represents a life-threatening complication in hematological ma... more OBJECTIVE Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. We aimed to analyze the utility of soluble vascular cell adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1), vascular endothelial growth factor (VEGF) levels compared with C-reactive protein (CRP) and procalcitonin (PCT) during febrile neutropenia episodes of pediatric patients with leukemia. METHODS Two plasma samples, on day 0 (initial of episode) and day 3 (48-72 h after episode), for VCAM-1, ICAM-1 and VEGF, CRP and PCT were prospectively collected concomitantly during each febrile neutropenic episode between December 2016 and December 2017. The primary outcome was bacteremia and the secondary outcome was intensive care unit (ICU) admission. RESULTS Twenty-two (28.6%) acute lymphoblastic lymphoma (ALL), seventeen (22.1%) acute myeloblastic lymphoma (AML) patients and thirty-eight (49.3%) control patients with no known underlying disease or fever were included in this study. Of the 39 patients; 16 (41%) had bacteremia. Mean serum sVCAM1 and sICAM1 levels were significantly higher in control group, compared to FN patients (p < 0.001). Mean serum sVCAM2 level was significantly higher in FN patients with bacteremia compared to FN patients without bacteremia (144.97 ± 70.35 pg/mL vs 85.45 ± 53.76 pg/mL, p = 0.022). Mean sVCAM1 and 2 levels were higher in FN patients with ICU admission. In this study, we found that sVCAM-1 and VEGF, when combined to CRP and PCT, could predict gram-negative bacteremia in FN episodes of pediatric hematological malignancy. CONCLUSION Serum endothelial adhesion molecules, excluding sVCAM-1, cannot predict bacteremia and ICU admission alone in FN patients; but may be associated with clinical outcome when used with PCT and CRP.

Research paper thumbnail of The effectiveness of topical 1% lidocaine with systemic oral analgesics for ear pain with acute otitis media

International Journal of Pediatric Otorhinolaryngology, 2022

BACKGROUND Acute otitis media (AOM) is one of the most common childhood infections. Ear pain, the... more BACKGROUND Acute otitis media (AOM) is one of the most common childhood infections. Ear pain, the main symptom of AOM, results in parents frequently seeking medical assistance for their children. The aim of this study was to compare the effectiveness of topical 1% lidocaine ear drops administered with oral analgesics with that of oral analgesics alone. METHODS This multicenter randomized, open-labeled study was conducted at 15 centers with 184 pediatric AOM patients with bilateral ear pain (aged 1-5 years) between May 1, 2016, and June 31, 2018. All patients received oral paracetamol or ibuprofen and topical 1% lidocaine, which was administered to each ear according to the randomization list. The ear pain score was evaluated within 48 h using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, and the patients were followed up for 10 days. RESULTS The median age was 31.8 months (min-max, 12-84.2 months). Of those patients enrolled, 22.3% received paracetamol, and 24.5% received paracetamol with lidocaine ear drops; 23.4% received ibuprofen, and 29.9% received ibuprofen with lidocaine ear drops. Lower pain scores were significantly measured at baseline and 10th minutes by a reduction 25% (RR 13.64, 95% CI 4.47-41.63, p = 0.001, RR 0.14, 95% CI 0.06-0.35, p = 0.001) and 50% (RR 4.76, 95% CI 1.63-13.87, p = 0.004, RR 0.14, 95% CI 0.05-0.4, p = 0.001) in the paracetamol and lidocaine versus paracetamol groups and the ibuprofen and lidocaine versus ibuprofen groups, respectively. No serious side effects were evident during follow-up. CONCLUSION This randomized study suggests that topical 1% lidocaine ear drops with paracetamol or ibuprofen seems to provide effective and rapid relief for children presenting with ear pain attributed to AOM.

Research paper thumbnail of Myocarditis associated with influenza infection in five children

Journal of Infection and Public Health, 2018

Background: Myocarditis is an inflammatory condition located mainly in the myocardium. It is caus... more Background: Myocarditis is an inflammatory condition located mainly in the myocardium. It is caused by a variety of bacterial and viral infections. Influenza is one of the most common relevant viruses that cause myocarditis. Objectives: We attempted to share our experiences about clinical and laboratory findings, cardiac evaluation, and treatment of children with influenza myocarditis. Methods: This retrospective study was performed by the Department of Pediatric Infectious Diseases at the Faculty of Medicine, Hacettepe University in Turkey. The medical records of patients diagnosed with myocarditis associated with an influenza infection between January 2014 and January 2017 were systematically reviewed. Results: Vaccination seems likely to be an important protection strategy for both influenza infections and complications.

Research paper thumbnail of Gram Negatif İdrar Yolu Enfeksiyonu Etkenlerinin Antibiyotik Dirençleri

Objective: Urinary tract infection (UTI) is one of the most common infections in childhood. The a... more Objective: Urinary tract infection (UTI) is one of the most common infections in childhood. The aim of this study was to determine etiologic agents and antimicrobial resistance patterns in urinary tract infections and to evaluate empirical treatment suggestions in a tertiary care hospital. Material and Methods: The culture and antibiogram results of 4,421 urine specimens, sent from Hacettepe University Ihsan Dogramaci Children’s Hospital to the microbiology laboratory (between 01.01.2012 and 31.12.2015) were evaluated retrospectively. Results: In 4421 samples where gram-negative (-) growth was detected, Escherichia coli was reported in 64.1%, Klebsiella spp in 17.1% and Proteus spp in 7.4%. Evaluation of all gram-negative microorganisms together, revealed the highest resistance against ampicillin (75.1%), cefazolin (59%), ampicillin-sulbactam (49.7%), trimethoprim-sulfamethoxazole (TMP-SMX) (45.2%), cefixim (33.1%) and ceftriaxone (31.4%). The lowest resistance was against meropenem...

Research paper thumbnail of Perianal abscess in children: A paediatric infectious disease perspective

Anales de Pediatría (English Edition), 2019

Introduction: There are limited data on the aetiology and management of perianal abscesses (PAs).... more Introduction: There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes. Methods: We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes. Results: We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P < .001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PA s drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PA s required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation. Conclusions: Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years.

Research paper thumbnail of The impact of meningococcal conjugate vaccine (MenACWY-TT) on meningococcal carriage in Hajj Pilgrims returning to Turkey

Human Vaccines & Immunotherapeutics, 2019

Meningococcal conjugate vaccine was administered for the first time to pilgrims in 2018 in Turkey... more Meningococcal conjugate vaccine was administered for the first time to pilgrims in 2018 in Turkey prior to their departure to the Hajj. This study aimed to determine the effect of vaccination on the prevalence of Neisseria meningitidis carriage among the pilgrims returning to Turkey.This prospective paired (departing and arriving) cohort study includedpilgrims aged 10-80 years and compared N.meningitidis carriage before and after pilgrimage.Oropharyngeal samples were collected from 229 pilgrims before departing for Mecca, Kingdom of Saudi Arabia (KSA) and after their return to Turkey.Meningococcal carriage was detected in3.9% (n=9) at the time of departure; all positive samples were serogroup B. Upon returning to Turkey,1 (0.4%) pilgrim,who was not a carrier before pilgrimage, was positive for serogroup B.This study is the first to examine meningococcal carriage following the administration of conjugate vaccine to Hajj pilgrims from Turkey.

Research paper thumbnail of Absceso perianal en niños: perspectiva desde el campo de la infectología pediátrica

Anales de Pediatría, 2019

Enfermedad inflamatoria intestinal; Absceso perianal; Recidiva; Tratamiento Resumen Introducción:... more Enfermedad inflamatoria intestinal; Absceso perianal; Recidiva; Tratamiento Resumen Introducción: Existen datos limitados acerca de los abscesos perianales (AP), con respecto a su etiología y tratamiento. Este estudio retrospectivo tiene como objetivo definir las características de los niños con AP, detallar nuestra experiencia en el campo de las enfermedades infecciosas pediátricas y determinar los factores que influyen en los resultados clínicos. Métodos: Entre enero de 2005 y julio de 2015 se llevó a cabo una revisión retrospectiva de niños con AP sin enfermedad subyacente en un hospital de referencia de nivel terciario. La información incluyó características demográficas, síntomas, tamaño y localización del absceso, recurrencias de los abscesos, hallazgos de laboratorio y microbiológicos, modalidades de tratamiento, diagnóstico de enfermedades sistémicas al finalizar las investigaciones etiológicas y pronóstico. Resultados: En el estudio se incluyeron 47 pacientes, con predominio masculino (93,6 frente a 6,4%, p < 0,001). La mediana de edad fue de 7,7 meses (rango intercuartílico 1,8 a 13,7 meses) y 40 de los niños (85,1%) tenían menos de 2 años de edad. Cuatro AP drenaron espontáneamente y 7 curaron sin necesidad de drenaje (23,4%). Se aplicó drenaje mediante incisión simple a 36 pacientes (76,5%) y 6 AP requirieron de fistulotomía (12,7%). Se observaron abscesos recurrentes en 25 pacientes (53,1%). Tres pacientes con AP recurrentes fueron diagnosticados de enfermedad inflamatoria intestinal al finalizar las investigaciones. Conclusiones: De acuerdo con los hallazgos del presente estudio, la determinación de la cifra de leucocitos, así como de los reactantes de fase aguda, parece ser útil en la primera evaluación de los niños con AP. En cuanto a las altas tasas de recurrencia en pacientes sometidos a procedimientos quirúrgicos, resulta razonable el uso de enfoques conservadores para pacientes menores de 2 años.

Research paper thumbnail of Streptococcus mitis/oralis Causing Blood Stream Infections in Pediatric Patients

Japanese Journal of Infectious Diseases, 2019

Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and cli... more Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and clinical presentations. We aimed to investigate the clinical presentations and outcomes of pediatric patients infected with Streptococcus mitis/oralis. Based on the accumulation of bloodstream infections (BSI) caused by S. mitis/oralis in 4 patients in our Hematology and Bone Marrow Transplantation Department at a particular time, a review of the medical and microbiological records of pediatric patients with positive blood cultures for S. mitis/oralis in the entire hospital was performed. In addition, a retrospective case-control study was conducted. Pulsed-field gel electrophoresis of S. mitis/oralis in 4 patients displayed unrelatedness of the strains. A total of 53 BSI (42 BSI and 11 catheter-related BSI) were analyzed. Thirty-four percent of patients with BSI caused by S. mitis/oralis had febrile neutropenia. Clinical and microbiological outcomes were favorable and infection-related mortality was not observed. Although not significant, previous antibiotic use and trimethoprim-sulfamethoxazole prophylaxis were more common in the case group. S. mitis/oralis seems likely an important agent in bacteremic children who are particularly neutropenic because of the underlying hematologic and oncologic diseases. Prompt management of infections with appropriate antimicrobials, regarding antibiotic susceptibilities of organisms, may facilitate favorable outcomes.

Research paper thumbnail of Respiratory viral infections in infants with possible sepsis

Journal of Medical Virology, 2018

BackgroundKnowledge of infections leading to sepsis is needed to develop comprehensive infection ... more BackgroundKnowledge of infections leading to sepsis is needed to develop comprehensive infection prevention and sepsis, as well as early recognition and treatment strategies.The aim of this study was to investigate the etiology of sepsis and evaluate the proportion of respiratory viral pathogens in infants under two years of age with possible sepsis.MethodsThe prospective study was performed in two years. Multiplex reverse transcriptase polymerase chain reaction (RT‐PCR) was performed to detect viral pathogens. All patients who were included in this study had sepsis symptoms as defined by the Surviving Sepsis Campaign.ResultsWe compared 90 patients with sepsis into three groups as patients (n = 33) who had only viral positivity in nasopharyngeal swab, patients (17) had proven bacterial infection with or without viral infection, and patients (40) without the pathogen detection. Human rhinovirus (16.7%) and influenza (7.8%) were the most commonly seen viruses. A cough was more common ...

Research paper thumbnail of Antibiotic Resistance Distribution of Gram-Negative Urinary Tract Infectious Agents: Single Center Experience

Turkish Journal of Pediatric Disease, 2017

İdrar yolu enfeksiyonları (İYE) çocukluk yaş grubunda en sık karşılaşılan enfeksiyonlar arasındad... more İdrar yolu enfeksiyonları (İYE) çocukluk yaş grubunda en sık karşılaşılan enfeksiyonlar arasındadır. Bu çalışma ile üçüncü basamak bir hastanede idrar yolu enfeksiyonlarında etiyolojik ajanların değerlendirilmesi, antimikrobiyal direnç paternlerinin belirlenmesi, ampirik tedavi önerilerinin gözden geçirilmesi amaçlandı. Gereç ve Yöntemler: Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi yataklı servis ve polikliniklerinden 01.01.2012-31.12.2015 tarihleri arasında hastanemiz mikrobiyoloji laboratuvarına gönderilen ve Gram negatif (-) üreme saptanan 4421 idrar örneğinin kültür ve antibiyogram sonuçları retrospektif olarak değerlendirildi. Bulgular: Gram negatif üreme saptanan 4421 örnekten %64.1'inde Escherichia coli, %17.1'inde Klebsiella spp, %7.4'ünde Proteus spp üremesi saptandı. Tüm gram negatif mikroorganizmalar birlikte değerlendirildiğinde; en yüksek direnç ampisilin (%75.1), sefazolin (%59), ampisilin-sulbaktam (%49.7), trimetoprim-sulfametoksazol (TMP-SMX) (%45.2), sefiksim (%33.1) ve seftriaksona (%31.4) karşı saptandı. En düşük direnç meropenem (%3.2), ertapenem (%3.4), kolistin (%7.2), amikasin (%16.2), siprofloksasin (%21.1), piperasilin tazobaktama karşı (%23.2)'di. Sonuç: Çalışmamızda çocukluk çağı idrar yolu enfeksiyonlarında ilk seçenek olarak kullanılan birinci kuşak sefalosporinlere, ampisilin, ampisilin-sulbaktam ve TMP-SMX'e karşı yüksek direnç saptanmıştır. Tedavide başarılı olabilmek, morbidite ve uzun dönem sekellerini en aza indirebilmek için İYE nedeni olan patojenlerin sıklığı, yerel veya bölgesel antibiyotik dirençlerinin bilinmesi ve bu doğrultuda ampirik tedavinin düzenlenmesi gereklidir.

Research paper thumbnail of Multidrug-Resistant Acinetobacter baumannii Bacteremia Treated with Tigecycline in Two Pediatric Burn Patients

Pediatric Infectious Disease Journal, 2015

Research paper thumbnail of The National Vaccination Schedule in Previously Healthy Children: The Practical Recommendations about Additional Vaccines

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2014

Research paper thumbnail of Üç olgu nedeniyle perinatal HİV ve koruma

Türk Pediatri Arşivi, 2012

Türk Pe di at ri Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır. / Tur ki... more Türk Pe di at ri Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır. / Tur kish Arc hi ves of Pe di at rics, pub lis hed by Ga le nos Pub lis hing

Research paper thumbnail of COVID-19 Pandemisinde Enfeksiyon Kontrol Çalışmaları Çerçevesinde Çocuk Hastalarla Çalışan Sağlık Personeli Eğitimi

Journal of Pediatric Infection, 2020

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare person... more Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on...

Research paper thumbnail of Education of Healthcare Personnel Working with Pediatric Patients During COVID-19 Pandemic within the Framework of Infection Control

Journal of Pediatric Infection, 2020

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare person... more Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on...

Research paper thumbnail of Author response for "Multicentric Castleman disease in a DOCK8‐deficient patient with Orf virus infection

Research paper thumbnail of Multisystem inflammatory syndrome in children

TURKISH JOURNAL OF MEDICAL SCIENCES, 2021

Introduction As the COVID-19 pandemic continues, it is becoming increasingly clear that severe cl... more Introduction As the COVID-19 pandemic continues, it is becoming increasingly clear that severe clinical manifestations of SARS-CoV-2 infection remain rare in children, accounting for only 1.5% of all COVID-19 hospital admissions [1]. Clinical symptoms of children with COVID from China, where the disease was first reported, generally were less severe than adults [2]. However, on April 27, 2020, The Pediatric Intensive Care Society of the United Kingdom released an alert regarding an increased number of children presenting with fever, shock, abdominal pain, vomiting, and diarrhoea , with disease features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS), many of whom had tested positive for COVID-19 [3]. This syndrome has been described in Europe as transient SARS-Cov-2 associated pediatric inflammatory multisystem syndrome (PIMS-TS), while Center for Disease Control and Prevention (CDC) reported that multiple systemic inflammatory syndrome is associated with COVID-19 (MIS-C), between March 1 and May 10, 2020 [4,5]. Children with MIS-C may have a fever and various symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired. Some features of MIS-C resemble KD, TSS, and secondary hemophagocytic lymphohistiocytosis/ macrophage activation syndrome. Kawasaki disease is a syndrome of unknown cause that results in a fever and mainly affects children under 5 years of age. It is a form of vasculitis, where blood vessels become inflamed. Although classic Kawasaki's disease disproportionately affects Asian children and young children, MIS-C that is associated with Covid-19 appears to occur among children of all ethnic backgrounds and is detected in older children [6]. The relationship of MIS-C to SARS-CoV-2 infection suggests that the pathogenesis involves post-infectious immune dysregulation. However, the possibility that MIS-C is more consistent with a subacute infection than a post-infectious syndrome was not fully considered. 2.Epidemiology In April 2020, cases resembling incomplete Kawasaki disease or toxic shock syndrome thought to be associated with COVID-19 were reported first time from UK [3]. Then, an increase was observed in the reporting of similar cases from various countries around the world, especially in New York (USA). Based on epidemiological data from the UK, New York, and Italy, it was also noted that there was a delay of several weeks between when COVID-19 cases were most common in the community and when the Abstract: As the COVID-19 pandemic continues, children can be infected with the virus that causes COVID-19. Clinical symptoms of children with COVID from China, where the disease was first reported, generally were less severe than adults. However, at the end of April 2020 in Europe, it was observed that some children with SARS-CoV-2 infection developed fever, abdominal pain, shock, myocardial insufficiency and they needed to be taken care of in intensive care unit. This new disease has been called multisystem inflammatory syndrome in children (MIS-C). Although the pathogenesis of MIS-C is unclear, it progresses with signs of multiorgan involvement as a result of uncontrolled inflammation of the immune system and even causes death. Therefore, the diagnosis and treatment of patients with MIS-C should be managed quickly. In this review, the pathophysiology, clinical and laboratory findings, diagnostic methods, and treatment regimens of MIS-C were discussed.

Research paper thumbnail of Hematological consequences of pandemic influenza H1N1 infection: a single center experience

Turkish Journal of Pediatrics, Nov 1, 2010

Since its identification in April 2009, pandemic influenza H1N1 virus has affected thousands of p... more Since its identification in April 2009, pandemic influenza H1N1 virus has affected thousands of people worldwide. Viruses, particularly Epstein-Barr virus, cytomegalovirus and parvovirus B19, may have diverse hematological consequences, including anemia, neutropenia, thrombocytopenia, lymphocytosis, hemophagocytic lymphohistiocytosis, and coagulation abnormalities. In this study, a total of 31 consecutive pediatric patients, with and without chronic diseases, who had flu symptoms and were confirmed to have pandemic influenza, were evaluated for hematological consequences upon presentation to hospital. Eight (25.8%) patients had leukopenia and six (19.4%) had thrombocytopenia at the time of diagnosis of H1N1 infection. Pandemic influenza H1N1 infection may cause diverse hematological findings, including cytopenias and hemophagocytosis.

Research paper thumbnail of 830 The Value of Mean Platelet Volume in the Determination of Community Acquired Pneumonia in Children

Archives of Disease in Childhood, Oct 1, 2012

hospitalization, while the remaining 57 (41.4%) were followed-up as outpatients. The control grou... more hospitalization, while the remaining 57 (41.4%) were followed-up as outpatients. The control group consisted of 61 healthy children. Patients with CAP had lower MPV values than their healthy counterparts (7.14±0.70 vs. 8.35±1.26 fL; p<0.001). Following ROC analysis, the cutoff value established for MPV was 8.05, which had a sensitivity of 91% and a specificity of 51% for making a diagnosis of CAP. Patients with severe CAP that required hospitalization had significantly higher CRP levels than those who were followed-up on an outpatient basis (p<0.001). Conclusions Our findings suggest that MPV could be used for the diagnosis of CAP in children.

Research paper thumbnail of Semptomatik hepatit A ve hepatit A komplikasyonu olarak kolestatik hepatit

Çocuk Enfeksiyon Dergisi, 2009

Research paper thumbnail of The use of serum endothelial adhesion molecules in pediatric patients with leukemia with febrile neutropenia to predict bacteremia

Cytokine, Dec 1, 2021

OBJECTIVE Febrile neutropenia (FN) represents a life-threatening complication in hematological ma... more OBJECTIVE Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. We aimed to analyze the utility of soluble vascular cell adhesion molecule 1 (sVCAM-1), intercellular adhesion molecule 1 (sICAM-1), vascular endothelial growth factor (VEGF) levels compared with C-reactive protein (CRP) and procalcitonin (PCT) during febrile neutropenia episodes of pediatric patients with leukemia. METHODS Two plasma samples, on day 0 (initial of episode) and day 3 (48-72 h after episode), for VCAM-1, ICAM-1 and VEGF, CRP and PCT were prospectively collected concomitantly during each febrile neutropenic episode between December 2016 and December 2017. The primary outcome was bacteremia and the secondary outcome was intensive care unit (ICU) admission. RESULTS Twenty-two (28.6%) acute lymphoblastic lymphoma (ALL), seventeen (22.1%) acute myeloblastic lymphoma (AML) patients and thirty-eight (49.3%) control patients with no known underlying disease or fever were included in this study. Of the 39 patients; 16 (41%) had bacteremia. Mean serum sVCAM1 and sICAM1 levels were significantly higher in control group, compared to FN patients (p < 0.001). Mean serum sVCAM2 level was significantly higher in FN patients with bacteremia compared to FN patients without bacteremia (144.97 ± 70.35 pg/mL vs 85.45 ± 53.76 pg/mL, p = 0.022). Mean sVCAM1 and 2 levels were higher in FN patients with ICU admission. In this study, we found that sVCAM-1 and VEGF, when combined to CRP and PCT, could predict gram-negative bacteremia in FN episodes of pediatric hematological malignancy. CONCLUSION Serum endothelial adhesion molecules, excluding sVCAM-1, cannot predict bacteremia and ICU admission alone in FN patients; but may be associated with clinical outcome when used with PCT and CRP.

Research paper thumbnail of The effectiveness of topical 1% lidocaine with systemic oral analgesics for ear pain with acute otitis media

International Journal of Pediatric Otorhinolaryngology, 2022

BACKGROUND Acute otitis media (AOM) is one of the most common childhood infections. Ear pain, the... more BACKGROUND Acute otitis media (AOM) is one of the most common childhood infections. Ear pain, the main symptom of AOM, results in parents frequently seeking medical assistance for their children. The aim of this study was to compare the effectiveness of topical 1% lidocaine ear drops administered with oral analgesics with that of oral analgesics alone. METHODS This multicenter randomized, open-labeled study was conducted at 15 centers with 184 pediatric AOM patients with bilateral ear pain (aged 1-5 years) between May 1, 2016, and June 31, 2018. All patients received oral paracetamol or ibuprofen and topical 1% lidocaine, which was administered to each ear according to the randomization list. The ear pain score was evaluated within 48 h using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, and the patients were followed up for 10 days. RESULTS The median age was 31.8 months (min-max, 12-84.2 months). Of those patients enrolled, 22.3% received paracetamol, and 24.5% received paracetamol with lidocaine ear drops; 23.4% received ibuprofen, and 29.9% received ibuprofen with lidocaine ear drops. Lower pain scores were significantly measured at baseline and 10th minutes by a reduction 25% (RR 13.64, 95% CI 4.47-41.63, p = 0.001, RR 0.14, 95% CI 0.06-0.35, p = 0.001) and 50% (RR 4.76, 95% CI 1.63-13.87, p = 0.004, RR 0.14, 95% CI 0.05-0.4, p = 0.001) in the paracetamol and lidocaine versus paracetamol groups and the ibuprofen and lidocaine versus ibuprofen groups, respectively. No serious side effects were evident during follow-up. CONCLUSION This randomized study suggests that topical 1% lidocaine ear drops with paracetamol or ibuprofen seems to provide effective and rapid relief for children presenting with ear pain attributed to AOM.

Research paper thumbnail of Myocarditis associated with influenza infection in five children

Journal of Infection and Public Health, 2018

Background: Myocarditis is an inflammatory condition located mainly in the myocardium. It is caus... more Background: Myocarditis is an inflammatory condition located mainly in the myocardium. It is caused by a variety of bacterial and viral infections. Influenza is one of the most common relevant viruses that cause myocarditis. Objectives: We attempted to share our experiences about clinical and laboratory findings, cardiac evaluation, and treatment of children with influenza myocarditis. Methods: This retrospective study was performed by the Department of Pediatric Infectious Diseases at the Faculty of Medicine, Hacettepe University in Turkey. The medical records of patients diagnosed with myocarditis associated with an influenza infection between January 2014 and January 2017 were systematically reviewed. Results: Vaccination seems likely to be an important protection strategy for both influenza infections and complications.

Research paper thumbnail of Gram Negatif İdrar Yolu Enfeksiyonu Etkenlerinin Antibiyotik Dirençleri

Objective: Urinary tract infection (UTI) is one of the most common infections in childhood. The a... more Objective: Urinary tract infection (UTI) is one of the most common infections in childhood. The aim of this study was to determine etiologic agents and antimicrobial resistance patterns in urinary tract infections and to evaluate empirical treatment suggestions in a tertiary care hospital. Material and Methods: The culture and antibiogram results of 4,421 urine specimens, sent from Hacettepe University Ihsan Dogramaci Children’s Hospital to the microbiology laboratory (between 01.01.2012 and 31.12.2015) were evaluated retrospectively. Results: In 4421 samples where gram-negative (-) growth was detected, Escherichia coli was reported in 64.1%, Klebsiella spp in 17.1% and Proteus spp in 7.4%. Evaluation of all gram-negative microorganisms together, revealed the highest resistance against ampicillin (75.1%), cefazolin (59%), ampicillin-sulbactam (49.7%), trimethoprim-sulfamethoxazole (TMP-SMX) (45.2%), cefixim (33.1%) and ceftriaxone (31.4%). The lowest resistance was against meropenem...

Research paper thumbnail of Perianal abscess in children: A paediatric infectious disease perspective

Anales de Pediatría (English Edition), 2019

Introduction: There are limited data on the aetiology and management of perianal abscesses (PAs).... more Introduction: There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes. Methods: We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes. Results: We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P < .001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PA s drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PA s required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation. Conclusions: Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years.

Research paper thumbnail of The impact of meningococcal conjugate vaccine (MenACWY-TT) on meningococcal carriage in Hajj Pilgrims returning to Turkey

Human Vaccines & Immunotherapeutics, 2019

Meningococcal conjugate vaccine was administered for the first time to pilgrims in 2018 in Turkey... more Meningococcal conjugate vaccine was administered for the first time to pilgrims in 2018 in Turkey prior to their departure to the Hajj. This study aimed to determine the effect of vaccination on the prevalence of Neisseria meningitidis carriage among the pilgrims returning to Turkey.This prospective paired (departing and arriving) cohort study includedpilgrims aged 10-80 years and compared N.meningitidis carriage before and after pilgrimage.Oropharyngeal samples were collected from 229 pilgrims before departing for Mecca, Kingdom of Saudi Arabia (KSA) and after their return to Turkey.Meningococcal carriage was detected in3.9% (n=9) at the time of departure; all positive samples were serogroup B. Upon returning to Turkey,1 (0.4%) pilgrim,who was not a carrier before pilgrimage, was positive for serogroup B.This study is the first to examine meningococcal carriage following the administration of conjugate vaccine to Hajj pilgrims from Turkey.

Research paper thumbnail of Absceso perianal en niños: perspectiva desde el campo de la infectología pediátrica

Anales de Pediatría, 2019

Enfermedad inflamatoria intestinal; Absceso perianal; Recidiva; Tratamiento Resumen Introducción:... more Enfermedad inflamatoria intestinal; Absceso perianal; Recidiva; Tratamiento Resumen Introducción: Existen datos limitados acerca de los abscesos perianales (AP), con respecto a su etiología y tratamiento. Este estudio retrospectivo tiene como objetivo definir las características de los niños con AP, detallar nuestra experiencia en el campo de las enfermedades infecciosas pediátricas y determinar los factores que influyen en los resultados clínicos. Métodos: Entre enero de 2005 y julio de 2015 se llevó a cabo una revisión retrospectiva de niños con AP sin enfermedad subyacente en un hospital de referencia de nivel terciario. La información incluyó características demográficas, síntomas, tamaño y localización del absceso, recurrencias de los abscesos, hallazgos de laboratorio y microbiológicos, modalidades de tratamiento, diagnóstico de enfermedades sistémicas al finalizar las investigaciones etiológicas y pronóstico. Resultados: En el estudio se incluyeron 47 pacientes, con predominio masculino (93,6 frente a 6,4%, p < 0,001). La mediana de edad fue de 7,7 meses (rango intercuartílico 1,8 a 13,7 meses) y 40 de los niños (85,1%) tenían menos de 2 años de edad. Cuatro AP drenaron espontáneamente y 7 curaron sin necesidad de drenaje (23,4%). Se aplicó drenaje mediante incisión simple a 36 pacientes (76,5%) y 6 AP requirieron de fistulotomía (12,7%). Se observaron abscesos recurrentes en 25 pacientes (53,1%). Tres pacientes con AP recurrentes fueron diagnosticados de enfermedad inflamatoria intestinal al finalizar las investigaciones. Conclusiones: De acuerdo con los hallazgos del presente estudio, la determinación de la cifra de leucocitos, así como de los reactantes de fase aguda, parece ser útil en la primera evaluación de los niños con AP. En cuanto a las altas tasas de recurrencia en pacientes sometidos a procedimientos quirúrgicos, resulta razonable el uso de enfoques conservadores para pacientes menores de 2 años.

Research paper thumbnail of Streptococcus mitis/oralis Causing Blood Stream Infections in Pediatric Patients

Japanese Journal of Infectious Diseases, 2019

Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and cli... more Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and clinical presentations. We aimed to investigate the clinical presentations and outcomes of pediatric patients infected with Streptococcus mitis/oralis. Based on the accumulation of bloodstream infections (BSI) caused by S. mitis/oralis in 4 patients in our Hematology and Bone Marrow Transplantation Department at a particular time, a review of the medical and microbiological records of pediatric patients with positive blood cultures for S. mitis/oralis in the entire hospital was performed. In addition, a retrospective case-control study was conducted. Pulsed-field gel electrophoresis of S. mitis/oralis in 4 patients displayed unrelatedness of the strains. A total of 53 BSI (42 BSI and 11 catheter-related BSI) were analyzed. Thirty-four percent of patients with BSI caused by S. mitis/oralis had febrile neutropenia. Clinical and microbiological outcomes were favorable and infection-related mortality was not observed. Although not significant, previous antibiotic use and trimethoprim-sulfamethoxazole prophylaxis were more common in the case group. S. mitis/oralis seems likely an important agent in bacteremic children who are particularly neutropenic because of the underlying hematologic and oncologic diseases. Prompt management of infections with appropriate antimicrobials, regarding antibiotic susceptibilities of organisms, may facilitate favorable outcomes.

Research paper thumbnail of Respiratory viral infections in infants with possible sepsis

Journal of Medical Virology, 2018

BackgroundKnowledge of infections leading to sepsis is needed to develop comprehensive infection ... more BackgroundKnowledge of infections leading to sepsis is needed to develop comprehensive infection prevention and sepsis, as well as early recognition and treatment strategies.The aim of this study was to investigate the etiology of sepsis and evaluate the proportion of respiratory viral pathogens in infants under two years of age with possible sepsis.MethodsThe prospective study was performed in two years. Multiplex reverse transcriptase polymerase chain reaction (RT‐PCR) was performed to detect viral pathogens. All patients who were included in this study had sepsis symptoms as defined by the Surviving Sepsis Campaign.ResultsWe compared 90 patients with sepsis into three groups as patients (n = 33) who had only viral positivity in nasopharyngeal swab, patients (17) had proven bacterial infection with or without viral infection, and patients (40) without the pathogen detection. Human rhinovirus (16.7%) and influenza (7.8%) were the most commonly seen viruses. A cough was more common ...

Research paper thumbnail of Antibiotic Resistance Distribution of Gram-Negative Urinary Tract Infectious Agents: Single Center Experience

Turkish Journal of Pediatric Disease, 2017

İdrar yolu enfeksiyonları (İYE) çocukluk yaş grubunda en sık karşılaşılan enfeksiyonlar arasındad... more İdrar yolu enfeksiyonları (İYE) çocukluk yaş grubunda en sık karşılaşılan enfeksiyonlar arasındadır. Bu çalışma ile üçüncü basamak bir hastanede idrar yolu enfeksiyonlarında etiyolojik ajanların değerlendirilmesi, antimikrobiyal direnç paternlerinin belirlenmesi, ampirik tedavi önerilerinin gözden geçirilmesi amaçlandı. Gereç ve Yöntemler: Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi yataklı servis ve polikliniklerinden 01.01.2012-31.12.2015 tarihleri arasında hastanemiz mikrobiyoloji laboratuvarına gönderilen ve Gram negatif (-) üreme saptanan 4421 idrar örneğinin kültür ve antibiyogram sonuçları retrospektif olarak değerlendirildi. Bulgular: Gram negatif üreme saptanan 4421 örnekten %64.1'inde Escherichia coli, %17.1'inde Klebsiella spp, %7.4'ünde Proteus spp üremesi saptandı. Tüm gram negatif mikroorganizmalar birlikte değerlendirildiğinde; en yüksek direnç ampisilin (%75.1), sefazolin (%59), ampisilin-sulbaktam (%49.7), trimetoprim-sulfametoksazol (TMP-SMX) (%45.2), sefiksim (%33.1) ve seftriaksona (%31.4) karşı saptandı. En düşük direnç meropenem (%3.2), ertapenem (%3.4), kolistin (%7.2), amikasin (%16.2), siprofloksasin (%21.1), piperasilin tazobaktama karşı (%23.2)'di. Sonuç: Çalışmamızda çocukluk çağı idrar yolu enfeksiyonlarında ilk seçenek olarak kullanılan birinci kuşak sefalosporinlere, ampisilin, ampisilin-sulbaktam ve TMP-SMX'e karşı yüksek direnç saptanmıştır. Tedavide başarılı olabilmek, morbidite ve uzun dönem sekellerini en aza indirebilmek için İYE nedeni olan patojenlerin sıklığı, yerel veya bölgesel antibiyotik dirençlerinin bilinmesi ve bu doğrultuda ampirik tedavinin düzenlenmesi gereklidir.

Research paper thumbnail of Multidrug-Resistant Acinetobacter baumannii Bacteremia Treated with Tigecycline in Two Pediatric Burn Patients

Pediatric Infectious Disease Journal, 2015

Research paper thumbnail of The National Vaccination Schedule in Previously Healthy Children: The Practical Recommendations about Additional Vaccines

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2014

Research paper thumbnail of Üç olgu nedeniyle perinatal HİV ve koruma

Türk Pediatri Arşivi, 2012

Türk Pe di at ri Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır. / Tur ki... more Türk Pe di at ri Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır. / Tur kish Arc hi ves of Pe di at rics, pub lis hed by Ga le nos Pub lis hing

Research paper thumbnail of COVID-19 Pandemisinde Enfeksiyon Kontrol Çalışmaları Çerçevesinde Çocuk Hastalarla Çalışan Sağlık Personeli Eğitimi

Journal of Pediatric Infection, 2020

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare person... more Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on...

Research paper thumbnail of Education of Healthcare Personnel Working with Pediatric Patients During COVID-19 Pandemic within the Framework of Infection Control

Journal of Pediatric Infection, 2020

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare person... more Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on...

Research paper thumbnail of Author response for "Multicentric Castleman disease in a DOCK8‐deficient patient with Orf virus infection

Research paper thumbnail of Multisystem inflammatory syndrome in children

TURKISH JOURNAL OF MEDICAL SCIENCES, 2021

Introduction As the COVID-19 pandemic continues, it is becoming increasingly clear that severe cl... more Introduction As the COVID-19 pandemic continues, it is becoming increasingly clear that severe clinical manifestations of SARS-CoV-2 infection remain rare in children, accounting for only 1.5% of all COVID-19 hospital admissions [1]. Clinical symptoms of children with COVID from China, where the disease was first reported, generally were less severe than adults [2]. However, on April 27, 2020, The Pediatric Intensive Care Society of the United Kingdom released an alert regarding an increased number of children presenting with fever, shock, abdominal pain, vomiting, and diarrhoea , with disease features that overlap with Kawasaki Disease (KD) and Toxic Shock Syndrome (TSS), many of whom had tested positive for COVID-19 [3]. This syndrome has been described in Europe as transient SARS-Cov-2 associated pediatric inflammatory multisystem syndrome (PIMS-TS), while Center for Disease Control and Prevention (CDC) reported that multiple systemic inflammatory syndrome is associated with COVID-19 (MIS-C), between March 1 and May 10, 2020 [4,5]. Children with MIS-C may have a fever and various symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired. Some features of MIS-C resemble KD, TSS, and secondary hemophagocytic lymphohistiocytosis/ macrophage activation syndrome. Kawasaki disease is a syndrome of unknown cause that results in a fever and mainly affects children under 5 years of age. It is a form of vasculitis, where blood vessels become inflamed. Although classic Kawasaki's disease disproportionately affects Asian children and young children, MIS-C that is associated with Covid-19 appears to occur among children of all ethnic backgrounds and is detected in older children [6]. The relationship of MIS-C to SARS-CoV-2 infection suggests that the pathogenesis involves post-infectious immune dysregulation. However, the possibility that MIS-C is more consistent with a subacute infection than a post-infectious syndrome was not fully considered. 2.Epidemiology In April 2020, cases resembling incomplete Kawasaki disease or toxic shock syndrome thought to be associated with COVID-19 were reported first time from UK [3]. Then, an increase was observed in the reporting of similar cases from various countries around the world, especially in New York (USA). Based on epidemiological data from the UK, New York, and Italy, it was also noted that there was a delay of several weeks between when COVID-19 cases were most common in the community and when the Abstract: As the COVID-19 pandemic continues, children can be infected with the virus that causes COVID-19. Clinical symptoms of children with COVID from China, where the disease was first reported, generally were less severe than adults. However, at the end of April 2020 in Europe, it was observed that some children with SARS-CoV-2 infection developed fever, abdominal pain, shock, myocardial insufficiency and they needed to be taken care of in intensive care unit. This new disease has been called multisystem inflammatory syndrome in children (MIS-C). Although the pathogenesis of MIS-C is unclear, it progresses with signs of multiorgan involvement as a result of uncontrolled inflammation of the immune system and even causes death. Therefore, the diagnosis and treatment of patients with MIS-C should be managed quickly. In this review, the pathophysiology, clinical and laboratory findings, diagnostic methods, and treatment regimens of MIS-C were discussed.