Dinçer Yıldızdaş - Academia.edu (original) (raw)

Papers by Dinçer Yıldızdaş

Research paper thumbnail of Clinical features of 27 turkish propionic acidemia patients with 12 novel mutations

The Turkish Journal of Pediatrics, 2019

Propionic acidemia (PA) is an inherited metabolic disease caused by the deficiency of one of the ... more Propionic acidemia (PA) is an inherited metabolic disease caused by the deficiency of one of the four biotin-dependent enzymes propionyl-CoA carboxylase (PCC), and is characterized by coma and death in unrecognized patients, additionally late diagnosis leads to severe developmental delay and neurological sequels. Manifestations of PA over time can include growth impairment, intellectual disability, seizures, basal ganglia lesions, pancreatitis, and cardiomyopathy. Other rarely reported complications include optic atrophy, hearing loss, premature ovarian insufficiency, and chronic renal failure. Mutations in PCCA-PCCB genes cause the clinically heterogeneous disease of PA. In this study, we investigate the mutation spectrum of PCCA-PCCB genes and phenotypic features of 27 Turkish patients with PA from the South and Southeast parts of Turkey. We report 12 novel PA mutations, five affecting the PCCA gene and 7 affecting the PCCB gene.

Research paper thumbnail of A 17-year-old girl with chronic intermittent abdominal pain

Research paper thumbnail of Genetic dilemma: eNOS gene intron 4a/b VNTR polymorphism in sepsis and its clinical features in Turkish children

The Turkish journal of pediatrics

The role of endothelial nitric oxide synthase gene intron 4 a/b (eNOS4a/b) variable number of tan... more The role of endothelial nitric oxide synthase gene intron 4 a/b (eNOS4a/b) variable number of tandem repeats (VNTR) polymorphism in various diseases was investigated. We investigated whether this polymorphism is associated with susceptibility to sepsis and its clinical features such as acute respiratory distress syndrome (ARDS), multiorgan dysfunction syndrome (MODS) and shock. eNOS4a/b VNTR polymorphism was determined by the polymerase chain reaction in 100 children with sepsis and in 134 healthy controls. The genotype distribution of eNOS4 was not different between the patients and controls (p=0.44). There was no statistically significant association between genotypes/allele frequency and outcomes like mortality, MODS, ARDS, and shock (p>0.05). This is the first study that evaluates the effect of eNOS4a/b polymorphism in sepsis. We were unable to show a relationship between eNOS gene intron 4 a/b VNTR polymorphism and MODS, ARDS, mortality and shock. Larger studies that do rese...

Research paper thumbnail of Antibiotic Use in Pediatric and Neonatal Intensive Care Units; Multicenter Point Prevalence Study

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2014

Nokta prevalans çalışması ile Türkiye'nin 6. büyük şehri olan Adana'da çocuk yoğun bakım ve yenid... more Nokta prevalans çalışması ile Türkiye'nin 6. büyük şehri olan Adana'da çocuk yoğun bakım ve yenidoğan yoğun bakımlarda antibiyotik kullanımını saptamak. Gereç ve Yöntemler: Bu nokta prevalans çalışmasında Adana şehir merkezinde bulunan 6 hastanede çocuk yoğun bakım ve yenidoğan yoğun bakım ünitesinde yatmakta olan hastaların aynı gün içerisinde demografik bilgileri ve antibiyotik tedavilerine ait veriler toplandı. Bulgular: Çalışmaya toplam dört çocuk yoğun bakım (iki üniversite, bir eğitim ve araştırma hastanesi, bir devlet hastanesi), altı yenidoğan bakım ünitesi (iki üniversite, bir eğitim ve araştırma hastanesi, bir devlet hastanesi, iki özel hastane) alındı. Çalışmanın yapıldığı gün yoğun bakımlarda 220 hasta yatmaktaydı. Hastaların 44'ü (%20) çocuk yoğun bakımlarda, 176'sı (%80) yenidoğan yoğun bakımlarda yatmaktaydı. Hastaların 146'sı (%66,4) antibiyotik kullanmaktaydı. Bu oran çocuk yoğun bakımlarda %72,7, yenidoğan yoğun bakımlarda %64,8 idi. Bir üniversite ve eğitim araştırma hastanesinde çocuk enfeksiyon hastalıkları uzmanı vardı. Çocuk enfeksiyon hastalıkları konsültasyonu yapılabilen kliniklerde antibiyotik kullanma oranı daha düşüktü (p=0,002). En sık ikili antibiyotik kombinasyonu tercih edilmişti. Yenidoğan yoğun bakımlarda en sık ampisilin tercih edilirken ikinci sıklıkta dönemsel

Research paper thumbnail of Thyroid Hormone Levels and their Relationship to Survival in Children with Bacterial Sepsis and Septic Shock

Journal of Pediatric Endocrinology and Metabolism, 2004

Reported studies have showed alternations of thyroid hormones in critical illness mostly in adult... more Reported studies have showed alternations of thyroid hormones in critical illness mostly in adults and some in children. In this study, we aimed to measure thyroid hormone levels in children with sepsis and septic shock and investigate the relationship of these hormones with clinical state and survival. Thyroid hormone levels of children with sepsis and septic shock, and age- and sex-matched controls were measured. There were 51 children in sepsis (group S), 21 children in septic shock (group SS) and 30 in the control (group C) group. Total triiodothyronine (TT3) levels were (nmol/l): 0.91 +/- 0.22, 0.64 +/- 0.23, 2.11 +/- 0.59; free triiodothyronine (FT3) (pmol/l): 0.027 +/- 0.006, 0.018 +/- 0.007, 0.049 +/- 0.010; total thyroxine (TT4) (nmol/l): 100.62 +/- 21.93, 65.79 +/- 19.35, 109.65 +/- 19.35; free thyroxine (FT4) (pmol/l): 18.06 +/- 3.87, 10.32 +/- 1.29, 19.35 +/- 3.87; and thyroid stimulating hormone (TSH) (mIU/ml): 5.0 +/- 2.0, 4.8 +/- 2.4, 5.2 +/- 3.0, in children with sepsis, septic shock, and controls, respectively. The TT3, FT3, TT4, and FT4 levels of group SS were significantly lower than those of groups S and C. The TT3 and FT3 levels of group S were lower than in group C, but there was no significant difference between TT4, and FT4 levels of groups S and C. TSH levels were slightly decreased in both sepsis and septic shock, but the difference was not significant. Eleven (21.6%) children with sepsis and 15 (71.4%) children with septic shock died (p < 0.001). The levels of TT3, FT3, TT4 and FT4 were markedly lower in non-survivors of groups S and SS compared to survivors (p < 0.001). These changes in the hypothalamo-pituitary-thyroidal axis may suggest a possible prognostic value of thyroid hormone levels in children with sepsis and septic shock. To the best of our knowledge, this report is the first study to compare thyroid hormone levels in a large number of patients with sepsis and septic shock with those in healthy controls in childhood.

Research paper thumbnail of Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach over 13 Years in 51 Cities of 19 Limited-Resource Countries from Latin America, Asia, the Middle East, and Europe

Infection Control & Hospital Epidemiology, 2013

Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection C... more Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multi-dimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance.Design.An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period.Setting.Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey.Participants.Healthcare workers at 99 ICU members of the INICC.Methods.A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (...

Research paper thumbnail of Old agent, new experience: colistin use in the paediatric Intensive Care Unit—a multicentre study

International Journal of Antimicrobial Agents, 2012

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem aro... more Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.

Research paper thumbnail of International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009

American Journal of Infection Control, 2010

We report the results of the International Infection Control Consortium (INICC) surveillance stud... more We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP).

Research paper thumbnail of Clinical features of 27 turkish propionic acidemia patients with 12 novel mutations

The Turkish Journal of Pediatrics, 2019

Propionic acidemia (PA) is an inherited metabolic disease caused by the deficiency of one of the ... more Propionic acidemia (PA) is an inherited metabolic disease caused by the deficiency of one of the four biotin-dependent enzymes propionyl-CoA carboxylase (PCC), and is characterized by coma and death in unrecognized patients, additionally late diagnosis leads to severe developmental delay and neurological sequels. Manifestations of PA over time can include growth impairment, intellectual disability, seizures, basal ganglia lesions, pancreatitis, and cardiomyopathy. Other rarely reported complications include optic atrophy, hearing loss, premature ovarian insufficiency, and chronic renal failure. Mutations in PCCA-PCCB genes cause the clinically heterogeneous disease of PA. In this study, we investigate the mutation spectrum of PCCA-PCCB genes and phenotypic features of 27 Turkish patients with PA from the South and Southeast parts of Turkey. We report 12 novel PA mutations, five affecting the PCCA gene and 7 affecting the PCCB gene.

Research paper thumbnail of A 17-year-old girl with chronic intermittent abdominal pain

Research paper thumbnail of Genetic dilemma: eNOS gene intron 4a/b VNTR polymorphism in sepsis and its clinical features in Turkish children

The Turkish journal of pediatrics

The role of endothelial nitric oxide synthase gene intron 4 a/b (eNOS4a/b) variable number of tan... more The role of endothelial nitric oxide synthase gene intron 4 a/b (eNOS4a/b) variable number of tandem repeats (VNTR) polymorphism in various diseases was investigated. We investigated whether this polymorphism is associated with susceptibility to sepsis and its clinical features such as acute respiratory distress syndrome (ARDS), multiorgan dysfunction syndrome (MODS) and shock. eNOS4a/b VNTR polymorphism was determined by the polymerase chain reaction in 100 children with sepsis and in 134 healthy controls. The genotype distribution of eNOS4 was not different between the patients and controls (p=0.44). There was no statistically significant association between genotypes/allele frequency and outcomes like mortality, MODS, ARDS, and shock (p>0.05). This is the first study that evaluates the effect of eNOS4a/b polymorphism in sepsis. We were unable to show a relationship between eNOS gene intron 4 a/b VNTR polymorphism and MODS, ARDS, mortality and shock. Larger studies that do rese...

Research paper thumbnail of Antibiotic Use in Pediatric and Neonatal Intensive Care Units; Multicenter Point Prevalence Study

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection, 2014

Nokta prevalans çalışması ile Türkiye'nin 6. büyük şehri olan Adana'da çocuk yoğun bakım ve yenid... more Nokta prevalans çalışması ile Türkiye'nin 6. büyük şehri olan Adana'da çocuk yoğun bakım ve yenidoğan yoğun bakımlarda antibiyotik kullanımını saptamak. Gereç ve Yöntemler: Bu nokta prevalans çalışmasında Adana şehir merkezinde bulunan 6 hastanede çocuk yoğun bakım ve yenidoğan yoğun bakım ünitesinde yatmakta olan hastaların aynı gün içerisinde demografik bilgileri ve antibiyotik tedavilerine ait veriler toplandı. Bulgular: Çalışmaya toplam dört çocuk yoğun bakım (iki üniversite, bir eğitim ve araştırma hastanesi, bir devlet hastanesi), altı yenidoğan bakım ünitesi (iki üniversite, bir eğitim ve araştırma hastanesi, bir devlet hastanesi, iki özel hastane) alındı. Çalışmanın yapıldığı gün yoğun bakımlarda 220 hasta yatmaktaydı. Hastaların 44'ü (%20) çocuk yoğun bakımlarda, 176'sı (%80) yenidoğan yoğun bakımlarda yatmaktaydı. Hastaların 146'sı (%66,4) antibiyotik kullanmaktaydı. Bu oran çocuk yoğun bakımlarda %72,7, yenidoğan yoğun bakımlarda %64,8 idi. Bir üniversite ve eğitim araştırma hastanesinde çocuk enfeksiyon hastalıkları uzmanı vardı. Çocuk enfeksiyon hastalıkları konsültasyonu yapılabilen kliniklerde antibiyotik kullanma oranı daha düşüktü (p=0,002). En sık ikili antibiyotik kombinasyonu tercih edilmişti. Yenidoğan yoğun bakımlarda en sık ampisilin tercih edilirken ikinci sıklıkta dönemsel

Research paper thumbnail of Thyroid Hormone Levels and their Relationship to Survival in Children with Bacterial Sepsis and Septic Shock

Journal of Pediatric Endocrinology and Metabolism, 2004

Reported studies have showed alternations of thyroid hormones in critical illness mostly in adult... more Reported studies have showed alternations of thyroid hormones in critical illness mostly in adults and some in children. In this study, we aimed to measure thyroid hormone levels in children with sepsis and septic shock and investigate the relationship of these hormones with clinical state and survival. Thyroid hormone levels of children with sepsis and septic shock, and age- and sex-matched controls were measured. There were 51 children in sepsis (group S), 21 children in septic shock (group SS) and 30 in the control (group C) group. Total triiodothyronine (TT3) levels were (nmol/l): 0.91 +/- 0.22, 0.64 +/- 0.23, 2.11 +/- 0.59; free triiodothyronine (FT3) (pmol/l): 0.027 +/- 0.006, 0.018 +/- 0.007, 0.049 +/- 0.010; total thyroxine (TT4) (nmol/l): 100.62 +/- 21.93, 65.79 +/- 19.35, 109.65 +/- 19.35; free thyroxine (FT4) (pmol/l): 18.06 +/- 3.87, 10.32 +/- 1.29, 19.35 +/- 3.87; and thyroid stimulating hormone (TSH) (mIU/ml): 5.0 +/- 2.0, 4.8 +/- 2.4, 5.2 +/- 3.0, in children with sepsis, septic shock, and controls, respectively. The TT3, FT3, TT4, and FT4 levels of group SS were significantly lower than those of groups S and C. The TT3 and FT3 levels of group S were lower than in group C, but there was no significant difference between TT4, and FT4 levels of groups S and C. TSH levels were slightly decreased in both sepsis and septic shock, but the difference was not significant. Eleven (21.6%) children with sepsis and 15 (71.4%) children with septic shock died (p < 0.001). The levels of TT3, FT3, TT4 and FT4 were markedly lower in non-survivors of groups S and SS compared to survivors (p < 0.001). These changes in the hypothalamo-pituitary-thyroidal axis may suggest a possible prognostic value of thyroid hormone levels in children with sepsis and septic shock. To the best of our knowledge, this report is the first study to compare thyroid hormone levels in a large number of patients with sepsis and septic shock with those in healthy controls in childhood.

Research paper thumbnail of Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach over 13 Years in 51 Cities of 19 Limited-Resource Countries from Latin America, Asia, the Middle East, and Europe

Infection Control & Hospital Epidemiology, 2013

Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection C... more Objective.To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multi-dimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance.Design.An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period.Setting.Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey.Participants.Healthcare workers at 99 ICU members of the INICC.Methods.A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (...

Research paper thumbnail of Old agent, new experience: colistin use in the paediatric Intensive Care Unit—a multicentre study

International Journal of Antimicrobial Agents, 2012

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem aro... more Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.

Research paper thumbnail of International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009

American Journal of Infection Control, 2010

We report the results of the International Infection Control Consortium (INICC) surveillance stud... more We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP).