Zuhal Tunay - Academia.edu (original) (raw)

Papers by Zuhal Tunay

Archives of Disease in Childhood, Oct 1, 2012

count, CRP, blood culture and urine screening. Cerebrospinal fluid (CSF) was collected on clinica... more count, CRP, blood culture and urine screening. Cerebrospinal fluid (CSF) was collected on clinical indication. EV or HPeV DNA was detected by PCR in plasma and/or CSF. Urine cultures were performed when urine screening was positive. 10 children with urinary tract infection were excluded. Data of the remaining 148 children were analysed. Results EV/HPeV PCR was performed in 122/148 children: 45 (37%) were EV positive and 22 (18%) HPeV positive. The most prominent difference between children with EV and HPeV was age. HPeV was solely diagnosed in children under 126 days of age. Clinical characteristics at presentation did not differ. Children with HPeV had lower leukocyte counts and lower CRP values. No difference in clinical management was found between EV and HPeV positive children. Conclusion Sepsis-like illness due to EV and HPeV infection is common in young children, and appeared in 37% and 18% of cases respectively. HPeV occurs in younger children and causes less elevation of infectious parameters than EV infection. All other clinical characteristics are similar. Clinical management does not differ.

Turkiye Klinikleri Ophthalmology - Special Topics, 2019

Indian Journal of Ophthalmology, 2021

Purpose: To investigate whether parents should be present during screening examinations for retin... more Purpose: To investigate whether parents should be present during screening examinations for retinopathy of prematurity (ROP) by investigating the anxiety levels of parents using two different approaches. Methods: This cross-sectional and two-center study was carried out with the parents at the time of the first ROP screening examination of their premature infants. At one center, the parents accompanied the infants during the ROP examination (Group 1), and in the other center, they did not (Group 2). Anxiety levels were assessed with the State-Trait Anxiety Inventory (STAI), which consists of the State Anxiety (STAI-S) and Trait Anxiety (STAI-T) subscales and a visual analog scale (VAS). Results: A total of 147 parents of 127 infants were included in the study. STAI-T and -S levels were 40.5 ± 8 and 37.9 ± 7.5, respectively, in Group 1 and 39.6 ± 8.1 and 39.4 ± 9.1 in Group 2 before the examination. There were no statistically significant differences in terms of these values between the two groups (P > 0.05). The state anxiety levels increased by an average of 1.7 ± 8 in Group 1 and reached 39.6 ± 10.1 after the examination. In Group 2, these levels decreased by an average of − 2.7 ± 7.5 points to a score of 36.4 ± 10.3. This difference was found to be statistically significant (P = 0.001). A similar pattern was observed in the evaluation of the VAS data. Conclusion: As a preliminary opinion, it may be more appropriate for parents to not participate in screening examinations, but single-center controlled studies are required to confirm the results.

Türk Oftalmoloji Dergisi, Jun 8, 2016

Objectives: To evaluate the diagnosis distribution, low vision rehabilitation methods and utiliza... more Objectives: To evaluate the diagnosis distribution, low vision rehabilitation methods and utilization of low vision rehabilitation in partially sighted persons over 65 years old. Materials and Methods: One hundred thirty-nine partially sighted geriatric patients aged 65 years or older were enrolled to the study between May 2012 and September 2013. Patients' age, gender and the distribution of diagnosis were recorded. The visual acuity of the patients both for near and distance were examined with and without low vision devices and the methods of low vision rehabilitation were evaluated. Results: The mean age of the patients was 79.7 years and the median age was 80 years. Ninety-six (69.1%) of the patients were male and 43 (30.9%) were female. According to the distribution of diagnosis, the most frequent diagnosis was senile macular degeneration for both presenile and senile age groups. The mean best corrected visual acuity for distance was 0.92±0.37 logMAR and 4.75±3.47 M for near. The most frequently used low vision rehabilitation methods were telescopic glasses (59.0%) for distance and hyperocular glasses (66.9%) ds. Conclusion: The causes of low vision in presenile and senile patients in our study were similar to those of patients from developed partially sighted geriatric patients. It is important to guide them to low vision rehabilitation.

Journal of Aapos, Jun 1, 2016

To evaluate the longitudinal change of intraocular pressure (IOP) and central corneal thickness (... more To evaluate the longitudinal change of intraocular pressure (IOP) and central corneal thickness (CCT) in healthy premature infants. Methods Premature infants born at 28 weeks' gestational age were included in this prospective, singlecenter longitudinal study. IOP was measured by handheld applanation tonometer (Tono-Pen Avia); CCT measurements were performed by ultrasonic pachymeter. Examinations were held at 32 weeks' gestational age initially and at 2-week intervals thereafter for a total of 5 consecutive measurements by the same ophthalmologist. Results A total of 110 right eyes of 110 healthy premature infants were analyzed. The mean IOP at 32

American Journal of Ophthalmology, Aug 1, 2016

To evaluate the relationship between maternal diabetes and the development of retinopathy of prem... more To evaluate the relationship between maternal diabetes and the development of retinopathy of prematurity (ROP) in infants with a birth weight of 1500 g or more. Design: Retrospective case control study. Subjects and Controls: Data of 78 premature infants from diabetic mothers were compared with data of 258 controls. Methods: We examine the relationship between maternal diabetes and the development of ROP and Type 1 ROP, adjusting for multiple risk factors. In order to identify the risk factors of outcome variables, multivariable logistic regression analysis was used. Prior to multivariable logistic regression analysis, the association of each independent variable with the outcome variables, a univariate estimate was performed. The crude and adjusted odds ratio (OR) values and their 95% confidence intervals (CI) were given. Main Outcome Measures: The development of ROP and the development of Type 1 ROP. Results: The study was conducted on 336 preterm infants, 78 were from diabetic mothers and 258 were from non-diabetic mothers. The rate of ROP (78.2% in case group and 14.7% in control group) and the rate of Type 1 ROP (20.5% in case group and 4.7% for controls) were found significantly higher in case group (p=0.001 for both). Maternal diabetes was shown to be an independent risk factor for both ROP and Type 1 ROP (OR with 95% CI: 25,040 [12,728-49,264]; 6,311 [2,647-15,048] respectively and p< 0.001 for both). Conclusion: Our data suggests that the presence of maternal diabetes is significantly associated with the development of ROP and Type 1 ROP in premature infants with a birth weight of 1500 g or more.

$Research paper thumbnail of Comparison of Refractive Errors Measured by Plusoptix A09 Photorefractometer and A Standard Autorefractometer in Adult Population$

Turkiye Klinikleri Journal of Ophthalmology, 2016

$Research paper thumbnail of Refractive errors and refractive development in premature infants$

Journal Francais D Ophtalmologie, Dec 1, 2015

To examine refractive errors and refractive development in premature infants. Methods.-Premature ... more To examine refractive errors and refractive development in premature infants. Methods.-Premature infants in the retinopathy of prematurity (ROP) screening program were recruited and examined longitudinally between 28 and 58 weeks postmenstrual age. For performing cycloplegic retinoscopy, 1% tropicamide was administered, two drops with a 10-minute interval, in order to paralyze accommodation and to achieve cycloplegia. Birth weight, gestational age, gender and acute ROP disease were recorded. The relationship between spherical equivalent, astigmatism and postmenstrual age was evaluated. Results.-A total of 798 readings were obtained from 258 infants (131 females, 127 males) between 28 and 58 weeks postmenstrual age. The median number of examinations was 3 (minimum 1, maximum 7). In the comparisons of birth weight, gestational age, spherical equivalent and astigmatism between genders, there were no statistically significant differences (P > 0.05). Gestational age (regression analysis, r 2 = 0.30, P < 0.01) and birth weight (regression analysis, r 2 = 0.22, P < 0.01) had a significant effect on refractive error development. Preterm babies with lower birth weight and those born more prematurely had lower spherical equivalent. The spherical equivalent of the eyes correlated significantly with the postmenstrual age of the infants (r = 0.512, P < 0.01).

Jinekoloji - obstetrik ve neonatoloji tıp dergisi, Dec 25, 2017

“Shaken baby syndrome” occurs due to shaking of babies under two years of age. It can lead to vis... more “Shaken baby syndrome” occurs due to shaking of babies under two years of age. It can lead to visual impairment, blindness, severe neurological deficit and death. Bilateral retinal hemorrhages are important characteristic finding of shaken baby syndrome but not pathognomonic. Because of the irreversible neurological damage related to shaken baby syndrome, primary prevention is so important. The aim of this case report is to call attention on shaken baby syndrome and to emphasize the importance of training of parents and medical staff in this area.

Jinekoloji - obstetrik ve neonatoloji tıp dergisi, Jun 18, 2017

A one month-old baby was examined with the complaints of eyelids swollen and ocular discharge for... more A one month-old baby was examined with the complaints of eyelids swollen and ocular discharge for one week. Eyelid edema, ocular discharge, conjunctival hyperemia and pseudomembrane in both eyes but more severe in the right eye were detected. It was considered that the patient had suffered outbreaks of conjunctivitis depends on the epidemic keratoconjunctivitis and pseudomembranes were removed. A corticosteroids ointment was added to the treatment. Four weeks later, the patient’s symptoms were completely recovered.

Jinekoloji - obstetrik ve neonatoloji tıp dergisi, Aug 23, 2015

Hipertansif ensefalopati olarak da isimlendirilen Posterior Reversibl Ensefalopati Sendromu (PRES... more Hipertansif ensefalopati olarak da isimlendirilen Posterior Reversibl Ensefalopati Sendromu (PRES) kan basıncında ani değişikliklere yanıt vermesi gereken posterior dolaşımın yetersizliğine ikincil oluşan nörotoksik bir durumdur. Kan-beyin bariyerinin hiperperfüzyon nedeniyle bozulması vazojenik ödem ile sonuçlanır. En yaygın olarak parieto-oksipital bölgelerde görülür (1,2). Çeşitli faktörler PRES'in patogenezinde rol oynamaktadır. Başlıcaları, eklampsi/ preeklampsi ve akut glomerulonefritin neden olduğu ciddi hipertansiyon, hemolitik üremik sendrom, trombositopenik trombositik purpura, sistemik lupus eritematozus ve çeşitli ilaç toksisiteleridir (3).

International Ophthalmology, Jan 2, 2021

Purpose To compare the retinal thickness at the fovea center, peripapillary retinal nerve fiber l... more Purpose To compare the retinal thickness at the fovea center, peripapillary retinal nerve fiber layer (RNFL) thickness and choroidal thickness (CT) in former preterm and full-term infants. Methods A total of 121 healthy children aged 4–8 years were divided 4 groups: group 1; children born on time, group 2; preterm children without a history of retinopathy of prematurity (ROP), group 3; preterm children with a history of spontaneously regressed ROP and group 4; preterm children who underwent diode laser photocoagulation for ROP. The retinal thickness at the fovea, peripapillary RNFL thickness at global, superior, inferior, nasal and temporal quadrants and submacular CT at 7 different points were measured by using spectral-domain optical coherence tomography. Results The mean retinal thickness at the fovea center was statistically higher, whereas the mean RNFL thickness values in global, nasal, superior and inferior quadrants were statistically lower in group 4. No difference was found in the mean submacular CT value of any point between the groups. Conclusion Transpupillary diode laser photocoagulation treatment for ROP seems to cause an increase in macular thickness and a decrease in RNFL thickness.

International Urogynecology Journal, Dec 7, 2015

Introduction and hypothesis To evaluate the effects of oral anticholinergic (OAC) drugs on tear s... more Introduction and hypothesis To evaluate the effects of oral anticholinergic (OAC) drugs on tear secretion in women with overactive bladder over a 3-month follow-up period. Methods In this prospective study, 108 women with a diagnosis of overactive bladder were evaluated. All patients were examined ophthalmologically at baseline (day 0), and after 1 month (day 30) and 3 months (day 90) of OAC treatment. Tear film break-up time (BUT) and Schirmer 1 test results were recorded. The subjective complaints of the patients including dry mouth, and burning, dryness and foreign body sensation in the eyes, were also recorded. The chi-squared test or the paired sample t test as appropriate, was used for statistical analysis. Results The mean age of the patients was 51.8 ± 9.2 years (30-69 years). The most frequent subjective complaints were dry mouth and dry eyes and both complaints were significant on both day 30 and day 90. Both tear film BUT and Schirmer 1 test results were significantly lower on day 30 and day 90. Dry eye measurement values worsened with prolongation of OAC treatment (p = 0.037 and p = 0.012 for BUT, and p = 0.046 and p = 0.035 for Schirmer 1 test, on day 30 and day 90, respectively). Conclusions OAC treatment in women with overactive bladder significantly and progressively affects tear secretion.

$Research paper thumbnail of Growth of biometric components and development of refractive errors in premature infants with or without retinopathy of prematurity$

Turkish Journal of Medical Sciences, 2016

Introduction Prematurity is by far the most frequent cause of neonatal morbidity and mortality. O... more Introduction Prematurity is by far the most frequent cause of neonatal morbidity and mortality. Over the last 50 years, survival rates for premature babies have dramatically increased. In parallel with this improved survival, the incidence of retinopathy of prematurity (ROP), refractive errors, and ocular anomalies has also risen. Prematurely born children are at increased risk of ocular morbidities such as myopia, strabismus, and defective visual acuity (1-5). Size of eyeball at birth, the neonatal period, and infancy and the curvature of the cornea, lens characteristics, and refractive errors are closely associated with physical characteristics such as birth weight, gestational age, length, and head circumference (6,7). The refractive errors among humans depend on several ocular causes such as cataract, corneal ectasia, and ROP. It has been demonstrated that the presence of ROP leads to the development of myopia, astigmatism, and anisometropia. There is a tendency towards low myopia in premature infants (8-10). The aim of this study is to examine prospectively the ocular growth parameters and refractive status in premature infants with or without ROP during the early months of infancy. 2. Materials and methods 2.1. Participants Infants were enrolled in the study by routine screening for ROP. Infants weighing 1500 g or less with a gestational age of 32 weeks, and selected premature infants with an unstable clinical progression, were included with the recommendation of a pediatrician or neonatologist (11). The exclusion criteria were the presence of congenital anomalies in other parts of the body, congenital eye abnormalities, unsuitable general conditions for an ocular examination, ROP of stage 4 and higher, and previous treatment applications such as laser photocoagulation and/or intravitreal injections. The right eyes of the infants were studied to obtain the results. 2.2. Refraction measurement Thirty minutes after the administration of 1% topical tropicamide twice at an interval of 10 min, cycloplegic Background/aim: To investigate the biometric components and refractive errors in premature infants with or without retinopathy of prematurity (ROP). Materials and methods: Anterior chamber depth, lens thickness, vitreous length, and axial length were measured with an ultrasound biometer. Cycloplegic refraction was performed by streak skiascopy. Infants with or without ROP were grouped according to postmenstrual age at the time of ocular examination: Group 1, ≤33 weeks; Group 2, 34-37 weeks; Group 3, 38-41 weeks; Group 4, 42-45 weeks; Group 5, ≥46 weeks. Results: The mean postnatal age of 894 infants (451 females and 443 males) was 8.7 ± 4.5 weeks, gestational age was 30.9 ± 2.8 weeks, and birth weight was 1506 ± 484 g. In Group 2, the mean vitreous length and axial length of infants with ROP were significantly lower than those of infants without ROP (P = 0.011, P = 0.001). The mean anterior chamber depth, lens thickness, spherical equivalent, and astigmatism in all groups did not differ significantly among the infants with or without ROP (P > 0.05). Conclusion: The anterior chamber depth, lens thickness, vitreous length, and axial length showed a linear growth throughout the follow-up period. The maximum elongation was observed in vitreous length and axial length.

Eye, Mar 4, 2011

Aim To analyze relative weight gain by 2-week intervals up to 6 weeks after birth in order to pre... more Aim To analyze relative weight gain by 2-week intervals up to 6 weeks after birth in order to predict the development of retinopathy of prematurity (ROP) requiring treatment among very low birth weight (BW) infants. Methods A prospective study including infants with BW r1500 g born in a single tertiary intensive care unit over 1-year period was conducted. Body weight measurements were recorded weekly and relative weight gains (g/kg/day) were calculated. The main outcome was development of ROP requiring treatment. Results Mean BW and gestational age (GA) of the whole cohort were 1165±223 g and 29.3 ± 2.3 weeks, respectively. Relative weight gain at 2 weeks and 4 weeks postnatal age were significantly lower in infants with severe ROP (P ¼ 0.041 and P ¼ 0.017, respectively). Relative weight gain at 6 weeks was not different between groups. Infants with severe ROP gained 6.7±4 g/kg/day in the first 4 weeks of life, compared with 9.3±4.5 g/kg/day for those with mild or no ROP. After adjusted for BW and GA in logistic regression poor relative weight gain in the first 4 weeks was found to be related to severe ROP (P ¼ 0.015). When all the other risk factors significant for severe ROP were included in the logistic regression poor weight gain did not arise as an independent risk factor. Conclusion Poor postnatal weight gain in the first 4 weeks of life is the end result of several comorbidities rather than being an independent risk factor. Poor weight gain can be an additional predictor of severe ROP in very low BW infants.

Turkish Journal of Medical Sciences, 2016

Background/aim: To evaluate refractive and strabismic results and the efficacy of intravitreal be... more Background/aim: To evaluate refractive and strabismic results and the efficacy of intravitreal bevacizumab in retinopathy of prematurity (ROP) ineligible for laser therapy. Materials and methods: Thirty-nine eyes of 20 consecutive infants with high-risk prethreshold ROP (11 infants with Zone I and 9 infants with Zone II disease) who were ineligible for laser therapy due to systemic and/or ocular conditions were treated with intravitreal bevacizumab. Recurrent retinopathy was treated with laser ablation. The final follow-up examination was performed at 29.8 ± 6.0 months of corrected age. Results: All eyes responded to the initial treatment with intravitreal bevacizumab. ROP recurred in 8 eyes (36%) with initial Zone I disease and in only 2 eyes (11%) with initial Zone II disease, which were successfully treated with laser ablation. No eye developed myopia higher than 5.0 diopters. At 2.5 years, the Zone I eyes that had received laser treatment appeared to be more myopic than the Zone I eyes treated only with intravitreal bevacizumab (P = 0.038). A tendency for a higher incidence of strabismus after additional laser therapy was also noted, but was not significant (P = 0.22). Conclusion: Avoidance or even deferral of laser ablation with intravitreal bevacizumab may lead to less myopization in ROP compared with conventional laser treatment.