Browsing by Author "Arslan, G"

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    Behavioral characteristics of children with type-1 diabetes and the effect of family attitudes on dietary adherence problems
    Onen, O; Nalbantoglu, O; Erkuran, HO; Sapmaz, SY; Erbas, M; Arslan, G; Ozkan, B
    Objective: Assessing the behavioral characteristics and family attitudes of children and adolescents in diabetes is linked to determining the reasons for difficulties in dietary adherence. Our aim was to assess the relationship between behavioral characteristics, family attitudes in children diagnosed with type 1 diabetes mellitus (T1DM), and the dietary adherence and glycemic control. Method: Fifty-four patients T1DM patients and 47 controls aged 7-18 years were included in the study together with their parents. Among the patients diagnosed with T1DM followed in the Pediatric Endocrinology Outpatient Clinic, those with high HbA1c levels (with poor dietary compliance) and those with a HbA1c level below 7.5 (with good dietary compliance) were included in the study as the patient and control group, respectively. A psychiatric assessment interview was conducted with both groups. Sociodemographic data and information on diabetes-related variables, Strengths and Difficulties Questionnaire and Parental Attitude Scale scores were recorded. Results: We have found higher standard diet application rates in patients compared to regular carbohydrate count. The patient group had higher odds of neglecting blood glucose measurement, insulin doses, and a history of stress before decompensation. The rate of psychiatric diagnosis was 26.2%, similar to the general literature, and combined diagnoses were less frequent. Hospital admissions and hypoglycemic episodes were observed at a higher rate in the group that had problems in dietary adherence. Compared to those with good dietary compliance, patients in the dietary non-adherence group had a higher level of parental control and poorer parental perception of their children's peer relationships. Conclusion: To reduce the risk of acute complications of the disease and to prevent long-term chronic sequelae, it is important to identify positive and some negative behavioral characteristics of child and parental attitudes. Parental role is among the key factors in supporting the autonomy of the child in ensuring dietary compliance.
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    COVID-19 disease in children presenting to the pediatric emergency department: A multicenter study with 8886 cases from Turkey
    Duman, M; Sik, N; Teksam, O; Akca, H; Kurt, F; Caglar, AA; Yildiz, LA; Tasar, MA; Fidanci, I; Yayla, BCC; Yilmaz, D; Gungor, E; Demir, S; Cokugras, H; Cebeci, SO; Onal, P; Saz, EU; Yurtseven, A; Uysalol, M; Yildiz, R; Gumus, S; Bal, A; Sen Bayturan, S; Zengin, N; Atik, S; Ciftdogan, DY; Berksoy, E; Cicek, A; Sahin, S; Kizil, MC; Kara, Y; Apa, H; Ulusoy, E; Kara, AA; Yesil, E; Erdem, M; Turan, C; Arslanoglu, S; Duyu, M; Besli, GE; Arslan, G; Oflu, AT; Celegen, M; Buldu, E; Piskin, IE; Kardes, H; Yilmaz, HL; Yildizdas, D; Gokulu, G; Cay, P; Ozer, U; Guleryuz, OD; Colak, O; Guneysu, ST
    Background: The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical out-comes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.Methods: This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific anti-bodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of con-tact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.Results: A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0-15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9-10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.Conclusion: Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.(c) 2022 Elsevier Inc. All rights reserved.
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    Investigating students' experience of online/distance education with photovoice during COVID-19
    Subasi, Y; Adalar, H; Tanhan, A; Arslan, G; Allen, KA; Boyle, C; Lissack, K; Collett, K; Lauchlan, F
    This study used online photovoice to study students' perceptions of online/distance education during the COVID-19 pandemic. It aimed to (a) find the factors that facilitated and impeded online/distance education during the pandemic and (b) determine to which level of ecological systems theory participants attributed facilitators and barriers. We utilized community-based participatory research as the theoretical framework, based on the ecological systems theory. The participants consisted of 119 university students. We used online interpretative phenomenological analysis to analyze the data and found 12 facilitating themes in favor of online education (e.g., technology, 31%; home study comfort, 23%; with family, 17%). In terms of barriers to online education, 14 main themes emerged (e.g., lack of finance, 28%; Internet problems, 22%). Participants attributed facilitators and barriers respectively to the following levels of ecological systems theory: individual/intrapsychic (50%, 51%), microsystem (56%, 58%), exosystem (38%, 43%), and macrosystem (25%, 45%).
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    The Use of Point-of-Care Ultrasound in Pediatric Emergency Departments and Intensive Care Units
    Sik, N; Arslan, G; Çaglar, AA; Tekerek, NU; Fidanci, I; Kendir, ÖT; Bal, A; Horoz,ÖÖ; Anil, AB; Yildizdas, D; Duman, M; Dursun, O
    ObjectivesThe aim was to evaluate the current status of point-of-care ultrasound (POCUS), perceptions, education, training, and barriers to using POCUS in pediatric emergency departments (PEDs) and pediatric intensive care units (PICUs) in Turkey.MethodsA descriptive, multicenter, cross-sectional study through an online survey was developed using the REDCap online platform. The survey was distributed through the Turkish Society of Pediatric Emergency and Intensive Care e-mail group. Each survey was answered only once by each PED/PICU and by the clinical chief of the department.ResultsA total of 19 PEDs and 26 PICUs responded to the survey. Among them, 84.2% of PEDs and 100% of PICUs reported the clinical use of POCUS. For diagnostic applications, the most common areas for PEDs and PICUs were thoracic (93.7%/100%) and cardiovascular (62.5%/65.4%) assessment, and in the procedural use of POCUS, the most frequent applications were those for vascular access (75.0%/92.3%) and thoracentesis (31.2%/65.4%). The most commonly reported clinical benefits were rapid diagnosis, rapid treatment, and decreased complications during procedural applications for PEDs and PICUs. Evaluating the barriers to POCUS use in PEDs and PICUs, the most common reasons for insufficient use were the lack of ultrasound machines and/or equipment, a shortage of manpower, lack of awareness, and lack of training. For PEDs (68.4%) and for PICUs (84.6%), participants agreed that POCUS training should be mandatory during fellowship programs.ConclusionsMost participants were aware of the need for POCUS. However, lack of education, equipment, manpower, and infrastructure still emerged as barriers to the use of POCUS. To further promote POCUS use, it would be helpful to improve accessibility by ensuring sufficient numbers of ultrasound devices together with sufficient numbers of appointed physicians and by expanding POCUS education in PEDs and PICUs.
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    Evaluation of 601 children with multisystem inflammatory syndrome (Turk MISC study)
    Yilmaz, D; Keles, YE; Emiroglu, M; Duramaz, BB; Ugur, C; Kocabas, BA; Celik, T; Ozdemir, H; Bayturan, S; Turel, O; Erdeniz, EH; Cakici, O; Taskin, EC; Erbas, IC; Genceli, M; Sari, EE; Caymaz, C; Kizil, MC; Sutcu, M; Demirbuga, A; Alkan, G; Bagci, Z; Dayar, GT; Ozkan, EA; Yilmaz, AT; Akca, M; Yesil, E; Kara, SS; Akturk, H; Yasar, B; Umit, Z; Uygun, H; Erdem, N; Buyukcam, A; Oncel, EK; Oz, SKT; Cetin, HS; Anil, AB; Yilmaz, R; Zengin, N; Uzuner, S; Albayrak, H; Borakay, O; Topal, S; Arslan, G; Yazar, A; Ozer, A; Kendirli, T; Kara, EM; Demirkol, D; Battal, F; Kosker, M; Akcan, OM; Kihtir, HS; Gul, D; Zararci, K; Alakaya, M; Kula, N; Celik, E; Petmezci, E; Evren, G; Aksay, AK; Konca, C; Sert, A; Arslan, D; Bornaun, H; Tekeli, O; Bal, A; Sahin, IO; Demir, S; Sap, F; Akyol, MB; Tanidir, IC; Donmez, YN; Ucar, T; Coban, S; Arga, G; Torun, SH; Karpuz, D; Celik, SF; Varan, C; Elmali, F; Oncel, S; Belet, N; Hatipoglu, N; Karabulut, ND; Turgut, M; Somer, A; Kuyucu, N; Dinleyici, EC; Ciftci, E; Kara, A
    Purpose Due to its link with the 2019 coronavirus, the multisystem inflammatory syndrome in children (MISC) has garnered considerable international interest. The aim of this study, in which MISC patients were evaluated multicenter, and the data of the third period of the Turk-MISC study group, to compare the clinical and laboratory characteristics and outcomes of MISC patients who did and did not require admission to an intensive care unit (ICU).Methods This retrospective multicenter observational study was carried out between June 11, 2021, and January 01, 2022. The demographics, complaints, laboratory results, system involvements, and outcomes of the patients were documented.Results A total of 601 patients were enrolled; 157 patients (26.1%) required hospitalization in the intensive care unit (ICU). Median age was 8 years (interquartile range (IQR) 4.5-11.3 years. The proportion of Kawasaki disease-like features in the ICU group was significantly higher than in the non-ICU group (56.1% vs. 43.2% p = 0.006). The ICU group had considerably lower counts of both lymphocytes and platelets (lymphocyte count 900 vs. 1280 cells x mu L, platelet count 153 vs. 212 cells x 10(3)/ mu L, all for p< 0.001). C-reactive protein, procalcitonin, and ferritin levels were significantly higher in the ICU group (CRP 164 vs. 129 mg/L, procalcitonin 9.2 vs. 2.2 mu g/L, ferritin 644 vs. 334 mu g/L, all for p< 0.001). Being between ages 5-12 and older than 12 increased the likelihood of hospitalization in the ICU by four [95% confidence intervals (CI)1.971-8.627] and six times (95% CI 2.575-14.654), respectively, compared to being between the ages 0-5. A one-unit increase in log d-dimer (mu g/L) and log troponin (ng/L) was also demonstrated to increase the need for intensive care by 1.8 (95% CI 1.079-3.233) and 1.4 times (95% CI 1.133-1.789), respectively. Conclusion: By comparing this study to our other studies, we found that the median age of MISC patients has been rising. Patients requiring an ICU stay had considerably higher levels of procalcitonin, CRP, and ferritin but significantly lower levels of lymphocyte and thrombocyte. In particular, high levels of procalcitonin in the serum might serve as a valuable laboratory marker for anticipating the need for intensive care.
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    A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey
    Yilmaz, D; Üstündag, G; Büyükçam, A; Sali, E; Çelik, Ü; Avcu, G; Belet, N; Taskin, EÇ; Demir, SÖ; Birbilen, AZ; Kiliç, Ö; Akcan, ÖM; Yilmaz, AT; Kocabas, BA; Hatipoglu, N; Karbuz, A; Çakir, D; Sütçü, M; Aygün, FD; Çelik, T; Sen, SB; Dalgiç, N; Ümit, Z; Kara, SS; Öncel, EK; Bolat, A; Çil, MK; Turan, C; Guzin, AÇ; Topal, S; Besli, GE; Dogan, G; Sahin, S; Akin, F; Bildirici, Y; Dayar, GT; Sari, EE; Isançli, DK; Kara, M; Önal, P; Aylaç, H; Lüleci, D; Yasar, B; Dede, E; Çaglar, A; Akova, S; Turgut, EA; Özkaya, PY; Gülmez, TK; Ulusoy, E; Duyu, M; Kara, Y; Çeliktas, H; Tekeli, O; Çaglar, F; Gül, D; Cebeci, SO; Battal, F; Bal, A; Aygün, E; Uysalol, M; Arslan, G; Özkavakli, A; Kizil, MC; Yazar, A; Aygün, F; Somer, A; Kuyucu, N; Dinleyici, EÇ; Kara, A
    This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027). Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs.
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    Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study
    Sik, G; Inamlik, A; Akçay, N; Kesici, S; Aygun, F; Kendirli, T; Atay, G; Sandal, O; Varol, F; Ozkaya, PY; Duyu, M; Birbilen, AZ; Ozcan, S; Arslan, G; Kangin, M; Bayraktar, S; Altug, U; Anil, AB; Havan, M; Yetimakman, AF; Dalkiran, T; Zengin, N; Oto, A; Kihtir, HS; Girgin, FI; Telhan, L; Yildizdas, D; Yener, N; Yukselmis, U; Alakaya, M; Kilinc, MA; Celegen, M; Dursun, A; Battal, F; Sari, F; Ozkale, M; Topal, S; Kocaoglu, C; Yazar, A; Alacakir, N; Odek, C; Yaman, A; Citak, A
    BackgroundThis study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit.MethodsA retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome.ResultsThe organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation.ConclusionsIn cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.ImpactMIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.