MCBÜ Açıkerişim Sistemi :: Browsing by Author "Bal, A"

Browsing by Author "Bal, A"

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A deep learning feature extraction-based hybrid approach for detecting pediatric pneumonia in chest X-ray images
Bal, U; Bal, A; Moral, ÖT; Düzgün, F; Gurbuz, N
Pneumonia is a disease caused by bacteria, viruses, and fungi that settle in the alveolar sacs of the lungs and can lead to serious health complications in humans. Early detection of pneumonia is necessary for early treatment to manage and cure the disease. Recently, machine learning-based pneumonia detection methods have focused on pneumonia in adults. Machine learning relies on manual feature engineering, whereas deep learning can automatically detect and extract features from data. This study proposes a deep learning feature extraction-based hybrid approach that combines deep learning and machine learning to detect pediatric pneumonia, which is difficult to standardize. The proposed hybrid approach enhances the accuracy of detecting pediatric pneumonia and simplifies the approach by eliminating the requirement for advanced feature extraction. The experiments indicate that the hybrid approach using a Medium Neural Network based on AlexNet feature extraction achieved a 97.9% accuracy rate and 98.0% sensitivity rate. The results show that the proposed approach achieved higher accuracy rates than state-of-the-art approaches.
The Evaluation of the Diagnostic Performance of the BioFire FilmArray Meningitis/Encephalitis Panel in Children: A Retrospective Multicenter Study
Bal, A; Saz, EU; Arslan, SY; Atik, S; Bayturan, S; Yurtseven, A; Gazi, H; Cicek, C; Kurugol, Z; Bal, ZS
Objective Acute bacterial meningitis (ABM) declined after implementing conjugate Haemophilus influenzae type B and the pneumococcal vaccines worldwide. However, it still contributes to significant morbidity and mortality. The Biofire FilmArray Meningitis Encephalitis (FAME) panel can rapidly diagnose common bacterial and viral pathogens. Several studies suggested that the use of FAME may accelerate diagnosis and decrease the time to pathogen-specific therapy. However, the clinical utility is still controversial due to scarce data and relatively high costs. Therefore, we aimed to evaluate the diagnostic performance of FAME in children. Methods A retrospective multicenter cross-sectional study was conducted to evaluate FAME in diagnosing ABM in children with a suspected central nervous system infection between January 2017 and May 2021. Results This study consisted of 179 children diagnosed with central nervous system infection who had parallel testing done using FAME and traditional microbiological diagnostic methods. Twenty-two FAME results were positive; 8 (36.3%) were bacterial pathogens and 14 (53.7%) were viral pathogens . The most common viral pathogen was human herpesvirus 6 (n =6; 27.2%), followed by herpes simplex virus 1 (n =4; 18.1%), Enterovirus spp. (n = 2; 9%), Parechovirus (n = 2; 9%), and Cytomegalovirus (n = 1; 4.5%). Bacterial pathogens included S. pneumoniae (n = 3; 13.6%), H. influenzae (n = 3; 13.6%), Neisseria meningitidis (n = 1; 4.5%), and Streptococcus agalactiae (n = 1; 4.5%). Bacterial culture confirmed S. pneumoniae infection in only 1 of 8 (12.5%) patients, while 7 of 8 bacterial meningitis were only detected by FAME. Conclusion FAME may also help with diagnosis and pathogen identification in patients who have already had antibiotics before cerebrospinal fluid collection. The use of FAME to detect infections quickly may minimize the improper use of medications, treatment duration, and the cost of hospitalization.
The Pediatric Tracheostomy Practice During COVID-19 Pandemic at a PICU
Zengin, N; Bal, A; Cankorur, OO; Tanriverdi, HI
Introduction: To evaluate pediatric tracheostomies performed at a tertiary care pediatric intensive care unit (PICU) before and after the Coronavirus disease-2019 (COVID-19) pandemic. Methods: A total of 57 pediatric tracheostomy patients performed at a tertiary care PICU were included. Prognostic scores including pediatric risk of mortality 2, pediatric index of mortality 2 and pediatric logistic organ dysfunction scores, the family education process and time to home discharge were evaluated according to time of tracheostomy (pre-pandemic vs. after pandemic) and responsible surgeon (pediatric surgeon vs. otolaryngologist). MedCalc (R) Statistical Software version 19.7.2 (MedCalc Software Ltd, Ostend, Belgium; https: //www.medcalc.org; 2021) was used for statistical analysis. Results: A non-significant tendency for higher rate of pediatric surgery-based tracheostomies was noted after the pandemic (76.0 vs. 24.0%, p=0.134). No significant difference was noted between tracheostomies performed before vs. after the COVID-19 pandemic and those performed by otolaryngologists vs. pediatric surgeons in terms of prognostic scores and time to home discharge. Conclusion: Our findings emphasize the maintenance of high quality patient care for pediatric tracheostomy patients in accordance with standardized tracheostomy protocols and policies during the pandemic period with no significant difference between tracheostomies performed before and after the COVID-19 pandemic and those performed by pediatric surgeons vs. otolaryngologists in terms of prognostic scores and time to home discharge.
Respiratory Viruses in Pediatric Patients with Suspected COVID-19 at the Early Stages of the Pandemic: A Single-center Experience
Zengin, N; Bal, A; Atik, S; Bayturan, SS; Akçal, S
Objective: This study aimed to report the respiratory tract viruses we detected in the respiratory polymerase chain reaction (PCR) samples taken from patients admitted to the Pediatric Emergency Service with suspicion of coronavirus disease-2019 (COVID-19) in the early stages of the pandemic, in addition to the clinical course, and laboratory features of the disease caused by these identified respiratory tract viruses.Method: All upper respiratory tract PCR samples were taken simultaneously from patients suspected of having COVID-19 disease. All pediatric patients who came to the Pediatric Emergency Department with suspicion of COVID-19 disease between March and June 2020 were included in the study. We retrospectively compared the laboratory findings, clinical manifestations, and primary outcomes of the children aged between 1 month and 18 years infected with respiratory viruses (RVs) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus.Results: Fifty-eight pediatric patients were tested. SARS-CoV-2 virus was detected in 27 (46. 6%) patients and other RVs in 31 (53. 4%) patients. The detection rate of SARS-CoV-2 was significantly higher in the older age group of children (p<0.01). We didn't detect co-infections with SARS-CoV-2 and other RVs in these patients. Compared to the children with COVID-19, those infected with other RVs required markedly higher rates of oxygen supplementation (p<0.01). There was no need for hospitalization in the COVID-19 patient group, and 23 of 31 critically ill children infected with other RVs were followed up in the pediatric intensive care unit. Conclusion: RVs are common causes of childhood infections and may cause critical illness. Infections caused by other RVs progressed with more severe clinical findings than those of COVID-19 disease in pediatric patients. During the COVID-19 pandemic, other RVs that cause mortality and morbidity in children should be also kept in mind.
A Comparison Study in Children with Lower Respiratory Tract Infections: Chest X-ray and Lung Ultrasound
Gürbüz, N; Zengin, N; Karaburun, NC; Düzgün, F; Bal, A
Aim: Lower respiratory tract infections (LRTIs) are one of the leading causes of mortality and morbidity in children. Chest X-rays, which are frequently used in diagnosis, cause ionizing radiation exposure and a loss of time. We aimed to compare the diagnostic accuracy of chest radiography (CR) and lung ultrasonography (US) in patients with LRTIs.Materials and Methods: This study was designed as methodological research. Of the 62 patients evaluated in our study, four refused to participate, and eight were excluded from the study due to their underlying chronic diseases. All 50 remaining patients (between the ages of 0-18 years) were evaluated with a preliminary LRTI diagnosis. Lung US was performed by a 3rd-year pediatric resident who had six hours of onlineResults: The mean age of the 50 cases included in this study was five years and three months; 35 of the 50 patients (70%) had a clinical diagnosis of pneumonia, 15 (30%) of them had a clinical diagnosis of bronchiolitis. Statistically significant interobserver agreement was found between US and CR [Kappa value 0.772, 95% confidence interval (0.590-0.925) (p=0.000)]. The sensitivity of lung US was 95%, and its specificity was 85.7% when CR was accepted as the gold standard.Conclusion: Our study demonstrates that lung US can be used instead of CR to diagnose and follow-up pediatric cases with LRTIs.
Comparison of early characteristics of multisystemic inflammatory syndrome and Kawasaki disease in children and the course of Kawasaki disease in the pandemic
Alkan, F; Bircan, O; Bal, A; Bayturan, S; Zengin, N; Coskun, S
IntroductionMultisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings. In this study, the clinical findings, organ involvements, similarities, and differences in laboratory and imaging of the children with MIS-C and KD at the time of admission will be revealed in detail, and the treatment methods and follow-up results will be revealed.Material and methodOur study was a single-center study and included pediatric patients who were treated with a diagnosis of MIS-C between March 2020 and July 2023 in the pediatric cardiology, pediatric emergency, pediatric infection, and pediatric intensive care clinics at Celal Bayar University and who were treated with a diagnosis of KD (complete/incomplete) between January 2015 and July 2023. MIS-C diagnosis was made according to the Turkish Ministry of Health COVID-19 guidelines. Sociodemographic characteristics, clinical, laboratory, and echocardiography findings, treatments given, and clinical course of all patients included in the study were evaluated.ResultsThe median age was 30 months (7-84) in KD and 96 months (6-204) in MIS-C, and it was significantly higher in the MIS-C group (p = 0.000). Symptom duration was significantly longer in the MIS-C group (p = 0.000). In terms of clinical features, gastrointestinal syndrome findings (nausea, vomiting, abdominal pain) and respiratory findings (dyspnea) were significantly higher in the MIS-C group (p = 0.007, p = 0.000, p = 0.002, respectively). Regarding cardiovascular system involvement, coronary involvement was significantly higher in the KD group. However, valvular involvement, left ventricular systolic dysfunction, and pericardial effusion were significantly higher in the MIS-C group (p = 0.000, p = 0.001, p = 0.003, p = 0.023, respectively). In terms of laboratory findings, white blood cell count was higher in KD (p = 0.000), absolute lymphocyte count, platelet level, blood sodium, and albumin levels were lower in MIS-C group (p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.003, respectively), ferritin and troponin levels were significantly higher in MIS-C group. These results were statistically significant (p = 0.000, p = 0.000, respectively). D-dimer and fibrinogen levels were high in both groups, and no significant statistical difference was detected between the two groups. There was no significant difference between the two groups regarding the length of hospitalization and mortality, but steroid use was significantly higher in the MIS-C group (p = 0.000).ConclusionIn conclusion, this study has demonstrated the similarities and differences between MIS-C and KD regarding clinical findings, organ involvement, and laboratory and imaging results. The results of our study have important implications in terms of contributing to the data in the existing literature on these two diseases and for the correct diagnosis and better management of pediatric patients presenting with these disorders.What is knownMultisystemic inflammatory syndrome (MIS-C) is a newly described disease manifestation in children associated with the novel coronavirus SARS-CoV-2 infection and can be easily confused with Kawasaki disease with its clinical and laboratory findings.What is newAlthough MIS-C and KD have many similarities, their symptoms, disease processes, possible complications, and treatment regimens may differ.
Seasonal Trends and Interactions of Viral Pathogens in Children Presenting with Acute Respiratory Tract Infections in the Advancing Periods of SARS-Cov-2 Pandemic
Türkmen Recen, Ö; Gazi, H; Bayturan Sen, S; Bal, A; Akçali, S
Although various bacteria and viruses have been identified in the etiology of acute respiratory tract infections (ARI), 90% of acute ARIs that develop in children are of viral origin. The aim of this study was to investigate the seasonal trends and interactions between infectious agents and to determine the risk factors associated with ARI in children aged 1-15 years admitted to the Pediatric Emergency Department of Manisa Celal Bayar University Hospital in the advancing periods of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. To determine the bacterial and viral agents, samples were taken from 314 patients attending to the hospital with symptoms suggestive for ARI, between 06/01/2021 and 05/31/2022. Viral and bacterial agents were identified by multiplex polymerase chain reaction (PCR) and automated identification system, respectively. Demographic data of the participants and possible risk fac- tors for ARI were recorded in the questionnaires. In the study, viral agents were detected in 77.3% of the children, and the most common infectious agent was rhinovirus/enterovirus (RV/EV) (36.3%), followed by influenza viruses (11.2%), and SARS-CoV-2 (10.5%). While RV/EV positivity was found to be higher in children with moderate and below average (p< 0.001) hand hygiene, influenza positivity was found higher in those attending school/preschool institution (p< 0.001) and whose mothers working full-time (p< 0.001). Respiratory syncytial virus positivity was associated with maternal smoking (p= 0.013) and home overcrowding (p= 0.014). Bacterial colonization was detected in 33 (11.6%) of 284 children whose swabs were taken for both bacterial and viral agents and the most frequently detected agents were Staphylococcus aureus (60.6%) and Pseudomonas aeruginosa (15.2%). Having siblings (p= 0.008) and maternal smoking (p= 0.012) were found to be associated with the detection of bacterial agents. In this study, in the advanced period of the pandemic, the most detected agents and seasonal characteristics were found to be similar to the pre-pandemic period. It is thought that knowing the regional etiology and risk factors will contribute to taking the necessary local control and protective measures.
Serum Vitamin D Levels in Relation to Development of Multisystem Inflammatory Syndrome in Pediatric COVID-19
Zengin, N; Bal, A; Goren, TA; Sen Bayturan, S; Alkan, F; Akcali, S
Objective The aim of the study is to evaluate vitamin D (vit D) levels in children with and without development of multisystem inflammatory syndrome in children (MIS-C) after coronavirus disease 2019 (COVID-19) and also between those with severe and moderate MIS-C. Methods This comprises retrospective data of 68 patients including 34 patients with MIS-C and admitted into the pediatric intensive care unit (MIS-C group) and 34 patients without MIS-C (non-MIS-C group) were analyzed for their presenting characteristics, serum vit D levels, ventilatory needs, and prognostic scores. Results Vit D levels were significantly lower in patients with versus without MIS-C [9 (2-18) vs. 19 (10-43) ng/mL, p <0.001], and also in patients with severe versus moderate MIS-C [7.5 (2-17) vs. 9 (5-18) ng/mL, p = 0.024]. Vit D deficiency (levels <12 ng/mL) was more common in the MIS-C versus non-MIS-C group (79.4 vs. 11.8%, p <0.001) and in severe versus moderate MIS-C (92.9 vs. 70.0%, p <0.001). The severe versus moderate MIS-C was associated with significantly higher levels of procalcitonin [7.6 (0.9-82) vs. 1.7 (0.2-42) ng/mL, p = 0.030] and troponin [211 (4.8-4,545) vs. 14.2 (2.4-3,065) ng/L, p = 0.008] and higher likelihood of reduced ejection fraction (75.0 vs. 15.4%, p = 0.004). Conclusion Our findings indicate the higher prevalence of vit D deficiency in pediatric COVID-19 patients with versus without MIS-C, as well as in those with severe versus moderate MIS-C. Higher troponin and procalcitonin levels and dyspnea at presentation seem also to be risk factors for severe MIS-C, more pronounced cardiac dysfunction, and poorer prognosis.
THE RELATIONSHIP BETWEEN MRI FINDINGS, PAIN AND DISABILITY IN THE PATIENTS WITH CERVICAL OSTEOARTHRITIS
Altan, L; Ökmen, BM; Tuncer, T; Akarirmak, U; Ayhan, F; Bal, A; Bozbas, G; Cerrahoglu, L; Cevik, R; Durmaz, B; Duruöz, T; Dülgeroglu, D; Gürer, G; Gürsoy, S; Hepgüler, S; Hizmetli, S; Kaçar, C; Kaptanoglu, E; Kocabas, H; Nas, K; Nur, H; Özçakir, S; Özdolap, S; Sindel, D; Sahin, O; Sendur, F; Tikiz, C; Ugurlu, H
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.
THE FREQUENCY AND ASSOCIATION OF KNEE, HIP, HAND AND SPINE OSTEOARTHRITIS IN TURKISH POPULATION: A PRELIMINARY RE PORT OF MULTICENTER LONGITUDINAL STUDY
Tuncer, T; Ugur, S; Nur, H; Kacar, C; Akarimak, U; Altan, L; Ayhan, F; Bal, A; Basaran, S; Bilgilisoy, M; Bozbas, G; Cerrahoglu, L; Cevik, R; Coskun, N; Dagli, Z; Durmaz, B; Duruoz, T; Dulgeroglu, D; Gurer, G; Gursoy, S; Hepguler, S; Hizmetli, S; Kaplanoglu, E; Kaya, T; Kocabas, H; Kuran, B; Melikoglu, M; Nas, K; Oncu, J; Ozcakir, S; Ozdolap, S; Saridogan, M; Sarikaya, S; Sindel, D; Sahin, O; Sendur, OF; Tikiz, C; Ugurlu, H; Yilmaz, F
THE RADIOLOGICAL, CLINICAL AND FUNCTIONAL PROPERTIES OF HAND OSTEOARTHRITIS AND THEIR RELATION WITH RADIOLOGICAL FINDINGS IN A TURKISH POPULATION: TLAR-OA STUDY
Duruöz, MT; Erdem, D; Tuncer, T; Altan, L; Ayhan, F; Bal, A; Cerrahoglu, L; Capkin, E; Cevik, R; Dulgeroglu, D; Gursoy, S; Hizmetli, S; Kacar, C; Kaptanoglu, E; Kaya, T; Kocabas, H; Nas, K; Ozcakir, S; Sindel, D; Sahin, O; Bozbas, GT; Tikiz, C; Ugurlu, H
Adolescents With Breakthrough COVID-19 Infections Requiring Hospitalization: A Multicenter Retrospective Study
Bal, ZS; Arslan, SY; Ozenen, GG; Okur, DS; Kiliçaslan,Ö; Demirbuga, A; Turgut, EA; Dalgic, N; Belet, N; Inceli, HB; Elvan-Tuz, A; Kara, TT; Bulbul, B; Demirdag, T; Çakici,Ö; Bal, A; Ergun, D; Altug, U; Arslan, A; Isancli, DK; Torun, SH; Çelik,Ü; Yasar, B; Erbas, IC; Oncel, EK; Akbas, A; Gudeloglu, E; Sen, S; Kacar, P; Dede, E; Petmezci, E; Aksoy, FD; Karbuz, A; Öncel, S; Tezer, H; Devrim, I; Ciftci, E; Hacimustafaoglu, M; Kurugol, Z
Background Vaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents >= 12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP. Methods A retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP. Results During the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval [CI]: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID- 19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio [OR]: 0.347 [95% CI: 0.184-0.654]). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 [95% CI: 2.920-11.200]), and PICU admission was less frequently required (p = 0.011, OR: 0.188 [95% CI: 0.045-0.793]). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%). Conclusions This study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS -C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents' decisions may be changed, particularly those who hesitate to or refuse vaccination.
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.
Noninvasive Hemoglobin Measurement Reduce Invasive Procedures in Thalassemia Patients
Bicilioglu, Y; Bal, A; Yenigürbüz, FD; Ergonul, E; Geter, S; Kazanasmaz, H; Bal, U
This study was conducted to investigate the agreement between laboratory hemoglobin (LabHb) measured in venous blood and noninvasive, spectrophotometric hemoglobin (SpHb) measurement and the usability of SpHb measurement in the transfusion decision-making in patients with thalassemia whose hemoglobin (Hb) was monitored by taking blood samples at frequent intervals and who were transfused. Cardiac pulse, oxygen saturation, Pleth variability index (PVI), and SpHb values were measured in patients who came to the hematology outpatient clinic for a control visit and whose Hb levels were planned to be measured. Venous blood samples were taken for LabHb measurement, which we accept as the gold standard. Cohen's kappa value was calculated for the agreement between SpHb measurements and LabHb values. The relationship and predictability between both measurement methods were evaluated by Pearson correlation analysis, a modified Bland-Altman plot and the linear regression model. In the study conducted with a total of 110 children with thalassemia, a moderate level of agreement between the two measurement methods (kappa = 0.370, p < 0.0001) and a significantly high correlation between the two tests (r = 0.675) were found. The mean bias between the differences was found to be 0.3 g/dL (-1.27 to 1.86 g/dL). The sensitivity and the specificity of SpHb in identifying patients who needed transfusions (Hb <10.0 g/dL) were calculated as 92.2 and 57.1%, respectively. Our results suggest SpHb measurement may be used to screen anemia in hemodynamically stable hemoglobinopathy patients and even for transfusion decision-making with combination clinical findings.
Levothyroxine poisoning in children is usually benign: A multi-center experience from Turkey
Sen Küçük, K; Demir, S; Sevim, RD; Akgül, F; Yalçin, G; Eser, Ö; Bal, A; Ergün, E; Öztürk, S; Anik, A
Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis
Altan, L; Ökmen, BM; Tuncer, T; Sindel, D; Çay, HF; Hepgüler, S; Sarikaya, S; Ayhan, F; Bal, A; Bilgilisoy, M; Çapkin, E; Cerrahoglu, L; Çevik, R; Dülgeroglu, D; Durmaz, B; Duruöz, T; Gürer, G; Gürsoy, S; Hizmetli, S; Kaçar, C; Kaptanoglu, E; Ecesoy, H; Melikoglu, M; Nas, K; Nur, H; Özcakir, S; Sahin, N; Sahin, O; Saridogan, M; Sendur, ÖF; Sezer, I; Bozbas, GT; Tikiz, C; Ugurlu, H
Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients.Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6 +/- 10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings.Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). Conclusion: The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.
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.
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.
Neuropathic Pain in Patients with Knee Osteoarthritis and Related Factors: A Multicenter Longitudinal Study-Preliminary Report
Kaptanoglu, E; Sahin, O; Tuncer, T; Hizmetli, S; Altan, L; Ayhan, F; Bal, A; Bilgilisoy, M; Bozbas, G; Cerrahoglu, L; Cevik, R; Duruoz, T; Dulgeroglu, D; Gurer, G; Gursoy, S; Hepguler, S; Kacar, C; Kaya, T; Melikoglu, M; Nas, K; Ozcakir, S; Ozdolap, S; Saridogan, M; Sarikaya, S; Sindel, D; Sendur, OF; Tikiz, C; Ugurlu, H

Browsing by Author "Bal, A"

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