Browsing by Author "Onag, A"

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    Environmental exposure to cadmium and lead in the pediatric age group
    Onag, A; Oksel, F; Taneli, B; Hakerlerler, H
    Lead additives in automotive fuel, smog from a nearby industrial center warranted an investigation on cadmium and lead in Manisa, a city of tabacco processing. Hundred and one children were screened in view of lead and cadmium exposure. In 23 children between the ages of 0-2 years the mean (+/-SEM) serum lead level was 7.15 +/- 0.10 mu g/dl, in 28 between the ages of 3-6 years was 7.20 +/- 0.10 mu g/dl and in 50 between the ages of 7-15 years was 7.20 +/- 0.10 mu g/dl, respectively, with no significant differences. Serum cadmium levels in the same groups of children was 0.066 +/- 0.008 ng/ml, 0.078 +/- 0.008 ng/ml 0.088 +/- 0.006 ng/ml, respectively. The difference in cadmium levels between the age groups of 0-2 years and 7-15 years was significant (p<0.038). This significant increase in blood cadmium level is also shown by simple linear regression analysis: Cadmium (ng/ml) = 0.049 + 0.005 (age), and p<0.0001, F Ratio = 50.578, coefficient of correlation = 0.581. Our study revealed that lead is not a serious environmental contaminant for children, yet; however, the increasing trend seen in exposure to cadmium warrants serious consideration and urgant preventive measures.
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    Effect of alarm treatment on bladder storage capacities in monosymptomatic nocturnal enuresis
    Taneli, C; Ertan, P; Taneli, F; Genç, A; Günsar, C; Sencan, A; Mir, E; Onag, A
    Objective: Despite a great number of studies, very little is known about the mechanism of action of enuresis alarm systems. Nevertheless, as a result of this treatment many children are able firstly to wake up before urination occurs and then, in time, to sleep through the night without voiding. The aim of this study was to investigate the effect of enuresis alarms on bladder storage capacities. Material and Methods: A total of 28 children aged >7 years who were not polyuric but who voided once every night, slept alone in their own bedroom and who were willing, along with their family members, to cooperate were recruited. Patients were asked to record their urine output using a frequency/volume chart for two consecutive days. After these records and the results of physical and laboratory examinations were taken into consideration, treatment was instituted with the bell-and-pad ( alarm) system for a period of 12 weeks. At the end of this period, patients were asked to complete another frequency/volume chart. Results: The pre- and post-treatment maximum functional bladder capacity was 178.35 +/- 87.86 ml and 243.03 +/- 102.84 ml, respectively and the pre- and post-treatment mean day-time bladder capacity was 111.11 +/- 45.87 and 148.445 +/- 7.68 ml. Both of these differences were statistically significant (p < 0.0001 and < 0.0001, respectively). The maximum nocturnal bladder capacity was found to be increased from 177.85 +/- 84.95 to 255.25 +/- 124.52 ml after treatment (p < 0.0001). Conclusion: Treatment with the alarm system for a period of 12 weeks was seen to be associated with a significant increase in bladder storage capacities ( maximum nocturnal bladder capacity, maximum functional bladder capacity and mean day-time bladder capacity).
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    Serological levels of zinc, copper and iron elements among Giardia lamblia infected children in Turkey
    Ertan, P; Yereli, K; Kurt, Ö; Balcioglu, IC; Onag, A
    Background : Giardiasis, an intestinal protozoan infection caused by Giardia lamblia , is common in Turkey, especially among children aged between 2- and 14-years-old. Effects of giardiasis on serological levels of zinc, copper and iron elements were assessed in this study. Methods : A total of 45 children, aged between 2- and 14-years-old, who were admitted to the Pediatrics Department of Celal Bayar University Medical School with gastrointestinal complaints and diagnosed as having giardiasis by stool examinations in the Parasitology Department, were enrolled as the study group (SG). The control group (CG) consisted of 45 age-matched healthy children. Serological levels of zinc, copper and iron were measured by atomic absorption spectrophotometer in all samples. Results : As a result of the study, serum zinc levels were 67.43 +/- 17.72 mug/dL and 145.20 +/- 9.13 mug/dL, copper levels were 198.45 +/- 39.14 mug/dL and 150 +/- 21.14 mug/dL and iron levels were 87.98 +/- 18.31 mug/dL and 160.45 +/- 45.40 mug/dL, in SG and CG, respectively. When compared separately as SG and CG, there was a statistically significant difference between the serological levels of all these elements. Conclusion : These results revealed that giardiasis increased the serological levels of copper, like other infectious agents. However, zinc and iron levels decreased during giardiasis due to malabsorption.
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    Should children with infection be tested for lipid, lipoprotein and apolipoprotein?
    Iscan, A; Yigitoglu, R; Onag, A; Vurgun, N; Ari, Z; Ertan, P; Sengil, AZ
    The lipid profile is known to alter in patients with infection, but there has not been a study of the apolipoprotein levels in serum of otherwise healthy children during infection. Lipids, lipoproteins, apolipoproteins A-1 and B and lipoprotein (a) were evaluated prospectively in 31 consecutive children, aged 4-15 years, who were admitted to the hospital with bacterial pharyngitis. The degree of dyslipidemia associated with bacterial pharyngitis was assessed using each child as his/her own control and by comparison with 79 healthy children who had not had an infection during the past 3 months. Serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A-1 and apolipoprotein B levels were significantly decreased during the symptomatic phase of the disease, whereas the serum triglyceride level was slightly elevated. Serum lipoprotein (a) concentration did not change significantly. In conclusion, it is suggested that serum lipids, lipoproteins and apolipoproteins should not be assessed during infection because of the possible transient changes of these parameters during infection or inflammation.
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    Evaluation of the location of the anus by a modified technique in the neonate
    Genç, A; Taneli, C; Tansug, N; Kasirga, E; Yilmaz, D; Küçükoglu, T; Onag, A
    Purpose: The aim of the current study was to bring to notice the anterior displacement of the anus and to recommend the measurement of anal position index in the neonate by a modified method. Methods: Sixty newborns (34 girls and 26 boys) were taken into study, and the anal position index (API), which is the ratio of anus-fourchette (scrotum) distance to coccyx fourchette (scrotum) distance, was measured. To obtain the measurement, a transparent adhesive tape was placed along the midline on the long axis, covering the anus. The upper and lower tips and the center of the anal circle was marked and measured using a caliber. Results: API was found as 0.46 (SD +/- 0.08) and 0.53 (SD +/- 0.05) in female and male neonates, respectively. Because an index of 0.34 in girls and 0.46 in boys are considered abnormal, the 3 female babies in the study group with API indices of 0.18, 0.28, and 0.33 were subjected to further examination. The abnormality was seen not to be rare in the Aegean region. Conclusions: An abnormal index alone cannot be the sole cause of constipation mentioned in the literature and therefore not an indication for operation, Anal position index in the neonates could be measured more accurately by the current modified method. If an anterior location of the anus is found early in infancy the baby should undergo follow-up accordingly. J Pediatr Surg 37:80-82. Copyright, (C) 2002 by W B. Saunders Company.
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    Doppler echocardiographic evaluation of pulmonary arterial pressure in children with allergic rhinitis
    Yüksel, H; Coskun, S; Onag, A
    In children, persistent upper airway obstruction may lead to increased pulmonary arterial pressure (PAP). Allergic rhinitis (AR) is one of the frequent cause of persisting upper airway obstruction by nasal blockage in childhood. Regular use of nasal topical corticosteroids are effective in reducing nasal blockage and obstruction. However, whether symptomatic children with AR have increased PAP and curative effect of topical steroids are not known. The aims of this study were to clarify whether children having active symptoms of AR have increased PAP and to investigate the curative effect of reducing nasal obstruction by topical corticosteroids. Twenty-three children, aged between 5 and 16, diagnosed as AR, consisted of 17 seasonal AR (SAR) and seven perennial AR (PAR), were included in the study. Nineteen age and sex matched healthy children were received as controls. PAP was measured by using Doppler echocardiography in all subjects and symptom scores of AR were recorded in rhinitis group. After first evaluation, nasal steroid, budesonid, was given to rhinitis group for three months. Mean systolic PAP was 33.4 +/- 3.1 for children with AR mmHg and 23.6 +/- 4.3 mmHg for the control group. The difference was statistically significant (P < 0.05). Mean systolic PAP of children with PAR was significantly higher than children with SAR (P < 0.05). In rhinitis group, mean PAP decreased significantly after relief of upper airway obstruction by nasal corticosteroid therapy to normal level of 24.9 +/- 3.6 mmHg (P < 0.05). Our results showed that children with AR may have significantly higher PAP than healthy subjects and decreased to normal levels after relieving nasal blockage by nasal corticosteroids. Nevertheless, Doppler echocardiography is a safe, non-invasive and practical tool for cardiac investigation of children with AR. Therefore, in symptomatic period, evaluation of PAP of children with AR by using Doppler echocardiography may be useful in the planning and following of their therapy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.
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    Incidence of giardiasis among siblings in Turkey
    Balcioglu, IC; Limoncu, E; Ertan, P; Yereli, K; Özbilgin, A; Onag, A
    Background: Giardiasis, a common infection among children, is caused by a flagellated protozoan called Giardia lamblia . It is well known to be contagious in common living places. This is an epidemiologic study investigating the incidence of giardiasis among the siblings of patients with giardiasis living in the same household. Methods: Stool samples of 50 patients with a G. lamblia positive sibling in the same household, and 50 patients with a G. lamblia negative sibling in the same household, were examined for giardiasis by saline-Lugol, formalin-ethyl acetate concentration and trichrome staining methods. Other causes of diarrhea were excluded by microbiologic laboratory tests. Results: Thirty-eight per cent of siblings of G. lamblia positive patients and 8% of siblings of G. lamblia negative children were found to be positive for G. lamblia cysts and/or trophozoites. The differences between the groups were statistically significant (P < 0.001). Conclusion: The results suggested that the examination of G. lamblia among the siblings of patients with giardiasis both in the same age group and living in the same household should be considered.
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    Premature labor and leukoerythroblastosis in a newborn with parvovirus b19 infection
    Gulen, H; Basarir, F; Hakan, N; Ciftdogan, DY; Tansug, N; Onag, A
    Leukoerythroblastosis is a rarely observed disease characterized by the presence of leukocytosis, erythroid and myeloid blast cells in peripheral blood. As to our knowledge, it was not diagnosed in a premature newborn before. A female case of 1164 grams who was born prematurely at 29th week of gestation by cesarean section was referred to our newborn intensive care unit due to prematurity and respiratory distress with no prenatal pathological findings. Physical examination revealed tachypnea and hepatosplenomegaly. Routine laboratory measurements of the case showed significant leukocytosis (85.000/mm(3)) and anemia (Hb: 9.6 gr/dL and Hct: 27.6%). Thrombocyte count was normal. Peripheral blood smear suggested leukoerythroblastosis with the presence of nucleated erythrocyte, monocytosis, and 4% blasts. Bone marrow cytogenetic examination was normal. Parvovirus B19 Ig G and M serology were detected to be positive. The etiological factors observed in leukoerythroblastosis occurring during neonatal and early childhood period are congenital-postnatal viral infections, juvenile myelomonocytic leukemia and osteopetrosis. As to our knowledge, no case diagnosed with leukoerythroblastosis in such an early phase is avaliable in literature. As a result, premature delivery and leukoerythroblastosis presentation was thought to develop secondary to intrauterine parvovirus B19 infection.
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    Giardiasis treatment in Turkish children with a single dose of ornidazole
    Özbilgin, A; Ertan, P; Yereli, K; Tamay, AT; Kurt, Ö; Degerli, K; Balcioglu, IC; Ok, ÜZ; Onag, A
    This study was designed to compare the treatment efficacy of single dose of ornidazole with 5 d treatments of ornidazole and metronidazole in children with giardiasis. 175 children, between 2 and 15 y old, whose stool samples were found to be positive for Giardia lamblia cysts and/or trophozoites by either saline-Lugol, formalin-ethyl acetate or trichrome staining, were enrolled in the study. Of these children, 105 were treated with a single dose of ornidazole: 35 with 30 mg/kg, 35 with 25 mg/kg and 35 with 20 mg/kg; 35 were treated with 25 mg/kg per day of ornidazole for 5 d in 2 doses and 35 children were treated with 20 mg/kg per day metronidazole for 7 d in 3 doses. All cases were examined on the 7th, 10th and 14th days after treatment by the same methods; clinical symptoms were also evaluated. Giardia lamblia was eradicated in 34 of 35 (97%), 34 of 35 (97%) and 33 of 35 (94%) patients treated with 30, 25 and 20 mg/kg single doses of ornidazole, respectively. Eradication was achieved in all 35 patients treated with 25 mg/kg per day ornidazole for 5 d and in 31 of 35 (89%) patients treated with metronidazole. There was no statistically significant difference among doses of ornidazole ( p > 0.05); however, all ornidazole treatment regimens were significantly more effective than metronidazole treatment ( p < 0.05). No important side-effects were detected in any patients and clinical symptoms disappeared in all. Single-dose ornidazole treatment could be considered as a proper and effective alternative method for the treatment of giardiasis in children.
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    Non-invasive evaluation of the adaptations of cardiac function in the neonatal period
    Coskun, S; Yüksel, H; Bilgi, Y; Lacin, S; Tansug, N; Onag, A
    Postnatal adaptations of cardiac hemodynamics in infants born vaginally or by caesarean section may be different. These cardiac functions were evaluated by Doppler echocardiography to assess adaptation differences. Cardiac output, heart rate, stroke volume, mean arterial pressure, total systemic vascular resistance, ejection fraction, and ductus arteriosus diameter were determined and compared at 1, 24 and 72 h of life in 22 infants born vaginally (group 1) and 23 born by caesarean section (group 2). One hour after delivery, heart rate, mean blood pressure, and total systemic resistance were found to be higher in group 1 infants (P < 0.01, P < 0.05, P < 0.05 respectively). Stroke-volume measurements were significantly higher in group 2 (P < 0.05). The ejection fraction and cardiac output values were similar in both groups. At 24 and 72 h, no significant differences were observed in measurements of infants born vaginally or by caesarean section. We did not find a parameter negatively affecting healthy newborns in either mode of delivery. However, under pathological conditions affecting the cardiovascular system at 1 h of life, including perinatal infections and hypoxemia, a lower stroke volume, higher heart rate, higher mean blood pressure, and higher peripheral resistance may cause additional work load to the cardiovascular system in infants born vaginally.
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    Protective effect of ketamine against hemorrhagic cystitis in rats receiving ifosfamide
    Ozguven, AA; Yilmaz, O; Taneli, F; Ulman, C; Vatansever, S; Onag, A
    Objective: To investigate the possible protective effect of a single dose of ketamine and the synergistic effect between ketamine and 2-mercaptoethane sulfonate (mesna) against ifosfamide-induced hemorrhagic cystitis. Materials and Methods: 35 adult female wistar rats were divided into five groups and pretreated with ketamine at 10 mg/kg and/or mesna 400 mg/kg 30 minutes before intraperitoneal injection of IFS (400 mg/kg) or with saline (control group). Hemorrhagic cystitis was evaluated 24 hours after IFS injection according to bladder wet weight (BWW), and microscopic changes, i.e. edema, hemorrhage, cellular infiltration, and urothelial desquamation. The markers of oxidative damage including nitric oxide (NO) and malondialdehyde (MDA) levels and the expressions of tumor necrosis factor alpha (TNF-alpha), interleukin 1-beta (IL-1 beta), inducible nitric oxide synthase (i-NOS) and endothelial nitric oxide synthase (e-NOS) were also assayed in the bladder tissues. Results: Pretreatment with ketamine alone or ketamine in combination with mesna reduced the IFS-induced increase of BWW (58,47% and 63,33%, respectively, P < 0.05). IFS-induced microscopic alterations were also prevented by ketamine with or without mesna (P < 0.05). In addition, also statistically insignificant, the bladder tissue expressions of IL-1 beta were lower in ketamine and/or mesna-receiving groups (P > 0,05). The parameters of oxidative stress, the NO and the MDA contents of the bladder tissues of the study groups were not different. Conclusion: The results of the present study suggest that a single dose of ketamine pretreatment attenuates experimental IFS-induced bladder damage. It is therefore necessary to investigate ketamine locally and systematically with various dosing schedulesin order to reduce the bladder damage secondary to oxazaphosphorine-alkylating agents and these results may widen the spectrum of ketamine.
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    The effect of seasonal changes on blood pressure and urine specific gravity in children living in mediterranean climate
    Polat, M; Akil, I; Yuksel, H; Coskun, S; Yilmaz, D; Erguder, I; Onag, A
    Background: We aimed to evaluate the effects of seasonal changes oil urinary specific gravity, blood pressure and urinary, erythrocyte number in children living in Mediterranean climate. Material/Methods: The study was conducted oil 547 children who presented for routine follow up to healthy-child care department between January, 1997 and December 2002. Age, sex, weight, height, blood pressure, urinary specific gravity and urinate, erythrocyte number were recorded by retrospective evaluation of files. Then, the parameters during summer were compared with those during winter. Additionally. correlation between the blood pressure, urinary specific gravity and urinary erythrocyte number was assessed separately during summer and winter. Results: Anthropometrical measurements and mean age of the patients in summer and winter groups were. similar. There was no significant change ill urinary specific gravity (p>0.05), while systolic and diastolic Wood pressures were significantly higher ill winter (p=0.031 and p=0.028 respectively). Temperature and humidity levels did not change significantly among different years but mean air temperatures during summer positively correlated with time front 1997 till 2002 (r=0.965, p=0.002). Blood pressure and urinary specific gravity were not correlated to each other at any time. Contrarily, there was a positive correlation between urinary specific gravity and erythrocyte number in summer (p=0.01). The number of children with hematuria and degree of hematuria did not differ significantly between summer and winter. Conclusions: Seasonal changes in Mediterranean climate do not lead to changes in hydration status or in urinary erythrocyte number in children. Therefore, the decrease in blood pressure during summer can not be attributed to the hydration status.
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    Fulminant meningococcemia and acute renal failure in a 3-year-old boy
    Akil, I; Yüksel, H; Coskun, S; Yilmaz, D; Onag, A
    Acute renal failure is a common occurrence in sepsis, but is rarely reported in meningococcemia. We present a young child diagnosed with fulminant meningococcemia who had several poor prognostic factors, including hypotension, thrombocytopenia, purpura fulminans, seizures, the absence of meningitis with meningococcemia, and acute renal failure, which was successfully treated with peritoneal dialysis. Peritoneal dialysis was started on the 5th day because the patient had been anuric for 48 h. At that time, analysis showed that the child was both hypokalemic and hypophosphatemic. His serum blood urea nitrogen was 61 mg/dl, creatinine 2.75 mg/dl, potassium 2.8 mEq/l, and phosphorus 0.7 mg/dl. Urine output began on the 12th day post admission and normalization of serum creatinine was achieved on the 26th day. In conclusion, renal failure is an important complication of meningococcemia and, to be effective, sometimes long-term peritoneal dialysis is required. Profound metabolic abnormalities, such as hypokalemia and hypophosphatemia, may occur paradoxically in the presence of oliguria.
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    Albendazole as an alternative therapeutic agent for childhood giardiasis in Turkey
    Yereli, K; Balcioglu, IC; Ertan, P; Limoncu, E; Onag, A
    The efficacy of albendazole for the treatment of giardiasis has been indicated by previous in-vitro and in-vivo studies. In order to compare the therapeutic efficacy of albendazole and metronidazole, 107 Giardia-positive children (aged 3-15 years), diagnosed by three consecutive positive stool examinations, were enrolled in the study. Of these children, 52 were given a single daily dose of albendazole 10 mg/kg for 5 days, and 55 were given metronidazole 20 mg/kg daily in three doses for 7 days. Parasite eradication was achieved in 47 (90.4%) of 52 children treated with albendazole and 49 (89.1%) of 55 children treated with metronidazole (p > 0.05). These results suggest that albendazole is an effective treatment option for childhood giardiasis.
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    Effects of different socioeconomic conditions on menarche in Turkish female students
    Ersoy, B; Balkan, C; Gunay, T; Onag, A; Egemen, A
    Purpose: The aim of this study was to determine the age at menarche, the menarcheal features, and the association between menarcheal age and socioeconomic status in an urban area in Turkey. In addition, we tried to assess whether there is a relationship between age at menarche and body composition. Methods: We asked some questions about menarche of 1017 female adolescent students in the high schools of Manisa region. Height and weight were measured. The body mass index (BMI; kg/M-2) was used as an index of relative weight. Adolescent girls were grouped into three socioeconomic status according to the educational and occupational levels of their parents. The age at menarche and the menarcheal pattern were evaluated according to the socioeconomic status. Results: The ages of girls involved in the study ranged between 14 and 18 years, with a mean of 15.7+/-1.1 years. Although the menarcheal age was found to be lower in girls with higher socioeconomic status, there was no significant difference between the three different socioeconomic status. In all of the three groups, menarche was more common in summer and fall than in spring and winter. Although the mother was an important source of knowledge in all groups, it was significantly more important in the group with high socioeconomic status. Adolescent girls with low socioeconomic status had fewer premenstrual complaints. However, there was no significant difference between the groups. We found an inverse correlation between menarcheal age and postmenarcheal weight and the BMI (r = -0.14, p = 0.000). However, there was no correlation between menarcheal age and postmenarcheal height. Conclusion: These results indicate that as the social status differences decrease, the difference observed in menarcheal age and pattern disappears in urban areas of developing countries. Menarcheal age may be an indicator of socioeconomic development. It does not influence postmenarcheal height; however, as menarcheal age decreases, BMI increases. (C) 2003 Elsevier Ireland Ltd. All rights reserved.