Browsing by Author "Simsek, Y"

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    Effect of Subcutaneous Immunotherapy on The Natural Course of Allergic Diseases in Pediatric Patients: A Real-Life Cohort
    Yilmaz, O; Yasar, A; Simsek, Y; Alpdogan, S; Kunay, B; Yuksel, H
    Aim: Specific allergen immunotherapy (SIT) is the only disease-modifying therapy for allergic diseases. We aimed to examine the effect of subcutaneous specific allergen immunotherapy (SCIT) applications on the prognosis of asthma and allergic rhinitis in pediatric cases in real-life settings. Methods: The study was designed as a retrospective cohort study. Patients with asthma and/or allergic rhinitis aged between 5 and 18 years old were enrolled between 2010 and 2015. The groups who received SCIT and who did not receive were compared in terms of disease severity parameters in follow-up recorded in their files. Results: A total of 298 cases, among which 140 received subcutaneous specific allergen immunotherapy. The frequency of asthma, allergic rhinitis, and co-morbidity was similar between the two groups. In the first year of the follow-up, asthma symptoms severity was not significant between the two groups; however, both asthma and allergic rhinitis symptoms were significantly lower in the SCIT patients at the end of the third year of follow-up. While the follow-up rate for three years or more was 62% in the group that received subcutaneous specific allergen immunotherapy, it was 38% in the group that did not receive. Conclusion: These results showed that SIT is an effective treatment modality in real-life settings with low side effects in pediatric patients with uncontrolled asthma and allergic rhinitis despite medical treatment.
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    Epithelial Barrier Dysfunction Related To Neutrophilic Inflammation In Non-Cystic Fibrosis Bronchiectasis
    Yilmaz, O; Simsek, Y; Aslan, C; Kanik, ET; Ulman, C; Yildiz, R; Ozdogru, E; Yuksel, H
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    The Key Cell of the Mucosal Immunity: M Cell
    Simsek, Y; Yilmaz, Ö; Yüksel, H
    M cells are immune cells located in the mucosal epithelium. They constitute the initial step of mucosal as well as systemic immune response by presenting antigens to the mucosa-associated lymphoid tissue located under the mucosa. Structural and functional characteristics of M cells which are different from their neighboring epithelial cells show that their primary function is antigen presentation. Furthermore, they are used as an entrance gate to the host tissue by many pathogens. These characteristics make M cells the target for oral, nasal vaccine and intestinal drug applications. The role of M cells in the antigen sampling makes these cells important for oral immunotherapy applications, too. With the advancement in M cell cultures and increasing understanding of M cells would make M cell-mediated differences in the treatment and applications.
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    Significant Changes in Trans-Epithelial Barrier Proteins of Adenoid Tissue with Atopic Status in Children
    Yilmaz, Ö; Simsek, Y; Inan, S; Buga, Ö; Eskiizmir, G; Pinar, E; Kanik, E; Yüksel, H
    OBJECTIVES: Adenoid tissue is important in local immune response and epithelial barrier dysfunction of this tissue may contribute to allergies. The aim of this study was to evaluate the relationship between the status of cross-epithelial barrier elements in adenoid tissue lymphoepithelium and inhalant allergen sensitization. MATERIALS AND METHODS: Children aged 5-15 years, who underwent adenotonsillectomy, participated in this study. All subjects underwent skin prick testing with environmental inhalant allergens. Occludin, ZO1, e-cadherin, beta-catenin, desmoglein, desmoplakin, and connexon-43 were stained immunohistodiemically in the adenoid tissues obtained and scored by H-score. RESULTS: We enrolled 76 children, 14 among whom were sensitized to environmental allergens. Among the zonula occludens proteins, median H-scores for occludin, claudin, and ZO-1 were significantly lower in the atopic compared to the nonatopic group respectively (p<0.001). Similarly, median H-scores for e-cadherin and beta catenin proteins of the zonula adherens were significantly lower in the atopic group (p<0.001). Both desmoglein and desmoplakin H-scores were significantly lower in the atopic group [60 (50-100) vs 280 (260-300), p<0.001 and 105 (87.5-120) vs 280 (67.25-300), p<0.001 respectively]. Moreover, connexin-43 protein of the gap junction was significantly lower in the atopic group (p<0.001). CONCLUSION: Adenoid tissue, which is the initial point of contact of inhalant allergens demonstrates epithelial barrier junctional protein, changes in children with inhalant allergen sensitization without clinical allergic disease symptoms. Therefore, it may be concluded that epithelial barrier function plays an important role in the development of allergen sensitization versus tolerance.
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    Evaluation Of Vascular And Inflammatory Parameters In Differential Diagnosis Of Transient Tachypnea Of Newbron And Neonatal Pneumonia
    Yilmaz, O; Kahraman, BA; Bilgili, G; Simsek, Y; Guvenc, Y; Cosar, H; Toksoz, R; Yuksel, H
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    Tetranectin and Cortisol as Markers of the Relationship Between Perinatal Maternal Depression-Anxiety Symptoms and Recurrent Wheezing in the First Year of Life
    Yilmaz, O; Polat, AC; Cingoz, FO; Ay, P; Alkin, T; Taneli, F; Yasar, A; Hasdemir, S; Simsek, Y; Yuksel, H
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    Clinical correlation of epithelial barrier dysfunction related to neutrophilic inflammation in cystic fibrosis
    Kanik, ET; Yilmaz, O; Ozdogru, E; Alper, H; Ulman, C; Kanik, A; Simsek, Y; Yuksel, H
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    Maternal psychiatric status and infant wheezing: The role of maternal hormones and cord blood cytokines
    Yilmaz, O; Yasar, A; Polat, AC; Ay, P; Alkin, T; Taneli, F; Cingoz, FO; Hasdemir, PS; Simsek, Y; Yuksel, H
    Rationale Maternal psychosocial stress might be associated with development of allergic diseases in the offspring. Objectives To evaluate the association of maternal depression and anxiety with ever wheezing and recurrent wheezing among infants and to assess the role of maternal hypothalamo-pituatary-adrenal axis changes and fetal immune response in this association. Methods This study encompasses two designs; cohort design was developed to evaluate the association of prenatal depression with development of wheezing in infants while nested case-control design was used to assess the role of maternal cortisol and tetranectin and cord blood interleukin 13 and interferon gamma. Results We enrolled 697 pregnant women. Elementary school graduate mother (odds ratio [OR] = 1.5, p = .06), maternal smoking during pregnancy (OR = 3.4, p = .001), familial history of asthma (OR = 2.7, p < .001) increased the risk of ever wheezing. Elementary school graduate mother (OR = 2.6, p = .002), maternal smoking during pregnancy (OR = 4.8, p < .001) and familial history of asthma (OR = 1.7, p = .01) increased the risk of recurrent wheezing. Maternal previous psychiatric disease, or Edinburgh Postnatal Depression Scale or Spielberger State-Trait Anxiety Inventory scores were not associated with wheezing. Maternal tetranectin levels were significantly higher among never wheezers compared to the ever wheezers (264.3 +/- 274.8 vs. 201.6 +/- 299.7, p = .04). Conclusions In conclusion, the major risk factors for ever wheezing and recurrent wheezing were maternal smoking, level of education and family history of asthma. However, maternal depression and anxiety were not determined as risk factors for wheezing. Maternal tetranectin carries potential as a biomarker for wheezing in the infant.
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    Relevance between clinical status and exhaled molecules related to neutrophilic inflammation in pediatric cystic fibrosis
    Kanik, ET; Yilmaz, O; Ozdogru, E; Alper, H; Ulman, C; Kanik, A; Simsek, Y; Yuksel, H
    Introduction:Cystic fibrosis (CF) is characterized with chronic inflammation with neutrophil and related cytokines in airway secretions. We aimed to measure the levels of neutrophil related inflammatory markers as nitric oxide, IL-8, IL-17, leukotriene B4 and neutrophil elastase as well as e-cadherin in exhaled breath condensate (EBC), and to determine their relation with clinical findings.Methods:We consecutively enrolled cystic fibrosis patients into our clinics between the age of six and eighteen years who could cooperate for exhaled breath condensate to this case-control study (n = 30). The age and sex matched control group (n = 26) was enrolled. Spirometry was performed during the stable period and EBC samples were obtained for measurement of the markers.Results:The mean age of the subjects enrolled was 12.1(4.2) years and 40% were positive forP.Aeruginosain sputum. Subjects who hadP.Aeruginosain sputum cultures had significantly lower FEV1, FVC and FEF 25/75 values compared to the ones withoutP.Aeruginosa(p = 0.002, p = 0.002 and p = 0.005 respectively). EBC neutrophil elastase levels were significantly higher in the CF patients compared to non-CF controls (3.11 4.71 versus 0.90 2.68, p = 0.04). Nitric oxide, IL-17, IL-8, e-cadherin, neutrophil elastase or leukotriene B4 levels in EBC of CF patients were not related toP.Aeruginosas infection, FEV1 levels or hospital admission in the last year.Conclusion:In our study, neutrophil elastase levels in EBC are higher in CF patients compared to non-CF controls. This is independent of acute infection and is evidence to the persistence of neutrophilic lung injury. However, EBC NO, IL-8, IL-17, e-cadherin, neutrophil elastase and leukotriene B4 levels as inflammatory markers, are not correlated with disease progression or clinical findings.
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    IgE mediated food allergy in children: clinical findings, diagnosis and prognostic features
    Simsek, Y; Yilmaz, Ö; Yüksel, H
    Objective: Food allergy is defined as an adverse immunological reaction to food intake. Although most adverse food reactions are thought to be allergic, non-immunological food reactions are more common. The aim of this study was to determine the frequency and clinical characteristics of food allergy among children who presented to our clinic with a presumptive diagnosis of food allergy. Materials and Methods: This retrospective cohort study included children under 16 years old who were evaluated with the presumptive diagnosis of food allergy in the pediatric allergy and pulmonology department. The age, gender and presenting symptom were recorded. The results of skin prick test, food spesific IgE and oral provocation tests used in the diagnosis of food allergy were analyzed. Other allergic symptoms diagnosed during follow up were recorded from the files. Results: Fifty-nine (68.6%) patients had food allergy. Urticaria, atopic dermatitis, angioedema, anaphylaxis, abdominal ache, nausea and vomiting, wheeze, rectal bleeding were observed in 76.6%, 30.5%, 22%, 10.3%, 1.7%, 6.8%, 5.1%, 1.7% of the food allergic patients. Etiologic foods identified were milk, egg in 45.8% and 11.9% respectively. On the other hand, 16.9% had milk and egg allergy together or nuts, legumes and fruit. Asthma was present at initial evaluation or developed during follow up in 17.2% of the patients. Conclusion: Food allergy which has an increasing incidence in recent decades may present with symptoms of many different allergic diseases. Considering food allergy in the diagnosis of these cases enables diagnostic tests to be carried out and prevents unnecessary therapies. Moreover, it is important to follow these patients up for other allergic diseases such as asthma.
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    Allergic Rhinitis
    Simsek, Y; Yilmaz, Ö; Yüksel, H
    Allergic rhinitis (AR) is one of the most commonly encountered allergic diseases and is characterized by rhinorrhea, nasal obstruction and itching as well as sneezing. In addition to the nasal mucosa inflammation, eye, ear and throat symptoms usually accompany the nasal symptoms. The prevalence is increasing throughout the world and the morbidity and economic consequences associated with the disease are becoming more important. The main aim of treatment is to control the symptoms and to prevent the complications.
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    Predicting Recurrence of Wheezing in First Time Wheezers: Serum Cc-16, Periostin, Galectin and YKL-40
    Yilmaz, O; Sarilar, T; Ulman, C; Simsek, Y; Yildiz, R; Kanik, ET; Yuksel, H
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    Comparative Evaluation of Clinical, Spiro/Oscillometric and Tomographic Parameters as a Global Assessment of Children with Cystic Fibrosis
    Kanik, ET; Yilmaz, Ö; Kanik, A; Özdogru, EE; Simsek, Y; Alper, HH; Yüksel, H
    Aim: The aim of our study was to compare clinical severity scores and classic spirometry with impulse oscillometry (IOS) results and thoracic high resolution computed tomography (HRCT) scores in children with cystic fibrosis (CF) in order to determine the utility of the latter approach in patient follow-up.Materials and Methods: CF patients over 6 years of age were included. Shwachman-Kulczycki score, underclassical spirometry and IOS were performed when not in acute exacerbation. Thoracic HRCT images obtained within the previous 6 months were evaluated using the BhallaResults: The mean age of the children studied (n=30) was 12.1 +/- 4.2 years and 40% were female. Pseudomonas aeruginosa (P. aeroginosa) was isolated from sputum cultures of 40% of the patients. Patients with forced expiratory volume in one second (FEV1) below 80% exhibited significantly higher (resistance) R5, R10 values and significantly lower (reactance) X5 values on IOS (p=0.03, 0.027, 0.006, respectively). Patients with P. aeruginosa had significantly lower FEV1, forced vital capacity, and forced expiratory flow (25-75) values in classic spirometry when compared with patients without P. aeruginosa (p=0.002, p=0.002, and p=0.005, respectively). P. aeruginosa-positive patients showed mucous plaques, saccularization, bronchial division, mosaic pattern parameters in groups with P. aeroginosa growth and/or FEV1 <80%; was found to be significantly more serious than the non-reproductive group (p<0.005, respectively). Again, in the group with P. aeroginosa growth, Shwachman-Kulczycki score was found to be significantly lower (p=0.001). No significant correlation was found between thoracic score data such as bronchiectasis weight and mosaic pattern presence and IOS values. In addition, in the group with high clinical score of Shwachman Kulczycki, resistance values such as R5 R10 R15 which are IOS parameters, and FEV1 were found above 80% (p=0.016, p=0.037, p=0.042, 0.004,Conclusion: IOS and tomographic scoring can be used safely in early detection of impairment in lung function. Further studies are needed to evaluate the utility of IOS in the clinical monitoring of children with CF who are not compliant with spirometry maneuvers.
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    Prevalence and predictors of gestational diabetes mellitus: a nationwide multicentre prospective study
    Aydin, H; Çelik, Ö; Yazici, D; Altunok, Ç; Tarçin, Ö; Deyneli, O; Sancak, S; Kiyici, S; Aydin, K; Yildiz, BO; Çakiroglu, AY; Özer, A; Tuzcu, AK; Kan, A; Çelik, A; Uysal, A; Atmaca, A; Evren, B; Taskiran, B; Bilir, BE; Duran, C; Arpaci, D; Tüzün, D; Kavak, EÇ; Aydeniz, E; Akbas, EM; Üstünyurt, E; Bil, E; Güney, E; Akbaba, E; Gürkan, E; Çagliyan, E; Karakiliç, E; Karakas, E; Kilinç, F; Söylemez, F; Küçükler, FK; Yorulmaz, G; Akbaba, G; Uysal, G; Kurt, G; Yaylali, GF; Selimoglu, H; Sari, H; Piskinpasa, H; Çelik, H; Peynirci, H; Bilal, I; Sahin, I; Gözükara, I; Anaforoglu, I; Senyuva, I; Ugur, K; Dogan, K; Keskin, L; Mert, M; Adas, M; Tonguç, M; Eroglu, M; Kulaksizoglu, M; Özcan, M; Çinar, N; Kutbay, NÖ; Dikbas, O; Bakiner, O; Turhan, ÖT; Tütüncüoglu, P; Sari, R; Melekoglu, R; Ayaz, R; Emral, R; Mumusoglu, S; Görar, S; Keskek, SÖ; Tosun, SA; Çetinkaya, SE; Temizkan, S; Ünsal, S; Demir, T; Yüce, T; Aksoy, Ü; Çinkir, Ü; Simsek, Y; Uyar, Y; Türk, Y; Pekkolay, Z; Hekimsoy, Z; Cantürk, Z; Üç, ZA
    Aim Prevalence rates of gestational diabetes mellitus (GDM) show considerable variation among different countries and regions of the world. The primary aim of this study was to determine the nationwide prevalence and predictors of GDM in Turkey. Methods We conducted prospective nationwide screening among pregnant women. Between August 2016 and November 2017, a total of 2643 pregnant women from 51 centres in 12 different regions were enrolled. A two-step screening method and Carpenter and Coustan criteria were used in the diagnosis of GDM. Clinical and biochemical data were obtained using electronic database software. Results The national prevalence of GDM was found to be 16.2% [95% confidence intervals (CI) 15.0% to 17.4%] without a significant difference between urban and rural regions. Women with GDM were older (mean age: 32 +/- 5 vs. 28 +/- 5 years, P < 0.001) and heavier (mean BMI: 27.2 +/- 5.1 vs. 24.7 +/- 4.7 kg/m(2), P < 0.001) than their counterparts without GDM. The prevalence of GDM tended to increase with age (< 25 years, 6.9%; 26-35 years, 15.6%; and 36-45 years, 32.7%; P < 0.001). Maternal age, maternal BMI, history of previous GDM and family history of diabetes mellitus were independent predictors of developing GDM (P < 0.05 for all). Low-risk women (age < 25 years, BMI < 25 kg/m(2), no family history of diabetes) comprised 10.7% of the total population and the prevalence of GDM in these women was 4.5% (95% CI 2.4% to 7.8%). Conclusion The results of this nationwide study indicate that GDM is very common, affecting one in seven pregnancies in Turkey. Implementation of international guidelines on screening and management of this public health problem is required.
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    Alterations in cross-epithelial barrier integrity and inhalant allergen sensitivity in children
    Yilmaz, O; Simsek, Y; Inan, S; Buga, O; Eskiizmirli, G; Pinar, E; Kanik, E; Yuksel, H