Browsing by Author "Türkeli, A"
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Item Does having an asthmatic sibling affect the quality of life in children?Yilmaz, Ö; Türkeli, A; Karaca, Ö; Yüksel, HChronic illness in a family member leads to deterioration of quality of life in other members of that family. We aimed to investigate the influence of having an asthmatic sibling on a child's quality of life (QoL). We enrolled 2-12 year aged healthy children with an asthmatic sibling in the study group and healthy children with a healthy sibling in the control group of this cross-sectional study. Sociodemographic characteristics of children and disease severity characteristics of asthmatic siblings were recorded. All parents filled in Turkish generic PedsQLTM short form appropriate for the child's age group. Study and control groups had 114 children each. Total PedsQLTM scores were not significantly different in any of the age groups (p=0.23, p=0.13, p=0.11 respectively). Emotional PedsQLTM sub-scores in children with an asthmatic sibling were significantly worse (83.0 +/- 16.5 vs 91.6 +/- 10.9 in the 2-4 year age group, 72.0 +/- 17.8 vs 92.2 +/- 11.6 in the 5-7 year age group, 73.7 +/- 24.1 vs 88.7 +/- 14.8 in the 8-12 year age group respectively, p=0.002 for all). Similarly, psychosocial sub-score was significantly lower in the 2-4 and 5-7-year-olds but not the 8-12 year old groups (p=0.01, p=0.01, p=0.08 respectively). In conclusion, healthy children with asthmatic siblings have significantly lower emotional QoL and this needs to investigated for other chronic diseases in further research.Item Anti-VEGF treatment suppresses remodeling factors and restores epithelial barrier function through the E-cadherin/β-catenin signaling axis in experimental asthma modelsTürkeli, A; Yilmaz, Ö; Karaman, M; Kanik, ET; Firinci, F; Inan, S; Yüksel, HBesides maintaining a physical barrier with adherens junctional (AJ) and tight junctional proteins, airway epithelial cells have important roles in modulating the inflammatory processes of allergic asthma. E-cadherin and beta-catenin are the key AJ proteins that are involved in airway remodeling. Various mediators such as transforming growth factor-beta (TGF-beta), epidermal growth factor (EGF), fibroblast growth factor (FGF), platelet derived growth factor (PDGF), insulin-like growth factor (IGF), tumor necrosis factor-alpha (TNF-alpha) and angiogenic factors, such as vascular endothelial growth factor (VEGF), are released by the airway epithelium in allergic asthma. The signaling pathways activated by these growth factors trigger epithelial-mesenchymal transition (EMT), which contributes to fibrosis and subsequent downregulation of E-cadherin. The present study used a mouse asthma model to investigate the effects of anti-VEGF, anti-TNF and corticosteroid therapies on growth factor and E-cadherin/beta-catenin expression. The study used 38 male BALB/c mice, divided into 5 groups. A chronic mouse asthma model was created by treating 4 of the groups with inhaled and intraperitoneal ovalbumin (n= 8 per group). Saline, anti-TNF-alpha (etanercept), anti-VEGF (bevacizumab) or a corticosteroid (dexamethasone) were applied to each group by intraperitoneal injection. No medication was administered to the control group (n=6). Immunohistochemistry for E-cadherin, beta-catenin and growth factors was performed on lung tissues and protein expression levels assessed using H-scores. Statistically significant differences were observed in E-cadherin, beta-catenin, EGF, FG, and PFGF (P<0.001 for all) as well as the IGF H-scores between the five groups (P<0.005). Only anti-VEGF treatment caused E-cadherin and beta-catenin levels to increase to the level of non-asthmatic control groups (P>0.005). All treatment groups had reduced TGF-beta, PDGF and FGF H-scores in comparison with the untreated asthma group (P=0.001). The EGF and IGF levels were not significantly different between the untreated asthmatic and non-asthmatic controls. The results suggested that anti-VEGF and TNF-alpha inhibition treatments are effective in decreasing growth factors, in a similar manner to conventional corticosteroid treatments. Anti-VEGF and TNF inhibition therapy may be an effective treatment for remodeling in asthma while offering an alternative therapeutic option to steroid protective agents. The data suggested that anti-VEGF treatment offered greater restoration of the epithelial barrier than both anti-TNF-alpha and corticosteroid treatment.Item Prevalence of and factors related to tobacco smoking in children with asthmaYüksel, H; Yasar, A; Türkeli, A; Kalkiner, CS; Yilmaz, OItem Safety of subcutaneous allergen immunotherapy in children: A retrospective review and bird eye to literatureToprak-Kanik, E; Yilmaz, Ö; Yangin-Ergon, E; Türkeli, A; Yüksel, HSubcutaneous allergen immunotherapy (SCIT) has been shown to improve clinical course in children with asthma and allergic rhinitis (AR). Systemic and local side-effects may be seen during its administration. The purpose of this study was to evaluate risk factors associated with systemic and local side-effects in children receiving SCIT. We performed a retrospective chart review in the children who received allergen subcutaneous immunotherapy for asthma and/or allergen rhinitis. Demographic data, diagnosis, skin prick test results, presence of additional allergic diseases, the seasonal variation of adverse events in the first and third years of SCIT were recorded. A total of 508 eligible patients were included in the study. Mean age of the children was 10.9 +/- 3.2 years, and 65.4% were male. Asthma was present in 21.9% of the children, AR in 44.7%, 33.5% of them had both asthma and AR. According to the skin prick test results, sensitivity to more than one allergen was present in 45.1%, while the most common single-allergen sensitivities were to grass pollen and dermatophagoids (32.5% and 14.4%, respectively). Ratio of systemic and local side-effects was 4.7% and 9.3%, respectively. Local side-effects were more common than systemic reaction. SCIT is a safe treatment modality while using the appropriate dose and with the administration of dose-escalation protocol.Item Autoimmune thyroiditis detected during allergen-specific immunotherapy: a case reportTürkeli, A; Yilmaz, O; Güler, S; Yüksel, HAllergen-specific immunotherapy (SIT) is a treatment modality that has been shown to be effective in the treatment of asthma, allergic rhinitis or anaphylaxis due to pollen, mite or venom hypersensitivity. Clinical and immunologic advantages of a successful immunotherapy continue for years after the treatment is finished. Local and systemic side effects have been reported to be associated with SIT, but long-term side effects have not yet been clarified. The term autoimmune thyroiditis includes many different diseases. Impairment of cellular immunity due to genetic defect of suppressor T-cells lies beneath Hashimoto thyroiditis. A 14-year-old girl diagnosed with asthma who developed findings of autoimmune thyroiditis and goiter four months after SIT with grass pollen antigens is presented to emphasize the possibility of autoimmune disease development during the course of SIT andItem Is Obesity Related to Worse Control in Children with Asthma?Yilmaz, O; Sögüt, A; Bozgül, A; Türkeli, A; Kader, S; Yüksel, HIntroduction: Asthma and obesity are related diseases however the influence of obesity on asthma severity is not clear yet. Therefore, the aim of our study was to evaluate the association between obesity and asthma control evaluated on the basis of symptoms and asthma control questionnaire (ACQ). Materials and Methods: We enrolled 98 children with asthma aged 4 to 14 years consecutively and recorded their disease characteristics and severity parameters as well as the symptom scores. All children filled in the ACQ. Children were classified as obese and non-obese according to body mass index. Obesity was defined as body mass index over 90th percentile. Results: Mean age of the children in the obese group (n=27) was 8.1 +/- 2.6 while that in the non-obese group (n=71) was 8.6 +/- 2.9 (p=0.41). Asthma symptom score in obese and non-obese groups were not significantly different (p=0.73). Children in the obese group had lower ACQ scores when compared to the non-obese group (1.2 +/- 0.9 vs 1.7 +/- 1.0, p=0.04) however this significance was lost when controlled for age and gender in the regression model. Conclusion: The results of this study suggest that obesity is not significantly associated with worse asthma control when adjusted for age and gender.Item Metered dose inhaler-spacer use education effects on achieve asthma control in childrenTürkeli, A; Yilmaz, Ö; Yüksel, HIntroduction: Improper Metered Dose Inhaler (MDI)-spacer use technique can result in less than optimal delivery of medicine to the lungs and poor asthma outcomes. The aim of this study was to evaluate the influence of standardized education on proper MDI-spacer use and asthma control in children with asthma and to identify the factors associated with these results. Materials and Methods: This is a cohort study that evaluated the influence of standardized education about MDI-Spacer device use on asthma control in children. Asthmatic children using MDI-Spacer device and their parents were enrolled in this study. Children were followed up for two months after standardized education and the change in asthma control was recorded. Results: Thirty eight children (14 females and 24 males) aged between 2.5 and 13 years were enrolled in the study. Mean age of the children was 7.5 +/- 2.8 years. Six patients were lost to follow up and thirty two patients completed the study. Mean inhalation technique score was 4.9 +/- 1.3 before education and increased significantly to 7.8 +/- 0.4 after education (p<0.001). Mean Asthma Control Questionnaire (ACQ) score decreased significantly with education (0.77 +/- 0.9 vs 0.1 +/- 0.1 respectively, p<0.001). Similarly, mean asthma symptom score (ASS) decreased significantly from 4.3 +/- 3.6 to 0.2 +/- 0.7 with education (p<0.001). Most common mistake in use of MDI-Spacer device use was detected to be lack of mouth rinsing after use before education in 78.9% of the patients. Conclusion: Providing standardized education about MDI-Spacer device use to children and parents leads to correct MDI-Spacer device use and is associated with improvement in asthma symptom score and asthma control.Item Bronchiolitis in childhood: Updates on etiopathogenesis and immunologic lung injuryYüksel, H; Türkeli, A; Yilmaz, Ö; Güler, SAcute bronchiolitis is a disease characterized with bronchiolar inflammation due to viral infections in children younger than two years that is associated with wheezing, cough, tachypnea, retractions and prolonged expiration. Many pathogens, among which respiratory syncytial virus is the most common, play role in the etiology. Cellular damage due to viral pathogens and anatomic and immunological factors of the host play a role in the development of lower respiratory tract infections only in some children exposed to respiratory syncytial virus and other viruses. Viral infections in children may change Th1/Th2 immune response pattern. Severity of disease changes with the degree of inflammation due to the immune response. Moreover, an increase in disease severity may be observed due to the activation of the non-adrenergic non-cholinergic neurogenic system. Severe RSV infections may develop in children with genetic predisposition. We explained the role of environmental factors, genetic and structural susceptibility of the host, and contribution of immunologic response in this susceptibility, in addition to the role of responsible infectious agents, in the development and severe progression of bronchiolitis (Turk Arch Ped 2010; 45: 75-81)Item Follicular bronchiolitis: a rare disease in childrenKanik, ET; Yilmaz, Ö; Türkeli, A; Sahin, S; Yüksel, HFollicular bronchiolitis (FB) is a benign progressive lung disease. It is characterized with lymphoplasmocellular infiltration and hyperplastic follicles in the peribronchial areas in the small airways. Follicular bronchiolitis should be considered in cases where chronic cough, recurrent upper respiratory tract infections and progressive dyspnea are observed in children. The diagnosis should be supported by lung biopsy. A 8-year old female patient presented to our hospital with complaints including continuing cough and wheezing. Bilateral extensive rales and rhonchi in the lungs were heard on auscultation and lung graphy revealed reticuloglandular appearance. Bilateral extensive septal thickennings, reticulonodular appearance, patchy bronchiectasis, bronchiolectasis and peribronchial thickennings were found on high-resolution thoracal computarized tomography. A diagnosis of follicular bronchiolitis was made as a result of lung biopsy. Improvement was observed in the complaints and findings of our patient after methylprednisolone treatment. This patient was presented to emphasize rare interstitial lung diseases should also be considered in children who present with a clinical picture of chronic bronchial obstruction and do not respond to standard treatment.Item Status of skin reactivity to allergens in parents of atopic children and its relationship with clinical characteristicsYilmaz, Ö; Türkeli, A; Sögüt, A; Yüksel, HObjective: Specific and nonspecific environmental factors as well as genetic tendency plays role in development of allergic diseases that are the most common chronic disease group in developed countries. The aim of this study was to determine the allergen sensitivity and frequency of allergic diseases in parents of children detected to have allergen sensitivity and an allergic disease. Materials and Methods: Thirty one children aged 8-18 years, diagnosed with allergic rhinoconjunctivitis or asthma and detected to have sensitivity to inhalant allergens on skin prick test (SPT) and their parents were enrolled in this study. SPT results and total immunoglobulin E levels of the children were recorded. Skin prick test with inhalant allergens were applied to the mothers and fathers. Results: Evaluation of SPT revealed positive results in 14 mothers (45.2%) and negative results in 17 mothers (54.8%). Among the fathers, 17 (54.8%) had negative and 14 (45.2%) had positive SPT results. Sensitized allergen type in children did not influence the skin prick test positivity in mothers and fathers significantly (p=0.88 and p=0.68 respectively). Conclusion: Skin allergen sensitivity is common in parents of allergic children irrespective of clinical findings. This difference between clinical and allergic sensitization may be attributed to environmental factors. The results of this study indicated that allergen type that the child is sensitized to does not influence the sensitization frequency in parents.Item The Effect of Flexible Bronchoscopy on Anxiety in ChildrenTürkeli, A; Yilmaz, Ö; Topçu, I; Yüksel, HOBJECTIVES: Flexible bronchoscopy (FB) is a semi-invasive diagnostic tool that allows direct visualization of the airways. The use for diagnostic and therapeutic purposes in children is incrasing with the developments in modern anesthesia. Irrespective of the type of the invasive diagnostic procedure, these interventions are known to cause anxiety in patients. The aim of our study was to evaluate the anxiety and depression status in children hospitalized for bronchoscopy and to investigate the effects of FB. MATERIAL AND METHODS: Thirty children hospitalized for FB and 30 controls, aged 7 to 16 years, were enrolled in this study. Anxiety was evaluated with the Hospital anxiety and depression scale (HADS) besides other parameters recorded. RESULTS: The mean HADS anxiety scores in the patient and control groups were respectively 10.1 (3.5) and 2.7 (1.3) (p=0.001). The mean HADS depression scores were respectively 8.8 (3.7) and 2.2 (1.1) (p=0.001). Among the patients, 50% had anxiety and 53.3% had findings while none in the control group showed signs of anxiety and depression. A positive correlation was found between the age and, anxiety and depression scores in patients' groups (respectively r(1) = 0.257; p=0.05 and r(2) = 0.288; p=0.02). CONCLUSION: Anxiety was demonstrated in nearly half of the children hospitalized for bronchoscopy. It has been observed that behavioral and physical problems may be encountered in approximately 40-60% of children who feel generalized anxiety before anesthesia, during the preoperative, postoperative period, and subsequent periods. These results suggest that the detection of children with increased anxiety and indicate the individual requirements can be assisted pharmacological and psychological supports.