Browsing by Author "Türkeli A."
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Item Bronchiolitis in childhood: Updates on etiopathogenesis and immunologic lung injury; [Çocukluk çaǧinda bronşiyolitler: Etiopatojenez ve immünolojik akciǧer hasarindaki yenilikler](Kare Publishing, 2010) Yüksel H.; Türkeli A.; Yilmaz Ö.; Güler S.Acute 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.Item Results of standardized device education in asthmatic children and their families; [Astimli çocuklarda ve ailelerinde standart cihaz eǧitiminin sonuçlari](Turkiye Klinikleri, 2014) Şimşek Y.; Türkeli A.; Yilmaz O.; Okkali Z.; Yüksel H.Objective: Inhalation is an efficacious and advatageous route of drug application. Therefore, systemic side effects decrease while treatment efficacy increases. However, use of inhalation devices requires specific skills therefore children need to be prescribed these devices according to their neuromotor development. Delivery of drug dose requires technically correct device use. Bu In this study, we aimed to determine the influence of standardized practical inhalation device education on correct device use as well as asthma symptomatology and control. Material and Methods: Thirty two children (6-12 ages) were enrolled in the study. Discus use skills were scored before and after receiving standard practical education. Asthma symptom score and asthma control questionnaire (ACQ) were also evaluated before education and at the end of first month after education. Results: Average discus use skill scores were 4.9±1.32 and 7,6±0.59 pre- and post-education respectively (p<0.001). Frequency of correct performance on the most commonly skipped step, that is "holding the breath for five seconds", increased from 34.4% to 87.5% (p<0,001). Average asthma symptom score was determined as 5.8±3.4 pre-education and 0.43±0.89 post-education (p<0.001). Average ACQ score decreased significantly post-education compared to pre-education (1.27±0.99 vs 0.11±0.22) (p<0.001). Conclusion: Education significantly improves the wrong application of discus use. This is associated with a significant improvement in asthma symtom score and asthma control. Therefore, device use education needs to be an essential component of treatment and follow up of asthmatic children. © 2014 by Türki ye Klinikleri.Item Follicular bronchiolitis: A rare disease in children(Galenos, 2014) Kanık E.T.; Yılmaz Ö.; Türkeli A.; Şahin Ş.; Yüksel H.Follicular 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. © 2014 by Turkish Pediatric Association.Item Is obesity related to worse control in children with asthma?; [Asti{dotless}mli{dotless} çocuklarda obezite daha kötü kontrol ile i̇lişkili mi?](Ankara University, 2014) Yilmaz O.; Söǧüt A.; Bozgül A.; Türkeli A.; Kader Ş.; Yüksel H.Introduction: 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 The effect of standardized training in nebulizer use on disease control in asthmatic or wheezing children; [Astimli ve hişiltili çocuklarda nebülizer kullanimi konusunda verilen standart eǧitimin hastalik kontrolüne etkisi](Cocuk Sagligi ve Hastaliklan Dergisi, 2015) Kanik E.T.; Yilmaz Ö.; Türkeli A.; Yüksel H.Inhalation therapy is administered to asthmatic patients in order to control symptoms and attacks by relieving airway obstruction. The effectiveness of this treatment depends on the correct use of inhalation devices as much as on pharmacological agents. Many asthmatic children receive no standard training in device use during intensive clinic observation, or else they are unable to apply the verbal instructions they receive. The purpose of this study was to evaluate the effect of standardized visual practical training on asthma control. Sixty children aged 1-15 who were under observation for infant wheezing or asthma and using nebulizers were included in the study. At the beginning of the study, patient's and parents' ages, occupation, education level, age at diagnosis, symptoms over the previous three months and disease severity were recorded. The child or mother's nebulizer use skills were assessed on a scale before and after training. In addition, asthma control levels were determined at the start of the study and one month after training using a symptom score and asthma control questionnaire (ACQ). Seven patients (11.7%) were being monitored for asthma and 53 (88.3%) for infant wheezing. The nebulizer use score was 5.4 before training and rose to 7.8 afterward (p<0.001). An increase was observed in the number of correct admininstrations in all six steps assessing device use skills after training. The asthma symptom score was 7.54 before training and 0.78 one month after training (p<0.001). A significant decrease was observed in the ACQ results after instruction in nebulizer device usage (2.1 and 0.1, respectively; p<0.001). Our study revealed that there were errors of device usage in children using nebulizers and diagnosed with asthma or infant wheezing, but that these could be overcome through standardized practical training. In addition, a significant improvement was achieved in respiratory symptom scores and asthma control with training in device usage.Item The effect of flexible bronchoscopy on anxiety in children(AVES Ibrahim Kara, 2016) Türkeli A.; Yılmaz Ö.; Topçu İ.; Yüksel H.OBJECTIVES: 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 to16 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 r1= 0.257; p= 0.05 and r2= 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. © 2016 by Turkish Thoracic Society.Item Does having an asthmatic sibling affect the quality of life in children?(Turkish Journal of Pediatrics, 2017) Yılmaz Ö.; Türkeli A.; Karaca Ö.; Yüksel H.Chronic 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 PedsQL™ short form appropriate for the child’s age group. Study and control groups had 114 children each. Total PedsQL™ scores were not significantly different in any of the age groups (p=0.23, p=0.13, p= 0.11 respectively). Emotional PedsQL™ 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. © 2017, Turkish Journal of Pediatrics. All rights reserved.Item Safety of subcutaneous allergen immunotherapy in children: A retrospective review and bird eye to literature(Turkish Journal of Pediatrics, 2018) Toprak-Kanık E.; Yılmaz Ö.; Yangın-Ergon E.; Türkeli A.; Yüksel H.Subcutaneous 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. © 2018, Turkish Journal of Pediatrics. All rights reserved.Item May zonula occludens proteins regulate the pathogenesis of allergic rhinitis?(Istanbul University Press, 2019) Yılmaz Ö.; Kanık E.T.; Pınar E.; Türkeli A.; Uluer E.T.; İnan S.; Yüksel H.Objectives: This study aims to investigate the expression pattern of zonula occludens (ZO) proteins, namely occludin, claudin-1, tricellulin, junctional adhesion molecules (JAM), and ZO-1,-2, and-3 in nasal mucosal biopsies of individuals with and without allergic sensitization. Patients and Methods: Between August 2011 and August 2012, a total of 69 patients (38 males, 31 females; mean age 28.0 years, range, 18 to 61 years) who underwent surgery for nasal septum deviation were included in this cross-sectional study. All patients underwent skin prick test with environmental allergen mixtures. Cup forceps biopsy samples were obtained from the inferior turbinate during septoplasty. These samples were stained immunohistochemically for occludin, claudin-1, tricellulin, JAM, and ZOs. Staining intensity was graded semi-quantitatively using the H-Score. Results: Of all patients, 14 were atopic. Occludin, claudin-1, and JAM scores were significantly lower in the mucosal samples from atopic patients, compared to the non-atopic patients (median 142.5 vs. 288, 153 vs. 296, and 156 vs. 312, respectively; p<0.001 for all). The ZO-1,-2, and-3 proteins were significantly lower in atopic patients (p<0.001 for all). The tricellulin, located at the intersection of three epithelial cells, was not significantly different between the two groups (208.5 vs. 195, respectively; p=0.686). Conclusion: Expression of the structural proteins of ZO decreases in the upper airways of asymptomatic atopic patients. These findings indicate that ZO may be an important determinant of atopic sensitization and, therefore, may be a potential target in the treatment of allergic rhinitis. © 2019 Behbut Cevanşir Otorhinolaryngology-Head and Neck Surgery Society. All rights reserved.