Retrospective assessment of growth hormone replacement therapy ın growth hormone deficient patients

Bu çalışmada, Uludağ Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Bilim Dalımız'da büyüme hormonu (BH) eksikliği tanısıyla tedavi alan çocukların lineer büyümeleri, kilo artışı, kemik yaşı ilerleme durumu ve puberte ilerleme hızlarının değerlendirilmesi amaçlandı. Ocak 1995-Aralık 2005 tarihleri arasındaki veriler retrospektif olarak değerlendirildi.Toplam 230 hasta çalışmaya alındı. Hastalar Grup-1; İzole BHE, Grup-2; Turner sendromu ve Grup-3; Diğer olarak ayrıldı.Tanı aşamasında bakılan ortalama maksimum BH yanıtı klonidin stimülasyon testi için 4,58 ng/ml, glukagon stimülasyon testi için ise 6,01 ng/ml bulundu. Ortalama BH dozu 0,215 (0,15- 0,46) mg/kg/hafta olarak belirlendi. BH tedavisi ile her üç grupta da boy SDS anlamlı olarak arttı (p<0,05). Tedavi süresince takvim yaşı ile kemik yaşı arasındaki farkın Grup-1 ve Grup-2 de birinci ve ikinci yıllarda azaldığı görüldü (p<0,05). Kemik yaşındaki ilerleme, TY/KY oranındaki azalma ile teyid edildi. KY daki ilerlemeye karşın öngörülen boy olumsuz etkilenmedi. Klonidin ve glukagon uyarısına maksimum BH yanıtı ile boy uzaması arasındaki ilişki Grup-1 için negatif yönde anlamlı bulundu (P<0,05). Boy uzaması ile BH dozu arasında pozitif yönde, başlangıç takvim yaşı arasında negatif yönde anlamlı bir ilişki saptandı (p<0,05). Serum IGF-1 SDS'leri ile boy uzaması arasında anlamlı ilişki saptanmadı (p=0,120). Boy uzaması ile öngörülen boy arasında; Grup-1 ve Grup-2 için 1. yılda pozitif yönde anlamlı bir ilişki saptandı (p<0,05). Toplam 180 hastanın hipofiz veya kranial MR'ı mevcuttu. Bunların % 78'i normaldi. Toplam 41 hastamız nihai boya ulaştı. Bu hastaların 27 tanesi hedef boylarına ulaştı.We aimed to investigate the linear growth, weight gain, bone age progression, and pubertal pace of children on growth hormone treatment followed in our Division of Pediatric Endocrinology at Uludag University. The data between January 1995 and December 2005 were analyzed retrospectively.A total of 230 patients were included. The patients were classified as isolated growth hormone deficiency (Group-1), Turner syndrome (Group-2), and others (Group-3). The mean maximum GH response to clonidin and glucagon stimulation tests was 4.58 and 6.01 ng/ml respectively. The mean GH dose was 0.215 (0.15- 0.46) mg/kg/week. Height SDS significantly increased in all three groups (p<0.05). The difference between the chronologic age (CA) and bone age (BA) decreased in Groups-1 and 2 during the first and second years of treatment (p<0.05). The BA acceleration was verified by the decrement in CA/BA ratio. However, predicted height was not negatively influenced despite BA advancement. There was a negative correlation between the response to GH treatment and the maximum GH response to stimulation with clonidin and glucagon (p<0.05). There was a positive correlation between response to treatment and GH dose and a negative correlation between response to treatment and the CA at the beginning of therapy (p<0.05). There was no correlation between the initial serum IGF-1 SDS and response to therapy (p=0,120). There was a positive correlation between the height velocity and the predicted height at the end of the first year of treatment for Groups-1 and 2 (p<0.05). Magnetic resonance imaging of the pituitary gland was available in 180 patients and 78% was normal. Forty one patients reached final height twenty seven of whom could attain their target height

Multicenter prospective surveillance study of viral agents causing meningoencephalitis.

The frequency of bacterial factors causing central nervous system infections has decreased as a result of the development of our national immunization program. In this study, it is aimed to obtain the data of our local surveillance by defining the viral etiology in cases diagnosed with meningoencephalitis for 1 year. Previously healhty 186 children, who applied with findings suggesting viral meningoencephalitis to 8 different tertiary health centers between August 2018 and August 2019, in Istanbul, were included. The cerebrospinal fluid (CSF) sample was evaluated by polymerase chain reaction. The M:F ratio was 1.24 in the patient group, whose age ranged from 1 to 216 months (mean 40.2 +/- 48.7). Viral factor was detected in 26.8%. Enterovirus was the most common agent (24%) and followed by Adenovirus (22%) and HHV type 6 (22%). In the rest of the samples revealed HHV type 7 (10%), EBV (6%), CMV (6%), HSV type 1 (6%), Parvovirus (4%) and VZV (2%). The most common symptoms were fever (79%) and convulsions (45.7%). Antibiotherapy and antiviral therapy was started 48.6% and 4% respectively. Mortality and sequela rate resulted 0.53% and 3.7%, respectively. This highlights the importance of monitoring trends in encephalitis in Turkey with aview to improving pathogen diagnosis for encephalitis and rapidly identifying novel emerging encephalitis-causing pathogens that demand public health action especially in national immunisation programme

İstanbul İlinde Viral Meningoensefalit Ön Tanılı Çocuk Vakalarda Bir Yıllık Sürveyans; Çok Merkezli Prospektif Gözlemsel Çalışma

Giriş: Ulusal bağışıklama programımızın gelişmesi sonucunda merkezi sinir sistemi enfeksiyonlarına neden olan bakteriyel etkenlerin sıklığı azalmıştır. Meningoensefalit tanısı alan hastalarda ağırlıklı olarak viral etkenlerin saptandığı bilinmektedir. Bu çalışmada bir yıl süreyle meningoensefalit ön tanılı vakalarda etiyolojiyi tanımlayarak yerel sürveyansımıza ait veri eldesi hedeflenmiştir.Materyal-Metod: İstanbul ilinde, Ağustos 2018 ile Ağustos 2019 tarihleri arasında, toplam sekiz üçüncü basamak niteliğindeki merkezden, viral meningoensefalit düşündürebilecek bilinen hastalığı olmayan 186 çocuk, aile onamının ardından çalışmaya alındı. Alınan beyin omurilik sıvısı(BOS) örneği, rutin tetkiklerin yanında polimeraz zincir reaksiyonu ile değerlendirildi. Bu çalışma. Türk Pediatri Kurumunu tarafından “Başlangıç AR-GE projeleri destekleme programı” çerçevesinde desteklenmiştir.Bulgular: Yaş aralığı 1-216 ay arasında (ortalama 40,2±48,7) değişen hasta grubunda erkek kız oranı 1,24 idi. Çalışılan örneklerin %26,8’inde viral etken saptandı. Etkenlerden %24(n=12) oran ile Enterovirus ilk sırada yer alırken, bunu %22(n=11) oran ile Adenovirus ve yine %22(n=11) oran HHV tip 6(n=11) takip etti. Örneklerin geri kalanında ise sırasıyla HHV tip 7(%10, n=5), EBV(%6, n=3), CMV(%6, n=3), HSV tip 1(%6, n=3), Parvovirus(%4, n=2) ve VZV(%2, n=1) olarak saptandı. Bir hastada hem enterovirus hem de HHV 7 saptandı. BOS örneğinde viral ajan saptanamayan bir hastanın ise kan kültüründe meningokok üremesi oldu. Viral etken saptanan vakalarda en sık gözlenen semptomlar sırasıyla %78 ateş ve %46 oranıyla konvülziyondu. Başvuru değerlendirmesi sonrasında %11,2(n=21) oranında yoğun bakım izlemi gerektiği görüldü. Başvuru döneminde bakılan akut faz reaktanlarında (C reaktif protein) %57,5 oranında pozitiflik saptandı. Özgeçmişleri değerlendirilen hastaların %82,2(n=153) oranında bakanlık takvimine ve yaşlarına uygun olarak bağışıklandığı görüldü. Hastaların %48,6’sına sadece antibiyoterapi, %4’üne sadece antiviral ve %47,3’üne hem antibiyoterapi hem de antiviral tedavi uygulanmış. İnternazisyon ile yapılan takipleri sonrasında hastaların %94,6’sı şifa ile taburcu edildi. Mortalite ve sekel oranı sırasıyla %0 ve %3,7 olarak sonuçlandı.Sonuç: Bu çalışma; ülkemiz nüfusunun %18,6’sını içerecek kadar yoğun bir popülasyonun yaşadığı İstanbul ilinde; bir yıllık süre zarfında seçilmiş hasta grubundaki viral sürveyansı ortaya koymuştur

COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey

To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions. Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available. What is Known: • COVID-19 in infants and older children has been seen more mildly than in adults. • The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever. What is New: • Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children. • Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital

Antibiotic associated diarrhea in outpatient pediatric antibiotic therapy

Background: Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. Methods: The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. Results: A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. Conclusion: This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region

A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey

This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). 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. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children

SARS-CoV-2 seropositivity among pediatric health care personnel just after the first peak of pandemic: A nationwide surveillance.

BACKGROUND: COVID-19 pandemic affected every single person on earth one way or the other. The healthcare personnel were no exception, their responsibilities as well as their risks being immense. METHODS: 4927 healthcare personnel all working in pediatric units at 32 hospitals from seven different regions of Turkey enrolled to the study to determine the seroprevalence of SARS Co-V-2 after the first peak wave. Point of care serologic lateral flow rapid test kit for IgM/IgG was used (Ecotest CE Assure Tech. Co. Ltd.). Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. RESULTS: Nearly 6.1% of healthcare personnel were found to be seropositive for SARS Co-V- 2. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19 co-worker increased the likelihood of infection. The least and the most experienced personnel affected more. Most of the seropositive healthcare personnel (68%) did not have any suspicion that they had COVID-19 previously. CONCLUSIONS: Health surveillance for healthcare personnel involving routine point-of-care nucleic acid testing as well as monitoring PPE adherence would be important strategies to protect healthcare personnel from COVID-19 and to reduce nosocomial SARS-CoV-2 transmission

Education of healthcare personnel working with pediatric patients during covid-19 pandemic within the framework of infection control Covid-19 pandemisinde enfeksiyon kontrol çalışmaları çerçevesinde çocuk hastalarla çalışan sağlık personeli eğitimi

© 2020, AVES. All rights reserved.Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic

Evaluation of vaccination status of health care workers for recommended vaccines and their acceptance of SARS-CoV-2 vaccines

© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.Introduction: Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs’ hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19. Method: A short survey was carried out in May–June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region. Results: In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines. Conclusion: Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs