Ayse Gultekingil
Baskent University, Faculty of Medicine, Faculty Member
Characteristics of patients that present to PED with seizures and risk evaluation for seizure recurrence
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Abstract Introduction Gastrointestinal bleeding is a common problem in pediatric emergency department(PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the... more
Abstract Introduction Gastrointestinal bleeding is a common problem in pediatric emergency department(PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the risk factors predicting clinically significant gastrointestinal(GIS) bleeding in patients presenting to PED. Methods This study was performed prospectively from January 1st 2013 to December 31th 2013 in patients with upper or lower GIS bleeding. Clinically significant GIS bleeding was defined as more than 2 gr/dL hemoglobin decrease at any time during observation in PED, need for erythrocyte tranfusion or need for rapid endoscopic evaluation. Results 105 patients were enrolled, 81 of which were eligible for the study. Twenty two patients (26,8%) had clinically significant GIS bleeding. These patients have significantly more commonly have upper GI bleeding and symptoms of melena, pallor and tachycardia. Initial laboratory findings revealed lower hemoglobin, RBC and albumin levels with higher WBC and BUN levels. They need significantly more nasogastric tube placement and PPI and H2 blocker treatment. Final diagnosis included more gastritis and peptic ulcers. These patients have less hematochesia, less lower gastrointestinal bleeding and less commonly diagnosed as acute gastroenteritis or Mallory Weiss tear as a final diagnosis. Conclusions Pediatric emergency physicians should be aware of clinical and laboratory parameters of patients with clinically significant GIS bleeding to predict which patients are under risk of life threatening blood loss. Patients who have melena, pallor, tachycardia, anemia and uremia at presentation are more prone to have significant GIS bleeding.
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Introduction Systemic lupus erythematosus (SLE) is a multisystemic autoinflammatory disease that can involve any organ system; therefore, diagnosis can be challenging. Hereby, we present 4 cases that presented to pediatric emergency... more
Introduction Systemic lupus erythematosus (SLE) is a multisystemic autoinflammatory disease that can involve any organ system; therefore, diagnosis can be challenging. Hereby, we present 4 cases that presented to pediatric emergency department with unusual clinical pictures of SLE. Cases Case 1 presented with inability to walk or talk for the last 1 week as well as intermittent pain and swelling in her joints. Case 2 presented with generalized edema and severe dyspnea. Case 3 and 4 presented to pediatric emergency department with rashes on the legs. Discussion Systemic lupus erythematosus may mimic many clinical entities, and differential diagnosis may be difficult, especially if presentation is atypical. In every emergency physician, right diagnosis and prompt treatment are very important especially in life-threatening conditions such as cardiac involvement in SLE.
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Purpose: Successful resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. This study aimed to determine the knowledge, skills, and attitudes of the pediatric healthcare... more
Purpose: Successful resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. This study aimed to determine the knowledge, skills, and attitudes of the pediatric healthcare professionals about the defibrillator use and to offer solutions if there was room for improvement. Procedures: This was a multicenter survey study. Findings: The study included 716 healthcare professionals with an average age of 30.1 ± 5.8 years; 50% (n=358) were pediatric residents and 41.3% (n=296) had less than three years of professional experience. Self-declared level of knowledge about defibrillation/cardioversion was low-to-medium for 66.5% (n=476); 60.8% (n=435) had never practiced these procedures and 22.2% (n=159) had never received any training about defibrillator use. There was a significant relationship between professional experience and the proportion of participants who correctly responded to the first-shock dose for defibrillation but no...
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Background Cystinosis is a multisystemic disease resulting from cystine accumulation primarily in kidney and many other tissues. We intended to study the evolution of less commonly seen extrarenal complications of cystinosis in a group of... more
Background Cystinosis is a multisystemic disease resulting from cystine accumulation primarily in kidney and many other tissues. We intended to study the evolution of less commonly seen extrarenal complications of cystinosis in a group of patients who have periods without cysteamine treatment. Methods Gastrointestinal and muscular complications of cystinosis were studied in a group of 21 patients. Results Twenty one patients were included in the study. Among them, 14 were homozygous and 3 were compound heterozygous for CTNS mutations. The median age of diagnosis was 15 months (range; 5 months-14 years) and the mean age at last visit was 11.3 ± 6.5 years. Nine patients (42%) had end stage renal disease at a mean age of 10.6 years (6.5–17 years). Abdominal ultrasonography and portal vein doppler ultrasonography were performed in19 patients, 14 of them (74%) had hepatomegaly, 10 patients (53%) had granular pattern or heterogeneity of liver. Only one patient had high transaminase levels...
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Background and Objectives: The emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients’ clinical... more
Background and Objectives: The emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients’ clinical characteristics and reasons for ambulance use in Turkey. Life-saving interventions and non-life-saving interventions performed during transport and patients’ outcomes following transport were also investigated. Methods: This is a prospective-multicentric study conducted at four metropolitan cities and nine tertiary pediatric emergency departments. This survey-based study evaluated all children brought by ambulance to emergency departments. Patient demographics, clinical features, triage levels, procedures performed in the ambulance or emergency department, and final outcomes were sought. Results: A total of 2094 patients were transported during the study period. Only a minority of ambulances were physician staffed (16.5%), and 72% of the patients were deliv...
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Sixth cranial nerve (SCN) palsy is an uncommon but important neurological problem in patients admitted to pediatric emergency department. The underlying etiology of SCN palsy has a wide range from viral infections to intracranial tumors;... more
Sixth cranial nerve (SCN) palsy is an uncommon but important neurological problem in patients admitted to pediatric emergency department. The underlying etiology of SCN palsy has a wide range from viral infections to intracranial tumors; therefore, a careful and systematic approach is necessary while examining these patients. Fourteen patients who presented with acute SCN paralysis to pediatric emergency department during the last 10 years were examined. The age at the time of admission ranged between 14 months and 16 years (median, 9.5 years). Of the 14 patients, 5 were girls and 9 were boys. A total of 3 of the 14 patients had bilateral cranial nerve VI paralysis, and 9 patients had additional abnormal findings on neurological examination. Neuroimaging studies included cranial tomography (n = 3) and brain magnetic resonance imaging in all patients. The underlying etiology was malignancy (n = 3); glioma, medulloblastoma, acute lymphoblastic leukemia, and dural sinus thrombosis (n =...
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Cystinosis is a rare autosomal recessive disorder that is characterized by defective cystine transport from lysosomes to cytoplasm and cystine crystal accumulation damaging many organs and tissues especially kidneys but extrarenal systems... more
Cystinosis is a rare autosomal recessive disorder that is characterized by defective cystine transport from lysosomes to cytoplasm and cystine crystal accumulation damaging many organs and tissues especially kidneys but extrarenal systems such as endocrine system. We aim to investigate endocrinologic complications of cystinosis In our study, twenty one patients were reviewed retrospectively for endocrinologic complications. Eighteen (85.7%) had short stature, out of nine patients who reached pubertal age, five (55.5%) had pubertal delay, five patients (23.8%) had overt hypothyroidism and five patients (23.8%) had subclinical hypothyroidism with only elevated thyroid stimulating hormone (TSH) levels, seven (33.3%) had glucose intolerance, two (9.5%) had diabetes mellitus. Relation of these complications to age, renal functions and the dosage of cysteamine were studied. Endocrinologic complications of cystinosis can be seen in pediatric population and it is important to understand und...
Research Interests: Pediatrics, Adolescent, Medicine, Humans, Child, and 15 moreDiabetes mellitus, Female, Male, Hypothyroidism, Dwarfism, Short stature, Adult, Retrospective Studies, Biological markers, Glucose Intolerance, Cysteamine, Cystinosis, Subclinical Infection, Child preschool, and Paediatrics and reproductive medicine
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Background: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B... more
Background: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B infections.Purpose: This study analyzed and compared the clinical features and laboratory findings of COVID-19 and influenza A and B infections in children.Methods: This retrospective study evaluated the medical data of 206 pediatric COVID-19 and 411 pediatric seasonal influenza A or B patients.Results: COVID-19 patients were older than seasonal influenza patients (median [interquartile range], 7.75 [2–14] years vs. 4 [2–6] years). The frequency of fever and cough in COVID-19 patients was lower than that of seasonal influenza patients (80.6% vs. 94.4%, P<0.001 and 22.8 % vs. 71.5%, P<0.001, respectively). Ageusia (4.9%) and anosmia (3.4%) were present in only COVID-19 patients. Leukopenia, lymphopenia, and thrombocytopenia were encountered more ...
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AIM OF THE STUDY Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-center study is to a) assess skills of pediatric... more
AIM OF THE STUDY Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-center study is to a) assess skills of pediatric health care providers (HCPs) concerning two domains: 1) recognizing rhythm abnormalities, 2) the use of defibrillator devices, and b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several pediatric emergency cares and intensive care settings of Turkey. METHODS This cross-sectional and multi-center survey study included several pediatric emergency care and intensive care settings from different regions of Turkey. this is a survey and is cross-sectional RESULTS: A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n=303/497) of the physicians and 45.2% (n=99/219) of the non-physician healthcare staff (p<0.001). The length of professional experience had favorable outcome towards an increased self-confidence in the physicians (p<0.01, p<0.001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronized cardioversion defibrillation (p<0.001, p<0.001). Non-certified healthcare providers were less likely to manage the initial doses of synchronized cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronized cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (p=0.047, p=0.003). CONCLUSIONS The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasized in Certified BLS - ALS programs. Certified BLS - ALS programs increase the level of knowledge and self-confidence towards synchronized cardioversion - defibrillation procedures.
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Characteristics of patients that present to PED with seizures and risk evaluation for seizure recurrence
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etiology of disease could not be fully understood, it is commonly believed that there is a genetic susceptibility and the inflammatory process is triggered by an infectious agent.2,3 Genetic susceptibilty to Kawasaki disease are based on... more
etiology of disease could not be fully understood, it is commonly believed that there is a genetic susceptibility and the inflammatory process is triggered by an infectious agent.2,3 Genetic susceptibilty to Kawasaki disease are based on the observations that it is seen much more common in the same ethnic group, especially Asians and Asian Americans,4 a few reports of occurrence between siblings and in people whose parents had a history of Kawasaki disease.5,6 Several factors have been associated with genetic predisposition, including IL-4, colony stimulating factor 2, IL13 and transcription factor.7 Although parental or sibling cases are not uncommon , complex families with Kawasaki disease seen not only in siblings but also in cousins are rarely reported. We suggest that the occurrence in
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To the Editor: In respiratory tract infections, the risk of hyponatremia increases by 29%–59%, especially in bronchiolitis patients [1]. Inappropriate antidiuretic hormone (ADH) secretion and decrease of oral intake, vomiting, and... more
To the Editor: In respiratory tract infections, the risk of hyponatremia increases by 29%–59%, especially in bronchiolitis patients [1]. Inappropriate antidiuretic hormone (ADH) secretion and decrease of oral intake, vomiting, and incorrect fluid administration can exacerbate the risk [1, 2]. The aim of this study is to describe the clinical factors associated with hyponatremia. Patients diagnosed with acute bronchiolitis between 2014 and 2018 were included. Hyponatremia was described as serum sodium level < 135 mEq/L. A total of 245 patients were included. The mean serum sodium level was 136.0 ± 2.23 mEq/L and hyponatremia was detected in 52 (21.2%) patients. When hyponatremic and normonatremic groups were compared, feeding difficulties and fever were significantly more frequent in the hyponatremic group. The body temperatures of hyponatremic patients at presentation were also significantly higher and their mean oxygen saturations were lower. C-reactive protein (CRP) levels and ...
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Background: A substantial group of patients suffer coagulopathy of Covid-19 (CAC) and are presented with thrombosis. The pathogenesis involved in CAC is not fully understood.Objectives: We evaluated the hemostatic and inflammatory... more
Background: A substantial group of patients suffer coagulopathy of Covid-19 (CAC) and are presented with thrombosis. The pathogenesis involved in CAC is not fully understood.Objectives: We evaluated the hemostatic and inflammatory parameters of 51 hospitalized Covid-19 adult patients and 21 controls. The parameters analyzed were danger signal molecule (High molecular weight group box protein-1/HMGBP-1), platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, endothelial protein C receptor (EPCR), soluble E-selectin, soluble P-selectin, thrombomodulin, tissue plasminogen activator (TPA), plasminogen activator inhibitor-1 (PAI-1), soluble fibrin monomer complex (SFMC), platelet-derived microparticles (PDMP), β-thromboglobulin, antithrombin and protein C. The main objective of our study was to investigate which part of the hemostatic system was mostly affected at the admission of Covid-19 patients and whether these parameters could diff...
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Gastrointestinal bleeding is a common problem in pediatric emergency department (PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the risk factors predicting... more
Gastrointestinal bleeding is a common problem in pediatric emergency department (PED). Some of these patients can lose significant amount of blood which may lead to shock. The aim of this study is to determine the risk factors predicting clinically significant gastrointestinal (GIS) bleeding in patients presenting to PED. This study was performed prospectively from January 1st 2013 to December 31th 2013 in patients with upper or lower GIS bleeding. Clinically significant GIS bleeding was defined as >2g/dL hemoglobin decrease at any time during observation in PED, need for erythrocyte transfusion or need for rapid endoscopic evaluation. 105 patients were enrolled, 81 of which were eligible for the study. Twenty two patients (26,8%) had clinically significant GIS bleeding. These patients have significantly more commonly have upper GI bleeding and symptoms of melena, pallor and tachycardia. Initial laboratory findings revealed lower hemoglobin, RBC and albumin levels with higher WBC...
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Etiology of Kawasaki disease could not be fully understood, it is believed that there is a genetic susceptibility related to a number of genetic associations; and familial cases have been reported. Hereby we present a 7 year-old boy who... more
Etiology of Kawasaki disease could not be fully understood, it is believed that there is a genetic susceptibility related to a number of genetic associations; and familial cases have been reported. Hereby we present a 7 year-old boy who had high fever, lymphadenopathy, ...