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    The effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases: objectives and design of a randomized controlled trial
    (Turkish National Pediatric Society, 2024) Sümengen, Aylin Akça; İsmailoğlu, Abdul Veli; İsmailoğlu, Pelin; Çeliker, Alpay; Namlısesli, Deniz; Poyraz, Ezgi; Subaşı, Damla Özçevik; Erdem, Ceren Zeren; Çakır, Gökçe Naz; N/A; Gümüş, Terman; N/A; Koç University Hospital
    Background. Understanding the severity of the disease from the parents’ perspective can lead to better patient outcomes, improving both the child’s health-related quality of life and the family’s quality of life. The implementation of 3-dimensional (3D) modeling technology in care is critical from a translational science perspective. Aim. The purpose of this study is to determine the effect of 3D modeling on family quality of life, surgical success, and patient outcomes in congenital heart diseases. Additionally, we aim to identify challenges and potential solutions related to this innovative technology. Methods. The study is a two-group pretest-posttest randomized controlled trial protocol. The sample size is 15 in the experimental group and 15 in the control group. The experimental group’s heart models will be made from their own computed tomography (CT) images and printed using a 3D printer. The experimental group will receive surgical simulation and preoperative parent education with their 3D heart model. The control group will receive the same parent education using the standard anatomical model. Both groups will complete the Sociodemographic Information Form, the Surgical Simulation Evaluation Form-Part I-II, and the Pediatric Quality of Life Inventory (PedsQL) Family Impacts Module. The primary outcome of the research is the average PedsQL Family Impacts Module score. Secondary outcome measurement includes surgical success and patient outcomes. Separate analyses will be conducted for each outcome and compared between the intervention and control groups. Conclusions. Anomalies that can be clearly understood by parents according to the actual size and dimensions of the child’s heart will affect the preoperative preparation of the surgical procedure and the recovery rate in the postoperative period. © 2024, Turkish National Pediatric Society. All rights reserved.
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    Comparison of the adolescent pregnancy outcomes between refugees and Turkish citizens
    (Turkish National Pediatric Society, 2024) Arslan, Oğuz; Tuğ, Niyazi; N/A; Giray, Burak; School of Medicine
    Background. Adolescent pregnant women have significant risk factors in terms of preterm birth, low birth weight, gestational and neonatal complications, and neonatal and infant deaths. In many countries, living as a refugee differs from living as a local citizen regarding education level, access to health services, and lifestyle. We aimed to compare the obstetric, perinatal, and neonatal outcomes of Turkish and refugee adolescent pregnant women admitted to a tertiary maternity center. Methods. The study was planned as a retrospective cross-sectional. We included adolescent pregnant women who delivered between February 2018 and August 2023. Adolescent pregnant women were divided into two groups, the Turkish group and the Syrian refugee group, and compared with each other. Results. One thousand and fifty-one Turkish and 742 refugee adolescent pregnant women were included in the study. Adolescent pregnancy rates are higher in refugees than in the Turkish group (p < 0.001). We found that maternal age (p < 0.001), preeclampsia rates (p=0.029), gestational age at delivery (p < 0.001), and cesarean delivery rates (p=0.02) were lower in refugee adolescent pregnant women. Furthermore, we found that the anemia rates (p < 0.001) and low birth weight newborn rates (p = 0.011) were higher in refugee adolescent pregnant women. Conclusions. Enhancing the outcomes of adolescent pregnancies among refugees necessitates a heightened focus on education regarding sexual reproduction, increased prenatal follow-ups, and enhanced training in family planning. © 2024, Turkish National Pediatric Society. All rights reserved.
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    Discrepancy between fingertip glucose vevels and HBA1C in an adolescent with diabetes: a fake logbook or pseudohypoglycemia?
    (AVES, 2023) N/A; Eviz, Elif; Yıldız, Amra Adrovic; Can, Ecem; Gökçe, Tuğba; Yeşiltepe Mutlu, Rahime Gül; Hatun, Şükrü; School of Medicine; Koç University Hospital
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    Letter to the editor regarding "effect of propolis on precocious puberty in female rats" - does propolis induce thelarche and gynecomastia in prepubertal children?
    (Galenos Publ House, 2023) Ağladıoğlu, Sebahat Yılmaz; Eviz, Elif; Yeşiltepe Mutlu, Rahime Gül; Hatun, Şükrü; School of Medicine; Koç University Hospital
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    Current management of Type 1 diabetes in children: guideline-based expert opinions and recommendations
    (Galenos Yayınevi, 2024) Smart, Carmel; Hanas, Ragnar; Hatun, Şükrü; Gökçe, Tuğba; Can, Ecem; Eviz, Elif; Karakuş, Kağan Ege; Yeşiltepe Mutlu, Rahime Gül; School of Medicine; Koç University Hospital
    Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycemia as far as possible and facilitation of glucose management. The International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every four years since 1995, covering more and more topics. For optimal metabolic outcomes, diabetes teams need to follow these current recommendations, adapt them to their clinical practice and provide guidance to people with T1D and their families. In this review, in the light of ISPAD 2018-2022 guidelines and clinical experiences, "10 Key Recommendations", emphasizing the importance of teamwork and the use of technology, current T1D treatment is described for practical applications.
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    Comprehensive insights into pediatric craniopharyngioma: endocrine and metabolic profiles, treatment Challenges, and long-term outcomes from a multicenter Study
    (Galenos Yayınevi, 2024) Şıklar, Z.; Özsu, E.; Kızılcan, Çetin, S.; Özen, S.; Çizmecioğlu-Jones, F.; Balkı, H.G.; Aycan, Z.; Goksen, D.; Kilci, F.; Abseyi, S.N.; Tercan, U.; Gürpınar, G.; Poyrazoğlu, Ş.; Darendeliler, F.; Demir, K.; Besci, Ö.; Özgen, İ.T.; Akın, S.B.; Kocabey, Sütçü, Z.; Aykaç, Kaplan, E.H.; Çamtosun, E.; Dundar, İ.; Sağsak, E.; Korkmaz, H.A.; Anık, A.; Özcabi, B.; Uçar, A.; Dağdeviren, Çakır, A.; Selver, Eklioğlu, B.; Kırel, B.; Berberoğu, M.; Yeşiltepe Mutlu, Rahime Gül; School of Medicine
    Objective: Craniopharyngiomas (CPG) have complex treatment challenges due to their proximity to vital structures, surgical and radiotherapeutic complexities, and the tendency for recurrence. The aim of this study was to identify the prevalence of endocrine and metabolic comorbidities observed during initial diagnosis and long-term follow-up in a nationwide cohort of pediatric CPG patients. A further aim was to highlight the difficulties associated with CPG management. Methods: Sixteen centers entered CPG patients into the & Ccedil;EDD NET data system. The clinical and laboratory characteristics at presentation, administered treatments, accompanying endocrine, metabolic, and other system involvements, and the patient's follow-up features were evaluated. Results: Of the 152 evaluated patients, 64 (42.1%) were female. At presentation, the mean age was 9.1 +/- 3.67, ranging from 1.46 to 16.92, years. The most common complaints at presentation were headache (68.4%), vision problems (42%), short stature (15%), and nausea and vomiting (7%). The surgical procedures were gross total resection (GTR) in 97 (63.8%) and subtotal resection in 55 (36.2%). Radiotherapy (RT) was initiated in 11.8% of the patients. Histopathological examination reported 92% were adamantinamatous type and 8% were papillary type. Postoperatively, hormone abnormalities consisted of thyroid-stimulating hormone (92.1%), adrenocorticotropic hormone (81%), antidiuretic hormone (79%), growth hormone (65.1%), and gonadotropin (43.4%) deficiencies. Recombinant growth hormone treatment (rhGH) was initiated in 27 (17.8%). The study showed hesitancy among physicians regarding rhGH. The median survival without relapse was 2.2 years. Median (range) time of relapse was 1.82 (0.13-10.35) years. Relapse was related to longer followups and reduced GTR rates. The median follow-up time was 3.13 years. Among the last follow-up visits, the prevalence of obesity was 38%, but of these, 46.5% were already obese at diagnosis. However, 20% who were not obese at baseline became obese on follow-up. Permanent visual impairment was observed in 26 (17.1%), neurological deficits in 13 (8.5%) and diabetes mellitus in 5 (3.3%) patients. Conclusion: Recurrence was predominantly due to incomplete resection and the low rate of postoperative RT. Challenges emerged for multidisciplinary regular follow ups. It is suggested that early interventions, such as dietary restrictions and increased exercise to prevent obesity, be implemented.
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    Two-year old girl with glial choristoma presented in a thyroglossal duct cyst
    (Turkish J Pediatrics, 2020) Peker, Önder; Eroğlu, Egemen; N/A; N/A; Şal, Oğuzhan; Özen, Mehmet Ali; Undergraduate Student; Faculty Member; School of Medicine; School of Medicine; Koç University Hospital; 341966; 293404
    Background: Neuroglial choristomas are rare entities that are composed of differentiated neuroectodermal cells presenting where they do not belong. Case: Here in this paper, we represent a two-year old patient with a very rare presentation of neuroglial choristoma which manifested itself within a thyroglossal duct cyst. In this paper we will also discuss pathogenesis, clinical manifestation, differential diagnosis and management of the neuroglial choristomas. Conclusion: In conclusion we believe this unique case may aid in understanding the pathophysiology, differential diagnosis, and management of this rare congenital anomaly.
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    Long-term evaluation of radioisotope synovectomy with yttrium-90 and rhenium-186 for chronic synovitis in pediatric hemophilia: Akdeniz University experience
    (2022) Küpesiz, Funda Tayfun; Eker, Nurşah; Boz, Adil; Akyıldız, Fikri Feyyaz; Güven, Deniz; Küpesiz, Alphan; N/A; Çevikol, Can; Doctor; N/A; Koç University Hospital; N/A
    OBJECTIVE: This study aimed to evaluate the effect of radioisotope synovectomy with Yttrium-90 and Rhenium-186 on the joints of patients with chronic hemophilic synovitis. MATERIAL and METHODS: Retrospective analysis of radioisotope synovectomy using Yttrium-90 and Rhenium-186 in pediatric hemophilia patients treated in the Akdeniz University School of Medicine between June 2005 and September 2014 was carried out. RESULTS: Eighteen patients with severe hemophilia (mean age 12.55±4.93 years) underwent a total of 32 radioisotope synovectomy procedures: 13 elbow (40.6%), nine knee (28.2%), nine tibiotalar (28.2%), and 1 metatarsal (3.1%) joint. Ten patients (55.5%) had radioisotope synovectomy to a single joint; five patients (27.8%) had simultaneous radioisotope synovectomy to two joints. Three patients with inhibitors underwent a total of five radioisotope synovectomy procedures (15.6%). In 15 patients (83.3%), hemarthrosis was reduced after radioisotope synovectomy and no further treatment was required. The other three patients (four joints) underwent repeat radioisotope synovectomy after a mean of 20.75±14.77 months. The mean follow-up period of our patients was 8.81 ± 4.87 years [9.42 years (min-max; 1-22.58)]. Uncontrolled bleeding, need for additional dose factor treatment, radioisotope leakage, and local inflammatory reaction were not observed during and after radioisotope synovectomy. CONCLUSIONS: Radioisotope synovectomy is an effective treatment method that can be used to prevent permanent joint damage in hemarthrosis and to reduce the frequency of bleeding and the use of coagulation factors. Treatment of radioisotope synovectomy should be considered before progressive joint damage has developed. /Öz: AMAÇ: Bu çalışmanın amacı, kronik hemofilik sinoviti olan hastaların eklemlerinde Yttrium- 90 ve Rhenium- 186 ile radyoizotop sinovektominin etkisini değerlendirmektir. GEREÇ VE YÖNTEM: Haziran 2005 - Eylül 2014 yılları arasında Akdeniz Üniversitesi Tıp Fakültesi`nde Yttrium- 90 ve Rhenium186 ile radyoizotop sinovektomi yapılan pediyatrik hemofili hastalarımızın verileri geriye dönük olarak analiz edildi. BULGULAR: Çalışmamızdaki 18 ağır hemofili hastasına (12,55 ± 4,93 yıl) uygulanan 32 radyoizotop sinovektomi işleminin; 13’ü (% 40,6) dirsek, 9’u (% 28,2) diz, 9’u (%28,1) tibiotalar ve biri (%3,1) de metatars eklemine yapıldı. Hastaların 10’unda (% 55,5) bir ekleme radyoizotop sinovektomi uygulandı. Aynı seansta birden çok ekleme uygulama yapılan beş (%27,8) hasta vardı ve eş zamanlı olarak en fazla iki ekleme uygulama yapıldı. İnhibitör pozitifliği olan üç hastaya toplam beş (% 15,6) işlem gerçekleştirildi. İşlem sonrası hastaların 15` inde (% 83,3) radyoizotop sinovektomi uygulanan eklemlerde kanamaların azaldığı ve izlemde tekrar bir cerrahi ya da radyoizotop sinovektomi uygulanması gerekmediği görüldü. Diğer üç hastanın dört eklemine ortalama 20,75 ±14,77 ay sonra ikinci kez uygulama yapıldı. Hastalarımızın ortalama izlem süresi 8,81 ± 4,87 yıldı [9,42 yıl (min-max; 1-22,58)]. Radyoizotop sinovektomi sırasında ve sonrasında kontrol altına alınamayan kanama, ek doz koagülasyon faktör tedavi ihtiyacı, radyoizotop sızıntısı, lokal enflamatuar reaksiyon gözlenmedi. SONUÇ: Radyoizotop sinovektomi, hemartrozda kalıcı eklem hasarını önlemek, kanama sıklığını ve pıhtılaşma faktörü kullanımını azaltmak için kullanılabilecek etkin bir tedavi yöntemidir. Radyoizotop sinovektomi, ilerleyici eklem hasarı gelişmeden önce düşünülmelidir.
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    Approaches of pediatric nephrologists to hypertensive patients in Turkey (Turkish pediatric hypertension working group study)
    (Springer, 2018) Demir, Belde Kasap; Hacıhamdioğlu, Duygu Övüç; Girişgen, İlknur; Dursun, Hasan; Çivilibal, Mahmut; Benzer, Meryem; Bıyıklı, Neşe Karaaslan; Özkayın, Neşe; Sönmez, Ferah; Taşdemir, Mehmet; Faculty Member; School of Medicine; 175867
    Objective: We aimed to evaluate the approaches of pediatric nephrologists in our country to the management of childhood hypertension. Methods: The pediatric nephrologists in our country were invited to fill out an online questionnaire including 24 questions. The answers were compared between those working in the field for <= 10 years (Group 1, n =74) and >10 years (Group 2, n = 62). Results: of 136 participants (M/F = 101/35), 52% were following a single guideline [31% Fourth Report of 2004, 17% European Society of Hypertension in 2016, and 52% American Academy of Pediatrics in 2017], which is more common in Group 1 (P =.035). The most commonly used guideline was American Academy of Pediatrics of 2017 and Group 2 used Fourth Report of 2004 more commonly (P =.042). The most common choice to diagnose hypertension was office + home + ambulatory blood pressure monitoring (59%). The frequency of screening for end-organ damage at first evaluation was 96%. The time to wait for the effect of lifestyle modifications was 3 months in 52%. The first choice medication was angiotensin-converting enzyme inhibitors (49%) or calcium-channel blockers (48%) in non-obese and angiotensin-converting enzyme inhibitors (74%) in obese children. Calcium-channel blockers were more commonly prescribed as the first choice in non-obese children in Group 1 (P =.035). The most accessible emergency drug was esmolol. Conclusion: Despite following recent guidelines, the time spent in the proficiency would change the practices.