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Publication Open Access Recommendations for clinical decision-making in children with type 1 diabetes and celiac disease: type 1 diabetes and celiac disease joint working group report(Galenos Yayınevi, 2022) Dalgıç, B.; Gökşen, D.; Aydoğdu, S.; Savaş, Erdeve Ş.; Kuloğu, Z.; Doğan, Y.; Aycan, Z.; Keser, A.; Beşer, Ö.F.; Özbek, M.N.; Bideci, A.; Ertem, D.; Evliyaoğlu, O.; Eliüz Tipici, B.; Gökçe, T.; Muradoğlu, S.; Koca, T.; Tütüncüler, F.; Baş, F.; Darendeliler, F.; Selimoğlu, M.A.; Hatun, Şükrü; Yeşiltepe Mutlu, Rahime Gül; Kızılkan, Nuray Uslu; Taşkın, Orhun Çığ; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; 153504; 153511; 221274; 166686It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.Publication Open Access Quadrant and dermatomal analysis of sensorial block in ultrasound-guided erector spinae plane block(Aves, 2022) Selvi, Onur; Tulgar, Serkan; Şerifsoy, Talat Ercan; Lance, Robert; Thomas, David Terence; Gürkan, Yavuz; Faculty Member; Koç University Research Center for Translational Medicine (KUTTAM) / Koç Üniversitesi Translasyonel Tıp Araştırma Merkezi (KUTTAM); School of Medicine; 154129Objective: as a novel procedure now gaining popularity, erector spinae plane block has been the subject of many studies. However, dermatomal coverage of the sensory block caused by erector spinae plane block has been rarely studied. The goal of this study is to evaluate the sensory block resulting from erector spinae plane block applied at the T9 vertebral level. Materials and methods: this observational, prospective, blinded study was conducted on 50 adult patients undergoing laparoscopic abdominal surgery. All patients underwent bilateral erector spinae plane block at the T9 level after completion of the surgery while under general anesthesia. In order to further evaluate the sensory blockade, we divided the hemiabdomen-hemithorax region into 4 quadrants: dorsal-medial, dorsallaterel, ventral-lateral, and ventral-medial. The sensorial evaluation was performed using the pinprick test, 2 hours following the application of erector spinae plane block. Results: a total of 28 female and 22 male patients were examined in this study. Complete failure of the block was recorded in 7 patients, with no thoracic/lumbar segmental or quadrant involvement. Successful sensory block was achieved in 67% of the dorsolateral quadrants, 58% of the dorsomedial quadrants, 69% of the ventrolateral quadrants, and 55% of the ventromedial quadrants. Conclusion: cutaneous sensory block of erector spinae plane block at T9 vertebral level revealed variable results and low failure rates. Administration of erector spinae plane block for postoperative analgesia in thoracoabdominal surgeries requires further randomized controlled trials to confirm its effectiveness and convenience.Publication Open Access Mutations in AR or SRD5A2 genes: clinical findings, endocrine pitfalls, and genetic features of children with 46,XY DSD(Galenos Yayınevi, 2022) Akcan, Neşe; Uyguner, Oya; Baş, Firdevs; Toksoy, Güven; Karaman, Birsen; Abalı, Zehra Yavaş; Poyrazoğlu, Şükran; Aghayev, Agharza; Karaman, Volkan; Bundak, Ruveyde; Basaran, Seher; Darendeliler, Feyza; Altunoğlu, Umut; Avcı, Şahin; Faculty Member; Faculty Member; School of Medicine; 126174; N/AObjective: androgen insensivity syndrome (AIS) and 5 alpha-reductase deficiency (5 alpha-RD) present with indistinguishable phenotypes among the 46,XY disorders of sexual development (DSD) that usually necessitate molecular analyses for the definitive diagnosis in the prepubertal period. The aim was to evaluate the clinical, hormonal and genetic findings of 46,XY DSD patients who were diagnosed as AIS or 5 alpha-RD. Methods: patients diagnosed as AIS or 5 alpha-RD according to clinical and hormonal evaluations were investigated. Sequence variants of steroid 5-alpha-reductase type 2 were analyzed in cases with testosterone/dihydrotestosterone (T/DHT) ratio of >= 20, whereas the androgen receptor (AR) gene was screened when the ratio was <20. Stepwise analysis of other associated genes were screened in cases with no causative variant found in initial analysis. For statistical comparisons, the group was divided into three main groups and subgroups according to their genetic diagnosis and T/DHT ratios. Results: a total of 128 DSD patients from 125 non-related families were enrolled. Birth weight SDS and gestational weeks were significantly higher in 5 alpha-RD group than in AIS and undiagnosed groups. Completely female phenotype was higher in all subgroups of both AIS and 5 alpha-RD patients than in the undiagnosed subgroups. In those patients with stimulated T/DHT <20 in the prepubertal period, stimulated T/DHT ratio was significantly lower in AIS than in the undiagnosed group, and higher in 5 alpha-RD. Phenotype associated variants were detected in 24% (n=18 AIS, n=14 5 alpha-RD) of the patients, revealing four novel AR variants (c.94G>T, p.Glu32*, c.330G>C, p.Leu110=; c.2084C>T, p.Pro695Leu, c.2585_2592delAGCTCCTG, p.(Lys862Argfs*16), of these c.330G>C with silent status remained undefined in terms of its causative effects. Conclusion: T/DHT ratio is an important hormonal criterion, but in some cases, T/DHT ratio may lead to diagnostic confusion. Molecular is for the robust of 46,XY DSD Four novel AR variants were identified in our study.Publication Open Access Lumbar plexus block performance for femur fracture for a Hamamy syndrome patient(Aves, 2022) Gürkan, Yavuz; Kalyoncu, İlayda; Gedik, Cemil Cihad; Manici, Mete; Gönen, Emel; Faculty Member; Resercher; Researcher; Faculty Member; Faculty Member; School of Medicine; 154129; 353184; 327612; 113502; 220454NAPublication Open Access The situation of nursing education in Turkey during the Coronavirus-19 Pandemic(Aves, 2021) Karaöz, Sümeyye; Üstün, Besti; Doğan, Selma; Eroğlu, Kafiye; Faculty Member; School of Nursing; 6061Aim: in this research, it is aimed to determine how applied education in nursing is carried out in Turkey, the education-teaching methods used, the difficulties experienced, and solution suggestions during the COVID-19 pandemic. Methods: the sample of the descriptive study consisted of nursing education administrators of 80 universities in Turkey that provide undergraduate education in nursing. The data were collected online between February 2021 and March 2021, in the Qualtrics program, through a questionnaire containing 43 questions about the introductory features of the institution and educational management during the epidemic process. In the evaluation of the data, descriptive statistics such as number, percentage, and mean were used. Results: in 56.6% of the institutions, the number of students was over 500, the average number of students per instructor was 36.13 ± 17.71, and there were no instructors at the rate of 13-18.8% in the courses who have intensive credit and clinical practice; 52.5% of the administrators found the skill laboratory equipment in their schools partially sufficient; 52.5% of them had problems with education before the pandemic. During the pandemic, almost all of the schools held meetings (96.1%) on how to conduct education, and the university’s top management (82.5%) and higher education institution (73.7%) were most influential in the decisions taken. It was determined that while all of the theoretical courses were conducted remotely and hybrid, only 8.8% of the laboratories and 12.5% of the clinical/ field practices were conducted face-to-face. Almost all the administrators (96.5%) stated that they could not reach the learning outcomes due to the inability to perform clinical/ field practices. Administrators have easy access to the document of the course of distance education (72.5%); they stated that distance education has positive contributions to save time and flexibility of the course time (48.8%). Conclusion: the problems experienced in nursing education programs due to the COVID-19 pandemic, especially the inability to carry out laboratory and clinical/field applications, made it difficult to reach the educational goals. For this reason, it was concluded that practical education should be made face-to-face and the missing practices should be compensated.Publication Open Access The effect of erythrocyte transfusion on pediatric patient outcomes in non-cardiac(İnönü Üniversitesi, 2022) Karaçay, Pelin; Kebapçı, Ayda; Faculty Member; Faculty Member; School of Nursing; 179331; 203808Non-kardiyak cerrahi girişim geçiren hastalarda eritrosit transfüzyonunun hasta sonuçlarına etkisini inceleyen çalışmaların sayısı oldukça sınırlıdır. Bu çalışmada amaç, non-kardiyak cerrahi girişim geçiren pediatrik hastalarda, eritrosit süspansiyonu (ES) transfüzyonunun hasta sonuçlarına etkisinin belirlenmesidir. Tanımlayıcı ve karşılaştırıcı nitelikte olan bu retrospektif çalışmaya, 2018-2020 yılında özel bir üniversite hastanesinde yatan, elektif non-kardiyak cerrahi girişim geçiren 144 çocuk hasta (ES uygulanan n=52; ES uygulanmayan n=92) dahil edildi. Verilerinin analizinde, tanımlayıcı istatistikler ve hasta sonuçlarının karşılaştırılmasında Mann-Whitney U testi kullanıldı. Çalışmada, hastaların taburculuk sırası hemoglobin (Hgb) düzeyi ve hastanede toplam kalış süreleri primer hasta sonucu ölçütleri olarak belirlendi. Her iki grup arasında taburculuk sırası bakılan Hgb değerleri (10.2 vs 10.8) arasında istatistiksel olarak anlamlı bir fark olmadığı belirlendi. Hastanede toplam yatış süreleri incelendiğinde ise; ES transfüzyonu uygulanan gruptaki hastaların hastanede yatış süresinin uygulanmayanlara göre (19.3 gün vs 6.2 gün) istatistiksel olarak anlamlı şekilde yüksek olduğu belirlendi (p<.01). Eritrosit transfüzyonu, non-kardiyak cerrahi girişim geçiren hastalarda hastanede kalış süresini uzattığını düşündürmüştür. Non-kardiyak cerrahi girişim geçiren pediatrik hastalara yönelik kısıtlayıcı transfüzyon stratejisinin kullanımına gereksinim vardır. Ayrıca multidisipliner ekip ve hemovijilans hemşireleri arasındaki iletişim arttırılarak ve hastaların klinik bulguları ve tanısı dikkate alınarak gereksiz transfüzyonu engelleyecek yaklaşımlar uygulanmalıdır. / The number of studies examining the effect of erythrocyte transfusion on patient outcomes in patients undergoing non-cardiac surgery is very limited. This study aimed to determine the effect of erythrocyte transfusion on patient outcomes in pediatric patients undergoing non-cardiac surgery. This descriptive, comparative, and retrospective study included 144 pediatric patients who underwent elective, non-cardiac surgery in a private university hospital in 2018-2020. In the analysis of the data; the Mann-Whitney U test was applied to compare descriptive statistics and patient outcomes. In the study, the hemoglobin level at the discharged time of the patients and the total hospitalization time were determined as the primary patient outcome criteria. It was determined that there was no statistically significant difference between the two groups in terms of Hgb values (10.2 vs 10.8) at discharge (p > .01). When the hospitalization time was examined; it was determined that the hospitalization period (19.3 days) of the patients in the experimental group was statistically significantly higher than the control group (6.2 days) (p < .01). Erythrocyte transfusion increased hospitalization time in hospital of pediatric patients undergoing non-cardiac surgery. There is a need for the use of a restrictive transfusion strategy for pediatric patients undergoing non-cardiac surgery. In addition, approaches should be implemented to prevent unnecessary transfusions by increasing the communication between the multidisciplinary team and hemovigilance nurses and considering the clinical findings and diagnosis of patients.Publication Open Access Use of biological agents(Galenos Yayınevi, 2022) Koç, Erol; Alper, Fatma Sibel; Faculty Member; School of MedicineBiological agents are used to treat psoriasis in patients who do not respond to conventional systemic therapies such as cyclosporine, acitretin, methotrexate, phototherapy/photochemotherapy, or for whom these therapies are contraindicated. Patients who will use these agents are selected based on the eligibility criteria for biological agents. Patients are assessed at regular intervals with relevant laboratory parameters before and during the treatment. Patients should be assessed particularly for tuberculosis, malignancies, congestive heart failure, demyelinating diseases, and infections. All necessary vaccinations should be completed before starting the treatment, if possible. Live vaccines should be avoided during the treatment, and patients who require surgical intervention should be assessed for postoperative infection risk on a case-to-case basis, and the treatment should be suspended if deemed necessary. / Biyolojik ajanlar siklosporin, asitretin, metotreksat veya fototerapi/fotokemoterapi gibi geleneksel sistemik tedavilere yanıt vermeyen ya da bu tedavilerin kontrendike olduğu durumlarda psoriasis tedavisinde kullanılırlar. Bu ajanları kullanacak hastalar biyolojik ajan için uygunluk ölçütlerine göre belirlenir. Hastalar tedavi öncesinde ve tedavi süresince uygun laboratuvar parametreleri ile belirli aralıklarla dğerlendirilirler. Hastalar özellikle tüberküloz, maligniteler, konjestif kalp yetmezliği, demiyelinizan hastalıklar ve enfeksiyonlar açısından değerlendirilmelidir. Tedaviye başlamadan önce mümkünse gerekli olan tüm aşılar yaptırılmalıdır. Tedavi esnasında canlı aşı yapılmamalı, cerrahi müdahale gerektiren hastalar postoperatif enfeksiyon riski açısından olgu bazlı değerlendirilerek gerekli görülen durumlarda tedaviye ara verilmelidir.Publication Open Access Recommendations for hepatitis B immunoglobulin and antiviral prophylaxis against hepatitis B recurrence after liver transplantation(Aves, 2021) Akarsu, Mesut; Önem, Soner; Turan, İlker; Adalı, Gupse; Akdoğan, Meral; Aladağ, Murat; Balaban, Yasemin; Danış, Nilay; Dayangaç, Murat; Gökcan, Hale; Sertesen, Elif; Gürakar, Merve; Harputluoğlu, Murat; Kabacam, Gökhan; Karademir, Sedat; Kıyıcı, Murat; İdilman, Ramazan; Karasu, Zeki; Akyıldız, Murat; Gençdal, Genco; Faculty Member; Doctor; School of Medicine; Koç University Hospital; 123080; N/AThe combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t)ide analogs after liver transplantation.Publication Open Access Being a pediatrician and living in the world of children(Aves, 2022) Hatun, Şükrü; Faculty Member; School of Medicine; 153504Publication Open Access Abnormal first and second trimester maternal serum marker levels for aneuploidy screening and adverse pregnancy outcomes(Yüzüncü Yıl Üniversitesi Tıp Fakültesi, 2021) Karakış, Lale Susan; Kıyak, Hüseyin; Yücel, Neşe; Türkgeldi, Engin; Faculty Member; School of Medicine; 329649To investigate if there is an association between pregnancy complications and abnormal maternal serum analytes used for first trimester screening (FTS) and second trimester screening (STS) for aneuploidy. More than two hundred three pregnant women who had FTS or STS for Down's syndrome who presented between July 2009 and January 2010 were included. First trimester maternal levels of PAPP-A and free hCG or 2nd trimester maternal levels of AFP, uE3 and hCG were compared between healthy pregnancies and those with preeclampsia, intrauterine growth retardation, intrauterine fetal death or oligohydramnios. PAPP-A levels less than 0.4 MoMs were related with elevated preeclampsia and fetal growth retardation risk. AFP levels over 2.5 MoMs were related with all adverse outcomes evaluated in the study including preeclampsia, fetal growth retardation, intrauterine fetal demise and oligohydramnios. While uE3 levels below 0.5 MoM were found to be related with higher preeclampsia incidence, elevated 2nd trimester hCG levels over 3.0 MoMs were associated with fetal growth retardation. No significant relationship could be established between low 1st trimester free hCG levels (less than 0.5 MoMs) and any of the adverse outcomes. First and 2nd trimester serum analytes for Down syndrome screening are significantly linked with pregnancy complications. However, because their sensitivity and positive predictive values are low, these analytes are not shown to be effective in the screening of pregnancy complications when used alone.