Researcher:
Soysal, Elif

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Elif

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Soysal

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Soysal, Elif

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2016 - 20193

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    The role of supportive treatment in the management of hyperammonemia in neonates and infants
    (Karger, 2019) Demirkol, Demet; Zeybek, Çigdem Aktuğlu; Karacabey, Burçin Nazlı; Cesur, Yaşar; Ataman, Yasemin; Soysal, Elif; Researcher; School of Medicine; N/A
    Background: The objective of this study is to investigate the efficacy of continuous renal replacement therapy (CRRT), mainly continuous venovenous hemodiafiltration (CVVHDF), and evaluate vasoactive requirements in hyperammonemic neonates and infants. Methods: Patients who underwent CRRT for hyperammonemia were retrospectively analyzed. Measurements and Main Results: Patients in 7 of the encounters were treated solely by CVVHDF. During 3 encounters, patients who received continuous venovenous hemodialysis (CVVHD) were transitioned to CVVHDF. CVVHD was used in 3 encounters. The median 50% reduction time for ammonia was 8 h (range 3-15 h). The median duration of CRRT treatment was 40 h (range 24-89 h). Survival to hospital discharge occurred in 12 encounters (92.3%). Eleven encounters (84.6%) were treated with different vasoactive agents. In those encounters, the median vasoactive medications' start time was the 6th hours (range 2-60 h) of CRRT. There was no association between the vasoactive index score and pre-dialysis ammonia concentration. Conclusions: CRRT achieves timely control of hypeammonemic states. Hemodynamic instability necessitating intervention with vasoactive medications is a common finding in patients with hyperammonemia.
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    Pediatric patients on ketogenic diet undergoing general anesthesia-a medical record review
    (Elsevier Science Inc, 2016) Gries, Heike; Wray, Carter; N/A; Soysal, Elif; Researcher; School of Medicine; Koç University Hospital; N/A
    Study objective: To identify guidelines for anesthesia management and determine whether general anesthesia is safe for pediatric patients on ketogenic diet (KD). Design: Retrospective medical record review. Setting: Postoperative recovery area. Patients: All pediatric patients who underwent general anesthesia while on KD between 2009 and 2014 were reviewed. We identified 24 patients who underwent a total of 33 procedures. All children were on KD due to intractable epilepsy. The age of patients ranged from 1 to 15 years. Intervention: General anesthesia for the scheduled procedures. Measurements: Patients' demographics, seizure history, type of procedure; perioperative blood chemistry, medications including the anesthesia administered, and postoperative complications. Main results: Twenty-four patients underwent a total of 33 procedures. The duration of KD treatment at the time of general anesthesia ranged from 4 days to 8 years. Among the 33 procedures, 3 patients had complications that could be attributable to KD and general anesthesia. A 9-year-old patient experienced increased seizures on postoperative day 0. An 8-year-old patient with hydropcephalus developed metabolic acidosis on postoperative day 1, and a 7-year-old patient's procedure was complicated by respiratory distress and increased seizure activity in the postanesthesia care unit. Conclusion: This study showed that it is relatively safe for children on KD to undergo general anesthesia. The 3 complications attributable to general anesthesia were mild, and the increased seizure frequencies in 2 patients returned back to baseline in 24 hours. Although normal saline is considered more beneficial than lactated Ringer's solution in patients on KID, normal saline should also be administered carefully because of the risk of exacerbating patients' metabolic acidosis. One should be aware of the potential change of the ketogenic status due to drugs given intraoperatively.
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    Thyroid hormone levels in late preterm, early term and term infants: a study with healthy neonates revealing reference values and factors affecting thyroid hormones
    (De Gruyter, 2017) Erçin, Seçil; Gürsoy, Tuğba; Aktaş, Özge Nur; Soysal, Elif; Esencan, Ecem; Faculty Member; Resercher; School of Medicine; Koç University Hospital; 214691; N/A; N/A; N/A
    Background: Thyroid function tests in neonates have been challenging to interpret because their levels are affected by several neonatal and delivery-related factors. The aim of the study was to evaluate reference values of thyroxine (T4) and thyrotropin (TSH) levels in different gestational age groups and to demonstrate the affect of perinatal factors on thyroid hormones. Methods: Medical records of 7616 neonates whose gestational age ranges between 34 and 42 weeks were analyzed retrospectively. Gender, mode of delivery, gestational age, postnatal age and birth weight were noted together with TSH and T4 levels. Results: Gestational age (r = 0.14, p < 0.001) and birth weight (r = 0.12, p < 0.001) had positive correlation with T4 levels, whereas they had no effect on TSH levels. Males had higher TSH and lower T4 levels (p = 0.001 for both) compared with females. T4 levels of babies born via vaginal delivery were lower than the ones born via cesarean section (p = 0.01). Multivariable analysis yielded gestational age as the only factor affecting T4 levels (p < 0.001). T4 and TSH levels based on 2.5-97.5 percentile cutoffs according to gestational age were presented. Conclusions: The thyroid hormone ranges given in this study can help pediatricians to interpret the thyroid hormone results with ease.