Browsing by Author "Girgin, Nurten"
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Item Çok düşük doğum ağırlıklı prematüre bebeklerin okul çağında gelişimlerinin değerlendirilmesi(Sağlık Bilimleri Enstitüsü, 2007) Ünal, Özlem; Girgin, Nurten; Çocuk Sağlığı ve HastalıklarıThis study aims to: 1) determine the developmental status at school age of children who received care in the Newborn Intensive Care Unit (NICU) at Ankara University Department of Pediatrics due to very low birth weight (VLBW) and 2) to develop an assessment method which can facilitate the developmental follow up of these children during health care encounters. The design of the study is cross sectional and non experimental. Of the 46 children children born with VLBW and cared for in the NICU in the year 1999, 8 died and 13 were living outside of Ankara. If the 25 living in Ankara, 21 could be contacted at age 7 and comprised the study sample (88%). The pediatrician?s evaluation included an interview with the parents and a thorough physical examination including neurological examination and vision screening. The pediatric assessment package referred to as the Guide for Monitoring Child Development in the School Age (GMCD-SA) was developed by adapting and compiling different screening tests such as Parent?s Evaluation of Developmental Status (PEDS), the Pediatric Symptom Checklist (PSC), problem behavior items from Vineland Adaptive Behavior Scales (VABS), School Performance Screening Test, Functional Independence Measure For Children (Weefım) and Draw-A-Person Test. The child psychiatrist?s evaluation was conducted one week within the pediatric assessment. This included results of the WISC-R administered by a psychologist, and a diagnostic assessment with the Schedule For Affective Disorders And Schizophrenia For School Age Children Present And Life Time Version (KSADS- PL). The pediatrician and child psychiatrist were blinded to each other?s results throughout the study until completion of all data collection. Most children were singleton (67%), boys (57%) and with birth weights between 1000-1500 grams (median 1200 g). Median age at assessment was 7,1 years (6,5 ? 7,9). The morbidity rates in 21 children were as follows: 10 children were diagnosed with behavior problems (47,6%), 7 with attention deficit hyperactivity disorder (33,3%), 5 (23,8%) with borderline IQ, 1 with learning disability (4,7%), and 1 child was diagnosed with major neurologic sequel involving spastic cerebral palsy. The overall sensitivity and specificity of the pediatrician?s screen using the GMCDSA to detect at least one problem that would lead to difficulties in functioning in school when compared to the gold standard assessment by the child psychiatrist was 80% (CI:0,54 ? 0,92) and 66,7% (CI:0,66 ? 0,90), respectively. The GMCD-SA added 20 minutes to the standard pediatric visit. Of the 16 children detected with at least one diagnosis only 5 had been detected before this evaluation and had received services. This study of the school age outcome of VLBW children from Turkey -a low to middle income country- has shown that although rates of mortality and major morbidity are low, minor morbidity including, behavioral problems, attention deficit hyperactivity disorder, cognitive problems, and learning disability is high and remains undetected at age seven. The GMCD-SA developed for the purposes of early detection during health visits has the potential to be used in countries such as Turkey to guide health providers and caregivers to determine the child?s need for additional support and services.Item Çölyak hastalığı olan çocuklarda kemik mineral dansitesinin uzun süreli izlenimi(Tıp Fakültesi, 2007) Kırsaçlıoğlu, Ceyda Tuna; Girgin, Nurten; Çocuk Sağlığı ve HastalıklarıAim To evaluate effect of long term gluten free diet on bone mineral density (BMD) in children with celiac disease. Material- Method Thirthy seven children with celiac disease, diagnosed based on European Society of Pediatric Gastroenterology and Hepatology revised criteria, were recriuted to study in Ankara University, Faculty of Medicine, Pediatric Gastroenterology Department. None of them had a chronic illness or treated with a drug which effects bone metabolism. Serum total protein, albumin, total calcium, inorganic phosphorous, alkalen phosphatase, parathormone (PTH) and BMD in lumbar 2-4 vertebra (L2-4) were evaluated at diagnosis and follow up. Bone mineral density in L 2-4 were compared with age and sex matched mean BMD in L2-4 of 143 healty children. Results Mean BMD of celiac patients (0.5073 ± 1, 14 g/cm2) was significantly lower than control group (p= 0.005) at diagnosis. Seventeen (45.9%) patients had osteopenia and 4 (10.8%) had osteoporosis with respect to aged matched z score. Mean age, height, body weight and L2-4 BMD both positively corelated to each other (p<0.001), but there were no relation between L2-4 BMD and calcium, phosphorus, alkalene phosphatase, PTH levels. Mean follow up period were 3.56 ± 2.29 years (1-8 years). Mean height, body weight, total calcium and alkalen phosphatase, BMD L2-4, aged matched z score significantly increased at the end of the first year with GFD. Twenty one patients were strictly compatible to GFD (group 1), and 16 patients were partly on GFD (group 2). Mean BMD levels was not statisticaly different at diagnosis and follow up between group 1 and 2. While the mean BMD of group 1 (0.4758 g/cm2 ) was significantly lower than control group (p= 0.014), no difference was found between group 2 and control group. Two patients who didn't strictly compatible to GFD, developed osteoporosis on follow up. Conclusion Bone mineral density can be restored with GFD. We consider BMD of all children with celiac disease should be evaluated at diagnosis and follow up until the end of growth up period. Due to increased risk of osteopenia and osteoporosis, they should be critically followed up, if they don't strictly compatible to GFDItem Mesalamine Intolerance in Three Children with Crohn's Disease(2016) Kirsaclioglu, Ceyda Tuna; Kuloglu, Zarife; Ustundag, Gonca; Kansu, Aydan; Ince, Erdal; Ensari, Arzu; Girgin, Nurten; TIP FAKÜLTESİObjective: To present the mesalamine-induced acute exacerbation of symptoms and inflammatory markers in children with Crohn's disease (CD). Clinical Presentation and Intervention: Three children who presented with CD had acute exacerbation of colitis symptoms or elevated inflammatory markers when mesalamine was added to treatment while tapering/ceasing steroid treatment. While on steroid treatment, the patients maintained clinical and laboratory remission, but with the initiation of mesalamine treatment, they had abdominal pain and bloody mucoid diarrhoea and/or elevation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Bacterial pathogens were excluded from the urine, throat and blood cultures, parasites with stool examination, viral pathogens with serology. Within 3-7 days after the mesalamine treatment had been stopped, the patients showed improvement of colitis symptoms and normalisation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Conclusion: In this study mesalamine mimicked CD relapse in children with CD while tapering or after stopping steroid treatment. Awareness of this side effect of mesalamine could prevent a misdiagnosis of steroid dependency. (C) 2015 S. Karger AG, BaselItem Mesalamine intolerance in three children with Crohn’s disease(2015) Tuna Kırsaçlıoğlu, Ceyda; Kuloğlu, Zarife; Üstündağ, Gonca Handan; Tanca, Aydan; İnce, Erdal; Ensari, Arzu; Girgin, Nurten; Tıp Fakültesi