ISSN 1302-9940 | e-ISSN 1308-8491

Hzl Arama




ocuk Dergisi - J Child: 19 (3)
Cilt: 19  Say: 3 - 2019
1.
Kapak
Cover

Sayfa I

2.
indekiler
Contents

Sayfalar II - V

3.
Yazarlara Bilgi
Author Information

Sayfalar VI - VII

DERLEME
4.
Fosfat Metabolizmas
Phosphate Metabolism
Hasan nal
doi: 10.5222/j.child.2019.43650  Sayfalar 105 - 115
Serum fosfatn fizyolojik aralkta korunmas birok biyolojik ilem iin kritiktir. Fosfat, kemiklerin, nkleik asitlerin, hcre zarlarnn nemli bir bileenidir ve hcresel enerji metabolizmasnda, proteinlerin fosforilasyonuyla hcre ii sinyalizasyonda ve hemoglobinden oksijen salnmasnda nemli bir rol oynar. Fosfat nemli bir idrar ve kan asidi baz tamponudur.
Serum fosfor seviyesi, barsak emilimi, hcre ii ve kemik depo havuzlarnn deiimi ve renal tbler yeniden emilim arasndaki karmak bir etkileimle salanr. Bbrek, bbrek tbler yeniden emilim ile fosfor homeostaznn dzenlenmesinde nemli bir rol oynar. Tip IIa ve tip IIc Na tayclar, proksimal tbler hcrelerin fra snr membrannda ifade edilen nemli renal Na baml inorganik fosfat tayclardr. Her ikisi de diyet ile inorganik fosfat alm, D vitamini, fibroblast byme faktr 23 (FGF23) ve paratiroid hormonu (PTH) tarafndan dzenlenir.
Maintenance of serum phosphate in the physiological range is critical for many biological processes. Phosphate is an essential component of bones, nucleic acids, and cell membranes, and it plays a crucial role in cellular energy metabolism, intracellular signaling by phosphorylation of proteins, and release of oxygen from hemoglobin. Phosphate is an important urinary and blood acid base buffer.
The serum phosphorus level is maintained through a complex interplay between intestinal absorption, exchange intracellular and bone storage pools, and renal tubular reabsorption. The kidney plays a major role in regulation of phosphorus homeostasis by renal tubular reabsorption. Type IIa and type IIc Na transporters are important renal Na dependent inorganic phosphate transporters, which are expressed in the brush border membrane of proximal tubular cells. Both are regulated by dietary inorganic phosphate intake, vitamin D, fibroblast growth factor 23 (FGF23) and parathyroid hormone.

5.
Grup B Meningokok Enfeksiyonlar ve Alama
Group B Meningococcal Infections and Vaccination
zge Kaba, Ayper Somer
doi: 10.5222/j.child.2019.06926  Sayfalar 116 - 123
Dnyann heryerinde endemi ve epidemilere neden olan meningokokal enfeksiyonlar, saatler ierisinde mortalite ile sonulanan tablolara yol aabilir. Corafi zellikler, konak faktr, mikroorganimann serogrubu gibi faktrler seyri etkilemektedir. Edinilen srveyans verilerine gre epidemilere en sk neden olan serogruplar A, B, C, W135 ve Y olarak belirlenmitir. Bunun zerine gelitirilen A, C, W135 ve Y serogruplarn ieren yeni meningokok alar ile tm dnyada bu serogruplarn grlme oran belirgin olarak azalma gstermitir. lkemizde ise baklama programnn Hib ve pnmokok alarnn eklenmesiyle zenginletirilmesinden sonra meningokokal hastalklar arpc bir ekilde kendini gstermitir. n planda olduu grlen serogrup Bye kar korunmann yollar aranm ve son dnemde ters vaksinoloji yntemiyle serogrup B as(4CMenB) gelitirilmitir.
Meningococcal infections leading to endemics and epidemics all over the world can lead to mortality resulting in hours. Factors such as geographical characteristics, host factors, serogroup of microorganism affect the course. According to the surveillance data, serogroups A, B, C, W135 and Y were the most common causes of epidemics. With the new meningococcal vaccines including serogroups A, C, W135 and Y, the incidence of these serogroups decreased significantly all over the world. In our country, meningococcal diseases have been striking after the immunization program has been enriched with the addition of Hib and pneumococcal vaccines. Protection against serogroup B, which appears to be in the forefront, has been sought and recently, serogroup B vaccine (4CMenB) has been developed by reverse vaccination method.

ARATIRMA
6.
ocukluk a Hodgkin Lenfoma Nedeniyle Tedavi Gren Hastalarda Tiroid Fonsiyonlarnn Deerlendirilmesi
Evaluation of Thyroid Functions in Patients Treated Pediatric Hodgkin Lymphoma
Mehmet Eltan, Ferhan Akc, Gnl Aydoan, Zafer alcolu, Ali Er, Hasan nal, Aya riba, Mehmet Emin Darendeliler, Deniz Tucu
doi: 10.5222/j.child.2019.45822  Sayfalar 124 - 131
GR ve AMA: ocukluk a Hodgkin Lenfoma tedavisinde sakalm oran ve sresi uzadka, tedavi sonucu gelien yan etkilerin grlme skl artmakta ve tedavinin ge etkileri giderek nem kazanmaktadr. Bu almada ocukluk anda Hodgkin Lenfoma nedeniyle tedavi gren hastalarda, kemoterapi ve radyoterapinin tiroid fonksiyonlar zerine ge yan etkilerinin deerlendirilmesi amaland.
YNTEM ve GERELER: stanbul Salk Bilimleri niversitesi, Kanuni Sultan Sleyman Eitim ve Aratrma Hastanesi, ocuk Hematoloji ve Onkoloji Kliniinde, 1994-2013 yllar arasnda Hodgkin Lenfoma tans ile tedavi grp, remisyonda olarak izlenen, en az 6 aydr tedavi almayan, 34 erkek, 6s kz olmak zere toplam 40 hastann tiroid fonksiyonlar retrospektif olarak incelendi.
BULGULAR: Tan alan hastalarn ya ortalamas 14.136.081(dalm: 4-31), erkek/kz oran 34/6 (%85/%15) idi. Ortalama takip sresi 5.54 3.68 yl (0,92-13,92)idi. Tm hastalara kemoterapi verildi. Boyun blgesine radyoterapi 37 hasta (%92,5) almt. Ortalama radyoterapi dozu 21.48754.48726 Gy idi. Hastalarmzda %72.5 orannda primer hastalk ba-boyun blgesine lokalize idi. B semptomu 7 hastada (%17,5) vard.
Krk hastann 12inde(%30 hasta) hipotiroidi saptand, 5 hastaya (%41) klinik hipotiroidi tansyla replasman tedavisine baland. Bu hastalarn 11i erkek (%91), 1i kzd (%9). Hastalarmzn 5inde (%12.5) yaplan tiroid USGsinde tiroid bezi nodl saptand. Tiroid nodl saptanan toplam 5 hastann 3 erkek (%60), 2si kzd(%40). Hipotiroidi gelime zaman 3.102.02 yl, tiroid nodl oluma zaman 8.907.10 yl olarak saptand. Tiroid sintigrafisi ve tiroid ultrasonografi sonularna gre seilen hasta tiroid biyopsisine ynlendirildi, malinite saptanmad.

TARTIMA ve SONU: Pediatrik Hodgkin Lenfoma hastalarnda radyasyona bal tiroid hastalklar, tedaviden sonraki yllarda, hastalk remisyonda iken geliebilir. zellikle boyun radyoterapisine maruz kalm hastalar, tiroid fonksiyon bozukluklarnn ortaya kmas asndan yakndan takip edilmelidir.
INTRODUCTION: As the survival rate and duration increases in the treatment of childhood Hodgkin's Lymphoma, the incidence of side effects resulting from the treatment increases and the late effects of the treatment become increasingly important. The aim of this study was to evaluate the late side effects of chemotherapy and radiotherapy on thyroid functions in patients treated for Hodgkin's Lymphoma in childhood.
METHODS: Thyroid functions of 40 patients who were treated with diagnosis of Hodgkin's Lymphoma, between 1994 and 2013, followed up in remission in Istanbul Health Sciences University, Kanuni Sultan Sleyman Training and Research Hospital, Department of Pediatric Hematology and Oncology, were evaluated retrospectively.
RESULTS: The mean age of the patients was 14.136.081 (range: 4-31) years, and the male / female ratio was 34/6 (85%/15%). The mean follow-up period was 5.543.68 years (0.92-13.92). All patients received chemotherapy. Thirty seven patients (92.5%) received radiotherapy to the neck region. The mean radiotherapy dose was 21.48754.48726 Gy. Primary disease was localized to head and neck region in 72.5% of our patients. B symptoms were present in 7 patients (17.5%).
Hypothyroidism was detected in 12 of 40 patients (30%) and replacement therapy was started in 5 patients (41%) with the diagnosis of clinical hypothyroidism. Eleven (91%) of these patients were male and 1 (9%) was female. Thyroid gland nodules were detected in 5 (12.5%) of our patients. Of 5 patients with thyroid nodules, 3 were male (60%) and 2 were female (40%). Hypothyroidism was 3.102.02 years and thyroid nodule was 8.907.10 years. Three patients who were selected according to thyroid scintigraphy and thyroid ultrasonography results were referred to thyroid biopsy and no malignancy was detected.

DISCUSSION AND CONCLUSION: Radiation-induced thyroid diseases in pediatric Hodgkin's Lymphoma patients may develop during the years following treatment, when the disease is in remission. In particular, patients exposed to neck radiotherapy should be closely monitored for the occurrence of thyroid dysfunction.
Keywords: Hodgkin's Lymphoma, childhood, chemotherapy, thyroid, late side effect


7.
Yuva ocuklarnda Bakl Destekleyici lalarn Solunum Yolu Enfeksiyonlarn nlemedeki Etkinlii
Evrim enkal, Sadk Toprak, yk zbr Akan, Canan Abdullah Gl, Ferit Duranku, Cokun Saf, Emin nvar
doi: 10.5222/j.child.2019.76993  Sayfalar 132 - 137
GR ve AMA: Salkl yuva ocuklarnda sonbahar ve k aylarnda solunum yolu enfeksiyonlar skln azaltmak iin bakl destekleyen birok ila aileler tarafndan yaygn olarak kullanlmaktadr. Bu aratrmada kre ocuklarnda bakl desteklemek amacyla verilen bu tr ilalarn yarar olup olmadn gstermeyi amaladk.
YNTEM ve GERELER: Aratrma stanbul un Tuzla ilesinde, farkl krete, yalar 64,1+/-10,3 ay olan 74 ocuk ile yrtld. Gvenilir anket bilgilerine ulalabilen 44 ocuun bilgileri ile aratrma tamamland (44/74, %58,6). Bunlardan 24 destek alan alma grubunu, geri kalan 20 si kontrol grubunu oluturdu. Anket formlar ile ocuklarn baklk destekleyici kullanp kullanmadklar ve geirdikleri hastalklara bal olarak kree devamszlk sreleri (gn) sorguland. Her ocuun okula devamsz olduu gn says ile baklk destekleyici kullanm arasndaki iliki incelendi.
BULGULAR: Destek alan alma grubunda devamszlk gn says 12,4+/-2.5 iken kontrol grubunda 6.0+/-4.8 idi. Devamszlk gn saylarnda destek alan ve almayan gruplar arasnda anlaml bir fark yoktu (p>0,05). ki grup arasnda kree balama ya, tart ve boy, kree gittii toplam sre arasnda da istatistiksel bir fark grlmedi. Adenoid hipertrofisi olanlar ve sk otit geirenler anlaml olarak daha sk destek alyorlard.
TARTIMA ve SONU: Baklk destekleyici olarak tanmlanan ilalarn yuvaya giden ocuklarda solunum yolu hastalklarnn skln azaltmada olumlu bir etkisi gsterilemedi. Adenoid hipertrofisi olan ocuklarn aileleri daha yksek oranda bakl destekleyici ila kullanyordu.

8.
ocukluk a Zehirlenmelerinin Geriye Dnk Deerlendirilmesi ve Maliyet Analizi
Retrospectve Evaluaton of Chldhood Posonng and Cost Analyss
Kadir Ulu, Canan Hasbal Akku, erife Ece Ulu, lyas Tolga Erkum, Sinem Oral Cebeci
doi: 10.5222/j.child.2019.94809  Sayfalar 138 - 147
GR ve AMA: Zehirlenmeler acil servislerde sk karlalan, lme yol aabilen, nlenebilir bir salk sorunudur. Zehirlenme etkenleri yaa, cinsiyete, lkelere, blgelere ve mevsimlere gre deikenlik gsterebilmektedir. Bu almada, ocuk acil polikliniine bavuran zehirlenme vakalarnn epidemiyolojik ve demografik zelliklerinin belirlenmesi, koruyucu nlemlerin saptanmas amalanmtr.
YNTEM ve GERELER: almamzda 01.06.2017 ve 01.06.2018 tarihleri arasnda Bakrky Dr. Sadi Konuk Eitim ve Aratrma Hastanesi ocuk acil polikliniine bavuran 0-17 ya aras zehirlenme vakalar geriye dnk incelendi.
BULGULAR: almamza 196 olgu dahil edilmitir. Bu olgularn %54.1i kz, %45.9u erkekti. Olgularn %81.6s kaza ile %13,3 zkym amal %5,1i ise teraptik hata nedeniyle meydana gelmiti. Zehirlenme etkenlerinin %61.2si ilalar, %38.8i ila d toksinlerden olumaktayd. En ok alnan etkenler srasyla %21.9unda analjezik-antipiretik, %18.9unda koroziv madde, %11.7sinde koroziv olmayan irritan madde, %7.7sinde antidepresan, %6.6snda vitamin-mineral eklindedir. Alm yolu incelendiinde; %96.9unun oral, %0.5inin cilt, %2.6snn inhalasyon yolla alnd grlmektedir. ocuklarn %81.6s ocuk acil nitesinde, %5.1i ayaktan, %7.1i ocuk servisinde ve %6.1i ocuk youn bakm servisinde takip edilmitir. Olgularn ortalama gzlem sresi 20.5519.98 saat iken, ortalama maliyeti 274.19445.69 TL olarak hesaplanmtr.
TARTIMA ve SONU: Salk personelinin ve ailelerin bilinlendirilmesi, koruyucu nlemler alnmasnda, hastanelerin i yknn azaltlmasnda ve lke ekonomisine olumlu katk salamada, birincil adm olacaktr.
INTRODUCTION: Poisoning is a preventable, lethal health problem, common in emergency services. Poisoning agents are various, and depend on gender, country, region and season. In this study, we aimed to determine the epidemiological and demographic characteristics of poisoning cases admitted to the pediatric emergency department and to define protective measures.
METHODS: Intoxication cases, between the ages of 0-17 that are admitted to Bakrky Dr. Sadi Konuk Education and Research Hospital pediatric emergency department, between 01.06.2017 and 01.06.2018 were retrospectively analyzed.
RESULTS: 196 cases were included in our study. 54.1% were female, 45.9% were male. 81.6% were caused by accident, 13.3% by suicide, 5.1% by therapeutic error. 61.2% of the poisoning compunds were drugs and 38.8% were non-drug toxins. Analgesic-antipyretics in 21.9%, were the most common agents, followed by corrosive agents in 18.9%, non-corrosive irritants in 11.7%, antidepressants in 7.7% and vitamin-minerals in 6.6%. Route of intake is examined and, 96.9% were oral, 0.5% through skin and 2.6% by inhalation. 81.6% of the cases were treated in the emergency department, 5.1% in the outpatient setting, 7.1% in the pediatric ward and 6.1% in the pediatric intensive care unit. The mean observation period was 20.55 19.98 hours and the mean cost was 274.19 445.69 TL.
DISCUSSION AND CONCLUSION: The awareness of health personnel and families will be the primary step in taking preventive measures, reducing the workload of hospitals and making a positive contribution to the country's economy.

9.
Sal Gelitiren Hastanede Preterm Yenidoan Sal: Doum Sonras Eitimin ocuk Bakmna Etkisi
Health of Preterm Newborns at the Health Promoting Hospital: The Effect of Postpartum Education on Child Care.
Zeynep etin amkran, Serpil Uur Baysal
doi: 10.5222/j.child.2019.20082  Sayfalar 148 - 157
GR ve AMA: Ge preterm yenidoanlarn gei dneminde evde yeterli bakmlarnn salanmasnda anne-baba eitiminin ve izlemin nemi ortaya konmutur. Bu aratrma, ge pretermlerin evde srdrlebilir optimum bakmlarn salayabilmek iin annelerine doum sonras gereken eitimi vermek; bylece evde bakm ile ilgili olas sorunlarn oluumunu engellemek, ilk ay boyunca, bebeklerin genel salk durumlarn izleyerek, daha sk grlebilecek hastaneye yat en aza indirmek amacyla yapld.
YNTEM ve GERELER: Tanmlayc nitelikte ve deney-kontrol dzeninde gerekletirilen bu prospektif aratrma, anket kullanlarak kesitsel yntemle yrtld. stanbul'da bir Eitim ve Aratrma Hastanesinde, Yerel Etik Kurul izni alnarak 34-36 gestasyon haftasnda tekil doan ge preterm toplam 70 yenidoan aratrma kapsamna alnd. Deney grubuna alnan yenidoanlarn annelerine hastanede bulunduklar sre boyunca, yenidoan konusunda deneyimli hemire (aratrmac) tarafndan bebek bakm konusunda iki ziyaret yapld. Verilen eitim, temel yenidoan bakmn ve hastalk belirtilerini kapsad. Her iki gruptaki bebeklerin birinci ve nc ayda izlemleri yapld.
BULGULAR: Doumdan hemen sonra hastanede yat nedenleri, deney grubunun %66,7sinde solunum sknts, %33,3nde hiperbilirubinemi olarak belirlendi. Kontrol grubunun %77,8i solunum sknts, %5,6s prematrelik, %11,1i hiperbilirubinemi, %5,6s enfeksiyon nedeniyle hastanede yatmt. Deney grubunda birinci ve nc aylarda bez dermatiti ve birinci ayda gzde sar aknt/ apaklanma daha az (p<0,05) grlrken acile bavurma oran da daha dk bulundu (p=0,001). Gruplar arasnda birinci ve nc ayda sadece anne st ile beslenme asndan anlaml bir fark yoktu (p>0,05); ancak, deney grubunda forml st ile beslenilen n says daha azd (p<0,05). Deney grubundaki annelerde bebeklerine ynelik beslenme, kilo alma ve bakm konusunda endie durumu birinci ayda anlaml olarak daha az bulundu (p<0,05).
TARTIMA ve SONU: Hastalk ve tekrar hastaneye yat oranlarnn azaltlabilmesi iin annelere ve evde bakm veren dier bireylere etkili ve yeterli eitim verilmesi, gei dnemindeki prematre salnn gelitirilmesi iin gerekmektedir. Bu yaklam, ge preterm yenidoanlarn evde yeterli bakmlarnn salanmasn, tek bana anne st ile beslenmelerini, forml st kullanmnn en aza indirilmesini, annelerin bebeklerinin bakm konusunda kayglarnn azaltlmasn kolaylatracaktr.
INTRODUCTION: The recent studies reveal that postpartum education has a great importance for the optimum home care of premature infants. The aim of this research was ensure the optimum health care and sustainability of home care of late preterms during transition by delivering health education to mothers; hence, to prevent health problems which may rise to, associated with inappropriate home care; to minimize the rehospitalization by increasing awareness of the signs and symptoms of possible diseases.
METHODS: This research which is a descriptive study carried out case-control scheme was performed in a cross-sectional method by using survey to collect data. The samples of this study are 70 singleton late preterm infants who were born at 34 to 36 weeks of gestational age at a Training and Research Hospital in stanbul. The mothers of the study group were given health education about home care of the baby by a newborn nurse(researcher) for two times. The education included basic newborn care and the symptoms of the diseases. Both groups were followed up at the first and third months.
RESULTS: Diaper dermatitis and eye discharge were significantly less in the case group in the first and third months (p<0,05); whileas the rate of admission in control group was higher than those in the study group (p=0,001). Exclusively breast feeding ratios were not different between the groups. In the study group, the amount of formula feeding was less than those of controls during the follow up(p<0,05). Mothers concern about feeding their babies was less in study group in the first month (p<0,05).
DISCUSSION AND CONCLUSION: Education delivered to mothers and care givers is necessary for health promotion of late preterms during transition to dicrease morbidity and rehospitalization rate. This approach provides the optimum home care, exclusive breastfeeding; and minimizes formula feeding; decreases mothers concern related to their babys health.

OLGU SUNUMU
10.
Otizmde Ebeveyn Aracl Youn Mdahale Yntemi Nroplay: Bir Olgu Sunumu
Neuroplay A New Parent Mediated Intensive Intervention Method for Autism
Bar Ekici, Mdriye Yldz Bak, Elif Nur Grkan, yk Su Unay, Burak Tatl
doi: 10.5222/j.child.2019.05902  Sayfalar 158 - 162
Otizm spektrum bozukluu erken ocukluk anda grlen nrogeliimsel bir hastalktr. Ebeveynlerin dahil edildii erken mdahale programlar son dnemde yaygnlamaktadr. Bu olgu sunumunda; 28 aylkken otizm spektrum bozukluu tans alan, Nroplay Yntemi ile takip edildikten sonra otizm bulgular nemli lde saltlan bir kz olgu aktarlmtr.
Autism is a neurodevelopmental disorder that appears in early childhood. In recent years, parent mediated early intervention programs have become increasingly popular. In this report, we present a girl who has diagnosed with autism spectrum disorder at 28 months, followed up with Neuroplay Method and improved significantly.

11.
Kromozom 22q11.2 Delesyum Sendromunun Nadir Bir Bulgusu: Multlkistik Displastik Bbrek
A Rare Fndng of Chromosome 22q11.2 Deleton Syndrome: Multcystc Dysplastk Kdney
Fuat Burul, Fahrettin Duymus
doi: 10.5222/j.child.2019.76768  Sayfalar 163 - 166
Velo-kardiyo-fasiyal /DiGeorge sendromu olarak da bilinen 22q11.2 delesyon sendromu 4000 canl doumda bir grlen en yaygn mikrodelesyon sendromudur. 22q11.2 otozomal dominant kaltlan bir hastalktr ancak hastalarn yaklak %90' 22q11.2 kromozomunda spontan ortaya kan heterozigot delesyonlara sahiptir. Sendromun klasik triad konotrunkal kalp anomalileri (Fallot, VSD, trunkusarteriozus, kesintili aortik ark gibi), hipoplastik timusa bal immun yetersizlik ve paratiroid hipoplazisine bal hipokalsemidir. Klinik zellikler hastann yana bal olarak deiiklik gsterebilir. Tan klinik ve laboratuvar bulgularyla phelenilen vakalarda floresan in situ hibridizasyon (FISH) yntemi kullanlarak delesyonun gsterilmesiyle konur. Bu yazda 22q11.2 delesyon sendromuna nadir elik eden multikistik displastik bbrei olan adlesan kz olgusu sunulmutur.
22q11.2 deletion syndrome also known as velocardiofacial/ DiGeorge syndrome is the most common microdeletion syndrome seen in every 4000 live births. 22q11.2 deletion syndrome is an autosomal dominant inherited disease approximately 90% of the patients have spontaneous heterozygous deletions on chromosome 22q11.2. The classic triad of the syndrome is conotruncal heart abnormalities, immune deficiency due to hypoplastic thymus and hypocalcemia due to parathyroid hypoplasia. The clinical features may vary depending on the age of the patient. The diagnosis is made by demonstrating microdeletion using FISH in cases suspected with clinical and laboratory findings. In this article a rare case of 22q11.2 deletion syndrome is presented in an adolescent girl with multicystic dysplastic kidney accompanying.

12.
Konu Dizini
Subject Index

Sayfalar 5000 - E1
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13.
Yazar Dizini
Author Indeks

Sayfalar E2 - E3
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