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Öğe A case of acute generalised exanthematous pustulosis (AGEP) induced by amoxicillin-clavulanic acid(Bilimsel Tip Yayinevi, 2014) Senbaba, Elif; Catal, Ferhat; Topal, Erdem; Ermistekin, Halime; Varol, Fatma Ilknur; Akpolat, NusretAcute generalised exanthematous pustulosis (AGEP) is a rare skin reaction characterized by sterile, small pustules on the erythematous background. Drugs, especially antibiotics are major caustic factors in etiology. The diagnosis of disease is made by the scoring system which determined by European Severe Cutaneous Adverse Reactions (EuroSCAR)s' working group. The four-year-old patient applied with the complaint of numerous pustular skin eruptions on the erythematous background and had the history of amoxicillin-clavulanic acid treatment which was given two days ago. The biopsy samples were taken from pustular lesions. The diagnosis of AGEP was made according to EuroSCAR score, evaluating clinical feature and the histopatological examination of the biopsy sample. In this presentation, we aimed to emphasize that AGEP can rarely be seen in childhood age and to review the clinical properties, diagnosis and treatment of disease.Öğe Delayed severe systemic reaction (anaphylaxis) after subcutaneous immunotherapy injections: case report(Bilimsel Tip Yayinevi, 2013) Senbaba, Elif; Catal, Ferhat; Topal, Erdem; Ermistekin, Halime; Yildirim, Nurdan; Sinanoglu, M. SelcukCurrently, allergen specific immunotherapy is administered to allergic rhinitis or asthmatic patients with uncontrolled symptoms despite medical treatment and avoidance of environmental allergens. Local or systemic reactions can occur after subcutaneous immunotherapy. Although almost all severe systemic reactions are reported to begin within 30 minutes after administration of injections, late onset reactions could be seen. Our case was 15 years old female patient with asthma whose complaints could not controlled by medical treatment and subcutaneous immunotherapy with Dermatophagoides farinae extract that she was sensitized was administered to her. Severe systemic reaction (anaphylaxis) has developed in the patient within fourth hours of post-injection observation period at the maintenance dose of 0.8 mL. We want to emphasize that severe late onset systemic reactions are rare but could occur after subcutaneous immunotherapy injections.Öğe Demographic and systemic manifestations of patients diagnosed with ataxia-telangiectasia(Bilimsel Tip Yayinevi, 2014) Catal, Ferhat; Topal, Erdem; Celiksoy, Mehmet Halil; Ermistekin, Halime; Kutluturk, Kazim; Yildirim, Nurdan; Sinanoglu, Muhammed SelcukObjective: Ataxia-telangiectasia is rare, an autosomal recessive, neurodegenerative disorder characterized by progressive cerebellar ataxia, cutaneous and conjunctival telangiectasia, immunodeficiency, and increased risk of malignancy. In this study, we aim to determinate demographics, neurological, dermatological and immunological manifestation of children diagnosed with ataxia-telangiectasia in our clinics. Materials and Methods: We did a retrospective medical chart review of pediatric allergy and immunology database for children diagnosed with ataxiatelangiectasia in Inonu and Ondokuz Mayis University Faculty of Medicine between 2006 and 2013. Results: Ataxia-telangiectasia was diagnosed in 25 patients. The mean age was 10.08 +/- 4.14 (died children were included) and 16 (64%) of the patients were male. The mean follow up period was 5.32 +/- 3.84 years. Ataxia was the first sign of disease which was noticed by the parents and median diagnosis age was 4 years old (min: 1.5, max: 12). Neurological and dermatological manifestations were seen in all patients. Also immunological manifestations were seen in 85% of all patients. The most frequent neurologic sign was ataxia and present in all patients, followed by dysmetria (96%), dysarthria (92%), bradykinesia (80%) and ocular apraxy (60%), respectively. Telangiectasia was present in all patients and the most frequent localization was conjunctiva. Pigmentary anomalies were present in 17 (68%) patients, molluscum contagiosum in 2 (8%) patients and verruca in 1 (4%) patient. The most frequent form of immunologic deficiency was IgA deficiency (80%) which was followed by Ig G deficiency (60%) and lymphopenia (12%). Growth failure was present in 96% of patients and head circumference was under -1 SD in 56% of patients. In follow up, 5 (20%) patients had experienced recurrent otitis media, 18 (% 72) patients had experienced recurrent pulmonary infection. Bronchiectasis was developed in 7 (28%) patients and hemophagocytic sendrome was developed in one patient. Seven patients died (three due to non-Hodgkin lymphoma, two due to pulmonary infection, one due to hemophagocytic sendrome and one due to acute lymphoblastic leukemia). Conclusion: Ataxia and telenjiectasia were the most frequent signs of the disease and followed by immunological and pigmentary anomalies. Therefore, ataxia telenjiectasia should be consider in diagnosis if the patients who have dermatological signs such as telangiectasia and pigmentary anomalies and growth failure with ataxia.Öğe The hematologic manifestations of pediatric celiac disease at the time of diagnosis and efficiency of gluten-free diet(Tubitak Scientific & Technological Research Council Turkey, 2015) Catal, Ferat; Topal, Erdem; Ermistekin, Halime; Yildirim Acar, Nurdan; Sinanoglu, Muhammed Selcuk; Karabiber, Hamza; Selimoglu, Mukadder AyseBackground/aim: To determine the hematologic manifestations at the time of diagnosis of celiac disease in children and the effects of a gluten-free diet on hematologic signs upon follow-up. Materials and methods: The records of patients with celiac disease who received a follow up examination at the Pediatric Gastroenterology Clinic between June 2006 and June 2013 were retrospectively examined. Results: Ninety-one patients were included in the study. The mean age at diagnosis was 8.1 +/- 4.21 years and 59 patients (64.8%) were female. Thirty-two patients (35.2%) had hematologic signs at the time of diagnosis. Anemia (24.2%) was the most common hematologic sign, followed by thrombocytosis (16.5%) and leukopenia (4.4%). The tTG IgA titers were screened in 80 of the 91 patients during diagnosis. Follow-up examinations found that remission for anemia (P = 0.017), thrombocytosis (P = 0.039), and decreases in tTG IgA titers (P = 0.034) were more prominent in patients who had followed a strict gluten-free diet. Conclusion: Approximately one-third of the celiac disease patients had hematologic manifestations at the time of diagnosis. Remission in hematologic signs and decrease in tTG IgA titers were more prominent in patients who had adhered to a gluten-free diet.Öğe Measuring the primary care physician's knowledge about diagnosis and treatment of cow's milk allergy and adrenaline auto injector usage(Bilimsel Tip Yayinevi, 2014) Topal, Erdem; Catal, Ferhat; Ozdemir, Ramazan; Karadag, Ahmet; Yildirim, Nurdan; Ermistekin, Halime; Sinanoglu, M. SelcukObjective: Cow's milk allergy is the most common form within the food allergy its prevalence increased recent years in children. In this study, we aim to determine the primary care physician's knowledge about diagnosis of cow's milk allergy, treatment and adrenaline auto injector usage. Materials and Methods: One hundred twenty-six voluntary primary care physicians who are working in Malatya city were included in the study. Interview with each participant were carried out and cow's milk allergy form which was prepared previously was filled in. Results: The median age was 42 (26-62), median length of professional experience was 16 (2-39) years and 89 (70.6%) of participant were male gender. The mean examined patient number by primary care physicians was 37.4 (+/- 14.6) for each day and the mean examined patient number whose age was under 3 years was 8.5 (+/- 4.5). Of the 25.4 percent of primary care physicians did not have knowledge about skin prick test, serum specific Ig E level and/or oral challenge test for diagnosis of cow's milk allergy. Although 73% of participant knew the elimination milk and dietary product from infant who was considered to have allergy to cow's milk and mother, only 13.5% of them knew the prescribe hypoallergenic formula for infant with cow's milk allergy. 64.3% of participant knew the prescribe the adrenaline auto injector in case of anaphylaxis due to cow's milk. Knowledge of adrenaline auto injector use, appropriate side for injection and dose were 34%, 34.1% and 30.2%, respectively. There was no significant effect of primary care physicians's age and length of professional experiences on the knowledge of cow's milk allergy and adrenaline autoinjector usage. Conclusion: The knowledge of primary care physician about diagnosis of cow's milk allergy, treatment and adrenaline auto injector usage are insufficient. Therefore it should be useful to training programs about these topics for primary care physician.Öğe The prevalence and severity of reaction during the oral food challenge(Bilimsel Tip Yayinevi, 2014) Topal, Erdem; Catal, Ferhat; Senbaba, Elif; Varol, Fatma Ilknur; Sinanoglu, Muhammed Selcuk; Yildirim, Nurdan; Ermistekin, HalimeObjective: The diagnostic gold standard of food allergy is the oral food challenge. Oral food challenge may induce allergic reactions, ranging from mild cutaneous symptoms to severe, potentially life-threatening reaction. Our aim was to investigate the prevalence and severity of reactions during oral food challenge. Materials and Methods: A retrospective charts review of children undergoing oral food challenge at the our Allergy Clinic between September 2012 and September 2013 was performed. Results: A total of 63 oral food challenges were included the study. Most frequently involved foods were cow's milk, pistachio nut and egg. Oral food challenge were carried out to confirm the diagnosis in 50 (79.4%) patients and were carried out to demonstrate the development of food tolerance in 13 (20.6%). 13/63 (20.6%) were positive. Twelve patients were defined mild reactions and one patient was anaphylaxis. There were no significant differences between the oral food challenge negative group and oral food challenge positive group in terms of sex, age at the time of oral food challenge, concomitant atopic disease, history of IgE mediated food allergy, peripheral eosinophils per cent, serum specific gE and total IgE (p>0.05). But there was a positive correlation between the size of skin prick test and oral food challenge positivity (rho: 0.307, p=0.019). Conclusion: The majority of reactions during oral food challenge were mild. The size of skin prick test was the risk factor for the development of reaction during oral food challenge. Therefore, oral food challenge should be done by the experts and size of skin prick test should be taken into consideration before oral food challenge.Öğe Vitamin and mineral deficiency in children newly diagnosed with celiac disease(Tubitak Scientific & Technological Research Council Turkey, 2015) Topal, Erdem; Catal, Ferat; Acar, Nurdan Yildirim; Ermistekin, Halime; Sinanoglu, Muhammed Seluk; Karabiber, Hamza; Selimoglu, Mukadder AyseBackground/aim: To establish the frequency of vitamin and mineral deficiency in children newly diagnosed with celiac disease. Materials and methods: The files of patients diagnosed with celiac disease in our Pediatric Gastroenterology Clinic from June 2008 to June 2013 were reviewed retrospectively. Results: A total of 52 pediatric patients diagnosed with celiac disease via serology and duodenal biopsy and who fulfilled the study criteria were enrolled in the study. The mean diagnosis age of the patients was 8.5 +/- 3.9 years and 33 (63.5%) of the patients were female. Vitamin D, vitamin A, vitamin E, zinc, and iron deficiencies were determined in 27 (51.9%), 4 (7.7%), 7 (13.5%), 35 (67.3%), and 18 (34.6%) patients, respectively, at the time of diagnosis. Vitamin D deficiency was observed more frequently in patients with growth retardation at the time of application (P = 0.02). Conclusion: Vitamin D, zinc, and iron deficiency are frequently observed in pediatric patients with celiac disease at the time of diagnosis. Therefore, serum vitamin D, zinc, and iron levels should be checked in all children diagnosed with celiac disease.
