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Öğe Aile hekimlerinin arı venom alerjisi, tedavisi ve adrenalin oto enjektör kullanım becerisi konularındaki bilgi düzeyleri(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Çatal, Ferhat; Topal, Erdem; Çeliksoy, Mehmet Halil; Söğüt, Ayhan; Şahin, Mustafa Kürşat; Şahin, Gülay; Dikici, Mustafa Fevzi; Sancak, RecepAmaç: Arı sokmaları sonrası gelişen alerjik reaksiyonlar şiddetli olmakta ve hayatı tehdit edebilmektedir. Bu reaksiyonların tanınması, ilk müdahalenin yapılması ve hastaların tetkik edilmesi için alerji kliniklerine yönlendirilmesi önem taşımaktadır. Çalışmamızda, birinci basamakta çalışan aile hekimlerinin arı sokması sonrası gelişen alerjik reaksiyonlara yaklaşım ve tedavileri konularındaki bilgi düzeylerini belirlemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Samsun ve Malatya yöresinde çalışan ve gönüllü olan toplam 205 aile hekimi dahil edilmiştir. Bulgular: Aile hekimlerinin 124 (%60,5)’ü erkek, ortanca yaşı 38 ve meslekteki yıllarının ortancası ise 13 yıl idi. Arı sokması sonrası gelişen şiddetli sistemik reaksiyon (anafilaksi) karşısında katılımcıların sadece %31,2’si intramüsküler adrenalin yapacaklarını belirttiler. Katılımcıların %80’ni hastaları sistemik reaksiyondan sonra alerji kliniğine yönlendireceklerini belirtmelerine rağmen sadece %38’i hastalara arı venomu ile immünoterapi uygulandığını biliyordu. Katılımcıların %75,6’sı adrenalin oto enjektörün ne olduğunu biliyordu ancak oto enjektörün kullanımını, dozunu ve uygulama yerini bildiğini belirten katılımcıların yüzdesi sırasıyla %38,5, %37 ve %35,1 idi. Katılımcıların yaşı ve mesleki süreleri ile arı venom alerjisi ve adrenalin oto enjektör kullanım becerileri konularında ki bilgi düzeyleri arasında istatistiksel olarak anlamlı bir ilişki yoktu. Sonuç: Birinci basamakta çalışan hekimlerin arı venom alerjisinin tedavisi ve adrenalin oto enjektör kullanım becerisi konularındaki bilgileri yetersizdir. Bu nedenle, aile hekimlerine bu konularda eğitim verilmesi yararlı olacaktır.Öğe Aile Hekimlerinin Arı Venom Alerjisi, Tedavisi ve Adrenalin Oto Enjektör Kullanım Becerisi Konularındaki Bilgi Düzeyleri(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Çatal, Ferhat; Topal, Erdem; Çeliksoy, Mehmet Halil; Söğüt, Ayhan; Şahin, Mustafa Kürşat; Şahin, Gülay; Dikici, Mustafa Fevzi; Sancak, RecepAmaç: Arı sokmaları sonrası gelişen alerjik reaksiyonlar şiddetli olmakta ve hayatı tehdit edebilmektedir. Bu reaksiyonların tanınması, ilk müdahalenin yapılması ve hastaların tetkik edilmesi için alerji kliniklerine yönlendirilmesi önem taşımaktadır. Çalışmamızda, birinci basamakta çalışan aile hekimlerinin arı sokması sonrası gelişen alerjik reaksiyonlara yaklaşım ve tedavileri konularındaki bilgi düzeylerini belirlemeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Samsun ve Malatya yöresinde çalışan ve gönüllü olan toplam 205 aile hekimi dahil edilmiştir. Bulgular: Aile hekimlerinin 124 (%60,5)’ü erkek, ortanca yaşı 38 ve meslekteki yıllarının ortancası ise 13 yıl idi. Arı sokması sonrası gelişen şiddetli sistemik reaksiyon (anafilaksi) karşısında katılımcıların sadece %31,2’si intramüsküler adrenalin yapacaklarını belirttiler. Katılımcıların %80’ni hastaları sistemik reaksiyondan sonra alerji kliniğine yönlendireceklerini belirtmelerine rağmen sadece %38’i hastalara arı venomu ile immünoterapi uygulandığını biliyordu. Katılımcıların %75,6’sı adrenalin oto enjektörün ne olduğunu biliyordu ancak oto enjektörün kullanımını, dozunu ve uygulama yerini bildiğini belirten katılımcıların yüzdesi sırasıyla %38,5, %37 ve %35,1 idi. Katılımcıların yaşı ve mesleki süreleri ile arı venom alerjisi ve adrenalin oto enjektör kullanım becerileri konularında ki bilgi düzeyleri arasında istatistiksel olarak anlamlı bir ilişki yoktu. Sonuç: Birinci basamakta çalışan hekimlerin arı venom alerjisinin tedavisi ve adrenalin oto enjektör kullanım becerisi konularındaki bilgileri yetersizdir. Bu nedenle, aile hekimlerine bu konularda eğitim verilmesi yararlı olacaktır.Öğe Approach to drug allergy in family physicians(Bilimsel Tip Yayinevi, 2014) Celiksoy, Mehmet Halil; Sogut, Ayhan; Topal, Erdem; Catal, Ferhat; Sahin, Mustafa Kursat; Sahin, Gulay; Sancak, RecepObjective: Allergic reactions that occurring as a result of drug allergy can result in anaphylaxis, even death. These reactions often evaluated by the primary care physicians. Primary care physicians who often encounter with drug allergy reactions should be able to evaluate the patients with drug allergy, if necessary, make first emergency intervention, and refer patients to an allergy specialist for further evaluation and treatment. In this study, we aimed to measure general approach and the level of knowledge family physicians about allergic reactions occurred after the drug allergy. Materials and Methods: Two hundred and five family physicians who work in the region of Malatya and Samsun participated in this study. We interviewed face-to-face with family physicians about drug allergy. After that, family physicians completed a questionnaire previously prepared by allergy specialists about drug allergy. Results: The median age was 38 years old (min: 24, max: 61), median length of professional experience was 13 (min: 1, max: 35) years old and 124 (60.5%) of participants were male gender. 90.2% of family physicians in this study expressed to encounter with drug allergy before. 52.2% of them explained to cut medication in case of allergic reaction that developed after drug intake and to refer patients to allergy specialist for further investigation. 39.5% of the participants didn't know that a systemic reaction will be able to occur after local drug using. 56.6% of family physicians stated that they needn't to cut responsible medication in mild drug reactions and only 35.1% of them knew that severe drug reactions can be fatal. Only 31.7% of participants explained that adrenaline is the first option when anaphylactic reaction occurs after drug allergy. Conclusion: The knowledge of primary care physicians about treatment and management of patients with drug allergy is insufficient. Therefore, it will be useful to be educated the primary care physicians about drug allergies.Öğe Assessment of skills using a spacer device for a metered-dose inhaler and related independent predictive factors in caregivers of asthmatic preschool children(Wiley-Blackwell, 2016) Topal, Erdem; Celiksoy, Mehmet Halil; Catal, Ferhat; Sinanoglu, Muhammed S.; Karakoc, Habib Tadayyon Einaddin; Sancak, Recep; Ozturk, FadilBackgroundThe correct use of inhalation devices is essential for successful therapy. We aimed to evaluate the skills in the use of a spacer device with an metered-dose inhaler (MDI) and factors that influence this skill in asthmatic preschool children's caregivers. MethodsThe caregivers of 12-month-old to 72-month-old children were interviewed face-to-face and filled out questionnaires. To assess use of the spacer device, we asked the caregivers to verbally describe and demonstrate how they used the device. ResultsA total of 244 patients were included in the study, and 142 (58.2%) of the caregivers demonstrated every step for using the spacer device. The most frequently mistaken step was waiting for 30 seconds for the second puff after the first puff. When statistically significant and clinically important parameters were analyzed in a logistic regression model, the parameters satisfaction with the spacer device (odds ratio [OR] 29.9; 95% confidence interval [CI], 7.64 to 117.39; p < 0.001), a university graduate (OR 13.5; 95% CI, 3.36 to 54.8; p < 0.001), family monthly income of more than US$1500 (OR 5.3; 95% CI, 2.16 to 13.39; p < 0.001), device training provided by a clinical trainer (OR 12.3; 95% CI, 4.82 to 31.73; p < 0.001), regular follow-ups (OR 3.6; 95% CI, 1.57 to 8.47; p = 0.003), and the absence of a severe attack during the last year (OR 6.5; 95% CI, 2.64 to 16.43; p < 0.001) were found to be independent factors that affected the correct demonstration of the device. ConclusionThe factors most effective in the correct use of the MDI spacer device were satisfaction with the device, training having been given by a clinical trainer on this subject, and the caregiver being a university graduate.Öğe Is the change in platelet parameters in children with allergic rhinitis an indicator of allergic inflammation?(2018) Topal, Erdem; Sancak, Recep; Gözükara Bağ, Harika; Demir, Filiz; Çeliksoy, Mehmet HalilAbstract: It was aimed to find out whether MPV can be used as an indicator of allergic inflammation in children with allergic rhinitis by looking at the changes in MPV and MPV/ Plt in this study. Pediatric patients between the ages of 6 and 18 who had a diagnosis of allergic rhinitis were included in the study. Sex- and age-matched healthy children who visited the outpatient clinic for routine controls were included as control in order to compare the changes in patients’ total blood count parameters (e.g.,WBC, Hb, RDW, PLT, PDW, MPV). 95 pediatric (50 male, mean age: 120 months ) patients and 90 healthy children (38 male, mean age: 120 months) were included in the study. There were no statistical differences between gender (p=0.15) and ages (p=0.33) of both groups. WBC (p=0.21), Hb (p=0.8), RDW values (p=0.3) and platelet numbers (p=0.05) of both groups were similar. In the allergic rhinitis group, mean MPV value (p?0.001), mean PDW value (p=0.005) were lower and mean Plt/MPV rate was higher (p=0.001). In addition, no significant association was found between the severity of allergic rhinitis and MPV (p=0.61). MPV value of 7.0 fL was identified as the cut off value at diagnosis with a sensitivity of 51.6 % and specificity of 83.3 % (AUC = 0.716; p=0.001). MPV values decrease in children with allergic rhinitis and MPV value is smaller than 7 fl is specific for allergic rhinitis.Öğe The Platelet Parameters as Inflammatory Markers in Preschool Children with Atopic Eczema(Clin Lab Publ, 2015) Topal, Erdem; Celiksoy, Mehmet Halil; Catal, Ferhat; Karakoc, Habib Tadayyon Einaddin; Karadag, Ahmet; Sancak, RecepBackground: Mean platelet volume has been frequently used as an inflammatory marker in various diseases associated with inflammation. In this study, we compared platelet parameter levels between preschool children with and without atopic eczema (AE). Methods: Preschool children with AE and age-matched healthy children were included in the study. Complete blood count was assessed in children with AE while platelet parameters were compared between children with and without AE. Results: One hundred twenty eight pediatric patients (78 boys, mean age: 14 months) diagnosed with AE and 128 healthy patients (71 boys, mean age: 12 months) were included in the study. There were no statistically significant differences between the genders (p = 0.375) and ages (p = 0.273) of both groups. WBC (p = 0.952), Hb (p = 0.370), MCV (p = 0.314) and RDW values (p = 0.124), and platelet counts (p = 0.198) of both groups were similar. In the AE group, while the MPV value was found to be higher (p = 0.003), mean PDW value (p = 0.025) and PLT/MPV ratio were found to be lower (p = 0.021). In addition, there was no correlation between the severity of AE and MPV (rho; 0.1, p = 0.257), POW (rho; -0.1, p = 0.269) and PLT/MPV (rho; 0.07, p = 0.432) ratio. Conclusions: In patients with AE, as a sign of inflammation, PDW value and PLT/MPV ratio decrease while MPV value increases. This study has also shown that there is no association between the severity of AE and platelet parameters.Öğe Relationship between hypogammaglobulinemia and elationship between hypogammaglobulinemia and severity and frequency of wheeze everity and frequency of wheeze(Astım Allerji İmmünoloji, 2015) Topal, Erdem; Çeliksoy, Mehmet Halil; Çatal, Ferhat; Sancak, RecepÖz: Giriş: Çeşitli çalışmalar tekrarlayan hışıltısı olan çocuklarda immünglobulin ve immünglobulin alt grubu düzeylerini değerlendirmiştir. Bu çalışmanın amacı tekrarlayan hışıltısı olan okul öncesi dönemdeki çocuklarda hipogamaglobulinemi ile hışıltı şiddeti ve sıklığı arasındaki ilişkiyi ortaya çıkarmaktır. Gereç ve Yöntem: Çalışmamıza kliniklerimizde tekrarlayan hışıltı tanısı ile izlenen 6 ay-5 yaş arası çocuklar alındı. Bu hastalar sık ve şiddetli atak geçirenler (grup 1, n= 86) ile seyrek ve hafif atak geçirenler (grup 2, n= 67) olmak üzere iki gruba ayrıldı. Ayrıca, benzer yaş grubunda yer alan ve sağlıklı çocuklardan oluşan bir kontrol grubu (grup 3, n= 75) oluşturuldu. Serum immünglobulin düzeyleri, periferik eozinofili ve deri prick testleri ile gruplar değerlendirildi. Bulgular: Ortanca yaş, hışıltı fenotipi, eşlik eden atopik hastalıklar, ailede astım öyküsü, periferik eozinofili ve hipogamaglobulinemi açısından gruplar arasında fark yoktu (p> 0.05). Ancak, erkek cinsiyet (p< 0.001) ilk hışıltı atağının erken yaşta geçirilmesi (p< 0.001) ile hışıltı sıklığı ve şiddeti arasında anlamlı ilişki vardı. Her üç grup karşılaştırıldığında, ortalama serum IgA düzeyi (p= 0.469), IgG düzeyi (p= 0.211), ve IgM düzeyi (p= 0.831) açısından fark yoktu. Grup 1 de üç hastada (%3.5), grup 2 de iki hastada (%3) ve grup 3 te dört hastada (%5.3) hipogamaglobulinemi bulundu. Gruplar arasında istatistiksel olarak anlamlı fark bulunamadı (p= 0.744). Sonuç: Okul öncesi dönemde sık ve şiddetli hışıltı atağı geçiren çocuklarda serum immünglobülin düzeyleri sağlıklı çocuklar ile benzerdir. Başlık (İngilizce): Hipogamaglobulinemi ile hışıltı şiddeti ve sıklığı arasındaki ilişki Öz (İngilizce): Objective: Several previous studies have assessed immunoglobulin and IgG subclass levels in children with recurrent wheezing. We aimed to determine whether a relationship exists between hypogammaglobulinemia and severity and frequency of wheeze in preschool children with recurrent wheeze. Materials and Methods: Our study population was children aged 6 months to 5 years who we were monitoring for recurrent wheeze in our clinics. We divided these children into two groups; those who have frequent and severe attacks (group one, n= 86), and those who have rare and mild attacks (group two, n= 67). We also established a control group consisting of healthy children of the same age (group three, n= 75). We assessed serum immunoglobulin levels, peripheral blood eosinophil count and performed a skin-prick test. Results: Th ere was no diff erence between groups in terms of median age, wheezing phenotype, comorbid atopic disease, parental asthma history, peripheral blood eosinophilia, and hypogammaglobulinemia (p> 0.05). However, there was a signifi cant relationship between being male (p< 0.001), having the fi rst attack of wheezing at an earlier age (p< 0.001), and having frequent and severe wheezing. When we compared the three groups, we found no diff erence between the mean serum IgA level (p= 0.469), serum IgG level (p= 0.211), and serum IgM level (p= 0.831). We found hypogammaglobulinemia in three patients (3.5%) in group one, in two patients (3%) in group two, and in four patients (5.3%) in group three; we found no statistically signifi cant diff erence between groups (p= 0.744). Conclusion: Th e serum immunglobulin levels of preschool children with frequent and severe wheezing attacks are similar to those of healthy preschool children.Öğe Relationship between hypogammaglobulinemia and severity of atopic dermatitis(Elsevier Science Inc, 2014) Celiksoy, Mehmet Halil; Topal, Erdem; Sancak, Recep; Catal, Ferhat; Sogut, AyhanBackground: Atopic dermatitis is an itchy, inflammatory, chronic, or chronically relapsing skin disease. The disease occurs in people who have an atopic tendency or may appear as a clinical sign of primary immunodeficiency. Objectives: To determine the relation between severity of atopic dermatitis and hypogammaglobulinemia. Methods: One hundred sixty pediatric patients with atopic dermatitis (98 boys and 62 girls, 1-60 months old, median age 14.5 months) and 95 healthy children (57 boys and 38 girls, median age 16 months; control group) were included in the study. In patients with atopic dermatitis, the severity of disease was determined by the SCORing Atopic Dermatitis index. Serum immunoglobulin levels of all patients and children in the control group were measured by nephelometry on admission. Results: The incidence of hypogammaglobulinemia was higher in patients with atopic dermatitis than in the control group (P = .009). The main reason for this difference was the low level of IgG in the atopic dermatitis group (P = .024). Analysis of the relation between hypogammaglobulinemia and the severity of atopic dermatitis showed no statistically significant difference between the group with mild to moderate atopic dermatitis and the group with severe atopic dermatitis with respect to hypogammaglobulinemia (P = .859), IgG (P = .068), IgA (P = .410), and IgM (P = .776) values. Conclusion: Hypogammaglobulinemia was more frequent in patients with atopic dermatitis compared with the control group, mostly owing to the low IgG level. Hypogammaglobulinemia is not associated with the severity of atopic dermatitis. (C) 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Öğe Role of IgA and IgM in severity of atopic dermatitis Response(Elsevier Science Inc, 2015) Celiksoy, Mehmet Halil; Topal, Erdem; Sancak, Recep[Abstract Not Available]Öğe The value of the clinical history for the diagnosis of immediate nonsteroidal anti-inflammatory drug hypersensitivity and safe alternative drugs in children(Ocean Side Publications Inc, 2016) Topal, Erdem; Celiksoy, Mehmet Halil; Catal, Ferhat; Sayan, Yekbun Gamze; Sancak, RecepBackground: Diagnosing hypersensitivity reactions that develop as a result of nonsteroidal anti-inflammatory drugs (NSAID) with a history is mostly misleading, and skin tests and/or provocation tests are needed for a definitive diagnosis. Objective: To determine the frequency of actual NSAID hypersensitivity and whether there are any parameters in the history to predict NSAID hypersensitivity. In addition, to determine safe alternative drugs for children who are diagnosed with actual NSAID hypersensitivity. Methods: Children with a history of NSAID hypersensitivity were evaluated by an allergist. Safe alternatives in children with a confirmed NSAID hypersensitivity were found by oral provocation tests. Results: Sixty-four patients who were admitted with a suspicion of immediate-type reaction to NSAIDs were included in the study. The median age of the patients was 6 years old (range, 1-17 years), and 37 of the patients (57.8%) were boys. We performed skin tests for suspected NSAID in 35 patients (54.7%). Of these, two had positive results. Provocation tests were performed with 62 patients whose skin test results were negative or for whom skin tests were not available. During the provocation tests, 16 patients (25.8%) developed reactions. Low- and high-dose acetaminophen, nimesulide, and tolmetin sodium were used to find safe alternative drugs. Two patients developed reactions to high-dose acetaminophen but no reaction to nimesulide and tolmetin sodium. When statistically significant parameters were analyzed in a logistic regression model, the presence of multiple NSAIDs hypersensitivity in the patient history (odds ratio 26.6 [95% confidence interval, 1.47-481.63]; p = 0.026) and the emergence of a reaction within an hour (odds ratio 26.4 [95% confidence interval, 1.73-403.11]; p = 0.019) were found as the independent factors to predicted actual NSAID hypersensitivity. Conclusion: The emergence of a reaction within an hour of taking the drug and the presence of multiple NSAIDs hypersensitivity history increased the possibility of actual NSAID hypersensitivity. Nimesulide, low-dose acetaminophen, and tolmetin sodium could be used as safe alternative drugs in patients with multiple NSAIDs hypersensitivity.
