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    Adverse drug reactions affecting treatment adherence in first-line treatment of asthma: An observational study
    (Codon Publications, 2023) Erdem, Semiha Bahceci; Nacaroglu, Hikmet Tekin; Can, Demet
    Background: Asthma is the most common chronic lung disease among children. International guidelines recommend inhaled corticosteroids (ICS) as the first-line daily controller therapy for children with asthma and leukotriene receptor antagonists (LTRA) as the second alternative therapy. Adherence to treatment is the most significant component to optimize the benefits of therapy in asthma. Objective: This study aims to investigate the frequency of drug discontinuation due to adverse drug reactions (ADRs) that affect adherence to treatment in children with asthma or asthma and allergic rhinitis using LTRA or ICS as monotherapy. Methods: The subjects aged 4-18 years with asthma or asthma and allergic rhinitis and using montelukast or ICS as monotherapy were included in the study. They were evaluated in terms of ADRs affecting adherence to treatment in the first and third months of treatment. Results: A total of 468 cases, 356 of whom received montelukast monotherapy and 112 of whom received ICS treatment, with a mean age of 9.10 +/- 3.08 (4-17) years, were included in the study. Males constituted 65.6% of the total cases (n = 307). In the first month of follow-up of the cases, it was observed that 4.8% (n = 17) of the patients in the montelukast group could not continue the treatment due to ADR. It was determined that the drug discontinuation rate in the montelukast group in the first month was significantly higher than in the ICS group (P = 0.016), and the risk of drug discontinuation due to ADR in the montelukast group was 1.333 (95% CI, 1.26-1.40) times higher. Conclusions: As a result, it was observed that the drug was discontinued due to ADR at a higher rate in children with asthma who received montelukast monotherapy compared to those who received ICS monotherapy. (c) 2023 Codon Publications. Published by Codon Publications.
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    CD4+CD25+CD127loFOXP3+cell in food allergy: Does it predict anaphylaxis?
    (Codon Publications, 2023) Erdem, Semiha Bahceci; Genel, Ferah; Nacaroglu, Hikmet Tekin; Karaman, Sait; Karkiner, Canan Sule Unsal; Surucu, Murat; Can, Demet
    Background: Food allergy (FA), hence the incidence of food anaphylaxis, is a public health problem that has increased in recent years. There are still no biomarkers for patients with FA to predict severe allergic reactions such as anaphylaxis. Objective: There is limited information on whether regulatory T (Treg) cell levels are a biomarker that predicts clinical severity in cases presenting with FA, and which patients are at a greater risk for anaphylaxis. Methods: A total of 70 children were included in the study: 25 who had IgE-mediated cow's milk protein allergy (CMPA) and presented with non-anaphylactic symptoms (FA/A-), 16 who had IgE-mediated CMPA and presented with anaphylaxis (FA/A+) (a total of 41 FA cases), and a control group consisting of 29 children without FA. The study was conducted by performing CD4+CD25+CD127(lo)FOXP3+ cell flow cytometric analysis during resting at least 2 weeks after the elimination diet to FA subjects. Results: When the FA group was compared with healthy control subjects, CD4+CD25+CD127(lo)FOXP3+ cell rates were found to be significantly lower in the FA group (p < 0.001). When the FA/A- and FA/A+ groups and the control group were compared in terms of CD4+CD25+CD127(lo)FOXP3+ cell ratios, they were significantly lower in the FA/A- and FA/A+ groups compared to the control group (p < 0.001). Conclusions: Although there was no significant difference between the FA/A+ group and the FA/ A- group in terms of CD4+CD25+CD127(lo)FOXP3+ cells, our study is important, as it is the first pediatric study we know to investigate whether CD4+CD25+CD127(lo)FOXP3+ cells in FA predict anaphylaxis. (c) 2023 Codon Publications. Published by Codon Publications.
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    Clinical and Treatment Evaluation of Anaphylaxis in Children Aged 0-2 Years: Multicenter Study
    (Springernature, 2024) Selmanoglu, Ahmet; Haci, Idil Akay; Koc, Fatih Sultan Mehmet; Yildiz, Yuksel Kavas; Yilmaz, Ebru Arik; Azkur, Dilek; Erdem, Semiha Bahceci
    BackgroundDiagnosing anaphylaxis in children within the first 2 years of life can be difficult due to the often confusing and nonspecific signs and symptoms.ObjectiveThis study focuses on the phenotype of anaphylaxis in children within the first 2 years of life and aims to increase awareness of anaphylaxis in this age group.MethodsThe study included children between 0 and 2 years who were diagnosed as having anaphylaxis by pediatric allergists in 11 tertiary hospitals.ResultsA total of 402 anaphylaxis episodes experienced by 360 patients (68.7% males) were included in the study. Food was the most common causative agent (n = 374, 93%), with the most common foods being cow's milk (n = 179, 44.6%). Drugs were the second most common trigger (n = 15, 3.7%). The most common clinical findings were cutaneous (95%) and respiratory (72%); nonspecific symptoms such as weakness (n = 63, 15.6%) and hoarseness (n = 14, 3.4%) were also reported. There was a biphasic course in 3 infants (0.8%). Only 3 of the 41 parents who had an adrenaline autoinjector used it during anaphylaxis.ConclusionInfants experience anaphylaxis most often when they are at home with their mothers, and the most common triggers are foods, particularly cow's milk and egg. Greater awareness of anaphylaxis symptoms and autoinjector use among mothers can facilitate management.ImpactInfant anaphylaxis cases may present with different symptoms compared to classic presentations, potentially leading to diagnostic oversight.The study elucidates the clinical course of anaphylaxis in children under 2 years of age.It details the treatment strategies employed in managing these cases.Anaphylaxis triggers were identified over several years.Cases from 11 regions of Turkey were included, representing a population reflective of national data.The study highlights the distinctiveness of anaphylaxis cases in children within the first 2 years of life.
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    Prognosis of Childhood Atopic Asthma: A 6-year Follow- up Study
    (Galenos Publ House, 2023) Erdem, Semiha Bahceci; Nacaroglu, Hikmet Tekin; Akcal, Omer
    Objective: There have been few studies on prognosis and factors influencing the prognosis in children with atopic asthma. We intended to evaluate the prognosis, clinical remission rate, and influencing factors of childhood atopic asthma. Methods: In 72 pediatric patients with atopic asthma who were followed up between 2016 and 2022 with a mean follow-up period of 6.03 +/- 2.19 years, demographic characteristics, family history, clinical symptoms, pulmonary function test results, and asthma control test scores were evaluated. Totally controlled patients who had not received any asthma treatment for >= 1 year were considered to be in clinical remission. Results: The study group included 72 children with atopic asthma (female/male: 28/44), with a mean age of 13.36 +/- 1.98 (8-18) years. 12.5% (n=9) of the patients had uncontrolled asthma, 45.8% (n=33) were partially controlled asthma, 41.7% (n=30) were complete controlled asthma. Clinical remission was seen in 23.6% (n=17) patients with total control. Patients who were symptomatic before the age of three and had a persistent course had a lower clinical remission rate (p=0.05). Conclusion: In our study, the clinical remission rate in atopic asthma in early adulthood was 23.6%. Our results reveal that the clinical remission rate was lower in patients who developed symptoms and had persistent wheezing before the age of three.