1,721,112 research outputs found
Language development and affecting factors in 3-to 6-year-old children
No full textAnlar, Banu/0000-0001-6727-6229The aim of this study was to assess factors affecting language developmental screening test results in 33.0- to 75.0-month-old children. The study group consists of 402 children, 172 (42.8 %) boys and 230 (57.2 %) girls, aged 33.0-75.0 months who were examined in four age groups: 3 years (33.0-39.0 months), 4 years (45.0-51.0 months), 5 years (57.0-63.0 months) and 6 years (69.0-75.0 months). Demographic data and medical history obtained by a standard questionnaire and Denver II Developmental Test results were evaluated. Maternal factors such as mother's age, educational level, and socioeconomic status (SES) correlated with language items in all age groups. Linear regression analysis indicated a significant effect of mother's education and higher SES on certain expressive and receptive language items at 3 and 4 years. Fine motor items were closely related to language items at all ages examined, while in the younger (3- and 4-year-old) group gross motor items also were related to language development. Maternal and socioeconomic factors influence language development in children: these effects, already discernible with a screening test, can be potential targets for social and educational interventions. The interpretation of screening test results should take into account the interaction between fine motor and language development in preschool children
Pediatric multiple sclerosis: Clinical features and outcome
Full text linkMultiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures
Çocukluk çağı otoimmün santral sinir sistemi hastalıklarında serum ve idrar örneklerinde neopterin ve serum kinürenin-triptofan yolağı ürünleri düzeylerinin karşılaştırılması.
No full textYıldız Kayaoğlu M, Comparison of the levels of neopterin in serum and urine samples and serum kinürenine-tryptophan pathway products in childhood autoimmune central nervous system diseases, Child Health and Diseases Thesis, Ankara, 2021. Inflammatory demyelinating diseases of the central nervous system (CNS) in childhood include clinically and radiologically defined diseases such as acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), MOG-antibody related disease and autoimmune encephalitis. In addition certain cases not meeting diagnostic criteria remain without specific diagnosis. Laboratory findings to guide the physician in the diagnosis and management of autoinflammatory diseases of CNS in childhood are needed. Variables called “biomarker” are objectively measurable characters that can be reliably used for diagnosis, grading, prognosis or monitoring of a clinical condition. A good biomarker should be easily measurable in body fluids such as urine, serum, cerebrospinal fluid (CSF). Previous studies suggest serum kynurenine-tryptophan pathway products and serum neopterin as biomarkers for CNS autoimmune diseases. Although neopterins have been studied in various CNS diseases, the number of studies especially in childhood CNS autoimmune disorders is limited. In addition, previous evidence indicates urine as a reliable source for analysis of these products, with the additional advantage of easy sampling increasing patient compliance. This study aimed to measure and compare serum and urine kynurenine-tryptophan pathway products molecules in autoimmune demyelinating diseases of CNS. We studied 27 pediatric multiple sclerosis (pMS) patients, 10 myelin oligodendrocyte glycoprotein (MOG) antibody positive (MOG Ab+) patients, 5 neuromyelitis optica (NMO) patients, and 13 healthy or non-demyelinating disease patients, totally 55 children. Consent was obtained from patients and parents. Neopterin, biyopterin and creatinine in urine, kynurenine and tryptophan in serum were measured by high performance liquid chromatography (HPLC), and neopterin in serum by ELISA method. Statistical analyzes were performed using SPSS (IBM SPSS Statistics 23) package program. The median age of the patients was 15 (5) and the mean age of the control cases was 13.69 ± 2.72 years. The ages of the patients differed significantly between diagnostic groups (p=0,001). The Bonferroni test indicated pMS patients were older than the other groups, siginificantly so from MOG Ab+ patients. The youngest age group was MOG Ab+ patients. When the whole patient group was compared with the controls, a significant difference was found between urinary neopterin values (p=0.006). The cut-off point was determined by ROC analysis: An urinary neopterin value above 167.75 µmol/mol creatinine could distinguish the patients from the controls with a sensitivity of 71%, and specificity of 90%. Comparison for biomarkers between all diagnostic groups showed a significant difference in urinary neopterin values (p=0.002). When examined with the Bonferroni test, it was observed that urinary neopterin values of pMS patients were different from NMO patients, MOG Ab+ patients and controls. The difference was caused by the pMS patient group, the most significant difference being between the pMS group and the control group. There was no difference between pMS patients who were in an attack or stable, but there was a difference in urinary neopterin values of pMS patients (whether in an attack or in a stable state), compared to controls (p=0.002). Therefore urinary neopterin appeared as a biomarker that could differentiate pMS from other demyelinating patient groups, MOG Ab+ patients and NMO patients as well as from controls. The fact that pteridine pathway products had not been studied in urine and serum in children with demyelinating disease before highlights the novelty of this study. If further research in larger samples confirm the present results, these biomarkers might assist the differential diagnosis of pMS from other demyelinating CNS diseases.
Keywords: Neopterin, Kynurenine, Biopterin, Multiple Sclerosis, Urine, Relapse, Stable, Demyelinating Disease, Neuromyelitis Optica Spectrum Disorder (NMOSD), MOG Antibody Associated Disease, Serum.Yıldız Kayaoğlu M, Çocukluk çağı otoimmün santral sinir sistemi hastalıklarında serum ve idrar örneklerinde neopterin ve serum kinürenin-triptofan yolağı ürünleri düzeylerinin karşılaştırılması. Çocuk Sağlığı ve Hastalıkları Uzmanlık Tezi, Ankara, 2021. Çocukluk çağında santral sinir sisteminin (SSS) ile inflamatuvar demiyelinizan hastalıkları arasında akut dissemine ensefalomiyelit (ADEM), multipl skleroz (MS), nöromiyelitis optika (NMOSB), Miyelin Oligodendrosit Glikoprotein (MOG) antikoruyla ilişkili hastalık gibi klinik ve radyolojik olarak tanımlanmış hastalıklar ve otoimmün ensefalitler yer alır. Başlangıçta belirli bir tanı grubuna uymayan olgular olduğu gibi, bu gruplar arasında ayrıcı tanı güçlüğüne de rastlanabilmektedir. Bu nedenle hem çocukluk, hem de erişkin çağı SSS otoinflamatuvar hastalıklarında tanıya, ayırıcı tanı ve tedaviye yönlendirecek, prognozu ön görmeye katkıda bulunacak laboratuvar ipuçlarına gereksinim duyulmaktadır. “Biyobelirteç” olarak adlandırılan ölçüm ya da veriler, normal ya da patolojik bir durumun değerlendirilmesinde tanı, derecelendirme, prognoz ya da izlem amaçlı kullanılabilecek, güvenilir ve objektif olarak ölçülebilen karakterlerdir. İyi bir biyobelirteç idrar, serum, beyin omurilik sıvısı (BOS) gibi klinik örneklerde tayin edilebilmelidir. Yayınlarda SSS otoimmün hastalıklarında serum kinürenin-triptofan yolağı ürünlerinin ve serum neopterin düzeyinin yol gösterebileceği yönünde sonuçlar vardır. Neopterinler çeşitli SSS hastalıklarında incelenmiş olmakla birlikte özellikle çocukluk çağı MS (çMS), ADEM gibi SSS otoimmün hastalarında çalışma sayısı azdır. Bu moleküllerin idrarda ölçülebilmeleri, örnek elde edilme kolaylığı ve hasta uyumu açılarından büyük yarar sağlayabilir. Bu çalışmada çMS ve diğer SSS otoimmün demiyelinizan hastalıklarının klinik özellikleriyle ve prognozla ilgili olabilecek pteridin yolağı moleküllerinin plazma ve idrarda ölçülmesi ve bu hastalıklarda belirteç olarak değerlerinin incelenmesi amaçlanmıştır. Demiyelinizan hastalığı olan çocuklarda: 27 çMS, 10 MOG antikoru pozitif (MOG Ak+) hasta, 5 nöromiyelitis optika (NMO) hastası ve 13 sağlıklı veya demiyelinizan hastalık dışı hastalığı olan toplam 55 çocuğun, ebeveyn ve kendisinin onamları alındıktan sonra idrar ve serum örnekleri alındı. İdrarda neopterin, biyopterin ve kreatinin ve serumda kinürenin ve triptofan yüksek performanslı sıvı kromatografisi (HPLC) ile, serumda neopterin ise ELİSA yöntemiyle ölçüldü. İstatistiksel analizler SPSS (IBM SPSS Statistics 23) paket programı kullanılarak yapıldı. Hastaların yaş ortancası 15 (5) ve kontrol grubunun yaş ortalaması ise 13,69 ± 2,72 yıl idi. Tanı grupları arasında hastaların yaşları bakımından anlamlı fark vardı (p=0,001). çMS hastaları MOG Ak+ hastalardan anlamlı derecede olmak üzere, diğer gruplara göre daha büyüktü. MOG Ak+ hastaları en küçük yaş grubunu oluşturuyordu. Tüm hasta grubu kontroller ile karşılaştırıldığında idrar neopterin değerleri arasında fark bulundu (p=0,006). ROC analizi ile kesim noktası hesaplanarak idrar neopterin değeri 167,75 µmol/mol kreatininin üzerinde olduğu takdirde hastaların %71 duyarlılık, %90 seçicilikle kontrollerden ayrılabildiği belirlendi. Tüm tanı grupları kendi aralarında karşılaştırıldığında idrar neopterin değerleri arasında istatistiksel olarak anlamlı fark bulundu (p=0,002). Bonferroni testi ile incelendiğinde, çMS hastalarının idrar neopterin değerlerinin NMO hastalarından, MOG Ak+ hastalardan ve kontrol bireylerden farklı olduğu görüldü. Bu durumda farkın çMS hasta grubundan kaynaklandığı görülmektedir. En belirgin fark ise çMS grubu ile kontrol grubu arasındaydı. çMS hastaları klinik durumlarına göre incelendiğinde atakta ve stabil durumdaki çMS hastaları arasında fark bulunmuyordu: Atakta da, stabil durumda da olsalar, çMS hastalarının idrar neopterin değerleri kontrollerden farklıydı (p=0,002). Bu durumda idrar neopterin düzeyi çMS hastalığını diğer demiyelinizan hasta grupları olan MOG Ak+ hastalardan ve NMO hastalarından, ayrıca kontrollerden de ayırabilecek bir biyobelirteç olarak görünmektedir. Daha önce çMS’te pteridin yolağı ürünlerinin idrar ve serumda incelenmemiş olması nedeniyle özgün bir çalışma niteliği taşıyan bu çalışmanın sonuçları daha geniş örneklemlerde doğrulandığı takdirde pratik ve anlamlı bir parametre olarak uygulamaya girebilir.
Anahtar Kelimeler: Neopterin, Kinürenin, Biyopterin, Multipl Skleroz, İdrar, Atak, Stabil, Demiyelinizan Hastalık, Nöromiyelitis Optika Spektrum Bozukluğu (NMOSB), MOG Antikoruyla İlişkili Hastalık, Seru
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
SUBACUTE SCLEROSING PANENCEPHALITIS
No full textSubacute sclerosing panencephalitis is a manifestation of persistent measles virus infection in the brain. It affects about 1/10 000 children who experience natural measles infection, but the risk is about 10 times higher if measles infection occurs below 1 year of age. Recent measles epidemics in central Europe will bring the possibility of this complication into consideration in the future. The diagnosis of subacute sclerosing panencephalitis should be considered in a child, adolescent or young adult with behavioral changes, myoclonia, forgetfulness, or deterioration of cognitive functions developing over weeks or months. Electroencephalogram is typical and measles antibody titers in the cerebrospinal fluid are diagnostic. Treatment includes immunomodulatory and antiviral agents, but results in relative remission or stabilization in less than 30% of patients. The fact that spontaneous remissions are also observed suggests host immunity as the main factor affecting outcome, therefore, supportive care and immunomodulatory agents constitute principal aspects of treatment
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Çocuklarda Vertigo Etiyolojisi, Çocukluk Çağı Benign Paroksismal Vertigosu ve Migren Ilişkisi
No full textVertigo in children has received much less attention in the literature than vertigo in adults and there is no standart algorithm for evaluation of these children. The most common reason of vertigo in childhood, benign paroxysmal vertigo of childhood (BPVC) is thought to be a migraine precursor. The aim of this study was to describe the characteristics of vertigo in pediatric patients presenting to a tertiary neurology clinic and to investigate the relationship between BPVC and migraine. All patients younger than 18 years of age and presenting with vertigo to Hacettepe University Ihsan Dogramaci Children?s Hospital Neurology Unit between January 1996-January 2012 were included in the study. These patients were retrospectively analysed through the patient files and follow-up data were obtained with phone interviews. One hundred patients with a mean age of 7,5 years were evaluated in our study. The most common symptoms associated with vertigo were headache (20%) and nausea (17%). The most common vertigo etiologies were BPVC (39%), psychogenic vertigo (21%), epileptic vertigo (15%), and migraine-associated vertigo (MAV) (11%). The most common etiology was BPVC in children ?5 years of age, while it was psychogenic vertigo in older children. Staring episodes were more common in epileptic vertigo patients (p=0,021) while headache was more commonly associated with MAV (p<0,001). Vertigo attacks lasting more than five minutes were less common in BPVC patients compared with others (p=0,013). Six (20%) out of 30 BPVC patients contacted through phone interviews were experiencing migraine type headaches. An algorithm for evaluation of children presenting with vertigo was formed based on data obtained from this study and the literature. When this algorithm was applied to 30 randomly selected cases from this series, 23 (76,6%) were correctly diagnosed. In most of the cases of vertigo disorders in children, a thorough medical history and a detailed physical examination, neurological examination and audiological evaluation are sufficient for accurate diagnosis. A standart algorithm for evalution of this patient group can help with the correct diagnosis and treatment.Çocukluk yaş grubunda vertigo, erişkin döneme göre daha az çalışılmış bir konu olup, vertigo yakınmasıyla başvuran çocukların değerlendirilmesinde belirli bir yaklaşım algoritması bulunmamaktadır. Çocuklarda vertigonun en sık nedeni bir migren öncülü olarak düşünülen çocukluk çağı benign paroksismal vertigosudur (ÇÇBPV). Bu çalışmanın amacı; üçüncü basamak bir hastanenin Pediatrik Nöroloji Ünitesi?ne vertigo yakınmasıyla başvuran çocuk hastaların özelliklerinin belirlenmesi ve ÇÇBPV ile migren ilişkisinin değerlendirilmesidir. Çalışmaya Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi Nöroloji Polikliniği?ne, Ocak 1996-Ocak 2012 arasında vertigo yakınmasıyla başvuran 18 yaşından küçük tüm hastalar dahil edilmiştir. Bu hastaların bilgileri hasta dosyaları üzerinden geriye dönük olarak incelenmiş; son durumları telefon görüşmeleri ile öğrenilmiştir. Çalışmamızda, vertigo yakınmasının başlangıç yaşı ortalama 7,5 yaş olan 100 hasta değerlendirildi. Vertigoya en sık eşlik eden yakınmalar baş ağrısı (%20) ve mide bulantısıydı (%17). Klinikte en sık saptanan vertigo nedenleri ÇÇBPV (%39), psikojenik vertigo (%21), epileptik vertigo (%15) ve migrenle ilişkili vertigoydu (MİV) (%11). Beş yaş altı çocuklarda en sık vertigo nedeni ÇÇBPV iken, beş yaş üstü çocuklarda psikojenik vertigo ilk sırayı almaktaydı. Dalma-boş bakma yakınması epileptik vertigo hastalarında daha sıktı (p=0,021); baş ağrısı yakınmasının MİV hastalarında baş dönmesine daha sık eşlik ettiği görüldü (p<0,001). Beş dakikadan uzun süren vertigo atakları, ÇÇBPV hastalarında diğer hastalara göre daha az sıklıkta görülmekteydi (p=0,013). Telefonla ulaşılan 30 ÇÇBPV hastasının altısında (%20) migren tipi baş ağrısının olduğu öğrenildi. Çalışma sonuçları ve literatürden gelen bilgiler çerçevesinde vertigolu çocuğa yaklaşım şeması oluşturuldu. Bu şema, çalışma grubundan rastgele seçilen 30 hastaya uygulanarak denendiğinde, 23 (%76,6) hastaya doğru tanı konulabildiği görüldü. Vertigolu çocuk hastaların büyük kısmında ayrıntılı bir öykü ve nörolojik ve odyolojik değerlendirmeyi de içeren ayrıntılı bir muayene tanı konulması için yeterlidir. Bu grup hastaya yaklaşımda, standart bir yaklaşım protokolünün belirlenmesi, doğru tanı ve tedavi seçiminde yol gösterici olacaktır
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