Person: GÜRAN, TÜLAY
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GÜRAN
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TÜLAY
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Publication Metadata only Withdrawal of inhaled steroids in children with non-cystic fibrosis bronchiectasis(WILEY, 2008) KARADAĞ, BÜLENT TANER; Guran, T.; Ersu, R.; Karadag, B.; Karakoc, F.; Demirel, G. Y.; Hekim, N.; Dagli, E.To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non-cystic fibrosis (non-CF) bronchiectasis. To evaluate the role of inhaled steroids in the treatment of children with non-CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis. Twenty-seven children with steady-state non-CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) levels and neutrophil ratios in induced sputum before and after 12-week withdrawal of inhaled steroids. There were 16 girls and 11 boys. Median (interquartile range) age was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years. Symptom scores (4 vs. 3; P = 0.27), oxygen saturation (95% vs. 97%; P = 0.06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0.73), sputum neutrophil ratios (29.9% vs. 46.8%; P = 0.20), TNF-alpha (58 pg/mL vs. 44.5 pg/mL; P = 0.55) and IL-8 (2.7 ng/mL vs. 2.4 ng/mL; P = 0.82) levels in induced sputum were similar before and after 12-week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0.016) and neutrophilic apoptosis in induced sputum decreased (42.8% vs. 20.2%; P = 0.03) after withdrawal. In this study, 12 week-withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non-CF bronchiectasis was observed.Publication Metadata only Association between inflammatory markers in induced sputum and clinical characteristics in children with non-cystic fibrosis bronchiectasis(WILEY-LISS, 2007) KARADAĞ, BÜLENT TANER; Guran, Tulay; Ersu, Refika; Karadag, Buient; Akpinar, Ihsan Nuri; Demirel, Gulderen Yanikkaya; Hekim, Nezih; Dagli, ElifTo study clinical, radiological and laboratory features of children with non-cystic fibrosis (non-CF) bronchiectasis (BE) and the association between symptom scores, spirometry, high-resolution computed tomography (HRCT) findings and inflammatory markers in induced sputum in these children. Twenty-seven children with steady-state non-CF BE were cross-sectionally evaluated by symptom scores, pulmonary function tests, anatomic extension and severity scores of BE in HRCT and tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) levels in induced sputum. There were 16 girls and 11 boys. Median (interquartile range) age of study group was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years and symptom scores were 4 (3-6). Pulmonary function tests revealed FEV1 of 82%pred (72-93), FVC of 82%pred (74-92), and FEF25-75% of 82%pred (68-95). According to anatomic extent of BE on HRCT; 2 patients had mild, 4 had moderate and 21 had severe BE. Based on severity scores of HRCT; 10 patients had mild, 10 had moderate and 7 had severe BE. Neutrophils consisted 29.9% (14.9-53.7) of the total leucocytes in induced sputum samples. Sputum concentration of TNF-alpha was 58 pg/ml (9.2-302) while IL-8 concentration was 2.7 ng/ml (1.7-2.8). Symptom scores correlated with FEV1 and sputum IL-8 levels (r=-0.49, r=0.67, P < 0.05). There was a significant correlation between HRCT severity scores and symptoms, FEV1, sputum IL-8 and TNF-alpha levels (r=0.64, r=-0.68, r=0.41, r=0.41, respectively, P < 0.05). In children BE is associated with ongoing inflammation. This inflammation can be reliably monitored by radiological scores, spirometry, as well as sputum inflammatory markers. Follow-up of children with BE using these clinical tools may improve patient care.Publication Metadata only Bone mineral density in children with non-cystic fibrosis bronchiectasis(KARGER, 2008) BEREKET, ABDULLAH; Guran, Tulay; Turan, Serap; Karadag, Bulent; Ersu, Refika; Karakoc, Fazilet; Bereket, Abdullah; Dagli, ElifBackground: Bronchiectasis presents as a common sequela of several chronic pulmonary diseases. Bone mineral density ( BMD) is generally decreased in children with cystic fibrosis ( CF). Although children with non-CF bronchiectasis have similar risk factors for osteopenia/osteoporosis, data on BMD in this group of patients are lacking. Objective: To evaluate BMD in children with non-CF bronchiectasis. Methods: In this study, we evaluated BMD of the radius and tibia in 32 children ( 17 girls) with non-CF bronchiectasis and in 23 healthy controls matched for age, sex and pubertal stage by quantitative ultrasound ( speed of sound). Daily calcium intake and pulmonary function tests and data about steroid use were noted. Results: Mean age was 12.5 +/- 4.6 years. Six children ( 18%) had moderate-to-severe lung disease (FEV1 < 60% predicted). All except 2 children ( 94%) were receiving inhaled steroids. There was no significant difference in BMD ( expressed as z- score) of the radius and tibia between the patient and control groups ( tibia z-scores: - 0.1+/-0.9 vs. - 0.8 +/- 0.8 and radius z- scores - 1.3 +/- 1.4 vs. - 1.0 +/- 0.9 in bronchiectasis patients and controls, respectively, p >0.05). However, more children with non-CF bronchiectasis had osteopenia ( z- scores between - 1 and - 2 SD) and osteoporosis ( z- score <= 2 SD) compared to the control group ( 62 vs. 30%, p = 0.019). There was a significant correlation between age and radius z- scores ( r = - 0.365, p = 0.04). There was no correlation between BMD and severity of lung illness, calcium intake or cumulative steroid doses. Conclusion: Osteopenia is more common in children with non-CF bronchiectasis compared to controls and the risk of osteoporosis and osteopenia increases with age. Copyright (C) 2007 S. Karger AG, Basel.Publication Metadata only Hypoglycemia is common in children with cystic fibrosis and seen predominantly in females(WILEY, 2017) BEREKET, ABDULLAH; Haliloglu, Belma; Gokdemir, Yasemin; Atay, Zeynep; Abali, Saygin; Guran, Tulay; Karakoc, Fazilet; Ersu, Refika; Karadag, Bulent; Turan, Serap; Bereket, AbdullahObjective: To determine the prevalence of hypoglycemia in children and adolescents with cystic fibrosis (CF) in 2-hour oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) under free-living conditions. Research Design and Methods: Height, weight, body mass index (BMI), hemoglobin A1c (HbA1c), and Forced expiratory volume (FEV1%) were measured in children with CF (aged 5-18 years). Following OGTT, CGM was installed for 3 days. The total hypoglycemic and hyperglycemic time (%) during 3 days was measured. Subjects were categorized according to hypoglycemic time < 3% (hypo -) and = 3% (hypo +). Each category was further divided according to hyperglycemic time < 3% (hyper -) or = 3% (hyper +). Results: OGTT and CGM were sequentially performed in 45 CF patients. The frequency of hypoglycemia in OGTT and hypoglycemic time >= 3% of CGM were 13.3% and 27.5%, respectively. After 5 cystic fibrosis-related diabetes (CFRD) subjects were excluded, the number of subjects in each subgroup was 17 (hypo-/hyper-), 12 (hypo-/hyper+), 6 (hypo+/hyper-), and 5 (hypo+/hyper+). Significantly higher insulin at 120 minutes was observed in OGTT in (hypo +/hyper-), as compared with subgroup (hypo-/hyper-) (P = .018). Total insulin levels were also significantly higher in (hypo+/hyper-), than (hypo-/hyper-), but were similar to those in the healthy control group (P = .049 and P =.076, respectively). There was a female predominance in hypoglycemic subjects both in OGTT and subgroup (hypo+/hyper-) in the CGM group (P = .033 and P = .033, respectively). FEV1 was significantly lower in hypo + group as a whole, and (hypo+/hyper+) subgroup than in (hypo-/hyper-), (P = .044 and P = .042, respectively); the difference was independent of body mass index-standard deviation score (BMI-SDS) (P = .15 and P = .12, respectively). Conclusion: The frequency of hypoglycemia in children with CF was higher in CGM than that in OGTT. Insulin secretion was delayed and total insulin levels increased in the hypoglycemic patients. Glucose instability/hypoglycemia is associated with poorer lung function in patients with CF, independent of nutritional status.