Emrah Şenel's research while affiliated with Ankara Yildirim Beyazit University and other places

Introduction We sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS). Materials and Methods Twenty-three infants were included in the study, 13 in the IHPS group and 10 in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values. Results No differences were found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylorus in the IHPS group was four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month. Conclusions 2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.

Introduction: We sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS). Material and Methods: Twenty-three infants were included in the study, thirteen in the IHPS group and ten in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values. Results: No difference was found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylori in the IHPS group were four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month. Conclusions: 2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.

Background Acute kidney injury (AKI) is a common and important complication of burn injury. Although there are numerous adult studies, data regarding AKI in pediatric burn patients are scarce. Here, we aimed to evaluate the frequency, clinical features, and prognosis of AKI among pediatric burn injury patients. Methods This is a retrospective cohort study. Patients aged between 1 month and 18 years who had been followed up between the years 2011 and 2017 were included, and patients with previous kidney disease were excluded. Demographic data, laboratory and clinical variables, management strategies, and outcome data were obtained from the hospital records. Factors associated with AKI were determined by logistic regression analysis. Results A total of 697 patients had been followed up, and 87 (12.5%) had AKI. Older age, refugee status, prolonged duration between the incident and time of hospitalization, presence of sepsis, severity and type of burn, volume of fluid administration, intubation status, and accompanying organ failure were all associated with the development of AKI. According to multivariate logistic regression analysis, the most statistically significant factors associated with the development of AKI were older age and increased serum hemoglobin values. In terms of outcomes, length of stay and mortality increased in patients with AKI when compared with patients without AKI. Conclusion Similar to adults, AKI is an important and common complication of burn injury in pediatric burn patients and is associated with increased length of stay, morbidity, and mortality. Early recognition and prompt and appropriate management are crucial to avoid morbidity and mortality. Graphical abstract

Objective: We aimed to reveal the toxicological analysis of the newly developed fibrin-derived scaffold forms (DermoTurk) before human studies. Material and Methods: 42 male Albino Wistar rats were used. Two of them were used to produce mesenchymal and epidermal stem cells. Forty rats were divided into five groups, each consisting of 8 rats; the acellular scaffold applied group as Group-1, the mesenchymal stem cells added scaffold used group as Group-2, the MSCs and epidermal stem cells-added scaffold applied group as Group-3, MSCs- and epidermal stem cells-added scaffold applied outbred group as Group-4 and control as Group-5. The changing of laboratory tests in the groups was evaluated five days before application and on the 7th and 40th days. After the autopsy performed on the 40th day of the study, rats’ organs and scaffold implanted skin area were evaluated histologically. All the results of the groups were compared. SPSS 22.0 was used for analyses. P <0.05 was accepted as statistically significant. Results: There were no differences between the groups in terms of laboratory results. Histologically, a mild-grade foreign body reaction against the DermoTurk was found in all groups; this reaction was less in groups 3 and 4 with the richest stem cells. Conclusion: This study revealed that DermoTurk is safe in rats. It could be an important alternative to skin substitutes, with stem cells or alone. Human studies for clinical efficacy should be carried out.

Purpose: The study aimed to assess the postoperative outcomes of pediatric thyroid nodules with Atypia of Undetermined Significance (AUS/FLUS) or Suspicious for a Follicular Neoplasm (SFN) and their EU-TIRADS scoring. Methods: The study retrospectively reviewed 44 patients at a single center with thyroid nodules classified as Atypia of Undetermined Significance or Suspicious for a Follicular Neoplasm from August 2019 to December 2022. Data on demographics, thyroid function, nodule size, and ultrasonographic features were collected. Postoperative pathologies were categorized into benign, low-risk, and malignant neoplasms according to WHO 2022 criteria, with EU-TIRADS used for radiologic scoring. Results: Among 21 pediatric patients, 72% had Bethesda 3 and 28% had Bethesda 4 thyroid nodules. Pathological outcomes post-surgery classified 43% as benign, 19% as low-risk, and 38% as malignant. Notably, EU-TIRADS 3 and 5 scores were present in 44% and 56% of benign cases, respectively. Malignant cases showed a prevalence of higher EU-TIRADS scores, with 64% rated as EU-TIRADS 5. Bethesda category 4 nodules had a 66% malignancy rate, significantly higher than the 27% in category 3. Conclusion: The investigation revealed that EU-TIRADS scoring showed a substantial proportion of benign cases were classified as EU-TIRADS 5, suggesting that EU-TIRADS may lead to unnecessary biopsies in benign cases. Malignant cases were more likely to have a higher EU-TIRADS score, indicating a positive correlation with malignancy risk, particularly in Bethesda 4 cases. However, the EU-TIRADS system's predictive value for malignancy in Bethesda 3 cases was less definitive.

Objective: Acute kidney injury (AKI) is a common and important complication of burn injury. Although there are numerous adult studies data regarding AKI in pediatric burn patients is scarce. In this study we aimed to evaluate the frequency, clinical features and prognosis of AKI among pediatric burn injury patients. Methods: This is a retrospective cohort study. Patients aged between 1 month and 18 years followed in pediatric burn intensive care unit between years 2011 and 2017 were included in the study.Patients with known kidney disease were not included. Demographic data, laboratory and clinical variables, management strategies and prognosis were obtained from the hospital records of the patients. Factors associated with AKI were determined by logistic regression analysis. Results: A total of 697 patients had been followed up and among them 87 (12.5%) had acute kidney injury. Older age, being a refugee, prolonged duration between the incident and time of hospitalization, presence of sepsis and severity and type of burn, the amount of fluid administered, being intubated, accompanying organ failure were all related with the development of AKI. According to multivariate logistic regression analysis the most important contributors of AKI were older age and increased serum hemoglobin values. Conclusion: As observed in adults AKI is also an important and common complication of burn injury among pediatric burn patients. Early recognition and prompt and appropriate management is crucial to avoid morbidity and mortality.

Background/aim The clinical presentation of pediatric coronavirus disease 2019 (COVID-19) is associated with a milder disease course than the adult COVID-19 syndrome. The disease course of COVID-19 has three clinicobiological phases: initiation, propagation, and complication. This study aimed to assess the pathobiological alterations affecting the distinct clinical courses of COVID-19 in pediatric age groups versus the adult population. We hypothesized that critical biogenomic marker expressions drive the mild clinical presentations of pediatric COVID-19. Materials and methods Blood samples were obtained from 72 patients with COVID-19 hospitalized at Ankara City Hospital between March and July 2021. Peripheral blood mononuclear cells were isolated using Ficoll-Paque and density-gradient sedimentation. The groups were compared using a t-test and limma analyses. Mean standardized gene expression levels were used to hierarchically cluster genes employing Euclidean Gene Cluster 3.0. The expression levels of identified genes were determined using reverse transcription-polymerase chain reaction. Results This study found that ANPEP gene expression was significantly downregulated in the pediatric group (p < 0.05, FC: 1.57) and IGF2R gene expression was significantly upregulated in the adult group (p < 0.05, FC: 2.98). The study results indicated that the expression of critical biogenomic markers, such as the first-phase (ACE2 and ANPEP) and second-phase (EGFR and IGF2R) receptor genes, was crucial in the genesis of mild clinical presentations of pediatric COVID-19. ANPEP gene expression was lower in pediatric COVID-19. Conclusion The interrelationship between the ANPEP and ACE2 genes may prevent the progression of COVID-19 from initiation to the propagating phase in pediatric patients. High IGF2R gene expression could potentially contribute to a protective effect and may be a contributing factor for the mild clinical course observed in pediatric patients.

Objective: The COVID-19 pandemic has affected the whole world in terms of health, social life, and economics. In this study, the frequency of pediatric home accidents in the second wave of the pandemic, where social isolation continues, was investigated. Material and Methods: This is a single center, retrospective study. We evaluated cases of patients under the age of 18 who were admitted to the hospital due to a home accident between November 1, 2020 and January 31, 2021 (the second wave of the pandemic). Results were compared with the patients who were admitted to the same emergency department within the same period of the previous year. Researchers examined home accidents in three groups: crash-fall-incision (1), intoxication-foreign body ingestion (2), and burns (3). The patients were divided into four age groups: 0-1 year, 2-5 years, 6-11 years, and 12-17 years. Results: The study was completed with 607 cases pre-Covid and 683 cases post-Covid. The median age was 44.4 month (17-57) from 2019-2020 and 49.1 month (18-64) from 2020-2021 (p=0.154). The outpatient and sequela-free discharges were more frequent in both periods (p=0.046). In the second wave of the pandemic, there was an increase in burns and fall related admissions compared to before the pandemic (p<0.001). All types of home accidents were frequently detected at the ages of five years and younger. Conclusion: In this study, analyzing the second wave of the pandemic compared to pre-pandemic times, Researchers noted a decrease in the number of emergency admissions and an increase in admissions related to home accidents.

Background: Authors widely use pulse oximetry in clinical monitoring of heart rate (HR) and peripheral oxygen saturation (SpO2) by attachment to the fingers; however, there can be a need for an alternative attachment site, especially for burned patients. We investigate the availability of a pulse oximeter probe attached to the penile shaft as an alternative site in pediatric male patients if all extremities became unavailable for pulse oximetry measurement due to severe burn and/or trauma. Methods: We designed a prospective comparative study in a training and research hospital. After local ethical committee approval, pediatric male cases eligible for penile and extremity pulse measurements were evaluated during general anesthesia for medical dressing and/or grafting due to severe burns. One probe was attached to the fingers of the unburned extremity, and the other was to the penile shaft. Furthermore, we recorded SpO2and HR values at 5-min intervals; 0th (baseline), 5th, 10th and 15th minutes. We compared HR and SpO2values measured by the finger probe with those measured by the penile probe. Results: Data of 51 patients (median age, 2.9 years (interquartile range, 2.0-5.0 years)) in whom the duration of dressing was at least 15min were analyzed. There was no significant difference either in comparisons of hemodynamic measurements (HR and SpO2 ) obtainedby finger probe and by a penile probe for each measurement time. The Bland-Altman plot analysis reveals agreement for penile and finger probes with a mean bias value between 0.20 and 0.37 on HR and between 0.43 and -0.20 on SpO2. Discussion: This clinical trial demonstrated that pulse oximetry measurement under nonhypoxic conditions we could perform confidently using penile probes in pediatric male patients whose extremities are unavailable for measurement.

Objective: Burns are complex, traumatic incidents including significant morbidity and impairment of psychological, emotional, and physical well-being. This study aimed to determine the relationship between self-esteem and social anxiety in adolescents with burns. Material and Methods: A cross-sectional, descriptive research design was used. The research was carried out in the 12-bed Pediatric Burn Center with 86 adolescents. The data collection form, Rosenberg Self-Esteem Scale and the Social Anxiety Scale for Children was used. Comparisons were made at the p<.05 significance level for statistical analyses. Results: Hot liquid (31.4%), chemicals (22.1%), flames (17.4%), electricity (16.3%), and contact with hot objects (12.8%) were burn factors. It was determined that 81.4% of the participants had a scar/mark. The total body surface area of the burn was determined as 1%-10% (61.6%), 10%-25% (32.6%), ≥50% (3.5%), and 25%-50% (2.3%). The multiple linear regression model established according to the effects of self-esteem scores and socio-demographic variables on children’s social anxiety was statistically significant (F(20.65)=2.384, p<.05). In the study, 42.6% of the variance in the scores on the social anxiety scale for children was explained by self-esteem scores and socio-demographic variables. Self-esteem scores predicted children’s social anxiety scores statistically positively and significantly (B=4.413, t=4.139, p<.05). Conclusion: The study revealed that there was relation between low self-esteem and high social anxiety in adolescents with burns in line with our study question, while there is no relation between characteristics of children and burn history in children.