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Umay E, Eyigor S, Giray E, Karadag Saygi E, Karadag B, Durmus Kocaaslan N, Yuksel D, Demir AM, Tutar E, Tikiz C, Gurcay E, Unlu Z, Celik P, Unlu Akyuz E, Mengu G, Bengisu S, Alicura S, Unver N, Yekteusaklari N, Uz C, Cikili Uytun M, Bagcier F, Tarihci E, Akaltun MS, Ayranci Sucakli I, Cankurtaran D, Aykın Z, Aydın R, Nazli F. Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts. World J Pediatr 2022; 18:715-724. [PMID: 35821340 DOI: 10.1007/s12519-022-00584-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. METHODS This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). RESULTS In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. CONCLUSIONS This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.
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Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey.
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospıtal, Istanbul, Turkey
| | - Evrim Karadag Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Nihal Durmus Kocaaslan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University, Istanbul, Turkey
| | - Deniz Yuksel
- Department of Pediatric Neurology, University of Health Sciences, Ankara Dr Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Engin Tutar
- Department of Pediatric Gastroenterology, Marmara University, Ankara, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Eda Gurcay
- University of Health Sciences Turkey, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Pelin Celik
- Department of Developmental Pediatric, Ankara City Hospital, Ankara, Turkey
| | - Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Guven Mengu
- Department of Western Languages and Literatures, Ankara Haci Bayram Veli University, English Language and Literature Division, Ankara, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Necati Unver
- Department of Otolaryngology, Head and Neck Surgery, Marmara University, Istanbul, Turkey
| | - Nida Yekteusaklari
- Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Cuma Uz
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Merve Cikili Uytun
- Department of Child and Adolescent Psychiatry, Ankara University, Ankara, Turkey
| | - Fatih Bagcier
- Department of Physical Medicine and Rehabilitation, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Elif Tarihci
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Iclal Ayranci Sucakli
- University of Health Sciences Turkey, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Aykın
- Ministry of Health, Mamak Public Hospital, Ankara, Turkey
| | - Resa Aydın
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Fatma Nazli
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
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Duclaux-Loras R, Lebreton C, Berthelet J, Charbit-Henrion F, Nicolle O, Revenu de Courtils C, Waich S, Valovka T, Khiat A, Rabant M, Racine C, Guerrera IC, Baptista J, Mahe MM, Hess MW, Durel B, Lefort N, Banal C, Parisot M, Talbotec C, Lacaille F, Ecochard-Dugelay E, Demir AM, Vogel GF, Faivre L, Rodrigues A, Fowler D, Janecke AR, Müller T, Huber LA, Rodrigues-Lima F, Ruemmele FM, Uhlig HH, Del Bene F, Michaux G, Cerf-Bensussan N, Parlato M. UNC45A deficiency causes microvillus inclusion disease-like phenotype by impairing myosin VB-dependent apical trafficking. J Clin Invest 2022; 132:154997. [PMID: 35575086 PMCID: PMC9106349 DOI: 10.1172/jci154997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/29/2022] [Indexed: 01/03/2023] Open
Abstract
Variants in the UNC45A cochaperone have been recently associated with a syndrome combining diarrhea, cholestasis, deafness, and bone fragility. Yet the mechanism underlying intestinal failure in UNC45A deficiency remains unclear. Here, biallelic variants in UNC45A were identified by next-generation sequencing in 6 patients with congenital diarrhea. Corroborating in silico prediction, variants either abolished UNC45A expression or altered protein conformation. Myosin VB was identified by mass spectrometry as client of the UNC45A chaperone and was found misfolded in UNC45AKO Caco-2 cells. In keeping with impaired myosin VB function, UNC45AKO Caco-2 cells showed abnormal epithelial morphogenesis that was restored by full-length UNC45A, but not by mutant alleles. Patients and UNC45AKO 3D organoids displayed altered luminal development and microvillus inclusions, while 2D cultures revealed Rab11 and apical transporter mislocalization as well as sparse and disorganized microvilli. All those features resembled the subcellular abnormalities observed in duodenal biopsies from patients with microvillus inclusion disease. Finally, microvillus inclusions and shortened microvilli were evidenced in enterocytes from unc45a-deficient zebrafish. Taken together, our results provide evidence that UNC45A plays an essential role in epithelial morphogenesis through its cochaperone function of myosin VB and that UNC45A loss causes a variant of microvillus inclusion disease.
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Affiliation(s)
- Rémi Duclaux-Loras
- Université Paris Cité, Imagine Institute, Laboratory of Intestinal Immunity, INSERM, UMR1163, Paris, France
- Department of Pediatric Gastroenterology, Assistance Publique-Hopitaux de Paris, Hopital Necker–Enfants Malades, F-75015, Paris, France
| | - Corinne Lebreton
- Université Paris Cité, Imagine Institute, Laboratory of Intestinal Immunity, INSERM, UMR1163, Paris, France
| | | | - Fabienne Charbit-Henrion
- Université Paris Cité, Imagine Institute, Laboratory of Intestinal Immunity, INSERM, UMR1163, Paris, France
- Department of Pediatric Gastroenterology, Assistance Publique-Hopitaux de Paris, Hopital Necker–Enfants Malades, F-75015, Paris, France
| | - Ophelie Nicolle
- Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes (IGDR)–UMR 6290, Rennes, France
| | - Céline Revenu de Courtils
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- Institut Curie, PSL Research University, INSERM U934, CNRS UMR3215, Paris, France
| | - Stephanie Waich
- Universitätsklinik für Pädiatrie I and
- Institute of Cell Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Taras Valovka
- Universitätsklinik für Pädiatrie I and
- Institute of Cell Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Anis Khiat
- Université Paris Cité, Imagine Institute, Laboratory of Intestinal Immunity, INSERM, UMR1163, Paris, France
| | - Marion Rabant
- Department of Pathology, Assistance Publique–Hopitaux de Paris, Hopital Necker–Enfants Malades, Paris, France
| | - Caroline Racine
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, Fédération Hospitalo–Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire, and Equipe GAD, Université de Bourgogne Franche-Comté, Faculté de Médecine, INSERM LNC UMR 1231, Dijon, France
| | - Ida Chiara Guerrera
- Proteomics Platform 3P5-Necker, Université Paris Descartes-Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Paris, France
| | - Júlia Baptista
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Maxime M. Mahe
- Université de Nantes, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
| | - Michael W. Hess
- Institut für Histologie und Embryologie Medical University of Innsbruck, Innsbruck, Austria
| | - Béatrice Durel
- Cell Imaging Platform, INSERM-US24-CNRS UMS 3633 Structure Fédérative de Recherche Necker, Université Paris Cité, Paris, France
| | - Nathalie Lefort
- iPS Core Facility, Imagine Institute, INSERM U1163, Paris Descartes University, Paris, France
| | - Céline Banal
- iPS Core Facility, Imagine Institute, INSERM U1163, Paris Descartes University, Paris, France
| | - Mélanie Parisot
- Genomics Core Facility, Institut Imagine–Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Cecile Talbotec
- Department of Pediatric Gastroenterology, Assistance Publique-Hopitaux de Paris, Hopital Necker–Enfants Malades, F-75015, Paris, France
| | - Florence Lacaille
- Department of Pediatric Gastroenterology, Assistance Publique-Hopitaux de Paris, Hopital Necker–Enfants Malades, F-75015, Paris, France
| | | | - Arzu Meltem Demir
- Ankara Child Health and Diseases, Training and Research Hospital, Pediatric Gastroenterology, Ankara, Turkey
| | - Georg F. Vogel
- Universitätsklinik für Pädiatrie I and
- Institute of Cell Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Laurence Faivre
- Department of Pathology, Assistance Publique–Hopitaux de Paris, Hopital Necker–Enfants Malades, Paris, France
| | | | | | | | | | - Lukas A. Huber
- Institute of Cell Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Frank M. Ruemmele
- Department of Pediatric Gastroenterology, Assistance Publique-Hopitaux de Paris, Hopital Necker–Enfants Malades, F-75015, Paris, France
| | - Holm H. Uhlig
- Translational Gastroenterology Unit and Department of Paediatrics, John Radcliffe Hospital, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Filippo Del Bene
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- Institut Curie, PSL Research University, INSERM U934, CNRS UMR3215, Paris, France
| | - Grégoire Michaux
- Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes (IGDR)–UMR 6290, Rennes, France
| | - Nadine Cerf-Bensussan
- Université Paris Cité, Imagine Institute, Laboratory of Intestinal Immunity, INSERM, UMR1163, Paris, France
| | - Marianna Parlato
- Université Paris Cité, Imagine Institute, Laboratory of Intestinal Immunity, INSERM, UMR1163, Paris, France
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Mazman Dİ, Dereci S, Hızlı Ş, Doğan HT, Ateş BB, Hızal G, Demir AM, Aksu AÜ. Celiac crisis with thrombocytopenia and coagulopathy in a child. Turk J Pediatr 2022; 64:1156-1160. [PMID: 36583900 DOI: 10.24953/turkjped.2022.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Celiac disease rarely presents with edema, hypoalbuminemia, acute metabolic deterioration, and electrolyte imbalances. This life-threatening condition is defined as a celiac crisis and may mimic disorders with metabolic derangement and sepsis. The crisis may present at onset or develop in celiac disease patients with poor compliance to a gluten-free diet. The fluid resuscitation and replacement of electrolyte deficits are life-saving modalities. CASE A 14-month-old girl was admitted with fever, lethargy, severe dehydration, edema, hypotension, and commenced sepsis therapy. However, the patient had a growth delay and loss of weight with diarrhea and delayed motor skills. On admission, laboratory evaluation showed anemia, coagulopathy, hypoalbuminemia, electrolyte disturbances, and metabolic acidosis and developed thrombocytopenia during follow-up. The celiac serological tests and upper gastrointestinal endoscopic duodenal mucosa appearance, and duodenum histopathology findings suggested celiac disease. CONCLUSIONS This case highlights that a celiac patient may present with a severe illness like sepsis and may be associated with cytopenia and coagulopathy in the celiac crisis.
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Affiliation(s)
- Duygu İskender Mazman
- Department of Pediatric Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara
| | - Selim Dereci
- Department of Pediatric Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara
| | - Şamil Hızlı
- Departments of Pediatric Gastroenterology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
| | - Hayriye Tatlı Doğan
- Departments of Pathology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
| | - Burcu Berberoğlu Ateş
- Department of Pediatric Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara
| | - Gülin Hızal
- Department of Pediatric Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara
| | - Aysel Ünlüsoy Aksu
- Department of Pediatric Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara
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4
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Arman Bilir Ö, Demir AM, Akçabelen YM, Ok Bozkaya İ, Gürlek Gökçebay D, Güneş A, Özbek NY, Yaralı N. Pneumatosis cystoides intestinalis: A rare complication after hematopoietic stem cell transplantation. Pediatr Transplant 2021; 25:e14136. [PMID: 34505744 DOI: 10.1111/petr.14136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/03/2021] [Accepted: 08/25/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pneumatosis cystoides intestinalis (PCI) is a disorder in which widespread air sacs are present in mucosa, submucosa, subserosa, and intraabdominal area of the intestinal wall. It has a heterogeneous clinical presentation as a rare complication of intestinal graft-versus-host disease (GVHD). Computed tomography is the preferred imaging method for the diagnosis. Since the air sacs could be ruptured spontaneously, the presence of free air in the peritoneal cavity does not confirm intestinal perforation. The conservative treatment approach is sufficient in cases that do not require urgent surgical intervention, such as perforation or obstruction. CASE Here, we present a 2.5-year-old patient diagnosed with primary hemophagocytic lymphohistiocytosis (pHLH), who underwent allogeneic hematopoietic stem cell transplantation from a matched unrelated donor (MUD) and developed PCI secondary to intestinal GVHD 14th months after HSCT. CONCLUSIONS Pneumatosis cystoides intestinalis, which is a rare complication, should be kept in mind, especially in patients with intestinal GVHD and receiving intensive immunosuppressive, octreotide, and steroid treatment after HSCT.
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Affiliation(s)
- Özlem Arman Bilir
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yunus Murat Akçabelen
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Gürlek Gökçebay
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Altan Güneş
- Department of Pediatric Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology and Oncology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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5
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Baysal M, Bas V, Demirci U, Gulsaran SK, Umit E, Kirkizlar HO, Demir AM. The Utility of CONUT Score in Diffuse Large B Cell Lymphoma Patients. Niger J Clin Pract 2021; 24:1194-1199. [PMID: 34397030 DOI: 10.4103/njcp.njcp_429_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Assessment of nutritional status is gaining more importance in cancer patients because nutritional status is associated with response to chemotherapy, side effects of cancer treatment and disease progression. Several studies that were performed on patients with solid malignancies have shown the clinical significance of CONUT score (Controlling nutritional status). Aims Therefore we tried to show the utility of CONUT score in newly diagnosed Diffuse Large B Cell Lymphoma (DLBCL) patients which is the most frequently seen B Cell Lymphoma type. Methods Data of the 81 patients diagnosed with DLBCL were retrospectively evaluated. The primary endpoint of our study was to evaluate and classify newly diagnosed DLBCL patients according to the CONUT score and secondary endpoint was to show any relationship with CONUT score and overall survival. Patients' demographics, treatment details, stages, extranodal involvements, the presence of bulky disease, response to treatment options and overall survivals were evaluated from medical recordings. Results Univariate cox regression analysis CONUT score was associated with overall survival (HR: 2.34-95% CI: 1.55-3.24 P = 0.040). On multivariate Cox regression analysis model CONUT score ≥5 was found to be an independent prognostic factor for overall survival (HR: 4.96-95% CI: 1.77-13.97- P = 0.002). Conclusion The value of obtaining nutritional status in cancer patients is underestimated and CONUT score is simple, easily applicable and in our opinion is going to fill the gap especially in DLBCL patients.
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Affiliation(s)
- M Baysal
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - V Bas
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - U Demirci
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - S K Gulsaran
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - E Umit
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - H O Kirkizlar
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - A M Demir
- Department of Hematology, Trakya University, Faculty of Medicine, Edirne, Turkey
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Demir AM, Aydin F, Acar B, Kurt T, Poyraz A, Kiremitci S, Gülleroglu B, Azili MN, Bayrakci US. IgG4-related disease and ANCA positive vasculitis in childhood: a case-based review. Clin Rheumatol 2021; 40:3817-3825. [PMID: 33590421 DOI: 10.1007/s10067-021-05635-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 12/24/2022]
Abstract
Autoimmune pancreatitis (AIP) type 1 is an IgG4-related disease (IgG4-RD), characterized by inflammatory pseudotumors and histologically by dense lymphoplasmacytic infiltrates rich in IgG4 positive plasma cells, storiform fibrosis, and obliterative phlebitis. Although quite rare, IgG4-RD was found to be associated with medium or small vessel vasculitides. A new overlap syndrome between IgG4-RD and ANCA-associated vasculitis (AAV) has recently been described in the adult population. Here we present a 16-year-old adolescent girl admitted with abdominal pain, episcleritis, palpable purpura, salivary gland enlargement, and bloody diarrhea. Laboratory investigations revealed findings of glomerulonephritis. Abdominal imaging surprisingly revealed a focal mass in the pancreatic tail, while the c-ANCA level was found to be quite high as well as serum IgG4 level. Biopsy of the pancreatic mass showed lymphoplasmacytic IgG4 positive cells infiltrating the pancreas with storiform fibrosis compatible with IgG4-related AIP. The renal biopsy that was done simultaneously showed necrotizing granulomatous vasculitis indicating AAV. Renal biopsy showed IgG4 positive plasma cells very rarely by immunohistochemical examination, which does not indicate any significance for IgG4-RD. Our diagnosis was IgG4-related AIP and AAV overlap syndrome, which has not been reported in the pediatric populations yet. IgG4-RD should be investigated in patients with ANCA-associated vasculitis who shows atypical organ involvement. We searched the Pubmed/Medline and Google Scholar databases to identify clinical findings, treatment, and outcome of the patients with IgG4-related AIP and AAV.
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Affiliation(s)
- Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ankara City Hospital, Ankara, Turkey.
| | - Fatma Aydin
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Tuba Kurt
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Aylar Poyraz
- Department of Pathology, Gazi University Medical Faculty, Ankara, Turkey
| | - Saba Kiremitci
- Department of Pathology, Ankara University Medical Faculty, Ankara, Turkey
| | - Basak Gülleroglu
- Department of Pediatric Radiology, Ankara City Hospital, Ankara, Turkey
| | - Müjdem Nur Azili
- Department of Pediatric Surgery, Ankara City Hospital, Ankara, Turkey
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Özyörük D, Cabı EÜ, Taçyıldız N, Pınarlı F, Erdoğan AO, Hanalioğlu Ş, Erdem AY, Demir AM. Cancer and constitutional Mismatch Repair Deficiency syndrome due to homozygous MSH 6 mutation in children with Café au Lait Spots and review of literature. Turk J Pediatr 2021; 63:893-902. [PMID: 34738371 DOI: 10.24953/turkjped.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare childhood cancer predisposition syndrome resulting from biallelic germline mutations of mismatch repair (MMR) genes. CMMRD syndrome is characterised by early onset malignancies in children. CASE Here we present affected children of consanguinous parents diagnosed with CMMRD syndrome due to germline bi-allelic MSH 6 gene mutations with café au lait spots and multiple family cancers from Turkey and reported cases with CMMRD syndrome associated MSH 6 mutation in English literature. Hence, we reviewed English literature from 1990 to 2020 using Pub-Med database. Keywords used to search included constitutional mismatch repair deficiency syndrome, childhood cancer and MSH 6 gene mutation. CONCLUSIONS We emphasize that the inclusion of CMMRD syndrome in the differential diagnosis of a patient who presents with cafe´ au lait spots and/or hypopigmented skin lesions and cancer especially when consanguinity and/or a history of cancer coexist in children.
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Affiliation(s)
- Derya Özyörük
- Departments of Pediatric Hematology and Oncology, Health Sciences University, Ankara Childrens' Hematology and Oncology Hospital, Ankara
| | - Emel Ünal Cabı
- Department of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara
| | - Nurdan Taçyıldız
- Department of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara
| | | | - Ayşe Oğuz Erdoğan
- Departments of Pathology, Health Sciences University, Ankara Childrens' Hematology and Oncology Hospital, Ankara
| | - Şahin Hanalioğlu
- Department of Neurosurgery, Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Arzu Yazal Erdem
- Departments of Pediatric Hematology and Oncology, Health Sciences University, Ankara Childrens' Hematology and Oncology Hospital, Ankara
| | - Arzu Meltem Demir
- Departments of Pediatric Gastroenterology, Health Sciences University, Ankara Childrens' Hematology and Oncology Hospital, Ankara
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8
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Demir AM, Berberoğlu Ateş B, Hızal G, Yaman A, Tuna Kırsaçlıoğlu C, Oğuz AS, Karakuş E, Yaralı N, Özbek NY. Autoimmune atrophic gastritis: The role of Helicobacter pylori infection in children. Helicobacter 2020; 25:e12716. [PMID: 32589356 DOI: 10.1111/hel.12716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/17/2020] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Autoimmune atrophic gastritis (AIG) is very rare in children. Despite a better understanding of histopathologic changes and serological markers in this disease, underlying etiopathogenic mechanisms and the effect of Helicobacter pylori (H pylori) infection are not well known. We aimed to investigate the relation between AIG and H pylori infection in children. MATERIALS AND METHODS We evaluated the presence of AIG and H pylori infection in fifty-three patients with positive antiparietal cell antibody (APCA). Demographic data, clinical symptoms, laboratory and endoscopic findings, histopathology, and presence of H pylori were recorded. RESULTS The children were aged between 5 and 18 years, and 28 (52.8%) of them were male. Mean age was 14.7 ± 2.6 years (median: 15.3; min-max: 5.2-18), and 10 (18.8%) of them had AIG confirmed by histopathology. In the AIG group, the duration of vitamin B12 deficiency was longer (P = .022), hemoglobin levels were lower (P = .018), and APCA (P = .039) and gastrin (P = .002) levels were higher than those in the non-AIG group. Endoscopic findings were similar between the two groups. Intestinal metaplasia was higher (P = .018) in the AIG group. None of the patients in the AIG group had H pylori infection (P = .004). One patient in the AIG group had enterochromaffin-like cell hyperplasia. CONCLUSIONS Our results show that, in children, H pylori infection may not play a role in AIG. AIG could be associated with vitamin B12 deficiency, iron deficiency, and APCA positivity in children. APCA and gastrin levels should be investigated for the early diagnosis of AIG and intestinal metaplasia.
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Affiliation(s)
- Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Burcu Berberoğlu Ateş
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Gülin Hızal
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Aytaç Yaman
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ceyda Tuna Kırsaçlıoğlu
- Department of Pediatric Gastroenterology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Selcen Oğuz
- Department of Pathology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Esra Karakuş
- Department of Pathology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Simone ML, Rabacchi C, Kuloglu Z, Kansu A, Ensari A, Demir AM, Hizal G, Di Leo E, Bertolini S, Calandra S, Tarugi P. Novel mutations of SAR1B gene in four children with chylomicron retention disease. J Clin Lipidol 2019; 13:554-562. [DOI: 10.1016/j.jacl.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
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10
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Demir AM, Kuloğlu Z, Yaman A, Fitöz S, Nergizoğlu G, Kansu A. Carotid intima-media thickness and arterial stiffness as early markers of atherosclerosis in pediatric celiac disease. Turk J Pediatr 2017; 58:172-179. [PMID: 27976558 DOI: 10.24953/turkjped.2016.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The association between pediatric celiac disease (CD) and atherosclerosis is unknown. Our aim was to investigate whether pediatric CD patients have an increased risk of atherosclerosis. We evaluated the premature atherosclerosis by pulse wave velocity (PWV) and carotid intima-media thickness (cIMT). A total of 37 CD patients (20 girls, mean age 13±3.3 years) and 36 healthy age and sex matched controls were enrolled. Mean duration of CD was 47.1±32.3 months and 40.5% of patients had positive tissue transglutaminase antibody (tTg) IgA. Total cholesterol level was lower in CD (p=0.026) and cIMT was lower in tTg IgA antibody negative CD (p=0.030). cIMT was significantly correlated with tTg IgA antibody positivity (r=0.336; p=0.042). Adherence to strict gluten-free diet is associated with decreased cIMT, suggesting that gluten withdrawal seems to have a beneficial effect on premature atherosclerosis.
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Affiliation(s)
- Arzu Meltem Demir
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zarife Kuloğlu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aytaç Yaman
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Suat Fitöz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Nergizoğlu
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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11
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Demir AM, Kuloglu Z, Berberoglu M, Kansu A. Euprolactinemic galactorrhea secondary to domperidone treatment. J Pediatr Endocrinol Metab 2015; 28:955-6. [PMID: 25781524 DOI: 10.1515/jpem-2014-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 02/04/2015] [Indexed: 11/15/2022]
Abstract
Milk leakage from the breast, which is known as galactorrhea, can be caused by a number of pharmacological, physical, and tumoral factors. Galactorrhea is a well-known side effect of domperidone, and is usually associated with hyperprolactinemia. However, euprolactinemic galactorrhea secondary to domperidone is very rarely seen and has yet to be reported in children before. Here, we report an adolescent with euprolactinemic galactorrhea caused by domperidone.
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12
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Salzer E, Kansu A, Sic H, Májek P, Ikincioğullari A, Dogu FE, Prengemann NK, Santos-Valente E, Pickl WF, Bilic I, Ban SA, Kuloğlu Z, Demir AM, Ensari A, Colinge J, Rizzi M, Eibel H, Boztug K. Early-onset inflammatory bowel disease and common variable immunodeficiency-like disease caused by IL-21 deficiency. J Allergy Clin Immunol 2014; 133:1651-9.e12. [PMID: 24746753 DOI: 10.1016/j.jaci.2014.02.034] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/16/2014] [Accepted: 02/05/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alterations of immune homeostasis in the gut can result in development of inflammatory bowel disease (IBD). Recently, Mendelian forms of IBD have been discovered, as exemplified by deficiency of IL-10 or its receptor subunits. In addition, other types of primary immunodeficiency disorders might be associated with intestinal inflammation as one of their leading clinical presentations. OBJECTIVE We investigated a large consanguineous family with 3 children who presented with early-onset IBD within the first year of life, leading to death in infancy in 2 of them. METHODS Homozygosity mapping combined with exome sequencing was performed to identify the molecular cause of the disorder. Functional experiments were performed to assess the effect of IL-21 on the immune system. RESULTS A homozygous mutation in IL21 was discovered that showed perfect segregation with the disease. Deficiency of IL-21 resulted in reduced numbers of circulating CD19(+) B cells, including IgM(+) naive and class-switched IgG memory B cells, with a concomitant increase in transitional B-cell numbers. In vitro assays demonstrated that mutant IL-21(Leu49Pro) did not induce signal transducer and activator of transcription 3 phosphorylation and immunoglobulin class-switch recombination. CONCLUSION Our study uncovers IL-21 deficiency as a novel cause of early-onset IBD in human subjects accompanied by defects in B-cell development similar to those found in patients with common variable immunodeficiency. IBD might mask an underlying primary immunodeficiency, as illustrated here with IL-21 deficiency.
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Affiliation(s)
- Elisabeth Salzer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University, Ankara, Turkey
| | - Heiko Sic
- Center for Chronic Immunodeficiency, University Medical Center, Freiburg, Germany
| | - Peter Májek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | | | - Figen E Dogu
- Department of Pediatric Immunology, Ankara University, Ankara, Turkey
| | - Nina Kathrin Prengemann
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | | | - Winfried F Pickl
- Christian Doppler Laboratory for Immunomodulation and Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ivan Bilic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Sol A Ban
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Zarife Kuloğlu
- Department of Pediatric Gastroenterology, Ankara University, Ankara, Turkey
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ankara University, Ankara, Turkey
| | - Arzu Ensari
- Department of Pathology, Ankara University, Ankara, Turkey
| | - Jacques Colinge
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Marta Rizzi
- Center for Chronic Immunodeficiency, University Medical Center, Freiburg, Germany
| | - Hermann Eibel
- Center for Chronic Immunodeficiency, University Medical Center, Freiburg, Germany
| | - Kaan Boztug
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
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Messmore HL, Coyne E, Wehrmacher WH, Demir AM, Fareed J. Studies comparing low molecular weight heparin with heparin for the treatment of thromboembolism: a literature review. Curr Pharm Des 2004; 10:1001-10. [PMID: 15078129 DOI: 10.2174/1381612043452802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The use of heparin for the prophylaxis and treatment of venous and arterial thrombosis had been the standard of care for clinicians until 1982. At that time the introduction of depolymerized heparin for the prophylaxis of deep vein thrombosis in surgical patients was introduced. A number of such products, low molecular weight heparins (LMWH) were patented and introduced as new drugs during the ensuing of 20 years. Each LMWH had to be given a clinical trial against standard heparin for the several thromboembolic disorders for which heparin was the standard of care. By definition LMWH had to have unequal factor Xa and IIa inhibitor potency, expressed as a Xa-IIa ratio of greater than 1. They also had a molecular weight reduction to about one third that of heparin. A major advantage of LMWH over heparin was the subcutaneous route of injection for treatment of thrombotic disorders in contrast to the intravenous route for heparin. They had greater bioavailability than heparin by the subcutaneous route, a longer half-life and better predictability of dose response. It was found that routine laboratory monitoring was unnecessary. When given a trial against heparin, LMWH was equally safe and effective for most venous and arterial disorders. A new synthetic version of (pentasaccharide) both heparin and LMWH has been at least if not more effective than one LMWH (enoxaparin).
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Affiliation(s)
- H L Messmore
- Department of Medicine, Loyola University Medical Center, IL, USA.
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