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Ozturk Z, Demir H, Karhan AN, Saltik Temizel IN, Özen H. Evaluation of non-infectious complications in children receiving parenteral nutrition. Ir J Med Sci 2023; 192:2735-2739. [PMID: 36849650 DOI: 10.1007/s11845-023-03313-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Parenteral nutrition may lead to inevitable complications. AIMS To determine the indications, metabolic and mechanical complications of parenteral nutrition in children. METHODS One hundred fifty-eight children (91 males; 57.8%) who received 179 episodes of individualized parenteral nutrition for ≥ 5 days within 2 years were analyzed. Indications and duration of parenteral nutrition, effect on growth, and metabolic and central venous catheter-related non-infectious complications were evaluated. RESULTS Parenteral nutrition was administered in 179 different episodes (109 males; 60.9%), and the median age during these episodes was 64.0 (14.0-129.0) months. The most common indications were hematological malignancies, gastrointestinal surgery, and hematopoietic stem cell transplantation. Most of the electrolyte imbalances occurred in the first 3 days. Hypophosphatemia (44.7%), hypomagnesemia (43.0%), hypokalemia (43.0%), hyponatremia (40.8%), and hypertriglyceridemia (38.2%) were the most common metabolic complications. Liver transaminases elevated in 32/145 (22.1%) episodes and bilirubin in 30/149 (21.0%). Ursodeoxycholic acid treatment was added to 25 patients with hypertransaminasemia and/or hyperbilirubinemia. Transaminase levels improved in 16 (64%) and bilirubin levels in 15 (60%) patients receiving ursodeoxycholic acid. Catheter thrombosis was seen in 4.5% of the episodes. The targeted energy could be given more efficiently via central catheters rather than peripheral venous accesses. Patients' bodyweights increased in 39.1% of the episodes. CONCLUSIONS Close monitoring of electrolyte levels, especially in the first 3 days, is crucial to prevent complications of parenteral nutrition. When individualized PN preparations are used for metabolically unstable patients, it can be easier to maintain the blood glucose, lipids, and electrolyte levels within the normal range.
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Affiliation(s)
- Zeynelabidin Ozturk
- Department of Pediatrics, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey.
| | - Hulya Demir
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University School of Medicine, Ankara, Turkey
| | - Asuman Nur Karhan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University School of Medicine, Ankara, Turkey
| | - Inci Nur Saltik Temizel
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University School of Medicine, Ankara, Turkey
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Yildirim Simsir I, Tuysuz B, Ozbek MN, Tanrikulu S, Celik Guler M, Karhan AN, Denkboy Ongen Y, Gunes N, Soyaltin UE, Altay C, Nur B, Ozalkak S, Akgun Dogan O, Dursun F, Pekkolay Z, Eren MA, Usta Y, Ozisik S, Ozgen Saydam B, Adiyaman SC, Unal MC, Gungor Semiz G, Turan I, Eren E, Kayserili H, Jeru I, Vigouroux C, Atik T, Onay H, Ozen S, Arioglu Oral E, Akinci B. Clinical features of generalized lipodystrophy in Turkey: A cohort analysis. Diabetes Obes Metab 2023; 25:1950-1963. [PMID: 36946378 DOI: 10.1111/dom.15061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/20/2023] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Abstract
AIM To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow-up. METHODS This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean ± SD follow-up was 86 ± 78 months. RESULTS The Kaplan-Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan-Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (≥ 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan-Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan-Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow-up period. Causes of death were end-stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. CONCLUSIONS Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL.
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Affiliation(s)
- Ilgin Yildirim Simsir
- Division of Endocrinology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Beyhan Tuysuz
- Department of Genetics, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Mehmet Nuri Ozbek
- Division of Pediatric Endocrinology, Mardin Artuklu University, Mardin, Turkey
| | - Seher Tanrikulu
- Division of Endocrinology, Department of Internal Medicine, Acibadem Hospital, Istanbul, Turkey
| | - Merve Celik Guler
- Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Asuman Nur Karhan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yasemin Denkboy Ongen
- Division of Pediatric Endocrinology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Nilay Gunes
- Department of Genetics, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Utku Erdem Soyaltin
- Division of Endocrinology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Banu Nur
- Division of Pediatric Genetics, Akdeniz University, Antalya, Turkey
| | - Servan Ozalkak
- Division of Pediatric Endocrinology, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Ozlem Akgun Dogan
- Department of Pediatric Genetics, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fatma Dursun
- Department of Pediatric Endocrinology and Diabetes, Istanbul University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Zafer Pekkolay
- Division of Endocrinology and Metabolism, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Mehmet Ali Eren
- Department of Endocrinology and Metabolism, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Yusuf Usta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Secil Ozisik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Basak Ozgen Saydam
- Division of Endocrinology and Metabolism, Yildirim Beyazit University, Yenimahalle Training Hospital, Ankara, Turkey
| | - Suleyman Cem Adiyaman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehmet Cagri Unal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gokcen Gungor Semiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ihsan Turan
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Erdal Eren
- Division of Pediatric Endocrinology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Hulya Kayserili
- Department of Medical Genetics, Koc University School of Medicine, Istanbul, Turkey
| | - Isabelle Jeru
- Department of Medical Genetics, DMU BioGeM, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Corinne Vigouroux
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Diabetology and Reproductive Endocrinology and Department of Molecular Biology and Genetics, and Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Tahir Atik
- Division of Pediatric Genetics, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Samim Ozen
- Division of Pediatric Endocrinology and Diabetes, Ege University School of Medicine, Izmir, Turkey
| | - Elif Arioglu Oral
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Ozturk Z, Demir H, Karhan AN, Cengiz AB, Ozen H, Saltik Temizel IN, Yuce A. Catheter-related bloodstream infections in children receiving parenteral nutrition: Experience of a single center with 178 patients. NUTR CLIN METAB 2023. [DOI: 10.1016/j.nupar.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Karhan AN, Esenboğa S, Gümüş E, Karaatmaca B, Cagdas D, Demir H, Saltik Temizel İN, Özen H, Yüce A, Tezcan İ. Nutritional status of children with primary immunodeficiency: A single center experience. Pediatr Int 2022; 64:e14996. [PMID: 34533857 DOI: 10.1111/ped.14996] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nutritional status in primary immunodeficiencies (PID) is a major factor influencing immune defense. We aimed to evaluate the nutritional status of patients with PID. METHODS Demographic findings and anthropometric measurements of 104 patients were recorded for this cross-sectional study. RESULTS Combined immunodeficiencies (n = 49), predominantly antibody deficiencies (n = 28) and phagocytic system disorders (n = 17), were the major disease groups. In total, 44 (42.3%) patients had at least one anthropometric measurement below -2 standard deviations. Chronic, acute, and mixed-type malnutrition were detected in 18.3%, 16.3%, and 7.7% of the patients, respectively. No significant difference was detected among groups regarding anthropometric measurements however higher malnutrition rates were observed in 'combined immune deficiency less profound than severe combined immuno deficiency' (52%), chronic granulomatous disease (66.6%), and X-linked agammaglobulinemia (50%) patients. Severe malnutrition was present in 22 (21.2%) of the patients, although it was not significant. It was more common in the phagocytic system disorder group. All patients in the severe combined immunodeficiency group had undergone hematopoietic stem cell transplantation and 50% of them had malnutrition. There was also no significant difference regarding age, sex, anthropometric indexes (Weight for age, lenght/height for age body mass index Z-scores), malnutrition types, and prevalence of malnutrition among three major disease groups. Only the hospitalization history inversely related to body mass index and weight for age Z-scores (P < 0.0001). In patients with malnutrition, daily caloric intake was at least 20% or more below the requirement. CONCLUSIONS Regardless of the type of immunodeficiency, nutritional status was poor in PID and hospitalization is the most important determinant of nutritional status. Even after hematopoietic stem cell transplantation, nutritional support should be continued.
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Affiliation(s)
- Asuman Nur Karhan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey.,Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Saliha Esenboğa
- Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ersin Gümüş
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Betül Karaatmaca
- Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Cagdas
- Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltik Temizel
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yüce
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlhan Tezcan
- Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Gümüş E, Karhan AN, Hızarcıoğlu-Gülşen H, Demir H, Saltık Temizel İN. Tenofovir Disoproxil Fumarate in the Management of Chronic Hepatitis B Infection in Children. Egypt J Immunol 2021. [DOI: 10.4274/vhd.galenos.2021.2020-11-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Karhan AN, Zammouri J, Auclair M, Capel E, Apaydin FD, Ates F, Verpont MC, Magré J, Fève B, Lascols O, Usta Y, Jéru I, Vigouroux C. Biallelic CAV1 null variants induce congenital generalized lipodystrophy with achalasia. Eur J Endocrinol 2021; 185:841-854. [PMID: 34643546 DOI: 10.1530/eje-21-0915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE CAV1 encodes caveolin-1, a major protein of plasma membrane microdomains called caveolae, involved in several signaling pathways. Caveolin-1 is also located at the adipocyte lipid droplet. Heterozygous pathogenic variants of CAV1 induce rare heterogeneous disorders including pulmonary arterial hypertension and neonatal progeroid syndrome. Only one patient was previously reported with a CAV1 homozygous pathogenic variant, associated with congenital generalized lipodystrophy (CGL3). We aimed to further delineate genetic transmission, clinical, metabolic, and cellular characteristics of CGL3. DESIGN/METHODS In a large consanguineous kindred referred for CGL, we performed next-generation sequencing, as well as clinical, imagery, and metabolic investigations. We studied skin fibroblasts from the index case and the previously reported patient with CGL3. RESULTS Four patients, aged 8 months to 18 years, carried a new homozygous p.(His79Glnfs*3) CAV1 variant. They all displayed generalized lipodystrophy since infancy, insulin resistance, low HDL-cholesterol, and/or high triglycerides, but no pulmonary hypertension. Two patients also presented at the age of 15 and 18 years with dysphagia due to achalasia, and one patient had retinitis pigmentosa. Heterozygous parents and relatives (n = 9) were asymptomatic, without any metabolic abnormality. Patients' fibroblasts showed a complete loss of caveolae and no protein expression of caveolin-1 and its caveolin-2 and cavin-1 partners. Patients' fibroblasts also displayed insulin resistance, increased oxidative stress, and premature senescence. CONCLUSIONS The CAV1 null variant investigated herein leads to an autosomal recessive congenital lipodystrophy syndrome. Loss of caveolin-1 and/or caveolae induces specific manifestations including achalasia which requires specific management. Overlapping phenotypic traits between the different CAV1-related diseases require further studies.
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Affiliation(s)
- Asuman Nur Karhan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Jamila Zammouri
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Martine Auclair
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Emilie Capel
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | | | - Fehmi Ates
- Department of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Marie-Christine Verpont
- Sorbonne University, Inserm UMR_S1155, LUMIC, Tenon Imagery and Cytometry Platform, Paris, France
| | - Jocelyne Magré
- Nantes University, CNRS, Inserm UMR_S1087, Institut du Thorax, Nantes, France
| | - Bruno Fève
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
| | - Olivier Lascols
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Molecular Biology and Genetics, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
| | - Yusuf Usta
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Isabelle Jéru
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Molecular Biology and Genetics, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
| | - Corinne Vigouroux
- Sorbonne University, Inserm UMR_S938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
- Department of Endocrinology, Diabetology and Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
- Department of Molecular Biology and Genetics, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Paris, France
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Karhan AN, Hizarcioglu-Gulsen H, Gumus E, Akçören Z, Demir H, Saltik-Temizel İN, Orhan D, Özen H. Distinctive Features of Hepatic Steatosis in Children: Is It Primary or Secondary to Inborn Errors of Metabolism? Pediatr Gastroenterol Hepatol Nutr 2021; 24:518-527. [PMID: 34796096 PMCID: PMC8593365 DOI: 10.5223/pghn.2021.24.6.518] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/11/2021] [Accepted: 08/29/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The incidence of hepatic steatosis among children has been increasing; however, data distinguishing simple steatosis from a more complex disorder are lacking. METHODS This study identified the etiologies resulting in hepatic steatosis through a retrospective review of pediatric liver biopsies performed in the last 10 years. A total of 158 patients with hepatic steatosis proven by histopathological evaluation were enrolled in the study, and baseline demographic features, anthropometric measurements, physical examination findings, laboratory data, ultrasonographic findings, and liver histopathologies were noted. RESULTS The two most common diagnoses were inborn errors of metabolism (IEM) (52.5%) and nonalcoholic fatty liver disease/steatohepatitis (NAFLD/NASH) (29.7%). The three most common diseases in the IEM group were glycogen storage disorders, Wilson's disease, and mitochondrial disease. The rates of consanguineous marriage (75.6%; odds ratio [OR], 26.040) and positive family history (26.5%; OR, 8.115) were significantly higher (p=0.002, p<0.001, respectively) in the IEM group than those in the NAFLD/NASH group. Younger age (p=0.001), normal anthropometric measurements (p=0.03), increased aspartate aminotransferase levels (p<0.001), triglyceride levels (p=0.001), and cholestatic biochemical parameters with disrupted liver function tests, as well as severe liver destruction of hepatic architecture, cholestasis, fibrosis, and nodule formation, were also common in the IEM group. CONCLUSION Parents with consanguinity and positive family history, together with clinical and biochemical findings, may provide a high index of suspicion for IEM to distinguish primary steatosis from the consequence of a more complex disorder.
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Affiliation(s)
- Asuman Nur Karhan
- Department of Pediatrics, Division of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hayriye Hizarcioglu-Gulsen
- Department of Pediatrics, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ersin Gumus
- Department of Pediatrics, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zuhal Akçören
- Department of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Department of Pediatrics, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltik-Temizel
- Department of Pediatrics, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatrics, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Karhan AN, Aydemir Y, Demir N, Arslan SS, Gümüş E, Demir H, Özen H, Yüce A, Karaduman AA, Saltık-Temizel İN. Assessment of swallowing function in pediatric patients with Wilson's disease: Results of a videofluoroscopic swallowing study. Arab J Gastroenterol 2021; 22:215-219. [PMID: 34538586 DOI: 10.1016/j.ajg.2021.05.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/25/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Wilson's disease (WD) is a complex disorder related to copper metabolism and neurological involvement may lead to swallowing disorders. The purpose of this study was to evaluate swallowing function in pediatric patients with WD by using videofluoroscopic swallowing study (VFSS). PATIENTS AND METHODS A total of 21 patients were included in the study, prospectively. The VFSS was conducted to evaluate swallowing function of the patients. The penetration-aspiration scale (PAS) was used to assess penetration-aspiration severity. RESULTS According to the VFSS, abnormal results were detected in nine patients (42.9%) with WD. Of these nine patients, oral phase dysfunction was present in one patient, laryngeal penetration was present in one patient and moreover, abnormal esophageal body function was detected in all nine patients. Of these nine patients, five had neurological presentation at the time of diagnosis, and remaining four patients had hepatic presentation. Mean PAS score of the patients was 1. CONCLUSION The current study results suggest that subclinical swallowing dysfunction may be observed in patients with either neurological or hepatic WD. Further studies are necessary to reveal the real incidence of esophageal phase problems of swallowing function in pediatric patients with WD.
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Affiliation(s)
- Asuman Nur Karhan
- Department of Paediatrics, Division of Gastroenterology, Mersin University, Faculty of Medicine, Ankara, Turkey.
| | - Yusuf Aydemir
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Numan Demir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Selen Serel Arslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ersin Gümüş
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hülya Demir
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hasan Özen
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Aysel Yüce
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Aynur Ayşe Karaduman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Department of Paediatrics, Division of Gastroenterology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
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Gumus E, Karhan AN, Hizarcioglu-Gulsen H, Demir H, Ozen H, Saltik Temizel IN, Dokmeci Emre S, Yuce A. Clinical-genetic characteristics and treatment outcomes of Turkish children with Gaucher disease type 1 and type 3: A sixteen year single-center experience. Eur J Med Genet 2021; 64:104339. [PMID: 34500086 DOI: 10.1016/j.ejmg.2021.104339] [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: 01/16/2021] [Revised: 05/31/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
Data from 38 children were retrospectively analyzed to determine the patient characteristics of Turkish children with Gaucher disease (GD) and evaluate the impact of enzyme replacement therapy (ERT) in a pediatric cohort consisting of two different sub-types of the disease, Gaucher disease type 1 (GD1) and type 3 (GD3). Both types were represented equally (GD1/GD3 = 20/18). L444P (35.5%) was the most common mutant allele while L444P/L444P (34.2%) was the most common genotype overall. Compound heterozygosity of N370S and L444P homozygosity were the dominant genotypes in Turkish children with GD1 and GD3, respectively. None of the patients had moderate to severe thrombocytopenia at last follow-up while the percent of patients with anemia decreased from 60% to 5.7% (p < 0.001). Significant improvements in mean liver (from 2.2 to 1.6 MN, p < 0.001) and spleen (from 15.5 to 7.6 MN, p < 0.001) volumes were observed in the first year of ERT. Linear growth was ameliorated as shown by the decrease in the percent of patients having short stature from 34.3% to 13.3% (p < 0.01) at year 5. Erlenmeyer flask deformity, osteopenia and scoliosis were common skeletal findings. Although none of the patients had lung disease at diagnosis, 20% developed radiological findings suggestive of pulmonary involvement. This single center experience is the first comprehensive study from Turkey not only reporting clinical and genetic characteristics of GD patients but also providing information on the outcomes of ERT in two different sub-types of GD. Genotypic background of Turkish children with GD is similar to western populations. Although visceral and hematological therapeutic goals are reached as early as one year of ERT in both sub-types, achieving normal growth takes several more years than suggested in significant number of children with GD.
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Affiliation(s)
- Ersin Gumus
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey.
| | - Asuman Nur Karhan
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | | | - Hulya Demir
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Hasan Ozen
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Inci Nur Saltik Temizel
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Serap Dokmeci Emre
- Department of Medical Biology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yuce
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
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Karhan AN, Gümüş E, Demir H, Saltik Temizel İN, Yüce A, Özen H. Amoebic colitis presenting with hypo-albuminaemia in an eight-month-old breastfed girl. Paediatr Int Child Health 2019; 39:73-75. [PMID: 29737935 DOI: 10.1080/20469047.2018.1467072] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Entamoeba histolytica is a protozoan parasite that affects a large proportion of the world's population and causes amoebic dysentery and extra-intestinal disease. Many individuals remain asymptomatic during colonisation; in 10% of individuals, the parasite breaks through the mucosal barrier and leads to invasive disease. An eight-month-old girl who was evaluated for hypo-albuminaemia and was diagnosed with amoebic colitis is reported. To the best of our knowledge, this is the first report of hypo-albuminaemia owing to amoebic colitis in any age group.
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Affiliation(s)
- Asuman Nur Karhan
- a Faculty of Medicine, Department of Paediatrics, Division of Gastroenterology , Hacettepe University , Ankara , Turkey
| | - Ersin Gümüş
- a Faculty of Medicine, Department of Paediatrics, Division of Gastroenterology , Hacettepe University , Ankara , Turkey
| | - Hülya Demir
- a Faculty of Medicine, Department of Paediatrics, Division of Gastroenterology , Hacettepe University , Ankara , Turkey
| | - İnci Nur Saltik Temizel
- a Faculty of Medicine, Department of Paediatrics, Division of Gastroenterology , Hacettepe University , Ankara , Turkey
| | - Aysel Yüce
- a Faculty of Medicine, Department of Paediatrics, Division of Gastroenterology , Hacettepe University , Ankara , Turkey
| | - Hasan Özen
- a Faculty of Medicine, Department of Paediatrics, Division of Gastroenterology , Hacettepe University , Ankara , Turkey
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Gumus E, Haliloglu G, Karhan AN, Demir H, Gurakan F, Topcu M, Yuce A. Niemann-Pick disease type C in the newborn period: a single-center experience. Eur J Pediatr 2017; 176:1669-1676. [PMID: 28951965 DOI: 10.1007/s00431-017-3020-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/20/2017] [Revised: 09/09/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023]
Abstract
UNLABELLED Niemann-Pick disease type C (NPC) is a neurovisceral lysosomal storage disorder with a great variation in clinical spectrum and age at presentation. Clinical features of 10 NPC patients who presented in the newborn period between 1993 and 2015 at our center were retrospectively analyzed. Males and females were equally distributed; there was a history of parental consanguinity (n = 8) and first-degree relative with NPC (n = 3). Patients were symptomatic between 1 and 10 days (mean 3.6 ± 2.6 days). Age at diagnosis was between 1 and 30 days (mean 14.6 ± 13.3 days). Laboratory work-up included bone marrow aspiration (n = 8) and/or filipin staining (n = 4). Confirmation was done by molecular analysis, indicating NPC1 (n = 8) and NPC2 (n = 2) mutations. All patients had neonatal cholestasis and hepatosplenomegaly. Pulmonary involvement (n = 9) and fetal ascites (n = 2) were additional accompanying features. All but one died due to pulmonary complications (n = 6) and liver insufficiency (n = 3) between 1.5 and 36 months of age (mean 8.1 ± 10.8 months). Currently, one patient is alive at the age of 11 months without any neurological deficit. CONCLUSIONS Neonatal presentation is a rare form of NPC with exclusively visceral involvement in the newborn period and poor prognosis leading to premature death due to pulmonary complications and liver failure. What is known: • Neonatal presentation is a rare form of NPC with exclusively visceral involvement in the newborn period and poor prognosis leading to premature death. • Progressive liver disease is the most common cause of death among neonatal-onset NPC patients. What is new: • Natural course of neonatal-onset NPC may show variations. • Pulmonary involvement should be considered as an important cause of death in neonatal-onset cases, and appropriate precautions should be taken to prevent complications of respiratory insufficiency and airway infections.
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Affiliation(s)
- Ersin Gumus
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Sihhiye, 06100, Ankara, Turkey.
| | - Goknur Haliloglu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Asuman Nur Karhan
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Sihhiye, 06100, Ankara, Turkey
| | - Hulya Demir
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Sihhiye, 06100, Ankara, Turkey
| | - Figen Gurakan
- Department of Pediatrics, VKV American Hospital, Istanbul, Turkey
| | - Meral Topcu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Aysel Yuce
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Sihhiye, 06100, Ankara, Turkey
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Soyer T, Yalçın Ş, Demir N, Karhan AN, Saltık-Temizel İN, Demir H, Tanyel FC. Does Nissen fundoplication improve deglutition in children? Turk J Pediatr 2017; 59:28-34. [PMID: 29168360 DOI: 10.24953/turkjped.2017.01.005] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Soyer T, Yalçın Ş, Demir N, Karhan AN, Saltık-Temizel İN, Demir H, Tanyel FC. Does Nissen fundoplication improve deglutition in children? Turk J Pediatr 2017; 59: 28-34. A prospective study was performed to evaluate the effect of Nissen fundoplication (NF) on deglutition in children. Children who underwent NF between 2011-2015 were evaluated for demographic features, clinical findings, diagnostic methods for gastroesophageal reflux (GER) and indications for NF. Penetration aspiration scale (PAS), functional oral intake scale (FOIS) and esophageal functions were evaluated by videoflouroscopy (VFS). Preoperative and postoperative VFS findings were compared to evaluate the effect of NF on clinical findings and deglutition. Twenty-three children with a mean age of 5.08 ± 3.7 years were included. Female to male ratio was 15:8. Recurrent respiratory infections (RTI) (n: 14, 60.8%), swallowing dysfunction (n:13, 56.5%) and vomiting (n:10, 43.4%) were the most common symptoms. Preoperatively GER was diagnosed with barium swallowing study (BSS) contrast graphs (n:20, 87%) and with 24-hour esophageal pH monitorization (n:8, 34.8%). In 39.1% of patients, medical treatment for GER was used with a mean duration of 8 ± 5.8 months. Indications for NF were swallowing dysfunction (n: 18, 78%), GER complications (n:6, 26%), associated anatomical problems (n:4, 17.3%) and unresponsiveness to medical treatment (n: 3, 13%). Postoperative barium swallowing study and 24-hour esophageal pH monitorization showed no GER after NF in 95% of patients. Number of RTI were significantly decreased after NF (preoperative vs postoperative infection rate 4.21 vs 1.6 respectively, p < 0.05). VFS findings showed that PAS was significantly decreased after NF during both liquid and semi-liquid swallowing (p < 0.05). After NF, upper esophageal opening (UEO) was decreased when compared to preoperative VFS findings (p < 0.05 Esophageal cleaning, esophageal motility, esophageal backflow and lower esophageal sphincter narrowing did not alter after NF (p > 0.05). FOIS were significantly improved after NF (p < 0.05). VFS findings showed that penetration and aspiration were significantly decreased after NF and children had less RTI. Although, esophageal motility evaluated by VFS did not changed after NF, functional oral intake significantly improved in children.
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Affiliation(s)
- Tutku Soyer
- Departments of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şule Yalçın
- Departments of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Numan Demir
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Asuman Nur Karhan
- Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Departments of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Karhan AN, Soyer T, Gunes A, Talim B, Karnak I, Oguz B, Saltik Temizel IN. Giant Omental Cyst (Lymphangioma) Mimicking Ascites and Tuberculosis. Iran J Radiol 2016; 13:e31943. [PMID: 27853495 PMCID: PMC5107244 DOI: 10.5812/iranjradiol.31943] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/10/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022]
Abstract
Omental and mesenteric cysts are both rare pathologies in children. Children who have omental cysts usually display symptoms of abdominal distension, with or without a palpable mass. The mass can simulate ascites on clinical observation, or tuberculosis on radiological images. The optimal treatment for this condition is complete resection. The presenting symptoms of abdominal distension and the simulation of septated ascites and abdominal tuberculosis are unusual. Reported cases in the literature usually display symptoms of abdominal distension, abdominal pain, painless mass or possible ascites. We describe the clinical presentation of a five-and-a-half-year-old boy who was treated for a diagnosis of abdominal tuberculosis and ascites at another hospital. After three years, he underwent abdominal surgery, and an omental cyst was found intraoperatively. The diagnosis was confirmed by pathological examination.
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Affiliation(s)
- Asuman Nur Karhan
- Department of Pediatric Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- Corresponding author: Asuman Nur Karhan, Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey. Tel: +90-3123051993-94, Fax: +90-3123054157, E-mail:
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Altan Gunes
- Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Beril Talim
- Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ibrahim Karnak
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berna Oguz
- Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Inci Nur Saltik Temizel
- Department of Pediatric Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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