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Şahin S, Botan E, Gün E, Yüksel MF, Süt NY, Kartal AT, Gurbanov A, Kahveci F, Özen H, Havan M, Yıldırım M, Şahap SK, Bektaş Ö, Teber S, Fitoz S, Kendirli T. Correlation between early computed tomography findings and neurological outcome in pediatric traumatic brain injury patients. Neurol Sci 2024:10.1007/s10072-024-07511-x. [PMID: 38622450 DOI: 10.1007/s10072-024-07511-x] [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] [Received: 01/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Head computed tomography (CT) is frequently utilized for evaluating trauma-related characteristics, selecting treatment options, and monitoring complications in the early stages. This study assessed the relationship between cranial CT findings and early and late neurological outcomes in pediatric TBI patients admitted to the pediatric intensive care unit (PICU). The study included children aged 1 month to 18 years who were admitted to the PICU due to TBI between 2014 and 2020. Sociodemographic data, clinical characteristics, and cranial CT findings were analyzed. Patients were categorized based on their Glasgow Coma Scale (GCS) score. Of the 129 patients, 83 (64%) were male, and 46 (36%) were female, with a mean age of 6.8 years. Falls (n = 51, 39.5%) and in-vehicle traffic accidents (n = 35, 27.1%) were the most common trauma types observed. Normal brain imaging findings were found in 62.7% of the patients, while 37.3% exhibited intracranial pathology. Hemorrhage was the most frequent CT finding. Severe TBI (n = 26, p = 0.032) and mortality (n = 9, p = 0.017) were more prevalent in traffic accidents. The overall mortality rate in the study population was 10.1%. In children with TBI, cranial CT imaging serves as an essential initial method for patients with neurological manifestations. Particularly, a GCS score of ≤ 8, multiple hemorrhages, diffuse cerebral edema, and intraventricular bleeding are associated with sequelae and mortality.
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Affiliation(s)
- Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ayşe Tuğba Kartal
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Seda Kaynak Şahap
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Suat Fitoz
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
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2
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Karaçoban G, Gurbanov A, Özen H, Gün E, Çakmaklı HF, Kendirli T. Successful Treatment with Ascorbic Acid in a Case of Methemoglobinemia Due to Glucose-6-Phosphate Dehydrogenase Deficiency. Turk Arch Pediatr 2024; 59:112-113. [PMID: 38454269 PMCID: PMC10837515 DOI: 10.5152/turkarchpediatr.2024.23112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/12/2023] [Indexed: 03/09/2024]
Abstract
Cite this article as: Karaçoban G, Gurbanov A, Özen H, Gün E, Çakmaklı HF, Kendirli T. Successful treatment with ascorbic acid in a case of methemoglobinemia due to glucose-6-phosphate dehydrogenase deficiency. Turk Arch Pediatr. 2024;59(1):112-113.
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Affiliation(s)
- Gülçin Karaçoban
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Fatih Çakmaklı
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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3
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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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Baltu D, Kurt Sukur ED, Gumus E, Tastemel Ozturk T, Ergen YM, Demirtas D, Gülhan B, Ozaltin F, Orhan D, Özen H, Düzova A. An unusual cause of diarrhea in a child with nephrotic syndrome: Answers. Pediatr Nephrol 2023; 38:3977-3981. [PMID: 37222936 DOI: 10.1007/s00467-023-06021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Demet Baltu
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Eda Didem Kurt Sukur
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ersin Gumus
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Tugba Tastemel Ozturk
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Yasin Maruf Ergen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Duygu Demirtas
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Bora Gülhan
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Fatih Ozaltin
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Ali Düzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
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Baltu D, Kurt Sukur ED, Gumus E, Tastemel Ozturk T, Ergen YM, Demirtas D, Gülhan B, Ozaltin F, Orhan D, Özen H, Düzova A. An unusual cause of diarrhea in a child with nephrotic syndrome: Questions. Pediatr Nephrol 2023; 38:3975-3976. [PMID: 37222935 DOI: 10.1007/s00467-023-06020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Demet Baltu
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Eda Didem Kurt Sukur
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ersin Gumus
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Tugba Tastemel Ozturk
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Yasin Maruf Ergen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Duygu Demirtas
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Bora Gülhan
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Fatih Ozaltin
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Diclehan Orhan
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ali Düzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
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Kahveci F, Karaçoban G, Çelik NA, Gurbanov A, Uçmak H, Özen H, Balaban B, Botan E, Dikmen N, Havan M, Gökhan Ramoğlu M, Eyileten Z, Uçar T, Kendirli T. Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation: Pediatric Acute Respiratory Distress Syndrome. Turk Arch Pediatr 2023; 58:600-606. [PMID: 37818844 PMCID: PMC10724726 DOI: 10.5152/turkarchpediatr.2023.23025] [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] [Received: 02/24/2023] [Accepted: 08/16/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy, complication, and mortality of patients who were supported by venovenous (VV) extracorporeal membrane oxygenation (ECMO) and venoarterial (VA) ECMO for pediatric acute respiratory distress syndrome (PARDS). MATERIALS AND METHODS This study is a single-center, retrospective cohort study between 2014 and 2022. We evaluated to indication of ECMO support, ECMO type, patients' demographic features, complications, and children's outcomes supported by ECMO for PARDS. RESULTS Twenty-two patients with PARDS, 12 (54%) with VV, and 10 (46%) with VA ECMO were selected. The median number of days to be intubated before ECMO cannulation was 5 (0-16) days. The distribution of intubated days before the patients underwent ECMO was as follows: 0-1 days, 7 (31.8%) patients; 2-3 days, 2 (9.1%) patients; 4-7 days, 7 (31.8%) patients; 8-14 days, 5 (22.8%) patients; >14 days, 1 (4.5%) patient. The median ECMO cannulation day after admission to the pediatric intensive care unit was 3 (range, 1-9) days in the VV ECMO patient group, whereas it was 8 (range, 0-19) days in the VA ECMO group (P = .02). Considering hospital survival, 4 (45%) patients who underwent double-lumen VV ECMO, 1 (33%) patient who underwent VV ECMO, and 3 (30%) patients who supported by VAECMO survived. There was no difference between the groups in terms of hospital discharge rates. CONCLUSION The highest survival rate was found in the VV ECMO patient group established with double-lumen cannulas, similar to the literature. There was no difference in mortality between the groups whose intubation time before ECMO was 14 days or less.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Karaçoban
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Ayça Çelik
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Dikmen
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatrics, Department of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatrics, Department of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
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Özen H, Aslan AD, Balaban B, Perk O, Uçmak H, Özcan S, Gurbanov A, Uyar E, Kahveci F, Gün E, Tehci AK, Emeksiz S, Kendirli T. Acute kidney injury in critically ill children with COVID-19 and MIS-C. Pediatr Nephrol 2023; 38:3475-3482. [PMID: 37171582 PMCID: PMC10177713 DOI: 10.1007/s00467-023-05987-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND This study's objective was to investigate the incidence of acute kidney injury (AKI) in children with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and multisystem inflammatory syndrome (MIS-C) and to report our clinical experience. METHODS Acute COVID-19 and MIS-C-diagnosed patients observed in two pediatric intensive care units (PICUs) between 2019 and 2021 were examined for AKI and retrospectively compared to children with AKI. RESULTS The study comprised 163 children, of whom 98 (60.1%) were diagnosed with acute COVID-19 and 65 (39.9%) with MIS-C. AKI was observed in 40 (40.8%) of the acute COVID-19 patients and 18 (27.7%) of the MIS-C patients. Low calcium level and hypotension were linked with AKI at initial presentation (OR: 0.56, 95% CI: 0.369-0.560, p = 0.006 and OR: 3.64, 95% CI: 1.885-7.152, p = 0.001, respectively). A history of nephrotoxic medication usage played an essential role in the development of AKI in patients who acquired AKI after hospitalization (p = 0.001, odds ratio: 9.32, confidence interval: 3.106-27.973). In clinical practice, individuals with respiratory distress and cough had a high chance of having AKI (OR: 4.47, 95% confidence interval: 2.25-8,892 and OR: 3.48, 95% confidence interval: 1.76-6.88). AKI patients had a greater demand for respiratory assistance and a longer period of stay in the PICU. CONCLUSIONS AKI in the COVID-19 and MIS-C patient groups is related with increased mortality and extended hospitalization, according to the findings. These statistics imply that identifying and preventing risk factors is necessary. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Hasan Özen
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey.
| | - Ayşen Durak Aslan
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Hacer Uçmak
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Serhan Özcan
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Emel Uyar
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Kansu Tehci
- Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University School of Medicine, Ankara, Turkey
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8
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Kahveci F, Ocak BÖ, Gün E, Gurbanov A, Uçmak H, Aslan AD, Ceran A, Özen H, Balaban B, Botan E, Şıklar Z, Berberoğlu M, Kendirli T. Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit. Acute Crit Care 2023; 38:371-379. [PMID: 37652866 PMCID: PMC10497885 DOI: 10.4266/acc.2023.00038] [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] [Received: 01/05/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA. METHODS This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis. RESULTS The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae. CONCLUSIONS Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Buse Önen Ocak
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Ayşen Durak Aslan
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Ayşegül Ceran
- Division of Pediatric Endocrinology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Zeynep Şıklar
- Division of Pediatric Endocrinology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Merih Berberoğlu
- Division of Pediatric Endocrinology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Türkiye
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9
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Thompson RJ, Artan R, Baumann U, Calvo PL, Czubkowski P, Dalgic B, D’Antiga L, Di Giorgio A, Durmaz Ö, Gonzalès E, Grammatikopoulos T, Gupte G, Hardikar W, Houwen RH, Kamath BM, Karpen SJ, Lacaille F, Lachaux A, Lainka E, Loomes KM, Mack CL, Mattsson JP, McKiernan P, Ni Q, Özen H, Rajwal SR, Roquelaure B, Shteyer E, Sokal E, Sokol RJ, Soufi N, Sturm E, Tessier ME, van der Woerd WL, Verkade HJ, Vittorio JM, Wallefors T, Warholic N, Yu Q, Horn P, Kjems L. Interim results from an ongoing, open-label, single-arm trial of odevixibat in progressive familial intrahepatic cholestasis. JHEP Rep 2023; 5:100782. [PMID: 37456676 PMCID: PMC10338319 DOI: 10.1016/j.jhepr.2023.100782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 07/18/2023] Open
Abstract
Background & Aims PEDFIC 2, an ongoing, open-label, 72-week study, evaluates odevixibat, an ileal bile acid transporter inhibitor, in patients with progressive familial intrahepatic cholestasis. Methods PEDFIC 2 enrolled and dosed 69 patients across two cohorts; all received odevixibat 120 μg/kg per day. Cohort 1 comprised children from PEDFIC 1, and cohort 2 comprised new patients (any age). We report data through 15 July 2020, with Week 24 of PEDFIC 2 the main time point analysed. This represents up to 48 weeks of cumulative exposure for patients treated with odevixibat from the 24-week PEDFIC 1 study (cohort 1A) and up to 24 weeks of treatment for those who initiated odevixibat in PEDFIC 2 (patients who received placebo in PEDFIC 1 [cohort 1B] or cohort 2 patients). Primary endpoints for this prespecified interim analysis were change from baseline to Weeks 22-24 in serum bile acids (sBAs) and proportion of positive pruritus assessments (≥1-point drop from PEDFIC 2 baseline in pruritus on a 0-4 scale or score ≤1) over the 24-week period. Safety monitoring included evaluating treatment-emergent adverse events (TEAEs). Results In cohort 1A, mean change from PEDFIC 1 baseline to Weeks 22-24 of PEDFIC 2 in sBAs was -201 μmol/L (p <0.0001). For cohort 1B and cohort 2, mean changes from odevixibat initiation to weeks 22-24 in sBAs were -144 and -104 μmol/L, respectively. The proportion of positive pruritus assessments in the first 24-week period of PEDFIC 2 was 33%, 56%, and 62% in cohorts 1A, 1B, and 2, respectively. Most TEAEs were mild or moderate. No drug-related serious TEAEs occurred. Conclusions Odevixibat in patients with progressive familial intrahepatic cholestasis was generally well tolerated and associated with sustained reductions in sBAs and pruritus. Clinical Trials Registration This study is registered at ClinicalTrials.gov (NCT03659916). Impact and Implications Disrupted bile flow is a hallmark feature of patients with progressive familial intrahepatic cholestasis and can result in build-up of bile constituents in the liver with spill over into the bloodstream; other effects that patients can experience include extremely itchy skin, and because not enough bile reaches the gut, patients can have problems digesting food, which may lead to poor growth. Odevixibat is an orally administered medication that shunts bile acids away from the liver. The current study, called PEDFIC 2, suggested that odevixibat can improve the problematic signs and symptoms of progressive familial intrahepatic cholestasis and was generally safe for patients.
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Affiliation(s)
| | - Reha Artan
- Department of Pediatric Gastroenterology, Akdeniz University, Antalya, Turkey
| | - Ulrich Baumann
- Pediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - Pier Luigi Calvo
- Pediatric Gastroenterology Unit, Regina Margherita Children’s Hospital, Azienda Ospedaliera-Città della Salute e della Scienza di Torino, Turin, Italy
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Nutritional Disorders, and Pediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Buket Dalgic
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Lorenzo D’Antiga
- Pediatric Hepatology, Gastroenterology, and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Angelo Di Giorgio
- Pediatric Hepatology, Gastroenterology, and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Özlem Durmaz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Emmanuel Gonzalès
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de Référence de l’Atrésie des Voies Biliaires et des Cholestases Génétiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Hépatinov, Inserm U 1193, Paris, France
| | - Tassos Grammatikopoulos
- Institute of Liver Studies, King’s College London, London, UK
- Pediatric Liver, GI, and Nutrition Center and MowatLabs, King’s College Hospital NHS Trust, London, UK
| | - Girish Gupte
- Liver Unit and Small Bowel Transplantation, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Winita Hardikar
- Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia
| | - Roderick H.J. Houwen
- Department of Pediatric Gastroenterology at the Wilhelmina Children’s Hospital and University Medical Center, Utrecht, The Netherlands
| | - Binita M. Kamath
- Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Saul J. Karpen
- Pediatrics Department, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Florence Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Alain Lachaux
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service D’hépatogastoentérologie et Nutrition Pédiatrique, Lyon, France
| | - Elke Lainka
- Department of Pediatric Gastroenterology, Hepatology, and Liver Transplantation, University Children’s Hospital, Essen, Germany
| | - Kathleen M. Loomes
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cara L. Mack
- Pediatric Gastroenterology, Hepatology, & Nutrition, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Patrick McKiernan
- Liver Unit and Small Bowel Transplantation, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | | | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sanjay R. Rajwal
- Children’s Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds Children’s Hospital, Leeds, UK
| | | | - Eyal Shteyer
- Faculty of Medicine, Hebrew University of Jerusalem, Juliet Keidan Department of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Etienne Sokal
- Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium
| | - Ronald J. Sokol
- University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Nisreen Soufi
- Pediatrics Department, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ekkehard Sturm
- Pediatric Gastroenterology and Hepatology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Mary Elizabeth Tessier
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
| | - Wendy L. van der Woerd
- Department of Pediatric Gastroenterology at the Wilhelmina Children’s Hospital and University Medical Center, Utrecht, The Netherlands
| | - Henkjan J. Verkade
- Department of Pediatrics, University of Groningen, Beatrix Children’s Hospital/University Medical Center Groningen, Groningen, The Netherlands
| | - Jennifer M. Vittorio
- Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY, USA
| | | | | | - Qifeng Yu
- Albireo Pharma, Inc., Boston, MA, USA
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Abstract
Glycogen storage diseases (GSDs), also referred to as glycogenoses, are inherited metabolic disorders of glycogen metabolism caused by deficiency of enzymes or transporters involved in the synthesis or degradation of glycogen leading to aberrant storage and/or utilization. The overall estimated GSD incidence is 1 case per 20000-43000 live births. There are over 20 types of GSD including the subtypes. This heterogeneous group of rare diseases represents inborn errors of carbohydrate metabolism and are classified based on the deficient enzyme and affected tissues. GSDs primarily affect liver or muscle or both as glycogen is particularly abundant in these tissues. However, besides liver and skeletal muscle, depending on the affected enzyme and its expression in various tissues, multiorgan involvement including heart, kidney and/or brain may be seen. Although GSDs share similar clinical features to some extent, there is a wide spectrum of clinical phenotypes. Currently, the goal of treatment is to maintain glucose homeostasis by dietary management and the use of uncooked cornstarch. In addition to nutritional interventions, pharmacological treatment, physical and supportive therapies, enzyme replacement therapy (ERT) and organ transplantation are other treatment approaches for both disease manifestations and long-term complications. The lack of a specific therapy for GSDs has prompted efforts to develop new treatment strategies like gene therapy. Since early diagnosis and aggressive treatment are related to better prognosis, physicians should be aware of these conditions and include GSDs in the differential diagnosis of patients with relevant manifestations including fasting hypoglycemia, hepatomegaly, hypertransaminasemia, hyperlipidemia, exercise intolerance, muscle cramps/pain, rhabdomyolysis, and muscle weakness. Here, we aim to provide a comprehensive review of GSDs. This review provides general characteristics of all types of GSDs with a focus on those with liver involvement.
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Affiliation(s)
- Ersin Gümüş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Ankara 06230, Turkey
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Ankara 06230, Turkey
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11
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Kahveci F, Gurbanov A, Uçmak H, Ödemiş AS, Özen H, Balaban B, Botan E, Gün E, Havan M, Dikmen N, Ramoğlu MG, Uçar T, Eyileten Z, Akar AR, Kendirli T. Prolonged extracorporeal membrane oxygenation in pediatrics: How long did we wait? Perfusion 2023:2676591231172607. [PMID: 37137815 DOI: 10.1177/02676591231172607] [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: 05/05/2023]
Abstract
BACKGROUND In this study, we aimed to evaluate the duration of extracorporeal membrane oxygenation (ECMO) and its effect on outcomes. Also, we sought to identify hospital mortality predictors and determine when ECMO support began to be ineffective. METHODS This was a single-center, retrospective cohort study conducted between January 2014 and January 2022. The prolonged ECMO (pECMO) cut-off point was accepted as 14 days. RESULTS Thirty-one (29.2%) of 106 patients followed up with ECMO had pECMO. The mean follow-up period of the patients who underwent pECMO was 22 (range, 15-72) days, and the mean age was 75 ± 72 months. According to the results of our heterogeneous study population, life expectancy decreased dramatically towards the 21st day. Hospital mortality predictors were determined in the logistic regression analysis in all ECMO groups in our study as high Pediatric Logistic Organ Dysfunction (PELOD) two score, continuous renal replacement therapy (CRRT) use, and sepsis. The pECMO mortality was 61.2% and the overall mortality was 53.0%, with the highest mortality rate in the bridge-to-transplant group (90.9%) because of lack of organ donation in our country. CONCLUSIONS In our study, the PELOD two score, presence of sepsis, and use of CRRT were found to be in the predictors of in-hospital ECMO mortality model. Considering the complications, in the COX regression model analysis, the factors affecting the probability of dying in patients followed under ECMO were found to be bleeding, thrombosis, and thrombocytopenia.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aslı Samsa Ödemiş
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Dikmen
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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12
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Kahveci F, Coşkun MK, Uçmak H, Özen H, Gurbanov A, Balaban B, Dikmen N, Karagözlü S, Sarıcaoğlu MC, Botan E, Gün E, Havan M, Ramoğlu MG, Uçar T, Eyileten Z, Tutar E, Akar AR, Kendirli T. Hybrid extracorporeal membrane oxynegation in pediatric intensive care patients: A single center experience: More is better? Perfusion 2023:2676591231168537. [PMID: 37010553 DOI: 10.1177/02676591231168537] [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: 04/04/2023]
Abstract
BACKGROUND The initial extracorporeal membrane oxygenation (ECMO) configuration is inefficient for patient oxygenation and flow, but by adding a Y-connector, a third or fourth cannula can be used to support the system, which is called hybrid ECMO. METHODS This was a single-center retrospective study consisting of patients receiving hybrid and standard ECMO in our PICU between January 2014 and January 2022. RESULTS The median age of the 12 patients who received hybrid ECMO and were followed up with hybrid ECMO was 140 (range, 82-213) months. The total median ECMO duration of the patients who received hybrid ECMO was 23 (8-72) days, and the median follow-up time on hybrid ECMO was 18 (range, 3-46) days. The mean duration of follow-up in the PICU was 34 (range, 14-184) days. PICU length of stay was found to be statistically significant and was found to be longer in the hybrid ECMO group (p = 0.01). Eight (67%) patients died during follow-up with ECMO. Twenty-eight-day mortality was found to be statistically significant and was found to be higher in the standard ECMO group (p = 0.03). The hybrid ECMO mortality rate was 66% (decannulation from ECMO). The hybrid ECMO hospital mortality rate was 75%. The standard ECMO mortality rate was 52% (decannulation from ECMO). The standard ECMO hospital mortality rate was 65%. CONCLUSIONS Even though hybrid ECMO use is rare, with increasing experience and new methods, more successful experience will be gained. Switching to hybrid ECMO from standard ECMO at the right time with the right technique can increase treatment success and survival.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mert Kaan Coşkun
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Dikmen
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selen Karagözlü
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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13
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Gün E, Uçmak H, Kahveci F, Botan E, Gurbanov A, Balaban B, Özen H, Aycan F, Çıplak G, Özcan G, Zirek F, Sözduyar S, Ergün E, Çobanoğlu N, Kendirli T. Retrospective Evaluation of Patients Who Underwent Bronchoscopy in a Tertiary Pediatric Intensive Care Unit. cayd 2023. [DOI: 10.4274/cayd.galenos.2022.65487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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14
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Kahveci F, Özen H, Gurbanov A, Gün E, Balaban B, Özakıncı H, Dizbay Sak S, Çobanoğlu N, Çiftçi E, Kendirli T. Fatal Invasive Aspergillosis in a Child with Idiopathic Pulmonary Hemosiderosis. Turk Arch Pediatr 2023; 58:226-228. [PMID: 36856362 PMCID: PMC10081066 DOI: 10.5152/turkarchpediatr.2023.22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Fevzi Kahveci
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hilal Özakıncı
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serpil Dizbay Sak
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Disease, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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15
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Kahveci F, Gurbanov A, Uçmak H, Özen H, Balaban B, Botan E, Gün E, Kendirli T. The Dilemma of Pediatric Intensive Care Admissions During Coronavirus Disease 2019 Outbreak. Turk Arch Pediatr 2023; 58:232-233. [PMID: 36856364 PMCID: PMC10081091 DOI: 10.5152/turkarchpediatr.2023.22205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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Gurbanov A, Çelik NA, Gurbanova L, Gün E, Botan E, Balaban B, Kahveci F, Özen H, Uçmak H, Çağlayan U, Havan M, Vatansever G, Tekin D, Kendirli T. Clinical and Laboratory Features and Factors Determining the Outcome in Poisoning Children in a Tertiary Pediatric Intensive Care Unit: Eleven Years of Experience. Turk Arch Pediatr 2023; 58:189-196. [PMID: 36856357 PMCID: PMC10081007 DOI: 10.5152/turkarchpediatr.2023.22206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the characteristics of patients admitted to a pediatric intensive care unit for poisoning and the factors associated with their outcomes. MATERIALS AND METHODS Patients who were admitted to the pediatric intensive care unit for poisoning over the 11-year period between January 2010 and December 2020 were retrospectively analyzed. The patients' demographic characteristics, poisoning agent, whether the poisoning was unintentional or intentional (suicide attempt), clinical findings at admission, indication for hospitalization, antidote administered, and supportive and extracorporeal treatments were examined. RESULTS During the study period, poisonings accounted for 9.4% (436/4653) of pediatric intensive care unit admissions. Of these, 419 patients with complete records were included in the analysis. Drug poisonings accounted for 81.9% of cases (multiple drugs in 38.5%). The most common drug group was central nervous system drugs (47%). Of the symptomatic patients, 56.5% had central nervous system-related findings and 55% had gastrointestinal findings. Before pediatric intensive care unit admission, 52.7% of the patients received activated charcoal and 7.4% received antidote therapy. In the pediatric intensive care unit, 68.9% of patients received no medical treatment, while 71.5% of those who received medical treatment had organ involvement. Multivariate logistic regression analysis to predict whether patients will require treatment during the intensive care follow-up showed that antidote administration before pediatric intensive care unit admission was associated with the need for medical treatment (odds ratio: 25.6, 95% CI: 6.8-96, P < .05). Three patients died, and the mortality rate was 0.72%. CONCLUSION Childhood poisoning is a widespread and important problem. Effective management in pediatric emergency and intensive care units contributes to patient survival without sequelae.
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Affiliation(s)
- Anar Gurbanov
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Ayça Çelik
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Lala Gurbanova
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Utku Çağlayan
- Department of Pediatric Emergency Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Göksel Vatansever
- Department of Pediatric Emergency Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatric Emergency Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
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17
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Demirtaş D, Ünal E, İdilman İS, Akçören Z, Göktaş MA, Boyraz MS, Karahan S, Orhan D, Haliloğlu M, Karçaaltıncaba M, Özen H. Magnetic resonance elastography in evaluation of liver fibrosis in children with chronic liver disease. Insights Imaging 2023; 14:39. [PMID: 36854936 PMCID: PMC9975132 DOI: 10.1186/s13244-023-01390-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Magnetic resonance elastography (MRE) has been used to stage liver fibrosis in adults. We aimed to assess the agreement between the Ishak scoring system and magnetic resonance elastography-measured liver stiffness (MRE-LS) in children. This study included all the children who underwent abdominal MRE and liver biopsies between February 2018 and January 2021. The correlation between MRE-LS and Ishak fibrosis stage, MRE parameters, and clinical and biochemical markers affecting this relationship was investigated. RESULTS A total of 52 patients (31 male; a median age of 11.8 years) were included in the study. The MRE-LS values were significantly different between Ishak fibrosis stages (p = 0.036). With a cut-off value of 2.97 kilopascals, MRE-LS had sensitivity, specificity, PPV, NPV and accuracy values of 90.9%, 82.9%, 58.8%, 97.1%, and 84.6%, respectively, for differentiating mild/moderate fibrosis (F0, 1, 2, 3) from severe fibrosis (F ≥ 4). Although MRE-LS was moderately correlated with Ishak fibrosis score and histological activity index and weakly correlated with aspartate aminotransferase, hepatic steatosis, and R2*, only Ishak fibrosis score was a significant predictor of MRE-LS. MRE-measured spleen stiffness was weakly correlated with the Ishak fibrosis score. CONCLUSIONS MRE has high sensitivity and specificity for evaluating liver fibrosis in children. MRE may be used to evaluate liver fibrosis in pediatric patients.
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Affiliation(s)
- Duygu Demirtaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Emre Ünal
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlkay S. İdilman
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Zuhal Akçören
- grid.14442.370000 0001 2342 7339Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Akif Göktaş
- grid.14442.370000 0001 2342 7339Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Meryem Seda Boyraz
- grid.14442.370000 0001 2342 7339Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sevilay Karahan
- grid.14442.370000 0001 2342 7339Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- grid.14442.370000 0001 2342 7339Department of Pediatric Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mithat Haliloğlu
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muşturay Karçaaltıncaba
- grid.14442.370000 0001 2342 7339Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Özen
- grid.14442.370000 0001 2342 7339Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Botan E, Gün E, Güneş SA, Gurbanov A, Özen H, Kuloglu Z, Kırsaçlıoğlu C, Kırımker EO, Selvi ÖC, Çiftçi E, Fitöz S, Koloğlu M, Kansu A, Balcı D, Kendirli T. Early period intensive care follow-up after liver transplantation in children: a single center experience. Turk J Pediatr 2023; 65:489-499. [PMID: 37395968 DOI: 10.24953/turkjped.2022.743] [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] [Indexed: 07/04/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a well-established, life-saving treatment for children with irreversible acute and chronic liver failure (LF). We aimed to evaluate the factors associated with morbidity and mortality in the early period of LT in children by reviewing our pediatric intensive care unit (PICU) experience. METHODS We reviewed children`s medical records followed in the PICU after LT between May 2015-August 2021, including demographic parameters, indications for LT, operative variables, respiratory and circulatory support requirements, LT-related complications and survival. RESULTS During this period, 40 pediatric patients who underwent LT were evaluated. LT was performed in 35 (87.5%) cases of chronic liver disease and 5 (12.5%) cases of acute liver failure. Twenty-four patients had chronic liver failure due to cholestatic liver disease. The patients` Pediatric Risk of Mortality (PRISM) III score was 18.82±SD (2-58) at PICU admission. 1-year survival was 87.5%, and overall survival was 85%. Younger age, low body weight, preoperative pediatric end-stage liver disease (PELD), and model for end-stage liver disease (MELD) values of 20 and higher were important risk factors for unfavorable outcomes after living donor liver transplantation (LDLT). These risk factors are both associated with technically more challenging vascular and bile duct reconstruction and higher complication rates, and increased mortality during the early period after LT. CONCLUSIONS The early period of optimum PICU management in pediatric LT recipients is crucial for successful outcomes, which is also related to the patients` characteristics, disease severity scores, and surgical procedures.
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Affiliation(s)
- Edin Botan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara
| | - Emrah Gün
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara
| | | | - Anar Gurbanov
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara
| | - Hasan Özen
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara
| | - Zarife Kuloglu
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University Faculty of Medicine, Ankara
| | - Ceyda Kırsaçlıoğlu
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University Faculty of Medicine, Ankara
| | - Elvan Onur Kırımker
- Department of General Surgery and Liver Transplantation, Ankara University Faculty of Medicine, Ankara
| | - Özlem Can Selvi
- Department of Anaesthesia and Intensive Care, Ankara University Faculty of Medicine, Ankara
| | - Ergin Çiftçi
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara
| | - Suat Fitöz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara
| | - Meltem Koloğlu
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University Faculty of Medicine, Ankara
| | - Deniz Balcı
- Department of General Surgery and Liver Transplantation, Ankara University Faculty of Medicine, Ankara
| | - Tanıl Kendirli
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara
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Gün E, Durak A, Botan E, Şimşek Pervane S, Gurbanov A, Balaban B, Kahveci F, Özen H, Uçmak H, Aycan F, Kuloğlu Z, Kendirli T, Kendirli T. Extracorporeal Therapies in Children with Acute Liver Failure: A Single-Center Experience. Turk J Gastroenterol 2023; 34:73-79. [PMID: 36445055 PMCID: PMC9985061 DOI: 10.5152/tjg.2022.22062] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study is to determine the indication, timing, and administration of extracorporeal therapies such as total plasma exchange and continuous renal replacement therapy in children with acute liver failure or acute-on-chronic liver failure. METHODS This study is conducted as a retrospective, single-center study. Between January 2016 and December 2021, pediatric acute liver failure or acute-on-chronic liver failure patients for whom total plasma exchange and/or continuous renal replacement therapy was performed were included in this study. RESULTS Thirty-four children with acute liver failure or acute-on-chronic liver failure were included during the study period. The children comprised 14 (41.1%) males, and the median age of the patients was 54 months (5-21). Twenty-four patients (70.6%) had pediatric acute liver failure, and 10 patients (29.4%) had acute-on-chronic liver failure. Patients' median model for end-stage liver disease and pediatric end-stage liver disease scores were 24.7/23.5, respectively. Total plasma exchange therapy was performed on all patients whereas continuous renal replacement therapy was performed on 13 patients (38.2%). The median duration of continuous renal replacement therapy was 2.5 days (2-24). The median number of the total plasma exchange sessions was 3 (1-20). The median length of stay in pediatric intensive care unit was 4.5 (2-74) days. Eleven (32.5%) patients had 1 or more improvements in hepatic encephalopathy scores after extracorporeal therapy. Eleven (32.5%) patients died. There was a significant difference between the survivors and non-survivors with respect to levels of albumin, ammonia, pediatric risk of mortality scores, and pre-hepatic encephalopathy scores. Liver transplantation was performed in 4 of 24 pediatric acute liver failure patients, and all of them survived. CONCLUSION Total plasma exchange and continuous renal replacement therapy are life-saving, and both methods may reduce morbidity and mortality, also bridging to liver transplantation.
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Affiliation(s)
- Emrah Gün
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey,Corresponding author: Emrah Gün, e-mail:
| | - Ayşen Durak
- Department of Pediatric, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Anar Gurbanov
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fulden Aycan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zarife Kuloğlu
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
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Şimşek-Onat P, Hizarcioglu-Gulsen H, Ergen YM, Gumus E, Özen H, Demir H, Özen S, Saltık-Temizel İN. Neutrophil-to-Lymphocyte Ratio: An Easy Marker for the Diagnosis and Monitoring of Inflammatory Bowel Disease in Children. Dig Dis Sci 2023; 68:233-239. [PMID: 35579794 DOI: 10.1007/s10620-022-07547-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/24/2021] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive inflammation biomarker that reflects systemic inflammation based on complete blood count values. AIMS In our study, we aimed to compare the NLR values in pediatric inflammatory bowel disease (IBD) and in healthy controls, and to define NLR levels in children with IBD during diagnosis, active disease, and remission. METHODS NLR values of patients with IBD at diagnosis, remission, and active disease of the patients were recorded retrospectively. Age- and sex-matched healthy subjects enrolled as the control group. RESULTS Sixty-three patients with IBD and 92 healthy subjects as the control group enrolled. The mean age of the patients with IBD was 9.31 ± 5.24 years, and 57.1% were males. The mean NLR values of the patients with IBD at diagnosis and remission were significantly higher than that of healthy controls (p < 0.001). The mean NLR values of the patients at diagnosis and active disease were significantly higher than that of during remission (p < 0.001). The best cutoff of NLR for prediction of diagnosis of IBD in children was 1.46 with a sensitivity of 86.2% and specificity of 93.5%. There was no significant difference regarding NLR between patients with IBD with and without associated diseases. At diagnosis the mean NLR level of patients with Crohn's disease was significantly higher than that of ulcerative colitis (p = 0.019). CONCLUSIONS It was shown for the first time that NLR levels were significantly increased at diagnosis and active disease of childhood IBD, compared to the remission period. We believe that NLR can be a non-invasive inflammatory biomarker that should be used in the initial evaluation and follow-up of the disease activity in children.
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Affiliation(s)
- Pınar Şimşek-Onat
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey.
| | - Hayriye Hizarcioglu-Gulsen
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Yasin Maruf Ergen
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ersin Gumus
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Hülya Demir
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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Aydın K, Dalgıç B, Kansu A, Özen H, Selimoğlu MA, Tekgül H, Ünay B, Yüce A. The significance of MUAC z-scores in diagnosing pediatric malnutrition: A scoping review with special emphasis on neurologically disabled children. Front Pediatr 2023; 11:1081139. [PMID: 36950173 PMCID: PMC10025394 DOI: 10.3389/fped.2023.1081139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/16/2023] [Indexed: 03/24/2023] Open
Abstract
This review by a panel of pediatric gastroenterology-hepatology-nutrition and pediatric neurology experts aimed to address the significance of mid-upper arm circumference (MUAC) assessment in diagnosis of pediatric malnutrition. Specifically, the potential utility of recently developed MUAC z-score tape in clinical practice for larger patient populations was addressed including the neurologically disabled children. In accordance with the evidence-based data, four statements were identified by the participating experts on the utility of MUAC z-score tape, including (1) MUAC z-scores correlate with body mass index (BMI) and weight for height/length (WFH/l) z-scores in diagnosing malnutrition; (2) MUAC z-score tape offers a higher sensitivity to diagnose the mild and moderate malnutrition and better ability to track the changes in nutritional status over time than the other single datapoint measurements; (3) Using single-step MUAC z-score tape in children with cerebral palsy (CP) seems to provide more reliable data on anthropometry; and (4) The clinical value of the tool in classifying secondary malnutrition in CP should be investigated in large-scale populations. In conclusion, enabling single-step estimation of nutritional status in a large-scale pediatric population regardless of age and within a wide range of weight, without formal training or the need for ancillary reference charts and calculators, MUAC z-tape offers a favorable tool for easier and earlier diagnosis of pediatric malnutrition. Nonetheless, further implementation of MUAC z-score screening in larger-scale and/or special populations is necessary to justify its utility in relation to other primary anthropometric indicators in diagnosis of malnutrition as well as in treatment monitoring in the community and hospital setting.
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Affiliation(s)
- Kürşad Aydın
- Department of Pediatric Neurology, Medipol University Faculty of Medicine, Istanbul, Türkiye
| | - Buket Dalgıç
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
- Correspondence: Hasan Özen
| | - Mukadder Ayşe Selimoğlu
- Department of Pediatric Gastroenterology, Memorial Atasehir and Bahcelievler Hospitals, Istanbul, Türkiye
| | - Hasan Tekgül
- Department of Pediatric Neurology, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Bülent Ünay
- Department of Pediatric Neurology, Gulhane Faculty of Medicine, Ankara, Türkiye
| | - Aysel Yüce
- Department of Pediatric Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Hizarcıoğlu-Gülşen H, Onat PŞ, Yıldırım D, Demirtaş D, Boyraz MS, Göktaş MA, Demir H, Özen H, Saltık-Temizel İN, Saltik Temizel IN. Is Prolonged Copper Restriction Needed in Pediatric Wilson's Disease? Turk J Gastroenterol 2023; 34:80-86. [PMID: 36511610 PMCID: PMC9984943 DOI: 10.5152/tjg.2022.22216] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dietary copper restriction in Wilson's disease is recommended mostly for 1 year or until showing normal liver enzymes. Little is known about the effect of long-term copper restriction on copper and nutritional status in the body. The relationship between daily copper consumption and serum and urine copper parameters, liver enzymes, and dietary contents was investigated. METHODS In this study, 32 pediatric Wilson's disease patients who had been on treatment at least for 12 months were included. Clinical features, liver enzymes, serum total copper concentrations, non-ceruloplasmin bound copper concentrations, adjusted copper concentrations, 24-hour urine copper excretions, and macro- and micronutrient consumptions were analyzed. RESULTS In total, 27 patients reported following copper-restricted diets, while daily copper consumption was low only in 7 patients (21.9%). Total copper concentrations and non-ceruloplasmin-bound copper concentrations were low at 78.1% and 53.1%, respectively. All but one adjusted copper concentration were within normal limits. Total copper concentrations, adjusted copper concentration, and non-ceruloplasmin-bound copper concentrations correlated with each other but none correlated with urine copper excretions. Daily copper consumption was inversely correlated with total copper concentrations (P = .041, r = -0.363) but not correlated with non-cerulo plasmin-bound copper concentrations and adjusted copper concentrations. There was no relationship between liver enzymes and daily copper consumption and serum and urine copper parameters. High fat consumption with low fiber and vitamin B6 was more common in low daily copper consumption group (P = .033, P = .029, P = .007, respectively). CONCLUSIONS Daily copper consumption may be the least effective or non-effective factor on liver enzymes in Wilson's disease. Prolonged copper restriction may result in unintentional dietary imbalance. Avoidance of undernutrition and high-fat meals, as well as enrichment of the meals with vitamin B6 and fiber, should be encouraged during copper-restricted diets.
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Affiliation(s)
- Hayriye Hizarcıoğlu-Gülşen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey,Corresponding author: Hayriye Hizarcıoğlu-Gülşen, e-mail:
| | - Pınar Şimşek Onat
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Damla Yıldırım
- Department of Dietetics and Nutrition, İhsan Doğramacı Children’s Hospital, Hacettepe University, Ankara, Turkey
| | - Duygu Demirtaş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey,Department of Pediatric Gastroenterology, Sağlık Bilimleri University, Van Training and Research Hospital, Van, Turkey
| | - Meryem S. Boyraz
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey,Department of Pediatric Gastroenterology, Sağlık Bilimleri University, Başakşehir Çam ve Sakura City Hospital, İstanbul, Turkey
| | - Mehmet A. Göktaş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey,Department of Pediatric Gastroenterology, Sağlık Bilimleri University, Başakşehir Çam ve Sakura City Hospital, İstanbul, Turkey
| | - Hülya Demir
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Botan E, Gün E, Şen EK, Yöndem C, Gurbanov A, Balaban B, Kahveci F, Özen H, Uçmak H, Gençay AG, Kendirli T. Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience. Acute Crit Care 2022; 37:644-653. [DOI: 10.4266/acc.2022.00395] [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] [Received: 03/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022] Open
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Gün E, Akova BŞ, Botan E, Çelik DB, Balaban B, Özen H, Gencay AG, Bektaş Ö, Fitoz S, Kendirli T. Clinical features and outcomes of children admitted to the pediatric intensive care unit due to posterior reversible encephalopathy syndrome. Clin Neurol Neurosurg 2022; 222:107476. [DOI: 10.1016/j.clineuro.2022.107476] [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] [Received: 08/07/2021] [Revised: 01/03/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
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Süzen-Orhan E, Botan E, Gün E, Özen H, Gurbanov A, Balaban B, Kahveci F, Vatansever G, Tekin D, Kendirli T. Colchicine Poisoning Cases in a Pediatric Intensive Care Unit: A Twenty-Year Study. Pediatr Emerg Care 2022; 38:489-493. [PMID: 36018729 DOI: 10.1097/pec.0000000000002835] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Colchicine intoxication is rare but potentially fatal. The toxic dose of colchicine is not well established; it has been reported that major toxicity starts after doses of 0.5 mg/kg. We aimed to evaluate the demographic, clinical aspects, treatments, and outcome of colchicine toxicity cases in the pediatric intensive care unit (PICU). METHODS We collected the data of patients aged between 0 and 18 years, admitted to Ankara University Faculty of Medicine PICU for colchicine poisoning (n = 22), from October 1999 to January 2020, retrospectively. Data extracted from the cases included age, sex, chronic condition, time between intake of drug and admission to PICU, source of drug, amount of drug ingested, other drug intake, symptoms, clinical findings, cardiac involvement, laboratory results, time of stay in PICU, treatment, and outcome. RESULTS Patients' age ranged from 7 months to 17 years. Median age was 86 months. The most common symptom at time of admission was vomiting, occurring in 13 (59%) of the patients. Two of the patients presented with change in mental status. Time between taking medication and applying to the hospital ranged from half an hour to 4 days. Medication intake of 3 of 22 patients was more than 0.5 mg/kg. One patient whose parents' best estimate of dose ingested was 0.48 mg/kg died because of the development of multiorgan failure. One patient who ingested 0.4 mg/kg of colchicine underwent plasma exchange and recovered without any complications. CONCLUSIONS Colchicine poisoning has a high risk of mortality, and death can be seen in doses less than a single acute dose of 0.5 mg/kg. These patients need close monitoring because there is always a risk of them to require aggressive support. Prognosis is poor in patients who have rapidly developing hemodynamic failure.
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Affiliation(s)
| | - Edin Botan
- Department of Pediatric Critical Care Medicine
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine
| | - Hasan Özen
- Department of Pediatric Critical Care Medicine
| | | | | | | | - Göksel Vatansever
- Department of Pediatric Emergency Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatric Emergency Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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Thompson RJ, Arnell H, Artan R, Baumann U, Calvo PL, Czubkowski P, Dalgic B, D'Antiga L, Durmaz Ö, Fischler B, Gonzalès E, Grammatikopoulos T, Gupte G, Hardikar W, Houwen RHJ, Kamath BM, Karpen SJ, Kjems L, Lacaille F, Lachaux A, Lainka E, Mack CL, Mattsson JP, McKiernan P, Özen H, Rajwal SR, Roquelaure B, Shagrani M, Shteyer E, Soufi N, Sturm E, Tessier ME, Verkade HJ, Horn P. Odevixibat treatment in progressive familial intrahepatic cholestasis: a randomised, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol 2022; 7:830-842. [DOI: 10.1016/s2468-1253(22)00093-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022]
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27
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Botan E, Durak A, Gün E, Gurbanov A, Balaban B, Kahveci F, Özen H, Uçmak H, Aycan F, Kendirli T. Continuous Renal Replacement Therapy with Regional Citrate Anticoagulation in Children with Liver Dysfunction/Failure. J Trop Pediatr 2022; 68:6614520. [PMID: 35737953 DOI: 10.1093/tropej/fmac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
Regional citrate anticoagulation (RCA) is an option but citrate accumulation is risk and it is a giving up cause for this situation. This retrospective study was conducted in the pediatric intensive care unit (PICU) between May 2019 and April 2021. We investigated 47 patients with liver failure (LF) in our PICU, and RCA during continuous renal replacement therapy (CRRT) was applied to 10 (21.3%) of them. Half of them were male (n: 5/10), their mean age was 104.7 ± 66.20 months. Nine of them needed vasoactive support during follow-up. The most common indication for CRRT was hepatorenal syndrome (40%). There was no significant difference between liver transaminases and liver function tests before and after CRRT (p > 0.05). In terms of citrate toxicity of the patients, there was no significant difference between total calcium/ionized calcium, lactate level, pH and bicarbonate values before and after CRRT (p > 0.05). The mean total CRRT time was 110.2 ± 118.2 h, and the mean circuit lifespan was 43.8 ± 48.7 h; the mean number of circuits was 2.7 ± 2.4. Total Ca/ionized Ca >2.5 was a clinically relevant endpoint, but no patient interrupted dialysis for this cause. There was no complication about RCA. This study did not observe any adverse effects on acid-base status, transaminases, an increase in bilirubin during RCA-CRRT treatment in pediatric patients with LF. Total calcium/ionized calcium ratio, serum lactate level and prothrombin time level should be closely monitored daily in terms of citrate accumulation in this patient group.
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Affiliation(s)
- Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ayşen Durak
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Fulden Aycan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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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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Ateş BB, Talim B, Gülşen HH, Demir H, Karaismailoğlu E, Özen H, Saltık-Temizel İN. Significance of intestinal alkaline phosphatase in predicting histological activity of pediatric inflammatory bowel disease. Turk J Pediatr 2022; 64:1068-1076. [PMID: 36583889 DOI: 10.24953/turkjped.2021.5413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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 Intestinal alkaline phosphatase (iAP) is an intestinal brush border enzyme that is one of the factors involved in the pathogenesis of inflammatory bowel disease (IBD). The aim of the study was to investigate the relationship between iAP enzyme and histological inflammatory activity in patients with IBD. METHODS A total of 44 children were enrolled in this study including IBD patients (n=24; 12 Crohn`s disease [CD] and 12 ulcerative colitis [UC]) and controls (n=20). Anti-human iAP antibody stained ileocolonoscopic biopsy specimens were graded for the terminal ileum and each section of the colon. Hematoxylin-eosin stained sections were used to determine inflammatory activity. Histopathological findings were compared in pre- and post-treatment biopsies of each group and with the control group (CG). RESULTS A low grade of iAP staining was detected in IBD patients compared to the CG (p=0.02). iAP was remarkably concentrated in the terminal ileum (TI) and especially in region 1, which involved the apical surface, brush border, and epithelial cells. A significant negative correlation was found between the grade of iAP staining and inflammatory activity both in pre- and post-treatment biopsies (p=0.02, p=0.008, respectively) in the terminal ileum of CD patients. Likewise, pre-treatment biopsies of UC and CD patients and biopsies of the CG were compared with each other according to the grade of iAP staining. There were significant negative correlations for CD patients compared to UC and the CG in region1 of TI, and regions 1 and 2 (lamina propria and goblet cells) of the colon (p= 0.015, p= 0.006, p < 0.001, respectively). CONCLUSIONS As a histological marker, iAP can be of value in monitoring the histological activity of IBD, particularly in remarkable inflammation in the small intestine.
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Affiliation(s)
- Burcu Berberoğlu Ateş
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Beril Talim
- Departments of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hayriye Hizarcıoğlu Gülşen
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hülya Demir
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Eda Karaismailoğlu
- Departments of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Özen
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - İnci Nur Saltık-Temizel
- Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Botan E, Gün E, Beşli Çelik D, Gurbanov A, Balsak S, Balaban B, Kahveci F, Özen H, Uçmak H, Gençay AG, Kendirli T. Corrigendum to 'The Evaluation of Transported Children to Pediatric Intensive Care Unit: Indications, Problems and Outcomes' [Air Medical Journal 40/4 (2021) 237-241]. Air Med J 2021; 40:459. [PMID: 34794790 DOI: 10.1016/j.amj.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Dilara Beşli Çelik
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Serdar Balsak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Genco Gençay
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Acar B, Gümüş E, Özcan-Bulut S, Özşin-Özler C, Boyraz MS, Tan Ç, Yaz I, Özbek B, Cagdas D, Saltık-Temizel İN, Demir H, Özen H, Karabulut E, Tezcan İ, Yüce A, Berker E. Cytokine profile in serum and gingival crevicular fluid of children with inflammatory bowel disease: A case-control study. J Periodontol 2021; 93:1048-1059. [PMID: 34730850 DOI: 10.1002/jper.21-0514] [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: 09/02/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND To evaluate the cytokine profile in gingival crevicular fluid (GCF) and serum of pediatric inflammatory bowel disease (IBD) patients and determine the cluster patterns of cytokines. METHODS Fifty IBD patients and 21 systemically healthy children were enrolled in the study. The GCF samples were collected from the participants during periodontal examination and periodontal indices were recorded. Based on activity indexes and response to conventional treatment, patients with IBD were further categorized into subgroups as: remission, active disease, and treatment-resistant. Serum samples were obtained from IBD patients to determine serum levels of cytokines. The levels of pro- (interleukin (IL)-1β, IL-12, IL-21, IL-22, IL-23, IL-17A, IL-17F) and anti-inflammatory (IL-4, IL-10) cytokines in serum and GCF were measured using Enzyme-linked Immunosorbent Assay (ELISA) kits. RESULTS Among 50 IBD patients, 58% were in remission, 20% had active disease, and 22% were defined as treatment-resistant. The severity of gingival inflammation measured by the criteria of Löe had increasing trends in IBD patients with active disease and treatment resistance. GCF IL-1β level was lower and GCF IL-4 and GCF IL-23 levels were higher in IBD patients compared to healthy controls. In the active disease group, more cytokine clusters occurred compared to the control group and other IBD subgroups, as explained by increased cytokine-cytokine interactions. CONCLUSIONS Considering the increased complexity of cytokine interactions and the increased severity of gingival inflammation in patients with active disease, it can be concluded that disease activity might have an impact on gingival inflammation in pediatric patients with IBD.
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Affiliation(s)
- Buket Acar
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Ersin Gümüş
- Department of Pediatric Gastroenterology, Hacettepe University Medical School, Ankara, Turkey
| | - Selcen Özcan-Bulut
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Cansu Özşin-Özler
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | - Meryem Seda Boyraz
- Department of Pediatric Gastroenterology, Hacettepe University Medical School, Ankara, Turkey
| | - Çağman Tan
- Department of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ismail Yaz
- Department of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Begüm Özbek
- Department of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Cagdas
- Department of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Department of Pediatric Gastroenterology, Hacettepe University Medical School, Ankara, Turkey
| | - Hülya Demir
- Department of Pediatric Gastroenterology, Hacettepe University Medical School, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hacettepe University Medical School, Ankara, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlhan Tezcan
- Department of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysel Yüce
- Department of Pediatric Gastroenterology, Hacettepe University Medical School, Ankara, Turkey
| | - Ezel Berker
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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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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Göktaş MA, Gümüş E, Demir H, Gülşen HH, Saltık-Temizel İN, Özen H, Güçer Ş, Yüce A. A very rare cause of protein losing enteropathy: Gaucher disease. Turk J Pediatr 2021; 63:708-715. [PMID: 34449155 DOI: 10.24953/turkjped.2021.04.020] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mesenteric lymphadenopathy is a rare manifestation of Gaucher disease (GD) in children and can be accompanied by protein losing enteropathy (PLE). PLE is a difficult-to-treat complication of GD. To date, only a few pediatric GD cases with PLE and massive mesenteric lymphadenopathies have been reported. CASE Here, we report a girl with chronic neuronopathic GD, whose disease course was complicated by massive mesenteric lymphadenopathies with resultant protein losing enteropathy despite a regular and appropriate enzyme replacement therapy of 60 IU/kg/biweekly until the development of mesenteric lymphadenopathies and 120 IU/kg/biweekly thereafter. CONCLUSIONS PLE is a devastating and life threatening complication of GD developing despite long term use of high dose ERT. Clinicians should be alert for this complication particularly in GD patients presenting with progressive abdominal distension, edema, ascites and diarrhea or in patients who have already developed mesenteric lymphadenopathies. Timely diagnosis may allow early intervention with previously suggested surgical or medical treatment options. Although there is no specific and effective treatment, surgical and aggressive medical interventions in addition to ERT were reported to relieve diarrhea and halt progression of mesenteric lymphadenopathies.
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Affiliation(s)
- Mehmet Akif Göktaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ersin Gümüş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hayriye Hızarcıoğlu Gülşen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Şafak Güçer
- Division of Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yüce
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
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35
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Urgancı N, Ozgenc F, Kuloğlu Z, Yüksekkaya H, Sarı S, Erkan T, Önal Z, Çaltepe G, Akçam M, Arslan D, Arslan N, Artan R, Aydoğan A, Balamtekin N, Baran M, Baysoy G, Çakır M, Dalgıç B, Doğan Y, Durmaz Ö, Ecevıt Ç, Eren M, Gökçe S, Gülerman F, Gürakan F, Hızlı S, Işık I, Kalaycı AG, Kansu A, Kutlu T, Karabiber H, Kasırga E, Kutluk G, Özbay Hoşnut F, Özen H, Özkan T, Öztürk Y, Bekem Soylu Ö, Tutar E, Tümgör G, Ünal F, Ugraş M, Üstündağ G, Yaman A, Study Group TI. Familial Mediterranean Fever Mutation Analysis in Pediatric Patients With İnflammatory Bowel Disease: A Multicenter Study. Turk J Gastroenterol 2021; 32:248-250. [PMID: 34160354 DOI: 10.5152/tjg.2021.20057] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases has been reported previously. METHODS Children with IBD (334 ulcerative colitis (UC), 224 Crohn's disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. RESULTS A total of 597 children (mean age: 10.8 ± 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/ heterozygous) in patients with UC (P < .05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P = .031, P = .045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P = .007). CONCLUSION Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not have a high impact on inflammatory response and clinical outcome of the disease.
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Affiliation(s)
- Nafiye Urgancı
- Division of Pediatric Gastroenterology, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Funda Ozgenc
- Department of Pediatric Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Zarife Kuloğlu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Yüksekkaya
- Department of Pediatric Gastroenterology, Meram University School of Medicine, Konya, Turkey
| | - Sinan Sarı
- Department of Pediatric Gastroenterology, Gazi University School of Medicine, Ankara, Turkey
| | - Tülay Erkan
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Zerrin Önal
- Division of Pediatric Gastroenterology, Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - Gönül Çaltepe
- Department of Pediatric Gastroenterology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Mustafa Akçam
- Department of Pediatric Gastroenterology, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Duran Arslan
- Department of Pediatric Gastroenterology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nur Arslan
- Department of Pediatric Gastroenterology, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Reha Artan
- Department of Pediatric Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ayşen Aydoğan
- Department of Pediatric Gastroenterology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Necati Balamtekin
- Division of Pediatric Gastroenterology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Maşallah Baran
- Division of Pediatric Gastroenterology, Health Sciences University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Gökhan Baysoy
- Department of Pediatric Gastroenterology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Murat Çakır
- Department of Pediatric Gastroenterology, Karadeniz University School of Medicine, Trabzon, Turkey
| | - Buket Dalgıç
- Department of Pediatric Gastroenterology, Gazi University School of Medicine, Ankara, Turkey
| | - Yaşar Doğan
- Department of Pediatric Gastroenterology, Fırat University School of Medicine, Elazığ, Turkey
| | - Özlem Durmaz
- Department of Pediatric Gastroenterology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Çiğdem Ecevıt
- Division of Pediatric Gastroenterology, Health Sciences University, Behçet Uz Training and Research Hospital, İzmir, Turkey
| | - Makbule Eren
- Department of Pediatric Gastroenterology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Selim Gökçe
- Department of Pediatric Gastroenterology, Bezmialem University School of Medicine, İstanbul, Turkey
| | - Fulya Gülerman
- Department of Pediatric Gastroenterology, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - Figen Gürakan
- Department of Pediatric Gastroenterology, American Hospital, İstanbul, Turkey
| | - Samil Hızlı
- Department of Pediatric Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ishak Işık
- Division of Pediatric Gastroenterology, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ayhan Gazi Kalaycı
- Department of Pediatric Gastroenterology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Tufan Kutlu
- Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Hamza Karabiber
- Department of Pediatric Gastroenterology, İnönü University School of Medicine, Malatya, Turkey
| | - Erhun Kasırga
- Department of Pediatric Gastroenterology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Günsel Kutluk
- Division of Pediatric Gastroenterology, Health Sciences University Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - Ferdağ Özbay Hoşnut
- Division of Pediatric Gastroenterology, Health Sciences University, Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tanju Özkan
- Department of Pediatric Gastroenterology, Uludağ University School of Medicine, Bursa, Turkey
| | - Yeşim Öztürk
- Department of Pediatric Gastroenterology, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Özlem Bekem Soylu
- Division of Pediatric Gastroenterology, Health Sciences University, Behçet Uz Training and Research Hospital, İzmir, Turkey
| | - Engin Tutar
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, İstanbul, Turkey
| | - Gökhan Tümgör
- Department of Pediatric Gastroenterology, Çukurova University School of Medicine, Adana, Turkey
| | | | - Meltem Ugraş
- Yeditepe University School of Medicine, Department of Pediatric Gastroenterology, İstanbul, Turkey
| | - Gonca Üstündağ
- Department of Pediatric Gastroenterology, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Aytaç Yaman
- Division of Pediatric Gastroenterology, Health Sciences University, Ankara Children's Hematology and Oncology Training and Research Hospital, Ankara, Turkey
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Botan E, Gün E, Beşli Çelik D, Gurbanov A, Balsak S, Balaban B, Kahveci F, Özen H, Uçmak H, Gençay AG, Kendirli T. The Evaluation of Transported Children to Pediatric Intensive Care Unit: Indications, Problems, and Outcomes. Air Med J 2021; 40:237-241. [PMID: 34172231 DOI: 10.1016/j.amj.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Critically ill children often require transport to tertiary centers where higher levels of care can be provided. In this study, we aimed to evaluate the reasons for transport, complications that occurred during transport, and the clinical outcomes of the patients transferred to our tertiary pediatric intensive care unit (PICU). METHODS This retrospective study was conducted in a tertiary pediatric hospital with 250 beds and 20 tertiary PICU beds. RESULTS During the study period, 108 patients were transferred to our PICU. The mean age was 75.0 ± 70.5 months (range, 1-211 months), and 59 were female. Most patients (82.4%) were transported by land; 17.6% were transported by air ambulance. Fourteen patients were referred for liver transplantation, and 7 patients were referred because of a need for extracorporeal membrane oxygenation support and heart transplantation or left ventricular assist device placement. Two patients were transported by air while on extracorporeal membrane oxygenation. Complications occurred in 25% of patients. CONCLUSION Vital signs were assesed, and certain critical interventions such as intravenous fluids and respiratory support were provided more frequently during air transport, possibly due to the fact that physicians were always present during air transport. Quality improvement of transport teams and multicenter and nationwide studies on PICU transport are needed.
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Affiliation(s)
- Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Dilara Beşli Çelik
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Serdar Balsak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Genco Gençay
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
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Balamtekin N, Baysoy G, Tan Ç, Kızılkan NU, Demir H, Saltık-Temizel İN, Özen H, Yüce A, Tezcan İ, Gürakan F. The HLA groups and their relationship with clinical features in Turkish children and adolescents with celiac disease. Turk J Pediatr 2021; 63:118-125. [PMID: 33686834 DOI: 10.24953/turkjped.2021.01.014] [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: 11/20/2022]
Abstract
BACKGROUND We aimed to investigate the relationship between human leukocyte antigens (HLA)-groups and clinical features, and degree of intestinal injury in children with celiac disease (CD). METHODS Study group included 73 (50 females, 68.5%) children with CD. Demographic and clinical features, accompanying autoimmune diseases, family history for CD and degree of damage in small intestinal mucosa (according to Marsh classification) at the time of diagnosis were determined. Twenty-two siblings of celiac patients without CD (15 females, 65.2%) consisted control group 1, and 66 (40 females, 60.6%) people from the normal population consisted control group 2. RESULTS The allele frequencies of HLA B8, B50, C6, C7, DR3, DR7, DQ2, and DR3 homozygosity were higher in the patient group. HLA DQ2 positivity was 89% in the patient group, 73.9 and 45.5% in control groups 1 and 2, respectively (p < 0.0001). HLA A30, C14, DR11, DQ3 frequency were lower in patients compared to both control groups. HLA-DR15 alleles in patient and control group 1 was significantly lower compared to the general population (p < 0.05). Thirty (41.1%) patients had typical, 43 (58.9%) patients had atypical presentation. Thirteen (17.8%) patients had other autoimmune diseases. There was no association between coexisting autoimmune diseases and the HLA antigens. Fifteen patients (20.5%) had a positive family history for CD; patients with HLA A69, B41 and C12 alleles had a higher positive family history (p < 0.05). Intestinal mucosal damage was as follows: 5 patients (6.8%) had Marsh 2, 25 (34.3%) Marsh 3a, 28 (38.4%) Marsh 3b, 15 (20.5%) Marsh 3c. Patients with HLA-DR15 alleles had more frequent Marsh 3a lesions (p < 0.05). CONCLUSIONS B8, B50, C6, C7, DR3, DR7, DR3/DR3, DQ2 alleles were risk factors for CD in the Turkish population. HLA C14, DR11, DR15, and DQ3 alleles were found to have a protective role in the same population.
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Affiliation(s)
- Necati Balamtekin
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Baysoy
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Çağman Tan
- Divisions of Pediatric Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nuray Uslu Kızılkan
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yüce
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlhan Tezcan
- Divisions of Pediatric Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Gürakan
- Divisions of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Bor S, Kalkan İH, Çelebi A, Dinçer D, Akyüz F, Dettmar P, Özen H. Alginates: From the ocean to gastroesophageal reflux disease treatment. Turk J Gastroenterol 2020; 30:109-136. [PMID: 31624050 DOI: 10.5152/tjg.2019.19677] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Serhat Bor
- Division of Gastroenterology, Department of Internal Medicine, Ege University School of Medicine, Ege Reflux Study Group, İzmir, Turkey
| | - İsmail Hakkı Kalkan
- Department of Gastroenterology, TOBB University of Economics and Technology School of Medicine, Turkey
| | - Altay Çelebi
- Division of Gastroenterology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Dinç Dinçer
- Division of Gastroenterology, Department of Internal Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Filiz Akyüz
- Division of Gastroenterology, Department of Internal Medicine İstanbul School of Medicine, Istanbul University, İstanbul, Turkey
| | - Peter Dettmar
- RD Biomed Limited, Castle Hill Hospital, Cottingham, UK
| | - Hasan Özen
- Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
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Boybeyi Türer Ö, Soyer T, Özen H, Arslan UE, Karnak İ, Tanyel FC. Challenges in management and prognosis of pediatric intestinal pseudo-obstruction. Turk J Gastroenterol 2020; 31:596-602. [PMID: 32915148 DOI: 10.5152/tjg.2020.19233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/AIMS Pediatric intestinal pseudo-obstruction (PIPO) is the most severe form of intestinal dysmotility in children. This study aims to present the cases of PIPO to discuss its diagnosis, management, and prognosis. MATERIALS AND METHODS We retrospectively analyzed the medical records of the patients with PIPO between 2010 and 2018. RESULTS A total of 7 patients were included. The admission age was 3 days-10 years. The complaints were abdominal distention and constipation in all the patients. All the patients had passed meconium in the first 48 hours of their life. An upper gastrointestinal (GI) series revealed slow transit in 6 patients and malrotation in 2 patients. Full-thickness rectum biopsies revealed normal ganglion cells. Neurological examination revealed postinfectious pandysautonomy in 1 patient. Furthermore, 2 patients are under follow-up with ileostomy and TPN, 1 patient is with enteral feeding and ileostomy, and 3 patients are stable with pyridostigmine, enemas. Moreover, 1 patient died because of sepsis. The prognosis was not significantly correlated with initial presentation time, lag time, and presence of extraintestinal manifestations (p>0.05). The prognosis was significantly better when fewer number of operations were performed (p=0.029) Conclusion: PIPO is a broad-spectrum disease group that is difficult to diagnose and treat. It is mandatory to rule out the secondary causes of diagnosis. Medical and surgical treatments are used to support the nutritional status, prevent sepsis, and restore the intestinal motility. The prognosis was better when the secondary causes were identified and fewer operations were performed.
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Affiliation(s)
- Özlem Boybeyi Türer
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Umut Ece Arslan
- Department of Biostatistics, Hacettepe University Institute of Public Health, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Feridun Cahit Tanyel
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Bajin İY, Demir H, Saltık-Temizel İN, Özen H, Yüce A. Long term follow-up of children with chronic hepatitis B: a single center experience. Turk J Pediatr 2020; 61:846-851. [PMID: 32134577 DOI: 10.24953/turkjped.2019.06.004] [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
Yaman Bajin İ, Demir H, Saltık Temizel İN, Özen H, Yüce A. Long term follow-up of children with chronic hepatitis B: a single center experience. Turk J Pediatr 2019; 61: 846-851. Chronic Hepatitis B infection is an important clinical issue because of the associated risk of developing cirrhosis and hepatocellular carcinoma. Especially in children, there is no consensus about the optimal treatment. Clinical features and long-term outcomes of 165 children diagnosed with chronic hepatitis B at our institution between January 1993 and June 2012 were analysed retrospectively. Patients were divided into four groups according to their treatment protocols. The first group received Interferon (IFN) only, the second group started lamivudine (LMV) first then IFN+LMV combined and then continued with LMV only, the third group started with IFN+LMV combined then continued with LMV only and the fourth group received LMV only. After a median follow-up period of 7 years (1-19 years) the highest e-seroconversion (the loss of HBeAg followed by gain of anti- HBe antibody) rate, biochemical and virological response was observed with combined (IFN+LMV) treatment regimens. Patients with higher ALT levels were better treatment responders (p: 0.003). Identification of the patients who need to be treated in order to determine the most effective therapy with optimal treatment duration is important to reduce the risk of developing future complications like cirrhosis and hepatocellular carcinoma.
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Affiliation(s)
- İnci Yaman Bajin
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yüce
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Hanalioğlu D, Özen H, Karhan A, Gümüş E, Demir H, Saltık-Temizel İN, Ekinci S, Karnak İ, Çiftçi AO, Tanyel FC, Yüce A. Revisiting long-term prognostic factors of biliary atresia: A 20-year experience with 81 patients from a single center. Turk J Gastroenterol 2020; 30:467-474. [PMID: 31061002 DOI: 10.5152/tjg.2019.18590] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND/AIMS The present study aimed at investigating the long-term outcomes and prognostic factors of patients with biliary atresia (BA) diagnosed and followed at a single center. MATERIALS AND METHODS Patients with BA treated during 1994-2014 at a large-volume pediatric tertiary referral center were reviewed retrospectively with regard to demographic, clinical, laboratory, and diagnostic characteristics for identifying the prognostic factors and long-term clinical outcomes. RESULTS Overall, 81 patients (49 males, 32 females) were included. Mean age at diagnosis was 73.1±4.7 (median: 64) days. Of the patients included, 78 patients (96%) underwent a portoenterostomy procedure. Mean age at operation was 76.8±4.7 (median: 72) days. The surgical success rate was 64.8%. A younger age (either at diagnosis or surgery) was the only determinant of surgical success. The 2-, 5-, and 10-year overall survival (OS) rates, including all patients with or without liver transplantation, were 75%, 73%, and 71% respectively, whereas the 2-, 5-, and 10-year survival rates with native liver (SNL) were 69%, 61%, and 57%, respectively. Mean follow-up duration was 9.4±7.5 years. Successful surgery, presence of fibrosis and/or cirrhosis on the liver pathology, and prothrombin time [international normalized ratio (INR)] at presentation were independent prognostic factors for both OS and SNL. CONCLUSION A younger age at diagnosis is strongly associated with surgical success in BA. Surgical success, the prothrombin time (INR) at presentation, and liver pathology are independent prognostic factors affecting the long-term outcomes in patients with BA. Therefore, timely diagnosis and early referral to experienced surgical centers are crucial for optimal management and favorable long-term results in BA.
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Affiliation(s)
- Damla Hanalioğlu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Asuman Karhan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ersin Gümüş
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hülya Demir
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - İnci N Saltık-Temizel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatrics Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatrics Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Arbay O Çiftçi
- Department of Pediatrics Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Feridun C Tanyel
- Department of Pediatrics Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysel Yüce
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University School of Medicine, 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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Uslu GA, Gelen V, Uslu H, Özen H. Effects of Cinnamomum cassia extract on oxidative stress, immunreactivity of iNOS and impaired thoracic aortic reactivity induced by type II diabetes in rats. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000317785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Ilgaz F, Serel Arslan S, Boyraz M, Demir N, Demir H, Saltık Temizel I, Karaduman A, Özen H, Yüce A, Gökmen Özel H. Screening of dysphagia and malnutrition risk in hospitalized children: Preliminary findings from a pilot study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1463] [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: 11/30/2022]
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Yıldırım D, Göktaş M, Demir H, Saltık Temizel I, Özen H, Yüce A, Gökmen Özel H. Preferred gluten free cereals in children with celiac disease. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1556] [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: 10/28/2022]
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Aydemir Y, Gürakan F, Saltık Temizel İN, Demir H, Oğuz KK, Yalnızoğlu D, Topçu M, Özen H, Yüce A. Evaluation of central nervous system in patients with glycogen storage disease type 1a. Turk J Pediatr 2017; 58:12-18. [PMID: 27922231 DOI: 10.24953/turkjped.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
We aimed to evaluate structure and functions of central nervous system (CNS) in children with glycogen storage disease (GSD) type 1a. Neurological examination, psychometric tests, electroencephalography (EEG), magnetic resonance imaging (MRI), visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) were performed. The results were compared between patients with good and poor metabolic control and healthy children. Twenty-three patients with GSD type 1a were studied. Twelve patients were in poor metabolic control group and 11 patients in good metabolic control group. Five patients had intellectual disability, 10 had EEG abnormalities, seven had abnormal VEP and two had abnormal BAEP results. MRI was abnormal in five patients. There was significant correlation between the number of hypoglycemic attacks and MRI abnormalities. Central nervous system may be affected in GSD type 1a even in patients with normal neurologic examination. Accumulation of abnormal results in patients with poor metabolic control supports the importance of metabolic control in GSD type 1a.
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Affiliation(s)
- Yusuf Aydemir
- Divisions of Pediatric Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Gürakan
- Divisions of Pediatric Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İnci Nur Saltık Temizel
- Divisions of Pediatric Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hülya Demir
- Divisions of Pediatric Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kader Karlı Oğuz
- Department of Pediatrics and Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yalnızoğlu
- Department of Pediatrics and Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meral Topçu
- Divisions of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Divisions of Pediatric Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yüce
- Divisions of Pediatric Gastroenterology and Hepatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Aydemir Y, Pınar A, Hızal G, Demir H, Saltık Temizel İN, Özen H, Akbıyık F, Yüce A. Neutrophil volume distribution width as a new marker in detecting inflammatory bowel disease activation. Int J Lab Hematol 2016; 39:51-57. [DOI: 10.1111/ijlh.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/29/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Y. Aydemir
- Department of Pediatric Gastroenterology, Hepatology and Nutrition; Hacettepe University School of Medicine; Ankara Turkey
| | - A. Pınar
- Department of Medical Biochemistry; Hacettepe University School of Medicine; Ankara Turkey
| | - G. Hızal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition; Hacettepe University School of Medicine; Ankara Turkey
| | - H. Demir
- Department of Pediatric Gastroenterology, Hepatology and Nutrition; Hacettepe University School of Medicine; Ankara Turkey
| | - İ. N. Saltık Temizel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition; Hacettepe University School of Medicine; Ankara Turkey
| | - H. Özen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition; Hacettepe University School of Medicine; Ankara Turkey
| | - F. Akbıyık
- Department of Medical Biochemistry; Hacettepe University School of Medicine; Ankara Turkey
| | - A. Yüce
- Department of Pediatric Gastroenterology, Hepatology and Nutrition; Hacettepe University School of Medicine; Ankara Turkey
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Balamtekin N, Aksoy Ç, Baysoy G, Uslu N, Demir H, Köksal G, Saltık-Temizel İN, Özen H, Gürakan F, Yüce A. Is compliance with gluten-free diet sufficient? Diet composition of celiac patients. Turk J Pediatr 2015; 57:374-379. [PMID: 27186700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study was planned to investigate the amount and content of foods consumed by child patients with celiac disease on a long-term gluten-free diet. Children aged 3-18 years who were diagnosed with celiac disease according to ESPGHAN criteria and were compliant to the gluten-free diet for at least one year were included. Age and gender matched healthy children were included as the control group. Food consumption records including the amount and content of the foods consumed for a total of three days were obtained. Once the records had been completed on the food consumption form, quantity analysis was again performed by the same dietician. Energy and other nutritional elements taken in through foodstuffs consumed by the patient and control groups were calculated using the Nutrition Data System for Research Package; these results were shown as mean ± standard deviation (x ±SD) and the values compared. The study consisted of 28 patients with a mean age of 10.3 ± 4.6 and 25 healthy controls with a mean age of 9.5 ± 3.4. Average age at diagnosis in the patient group was 6.7 ± 4.3 and mean duration of gluten-free diet was 4.0 ± 3.3 years. Children with celiac disease on a gluten-free diet had significantly lower daily energy intake levels compared to the healthy controls (p<0.05). The proportional fat consumption was significantly higher in the patient group compared to the controls (p<0.05). Moreover, proportional carbohydrate and protein, vitamin E and vitamin B1, and microelements such as magnesium, phosphorus and zinc consumptions were significantly lower in celiac group with respect to v-control group. Solely determining compliance to the gluten free diet might be inadequate in the follow-up of children with celiac disease, adequacy of the nutritional content in terms of macro and micronutrients of celiac disease patients is also important.
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Affiliation(s)
- Necati Balamtekin
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
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Maçin S, Demir H, Özen H, Yüce A, Akyön Y. Determination of Helicobacter pylori antibiotic resistance patterns in pediatric gastroenterology patients: the Hacettepe experience. Turk J Pediatr 2015; 57:254-257. [PMID: 26701944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this study, our aim was to show the antibiotic resistance patterns of Helicobacter pylori (H. pylori) strains isolated from patients who had undergone esophagogastroduodenoscopy at Hacettepe University. Ninety-three culturepositive patients with no history of H. pylori treatment were included in the study. MIC values against clarithromycin, metronidazole, amoxicillin and tetracycline were evaluated by gradient strips. In the 93 strains, no resistance against tetracycline and amoxicillin was observed. Clarithromycin resistance was detected in 28 (30.1%) and metronidazole resistance in 45 (48.4%) patients' strains. Resistance to clarithromycin and metronidazole, respectively, was observed in three age groups as follows: in 3 (17.6%) and 5 (29.4%) strains in the 5-9 age group; in 13 (30.9%) and 16 (38.1%) strains in the 10-14 age group; and in 12 (35.3%) and 24 (70.6%) strains in the 15-19 age group. Antibiotic susceptibility testing prior to treatment would prevent the administration of useless treatments. It is therefore recommended that such testing be performed before planning the treatment.
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Affiliation(s)
- Salih Maçin
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Baysoy G, Saltık Temızel İN, Uslu N, Balamtekın N, Demır H, Gürkan F, Özen H, Akyön Y, Yüce A. Ornidazole-based sequential therapy is not effective in Helicobacter pylori eradication in children. Turk J Gastroenterol 2014; 24:382-6. [PMID: 24557960 DOI: 10.4318/tjg.2013.0575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIMS Sequential therapy is one of the recent answers given to the problem of increasing antibiotic resistance and decreasing eradication rates of Helicobacter pylori infection. The aim of this study is to compare the ornidazole-based sequentialtherapy with the standard triple therapy in Helicobacter pylori eradication. MATERIALS AND METHODS Children aged 4-18 years diagnosed with Helicobacter pylori infection based on histology and at least one of 13 C urea breath test and rapid urease test positivity were included in the study. Children were randomized to standard triple therapy with amoxicillin, clarithromycin, and lansoprazole for 14 days and sequential therapy with amoxicillin and lansoprazole for the first 5 days and clarithromycin, ornidazole and lansoprazole for another 5 days in 2:3 randomization. At the end of the treatment, families were contacted by phone, and side effects of and the compliance to the treatment were noted. Patients were requested to do 13 C urea breath test 6-8 weeks after the treatment. RESULTS Sixty-one children were included for the final analysis. Per-protocol eradication rates were 48.6% for sequential therapy group and 54.2% for standard triple therapy group. Intention to treat eradication rates were 40.9% and 46.0%, respectively. There were no differences between eradication rates in the two study groups. Side effect rates were also similar between the two groups. CONCLUSIONS Ornidazole-based sequential therapy did not show any superiority compared to the standard triple treatment in children with Helicobacter pylori infection.
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Affiliation(s)
- Gökhan Baysoy
- Hacettepe University School of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara, Turkey
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