Publications by authors named "Selim Gokce"

45 Publications

Familial Mediterranean Fever Mutation Analysis in Pediatric Patients With İnflammatory Bowel Disease: A Multicenter Study.

Turk J Gastroenterol 2021 03;32(3):248-250

Department of Pediatric Gastroenterology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey.

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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http://dx.doi.org/10.5152/tjg.2021.20057DOI Listing
March 2021

The role of plasma exchange in acute liver failure of autoimmune etiology.

Turk J Pediatr 2021 ;63(2):329-333

Intensive Care Unit, İstanbul Memorial Hospital, İstanbul, Turkey.

Background: Autoimmune hepatitis (AIH) is characterized by increased immunoglobulin G (IgG) levels, the presence of autoantibodies, and various degrees of lymphocyte predominant inflammation and fibrosis histologically. Immunosuppressive therapy induces remission in approximately 80% of those affected. However, liver transplantation is indicated in patients with acute liver failure with encephalopathy at presentation. Liver supporting systems, including plasma exchange (PE) allow bridging patients to transplantation or spontaneous recovery in the setting of liver failure. The role of these systems has not been assessed in children with liver failure of autoimmune etiology.

Case: Herein, we report three cases of AIH with fulminant presentation, with marked symptom resolution with PE as an adjunct therapeutic option to immunosuppressive treatment.

Conclusion: In the setting of AIH, PE may have a special therapeutic role by removing autoantibodies and cytokines, therefore preventing further liver damage and decompensation, and allowing time for recovery.
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http://dx.doi.org/10.24953/turkjped.2021.02.019DOI Listing
January 2021

Successful treatment of pediatric post-liver transplant Kaposi`s sarcoma with paclitaxel.

Turk J Pediatr 2020 ;62(5):858-862

Pediatric Surgery and Liver Transplantation Center, Memorial Şişli Hospital, İstanbul, Turkey.

Background: Kaposi`s sarcoma (KS) is a complication of immunosuppressive therapy for transplant recipients. Unlike adult recipients, KS in pediatric organ transplantation is quite rare. Treatment is usually withdrawal of immunosuppression; non-responders often receive chemotherapy.

Case: We have reported a child with post-liver transplant visceral KS which has progressed despite withdrawal of immunosuppressive therapy, who has been treated with Paclitaxel for three weeks. KS has regressed completely after four cycles of Paclitaxel.

Conclusion: Paclitaxel should be considered as an effective first line treatment option for patients with posttransplant KS.
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http://dx.doi.org/10.24953/turkjped.2020.05.020DOI Listing
January 2020

Changing Clinical Manifestations of Celiac Disease in Children.

Authors:
Selim Gokce

J Pediatr Gastroenterol Nutr 2016 08;63(2):e25

*Department of Pediatric Gastroenterology, Hepatology and Nutrition, Biruni University Medical School †Department of Pediatric Gastroenterology, Hepatology and Nutrition, Memorial Sisli Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MPG.0000000000001254DOI Listing
August 2016

The Key Clinical Manifestations of Lysosomal Acid Lipase Deficiency.

Authors:
Selim Gokce

J Pediatr Gastroenterol Nutr 2016 09;63(3):e39

*Department of Pediatric Gastroenterology, Hepatology and Nutrition, Biruni University Medical School †Department of Pediatric Gastroenterology, Hepatology and Nutrition, Memorial Sisli Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MPG.0000000000001255DOI Listing
September 2016

Oral Motor Impairment in Children With Feeding Disorder.

Authors:
Selim Gokce

J Pediatr Gastroenterol Nutr 2016 09;63(3):e40

*Department of Pediatric Gastroenterology, Hepatology and Nutrition, Biruni University Medical School †Department of Pediatric Gastroenterology, Hepatology and Nutrition, Memorial Sisli Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MPG.0000000000001249DOI Listing
September 2016

Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm.

Ital J Pediatr 2015 Oct 6;41:73. Epub 2015 Oct 6.

Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.

Background: This study aims to evaluate the children with chronic cough and to analyze their etiological factors according to the age groups.

Method: Five hundred sixty-three children with chronic cough were included. The last diagnosis were established and were also emphasized according to the age groups.

Results: The mean age was 5.4 ± 3.8 years (2-months-17-years) and 52 % of them were male. The most common final diagnosis from all the participants were: asthma (24.9 %), asthma-like symptoms (19 %), protracted bacterial bronchitis (PBB) (11.9 %), and upper airway cough syndrome (9.1 %). However, psychogenic cough was the second most common diagnosis in the subjects over 6 years of age.

Conclusion: Asthma and asthma-like symptoms were the most common diagnosis in children. Different age groups in children may have a different order of frequencies. Psychogenic cough should be thought of in the common causes especially in older children.
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http://dx.doi.org/10.1186/s13052-015-0180-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595107PMC
October 2015

Carotid intima-media thickness and flow-mediated dilation in obese children with non-alcoholic fatty liver disease.

Turk J Gastroenterol 2014 Dec;25 Suppl 1:92-8

Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey.

Background/aims: This study aimed to understand the role of non-alcoholic fatty liver disease (NAFLD) in increasing the risk of atherosclerosis in obese pediatric patients.

Materials And Methods: The study included 109 obese children (age, 9-15 years) and a control group comprising 44 healthy age- and gender-matched children with normal weight. NAFLD was diagnosed using conventional ultrasound (US) examination. Both right carotid intima-media thickness (CIMT) and flow-mediated dilation (FMD) were assessed in addition to anthropometric measures and serum biochemical parameters, including lipid profile and fasting glucose and insulin levels. Homeostatic model assessment of insulin resistance (HOMA-IR) was calculated as a measure of insulin resistance.

Results: Mean age and gender distributions were similar in the obese children and control group (p=0.168 and p=0.705, respectively). Median body mass index standard deviation scores of obese children with grade II-III NAFLD were significantly higher than those of obese children without hepatosteatosis (p<0.001). Median total cholesterol levels were similar in all the groups (p=0.263). Low-density lipoprotein cholesterol and triglyceride levels increased and high-density lipoprotein cholesterol levels decreased significantly as the grade of steatosis increased (p<0.001, p<0.05, and p=0.05, respectively). Median alanine aminotransaminase (ALT) and HOMA-IR levels of obese children with grade II-III NAFLD were significantly higher than those of obese children without NAFLD (p=0.01) and obese children with grade I NAFLD (p=0.001). CIMT was significantly correlated with the grade of steatosis (p<0.001) and level of ALT (p=0.005). Linear regression analysis showed that the grade of hepatosteatosis had a significant effect on CIMT. FMD decreased as the grade of hepatosteatosis increased, but it did not reach a significant level.

Conclusion: The obese children with hepatosteatosis showed increased CIMT, as indicated by the grade of steatosis, compared with healthy controls and obese children without hepatosteatosis. FMD was not superior to CIMT in predicting the risk of early atherosclerosis.
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http://dx.doi.org/10.5152/tjg.2014.5552DOI Listing
December 2014

Steroid treatment of protracted cholestatic hepatitis A in a child with β-thalassemia.

Turk J Gastroenterol 2014 Dec;25 Suppl 1:278-9

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University, Fcaulty of Medicine, İstanbul, Turkey.

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http://dx.doi.org/10.5152/tjg.2014.6384DOI Listing
December 2014

Rare causes of gastrointestinal hemorrhage in infancy.

Pediatr Int 2015 Apr;57(2):304-7

Department of Pediatric Surgery, Gaziantep Children's Hospital, Sehitkamil, Gaziantep.

Gastrointestinal hemorrhage in children is a critical condition that demands quick and effective management. The differential diagnosis of gastrointestinal hemorrhage is wide. Heterotopic pancreas is a rare congenital anomaly and usually discovered incidentally. It is generally asymptomatic, but symptoms may occur when complicated by inflammation, bleeding, obstruction or malign transformation. Heterotopic pancreas may present throughout the gastrointestinal tract, but it is most commonly found in the stomach, duodenum and proximal jejunum. Juvenile polyps are common during childhood and present most often with painless rectal hemorrhage. They remain the most common colonic polyps in children. Colonoscopic polypectomy is the most effective procedure in the treatment of juvenile polyps. In this study, we describe rare causes of gastrointestinal system hemorrhage in infancy and discuss some diagnostic and therapeutic approaches.
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http://dx.doi.org/10.1111/ped.12452DOI Listing
April 2015

Celiac disease and iron deficiency anemia.

Authors:
Selim Gökçe

Turk J Gastroenterol 2014 Dec;25(6):741

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University Faculty of Medicine, İstanbul, Turkey. Drgokce0007.

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http://dx.doi.org/10.5152/tjg.2014.6377DOI Listing
December 2014

Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension.

J Pediatr Gastroenterol Nutr 2015 Feb;60(2):177-81

*Sifa Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Sifa University, Izmir †Istanbul Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Istanbul University, Istanbul ‡Istanbul Faculty of Medicine, Pediatric Cardiology, Istanbul University, Istanbul §Bezm-i Alem Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Bezm-i Alem University, Istanbul ||Kocaeli Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Kocaeli University, Izmit/Kocaeli ¶Selcuk Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Selcuk University, Konya, Turkey.

Background: Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT).

Methods: This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50). Fifty healthy children were also selected for the control group. Electrocardiography and echocardiography were used to evaluate cardiac functions. Corrected QT (QTc) ≥ 0.45 was accepted as prolonged on electrocardiography. The study group was divided into 3 groups: cirrhotic, noncirrhotic, and control. Then, the CCMP group was created according to the diagnostic criteria. Latent CCMP was diagnosed in the presence of prolonged-QTc along with a minor criterion (tachycardia). Manifest CCMP was diagnosed in the presence of at least 2 major criteria (prolonged-QTc along with abnormal echocardiographic findings). Moreover, in this study, the risk factors for CCMP were investigated.

Results: The CCMP group included 10 cases (20%). Nine of these cases had latent CCMP (18%), and the remaining one (2%) had manifest CCMP. All of the cases with CCMP had cirrhosis and ascites. None of the patients with CCMP had severe cardiac symptoms, but they were already using some cardioprotective drugs such as propanolol and spironolactone. As risk factors for CCMP, pediatric end-stage liver disease scores, Child-Pugh scores, and ascites grades were found to be significant for the determination of CCMP. The most important risk factor was ascites severity (P = 0.001, odds ratio 9.4).

Conclusions: Approximately 20% of children with PHT have CCMP. A detailed cardiac examination should be carried out periodically in children with cirrhotic PHT, especially in the presence of ascites and high Child-Pugh score.
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http://dx.doi.org/10.1097/MPG.0000000000000580DOI Listing
February 2015

Plasmapheresis in treatment of vanishing bile duct syndrome.

Authors:
Selim Gökçe

J Pediatr Gastroenterol Nutr 2014 Jul;59(1):e14

Bezmialem Vakif University, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul, Turkey.

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http://dx.doi.org/10.1097/MPG.0000000000000321DOI Listing
July 2014

Changing face and clinical features of celiac disease in children.

Pediatr Int 2015 25;57(1):107-12. Epub 2014 Nov 25.

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmialem Vakif University, Istanbul, Turkey.

Background: The aim of this study was to analyze and compare the epidemiological and presenting features, clinical patterns, and complications of celiac disease (CD) in children.

Methods: The clinical charts of children with CD were retrospectively analyzed. Data for children who presented during the first time period (January 2005-October 2008; group 1) were compared to those of children who presented during the second time period (November 2008-April 2012; group 2).

Results: Group 1 and 2 consisted of 96 and 95 children, respectively. There were no differences in gender distribution, weight, or height z-scores between the two groups. Mean age at the time of diagnosis in group 2 (9.3 ± 4.5 years) was significantly higher than in group 1 (6.9 ± 3.9 years; P < 0.001). Non-classical presentation was more frequent in group 2 (P = 0.01). Associated disorders were observed in 49 children (25.7%) overall. There were significantly more children with type 1 diabetes mellitus in group 2 (P = 0.030). In all, 11 patients (5.8%) were overweight (either obese or at risk of obesity) at presentation. Isolated short stature was the presenting feature in 15 children (7.9%) overall, but was more frequently observed in group 2 (P = 0.003). In total, 15 patients (7.9%) presented with refractory iron deficiency anemia; the frequency was similar in both groups. Dual-energy X-ray absorptiometry was performed in 102 patients, and 82 (80.4%) had metabolic bone disease (MBD).

Conclusion: The mode of presentation and clinical features of CD in childhood continue to change. Of note, a substantial percentage of patients were overweight at presentation. MBD is a frequent complication, necessitating routine evaluation.
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http://dx.doi.org/10.1111/ped.12448DOI Listing
December 2016

A retrospective review of children with gallstone: single-center experience from Central Anatolia.

Turk J Gastroenterol 2014 Feb;25(1):46-53

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bezmiâlem Vakif University Faculty of Medicine, İstanbul, Turkey.

Background/aims: To evaluate children with gallstone in respect to demographic features, type of presentation, predisposing risk factors, laboratory features, complications, and outcome.

Materials And Methods: Overall, 124 children with sonographically diagnosed gallstone were stratified into group 1 (symptomatic) and group 2 (asymptomatic). The data on demographic features, predisposing risk factors, laboratory features, complications, and outcome were collected from medical charts and compared by using convenient statistical methods.

Results: There were 76 (61%) children in group 1. Females were significantly older than males at the time of diagnosis (p=0.001). After adjusting for age and sex, asymptomatic presentation was associated with hemolytic anemia (r=346, <0.001) and being an oncologic patient (r=248, p=0.006). No risk factor was specifically associated with having a symptomatic presentation. Sixteen children (12.9%) developed complications: 14 (18.4%) in group 1 and 2 (4.2%) in group 2 (p=0.027). Gallstone resolution was detected in 20 (29.4%) and 10 children (23.3%) in groups 1 and 2, respectively (p=0.477). Resolution was observed in 43.8% of children with ceftriaxone-associated gallstone. The rate of resolution with ursodeoxycholic acid (UDCA) was similar to that observed with expectant management. Gallstone resolution was evident in 9 infants (50.0%) and was significantly higher than children over 2 years of age (21 out of 106 children, 19.8%) (p=0.006). The most important factor associated with gallstone resolution was to be an infant (<2 years of age) at the time of diagnosis (OR: 3.1; 95% CI: 1.1-8.8; p=0.034).

Conclusion: Ceftriaxone-associated gallstones are most likely to resolve but do not always undergo spontaneous resolution. UDCA treatment seems to be ineffective. Young age is a favorable factor for gallstone resolution. The rate of complications in children with asymptomatic presentation is considerably low. Thus, clinical follow-up rather than surgical intervention is suggested in children with asymptomatic presentation and in infants.
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http://dx.doi.org/10.5152/tjg.2014.3907DOI Listing
February 2014

Lorazepam in the treatment of posttraumatic feeding disorder.

J Child Adolesc Psychopharmacol 2014 Jun 9;24(5):296-7. Epub 2014 May 9.

1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University , Istanbul, Turkey .

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http://dx.doi.org/10.1089/cap.2013.0149DOI Listing
June 2014

Serum paraoxonase activity and oxidative stress and their relationship with obesity-related metabolic syndrome and non-alcoholic fatty liver disease in obese children and adolescents.

J Pediatr Endocrinol Metab 2014 Jul;27(7-8):667-75

Objective: Oxidative stress has been reported to be involved in the pathogenesis of metabolic disorders related with obesity. The aim of the study was to investigate the association of oxidative stress and paraoxonase activities with non-alcoholic fatty liver disease (NAFLD) as well as metabolic syndrome.

Materials And Methods: A total of 109 obese children and adolescents and 44 healthy and lean control subjects were enrolled in the study. According to their ultrasonographic steatosis scores, they were classified into four groups as follows: healthy children; obese, non-NAFLD; obese, grade I-NAFLD; and obese, grade II-III NAFLD. The biochemical parameters and insulin resistance (HOMA-IR) were evaluated from fasting samples. The plasma total antioxidant status (TAS), total oxidant status (TOS), and serum paraoxonase activities were measured and then oxidative stress index (OSI) was calculated as the indicator of degree of oxidative stress.

Results: As the steatosis increased, the alanine aminotransferase, C-reactive protein, HOMA-IR, total cholesterol, and LDL cholesterol increased, whereas HDL cholesterol decreased. The TAS measurements were higher in the obese NAFLD group compared with that of the healthy control group. The TOS and OSI measurements did not differ between the groups. Paraoxonase activities increased significantly as steatosis increased.

Conclusions: Among the children in this study, no relationship could be demonstrated between obesity with/without steatosis and oxidant/antioxidant status.
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http://dx.doi.org/10.1515/jpem-2013-0337DOI Listing
July 2014

Thyroid hormone levels in obese children and adolescents with non-alcoholic fatty liver disease.

J Clin Res Pediatr Endocrinol 2014 ;6(1):34-9

Bezmialem Vakıf University Medical Faculty, Department of Pediatrics, İstanbul, Turkey. E-ma-il:

Objective: We aimed to determine the association of thyroid functions with the components of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) in pediatric obese patients.

Methods: The study included 109 obese children (aged 9-15 years) and a control group of 44 healthy age and gender-matched children of normal weight. NAFLD was diagnosed by conventional ultrasound examination. We assessed the anthropometric data and serum biochemical parameters including lipid profile, alanine aminotransferase (ALT), fasting glucose and insulin levels and thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) levels. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as a measure of IR.

Results: The mean age and gender distributions in the groups were similar (p=0.23). The mean body mass index (BMI) z-scores of obese children with grade 2-3 NAFLD were significantly higher than those of the obese children without hepatic steatosis (p<0.001). Mean ALT, triglyceride (TG) and LDL cholesterol increased and HDL-cholesterol significantly decreased as the hepatic steatosis increased (p<0.05). HOMA-IR levels in obese subjects with grade 2-3 NAFLD were significantly higher than those in both obese children without NAFLD and grade 1 NADFL (p=0.05 and 0.001, respectively). In the obese subjects, TSH levels were increased significantly as the degree of steatosis increased (p=0.04) but fT3 and fT4 levels were not different. In correlation analysis, TSH was significantly correlated with ALT, BMI SDS and the degree of steatosis.

Conclusions: Obese children demonstrate an increase in TSH levels as the degree of steatosis increased.
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http://dx.doi.org/10.4274/Jcrpe.1155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986737PMC
November 2014

Conjugated hyperbilirubinemia in the neonatal intensive care unit.

Turk J Gastroenterol 2013 ;24(5):406-14

Background/aims: To determine the underlying causes and short-term prognosis of patients with conjugated hyperbilirubinemia in a tertiary neonatal intensive care units.

Materials And Methods: We retrospectively analyzed the etiology, course, and shortterm prognosis of conjugated hyperbilirubinemia observed in newborn infants in a tertiary neonatal intensive care units.

Results: Of a total of 104 infants with conjugated hyperbilirubinemia (2.1%, 104/4915), 92 infants (56 full-term, 36 preterm) were enrolled in the study. Cholestatic jaundice as a sole finding on physical examination during admission was present in 15.2% infants, and conjugated hyperbilirubinemia developed within the first week of life in nearly half of the infants (51.1%). The most frequent causes of conjugated hyperbilirubinemia within the first days of life were vascular/ischemic events, inspissated bile, and inherited metabolic disorders. The majority of the infants (80%) had also concomitant clinical disorders that might possibly contributed tothe development of conjugated hyperbilirubinemia. The majority of the deaths (87%) were primarily related to serious perinatal events and genetic/inherited disorders. Bilirubin levels in the most of the survivors (87.1%) returned to normal within six months.

Conclusions: Conjugated hyperbilirubinemia is not uncommon in neonatal intensive care unit. Etiology is often multifactorial and more commonly arise from non-hepatic causes. Outcome depends on the underlying causes. Early diagnosis and treatment may be critical for favorable outcome.
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http://dx.doi.org/10.4318/tjg.2013.0553DOI Listing
November 2014

An unusual presentation of galactosemia: hemophagocytic lymphohistiocytosis.

Turk J Haematol 2012 Dec 5;29(4):401-4. Epub 2012 Dec 5.

Dr.Sami Ulus Hospital, Neonatology Department, Ankara, Turkey.

Unlabelled: Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening condition. Uncontrolled proliferation of activated lymphocytes secreting high amounts of inflammatory cytokines seems to be the main pathogenesis. The diagnosis of HLH can often be difficult. It may presents in many forms such as fever of unknown origin, hepatitis, acute liver failure, and sepsis-like illness. Here we present a newborn galactosemia case presented with HLH. Close monitoring of the diagnostic criteria of HLH during the course of galactosemia-associated hemophagocytosis, both before and after dietary treatment, should be performed in order to fully determine if the triggering mechanism is infection or accumulation of metabolites.

Conflict Of Interest: None declared.
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http://dx.doi.org/10.5505/tjh.2012.65148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781627PMC
December 2012

Psychosocial status and quality of life in mothers of infants with colic.

Turk J Pediatr 2013 Jul-Aug;55(4):391-5

Department of Pediatric, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara-Turkey. Turkey.

We aimed to measure the psychosocial status and quality of life in mothers of babies with infantile colic (IC). Mothers and their newborns were stratified into Group 1 (colicky infant-mother dyad [n: 39]) and Group 2 (non-colicky infant-mother dyad [n: 39]). Maternal symptoms of depression and anxiety were assessed using the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), respectively. The Short Form-36 (SF36) was used to measure quality of life. Mean BDI score in Group 1 (14.7 ± 12.9) was significantly higher than in Group 2 (7.7 ± 5.5) (p=0.020). Mothers in Group 1 had lower Short Form- 36 physical functioning (26.6 ± 4.3 vs. 28.7 ± 2.6; p=0.010) and social functioning (7.4 ± 2.5 vs. 8.9 ± 3.2, p=0.024) domain scores. Infantile colic (IC) was associated with higher maternal depression symptom scores and lower quality of life scores. As such, we think that mothers who have babies with IC should be closely monitored.
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August 2014

The relationship between pediatric nonalcoholic fatty liver disease and cardiovascular risk factors and increased risk of atherosclerosis in obese children.

Pediatr Cardiol 2013 Feb 9;34(2):308-15. Epub 2012 Aug 9.

Department of Pediatric Gastroenterology, Dr Sami Ulus Obstetrics and Gynecology, Children's Health and Disease Training and Research Hospital, 06080 Altındağ, Ankara, Turkey.

To investigate the relationship between nonalcoholic fatty liver disease and cardiovascular risk factors and increased risk of atherosclerosis in obese children. The study included 80 consecutive obese children who were stratified into group 1 [ultrasonographically diagnosed with NAFLD (n = 50)] and group 2 [not diagnosed with NAFLD (n = 30)]. The control group included 30 healthy children. The groups were compared in terms of clinical cardiovascular risk factors and carotid intimal medial thickness (CIMT) (as a marker of atherosclerosis) measured using B-mode ultrasound. Mean body mass index (BMI) and blood pressure (BP), as well as the frequency of dyslipidemia, metabolic syndrome (MetS), and insulin resistance (IR), were similar in groups 1 and 2. Mean BMI and triglyceride (TG) levels, and the frequency of IR and MetS, increased significantly as the grade of steatosis increased. Mean CIMT in group 1 was significantly greater than that in the control group (P < 0.01). There was a positive correlation between CIMT and age, BP, and BMI in groups 1 and 2. In addition, CIMT was correlated with TG, low high-density lipoprotein (HDL) cholesterol, MetS, and IR only in group 1. Linear regression analysis between CIMT and age, BP, BMI, TG level, HDL cholesterol level, IR, MetS, and grade of steatosis yielded a significant difference only for grade of steatosis. Cardiovascular risk factors are more impressive and CIMT was significantly higher in group 1 than in group 2 and the control group, indicating that they are associated with greater risk of atherosclerosis and future adverse cardiovascular events.
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http://dx.doi.org/10.1007/s00246-012-0447-9DOI Listing
February 2013

Cystic fibrosis presenting with neonatal cholestasis simulating biliary atresia in a patient with a novel mutation.

Indian J Pediatr 2013 Jun 15;80(6):502-4. Epub 2012 Jul 15.

Department of Pediatric Metabolism and Nutrition, Dr. Sami Ulus Child Health and Diseases & Maternity Hospital, Ankara, Turkey.

Neonatal cholestasis is a rare presenting feature of cystic fibrosis which usually cannot be differentiated from other types of cholestasis. Herein, the authors report a 63 d-old boy with cystic fibrosis presenting with neonatal cholestasis mimicking biliary atresia. A new mutation in CFTR gene resulting in severe phenotype has been described. The cystic fibrosis patients with c.3871 G > T mutation may have acholic gaita mimicking biliary atresia in the absence of insipissated bile with minimal histologic findings in the liver.
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http://dx.doi.org/10.1007/s12098-012-0842-5DOI Listing
June 2013

Selective IgA deficiency: clinical and laboratory features of 118 children in Turkey.

J Clin Immunol 2012 Oct 1;32(5):961-6. Epub 2012 May 1.

Department of Pediatric Immunology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, 06080, Ankara, Turkey.

Selective IgA deficiency (IgAD) is considered as the most common primary immunodeficiency. Although the vast majority of affected individuals are asymptomatic, symptomatic patients suffer from recurrent infections, allergies and autoimmune diseases. In the present study, we aimed to investigate the clinical and laboratory features of children with IgAD in a tertiary children's hospital in Turkey. The medical records of 118 patients (63 males, 55 females) aged 4-18 years (median: 7 years) seen from 2006 to 2011 were retrospectively reviewed. The most common clinical condition was infectious disease (99 patients, 83.9 %), followed by allergic (51 patients, 43.2 %) and autoimmune (20 patients, 17 %) disorders. Serum IgG, IgM and IgE levels were increased in 61 %, 22 % and 37.3 % of patients, respectively. Serum IgG subclasses were measured in 65 patients, and only 4 (6.2 %) patients had IgG2 subclass deficiency. Autoantibodies (ANA, anti-dsDNA, antigliadin IgA and IgG, tissue transglutaminase IgA and IgG, anti-TPO and anti-TG) were evaluated in 84 patients. Autoantibodies were detected in 26 (31 %) patients, only 10 had an autoimmune disorder. Sixty-one patients were followed for more than 6 months (mean: 2 years, range: 0.5-5 years), and none of them resolved during this period. Being the most comprehensive study conducted in Turkey, we believe it has importance in providing significant data on the clinical and laboratory characteristics of children with IgAD.
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http://dx.doi.org/10.1007/s10875-012-9702-3DOI Listing
October 2012

Assessment of living donors with respect to pre- and posttransplant psychosocial properties and posttransplant family functioning in pediatric liver transplantation.

Turk J Gastroenterol 2011 Feb;22(1):36-41

Department of Pediatric Gastroenterology, İstanbul University, İstanbul School of Medicine, İstanbul.

Background/aims: We aimed in this study to investigate pre- and posttransplant clinical and psychosocial features of the donors and the effects of living-related liver transplantation and possible relevant factors on psychosocial outcome and family functioning.

Methods: Thirty-two living donors (19 females, age 31.84 ± 7.10 years) were evaluated. Medical records of donors regarding pre- and posttransplant clinical and psychological features and family life were evaluated.

Results: The donors were parents (n=28, 87.6%) in most. In the pretransplant evaluation, 5 donors (19.3%) had anxiety regarding postoperative complications and quality of life. Donors were discharged from the hospital in a median of 7 days (range, 5-30 days). Return to work and feeling of complete well-being were accomplished in a median of 4 weeks (range, 1-32 weeks) and 10 weeks (range, 4-48 weeks), respectively. Sixteen recipients (50.0%) suffered from major complications, and 3 (9.4%) required invasive intervention. Fourteen donors (43.4%) reported pain around the surgical incision and nonspecific gastrointestinal problems postoperatively. Psychological problems were observed in 8 donors (25.0%); 2 (6.3%) had depression requiring drug and psychotherapeutic intervention. Psychological disruption was found to be correlated with the presence of problems in the recipient (p<0.01, r=0.487). The donors' relationship with the recipient was negatively affected in 1 (3.1%), but improved in 15 (46.9%) cases. Nine donors (34.6%) displayed nervous behavior toward their spouses, and 2 (7.7%) later divorced. Life of the other family members was negatively affected in 8 (30.7%). Two donors' spouses (7.7%) failed to carry out domestic responsibilities.

Conclusions: Psychological disturbance and abnormal family functioning are frequently observed during the posttransplant period. Therefore, psychologic assessment and evaluation of family functioning should be regularly repeated during the posttransplant period.
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February 2011

Portal gastropathy and duodenopathy in children with extrahepatic and intrahepatic portal hypertension: endoscopic diagnosis and histologic scoring.

J Pediatr Gastroenterol Nutr 2011 May;52(5):612-6

Department of Pediatric Gastroentrology, Hepatology, and Nutrition, Istanbul University Faculty of Medicine, Istanbul, Turkey.

Objectives: The aim of the study was to determine the frequency of portal gastropathy (PG) and duodenopathy (PD) in children, to document the correlation of various clinical and laboratory parameters associated with portal hypertensive gastroduodenal lesions, to compare the endoscopic portal hypertensive lesions with different histologic findings, and to evaluate the use of a possible histologic scoring system.

Methods: All children undergoing endoscopic investigation for portal hypertension (PH) between January 2006 and November 2007 were analysed retrospectively. Clinical and demographical data and endoscopic and histologic findings were recorded. Histologic findings suggestive of PG and PD (capillary dilation, increased numbers of capillaries, histologic bleeding, and edema) were scored.

Results: Of 51 consecutive children (29 boys, mean age 10.1 ± 3.6 years [range 2.5-15.8 years]), 28 were cirrhotic. PG was diagnosed in 58.8% endoscopically. Children with cirrhotic PH had the highest rate of PG (64.3%), whereas those with extrahepatic or intrahepatic noncirrhotic PH were alike (50% and 54.5%, respectively). Baveno PG scores were higher in children with cirrhosis with higher Child-Pugh scores. Capillary dilation was the only histologic finding showing significant association with the endoscopic diagnosis. Only 9% had PD on endoscopy. None of the histologic findings correlated with endoscopic diagnosis of PD.

Conclusions: PG and PD are seen in children with extrahepatic and intrahepatic PH at rates similar to those reported in adult studies. Baveno PG scores increased in parallel with Child-Pugh class in children with cirrhosis. Capillary dilation was the only histologic finding showing significant association with the endoscopic diagnosis of PG in this study.
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http://dx.doi.org/10.1097/MPG.0b013e3182125e7cDOI Listing
May 2011

Familial Mediteranean fever with protein-losing enteropathy due to constrictive pericarditis.

World J Pediatr 2011 Nov 5;7(4):365-7. Epub 2011 Jan 5.

Department of Pediatric Nephrology and Rheumatology, Gülhane Military Academy of Medicine, School of Medicine, 06018 Etlik, Ankara, Turkey.

Background: Constrictive pericarditis (CP) represents a rare cause of protein-losing enteropathy (PLE) resulting from intestinal lymphangiectasia (IL). In this report, we describe an 8-year-old Turkish boy with IL and PLE secondary to CP.

Methods: The boy was introduced to our clinic due to bilateral pretibial edema and swelling of the eyelids caused by hypoproteinemia. Physical examination revealed a distended right jugular vein. Laboratory investigation revealed PLE with fecal concentration of alpha-1 antitripsin of 4.87 mg/g. Histopathologic examination of random biopsies obtained from the duodenum revealed markedly dilated lymphatics compatible with IL. Constrictive pericarditis was diagnosed by tagged cine cardiac magnetic resonance imaging.

Results: Pericardiectomy was performed for the patient. Genetic analysis was done and heterozygous mutation E148Q was detected as a disease-causing Mediterranean fever (MEFV) mutation. Colchicine was started after the operation. Six months after the initiation of regular colchicine therapy, echocardiography revealed disappearance of CP.

Conclusion: This is the first reported case of PLE with a distended right jugular vein due to CP secondary to familial Mediterranean fever associated with E148Q heterozygosity in the MEFV gene.
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http://dx.doi.org/10.1007/s12519-011-0255-yDOI Listing
November 2011

Utility of noninvasive markers of liver injury.

J Pediatr Gastroenterol Nutr 2010 Nov;51(5):685-6

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http://dx.doi.org/10.1097/MPG.0b013e3181ea7456DOI Listing
November 2010

The role of the non-invasive serum marker FibroTest-ActiTest in the prediction of histological stage of fibrosis and activity in children with naïve chronic hepatitis B infection.

Scand J Infect Dis 2010 Sep;42(9):699-703

Department of Paediatric Gastroenterology, Istanbul University, Istanbul,Turkey.

The aim of this study was to investigate whether the non-invasive serum marker FibroTest-ActiTest (FT-AT) reliably predicts the histological stage of fibrosis and/or activity, and decreases the need for a liver biopsy. Twenty-five children with naïve chronic hepatitis B were analyzed for haptoglobin, alpha2-macroglobulin, apolipoprotein A1, bilirubin, gamma-glutamyl transferase, and alanine aminotransferase activity, and the FT-AT scores were computed. FT-AT scores were compared with histological data. FT predicted insignificant fibrosis in 14/23 (61%) patients at a cut-off level of 0.31. Nine patients (36%) had significant histological fibrosis, but none were predicted by FT. There was no correlation between FT scores and histological stage of fibrosis (r: -0.221, p = 0.228). All 4 patients with significant histological activity had corresponding significant activity in AT (100%). Fifteen out of the 19 patients (78.9%) with significant activity in AT had insignificant histological activity. At the cut-off level of 0.36, AT predicted insignificant activity in all 6 patients (100%). There was no correlation between AT scores and histological activity (r: 0.245, p = 0.237). According to histological data, 12 patients were candidates for treatment, but FT-AT did not predict 3 of them (25%). FT-AT does not appear ready for use in detecting either the stage of fibrosis or activity in children with chronic hepatitis B.
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http://dx.doi.org/10.3109/00365541003774616DOI Listing
September 2010