Publications by authors named "Yasin Yilmaz"

17 Publications

  • Page 1 of 1

Late effects of osteosarcoma and its treatment in pediatric patients: A single-center experience.

J BUON 2021 May-Jun;26(3):1102-1110

Ankara University School of Medicine, Department of Pediatric Hematology-Oncology, Ankara, Turkey.

Purpose: The success of osteosarcoma treatment strategies improved survival rates. The need of diagnosing and managing adverse effects is increasing. We aimed to investigate the outcomes and late results of pediatric osteosarcoma treatment in the survivors.

Methods: Out of osteosarcoma patients (n=54), we assessed the long-term outcomes of survivors (n=39) diagnosed from 2002-2018. We compared the survivors' (n=39) health status (cardiac, renal, neurologic, psychiatric, physical limitations), pain, and psychosocial outcomes (education level, smoking history, and alcohol consumption, marital status, parenthood, health care services usage) with their siblings (n=77). The quality of life and overall survival of amputee and nonamputee survivors are also compared. We provided the retrospective data from the files and phone calls and used Kaplan Meier survival analysis, Ki-Kare, and t-test. Results The overall survival (OS) of children with osteosarcoma (n=54) who survived at 2 years and 5 years from the diagnosis was 90.7 and 77.8%, respectively. These patients achieved 2- year event-free survival (EFS) of 70.4% and 5-year EFS of 57.4%. Thirty-nine survivors of osteosarcoma were compared with 77 sibling controls. Osteosarcoma survivors were more likely than the sibling cohort to report adverse health status containing nephrotoxicity (5.1 vs 0%) (p=0.045), cardiotoxicity (10.3 vs 0%)(p<0.01), neurotoxicity (5.1 vs 1.7%) (p=0.045), activity limitations (64 vs 1.3%)(p<0.01) and pain (12.8 vs 0%) (p=0.002). Survivors' educational status (p=0.014), marital status (5.1 vs 32.5%)(p=0.001), employment (2.6 vs 28.6)(p < 0.001), parenthood (0 vs 29.9%)(p < 0.001) were negatively affected compared with the control group. The prevalence of smoking, alcohol use, psychiatric treatment, and deafness were similar. The amputees (n=9) had an OS rate of 55.6%, and the nonamputees (n=45) had 75.6%. We found similar quality of life results between them.

Conclusion: Long-term survivors of pediatric osteosarcoma are at significant risk of chronic health conditions, physical limitations, and pain up to 16 years follow up. Follow-up clinics and clinical guidelines are required for the survivors of children with osteosarcoma.
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July 2021

Pancreatic MR imaging and endocrine complications in patients with beta-thalassemia: a single-center experience.

Clin Exp Med 2021 Jul 10. Epub 2021 Jul 10.

Department of Pediatrics, Division of Hematology and Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Iron deposition in various organs can cause endocrine complications in patients with transfusion-dependent beta-thalassemia. The aim was to investigate the relationship between endocrine complications and pancreatic iron overload using magnetic resonance imaging (MRI). Forty patients with transfusion-dependent thalassemia (TDT) were enrolled in the study. The magnetic resonance imagings of the patients were performed using a 1.5 Tesla Philips MRI scanner. Two out of three patients had at least one clinical endocrine complication. The rate of iron deposition was 62.5% in liver, and 45% in pancreas tissue, and was 12.5% in heart tissue. Pancreatic T2* and hepatic T2* values were significantly positively correlated (p = 0.006). Pancreatic T2* and ferritin were significantly negatively correlated (p = 0.03). Cardiac T2* values were negatively correlated with fasting blood glucose (p = 0.03). Patients with short stature had significantly higher cardiac iron burden (22.3 vs. 36.6 T2*ms; p 0.01), and patients with hypothyroidism had higher liver iron concentrations (9.9 vs. 6.4 LIC mg/g; p = 0.05). The ferritin level of 841 ng/mL and liver iron concentration (LIC) value of 8.7 mg/g were detected as the threshold level for severe pancreatic iron burden (AUC 70%, p:0.04, AUC 80%, p = 0.002, respectively). Moreover, males were found to have decreased pancreas T2* values compared with the values in females (T2* 19.3 vs. 29.9, p = 0.05). Patients with higher ferritin levels over than 840 ng/mL should be closely monitored for pancreatic iron deposition, and patients with endocrine complications should be assessed in terms of cardiac iron burden.
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http://dx.doi.org/10.1007/s10238-021-00735-7DOI Listing
July 2021

Pituitary Iron Deposition and Endocrine Complications in Patients with β-Thalassemia: From Childhood to Adulthood.

Hemoglobin 2020 Sep 8;44(5):344-348. Epub 2020 Sep 8.

Department of Pediatric Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

The endocrinological complications are a great concern in transfusion-dependent β-thalassemia (β-thal) patients. The pituitary iron deposition is regarded as the main cause of hormonal changes in thalassemic patients. In this study, our aim was to explore the association between endocrinological complications and pituitary iron overload by magnetic resonance imaging (MRI). Fifty transfusion-dependent thalassemia (TDT) patients were recruited for the study. Pituitary MRIs of patients were taken using a 1.5 Tesla Philips MRI machine. There was at least one clinical endocrine complication in two of three patients. The iron accumulation was moderate in the liver (60.0%) and was mild in hypophysis (16.0%) and in heart (8.0%). The hypogonadism and diabetes mellitus (DM) were not seen with a significantly increased pituitary iron burden. The hypogonadism was related to cardiac iron deposition ( = 0.04). The short stature was associated with a hepatic iron overload ( = 0.05). The conventional follow-up of patients with TDT might be inadequate and screening of patients with MRI of hypophysis along with heart and liver leads to better results.
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http://dx.doi.org/10.1080/03630269.2020.1812636DOI Listing
September 2020

Gastrointestinal Involvement in a Patient with Chronic Lymphocytic Leukemia

Balkan Med J 2019 12 7;37(1):50-51. Epub 2019 Nov 7.

Department of Internal Medicine, Kocaeli University School of Medicine, Division of Medical Oncology, Kocaeli, Turkey

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http://dx.doi.org/10.4274/balkanmedj.galenos.2019.2019.9.51DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6934011PMC
December 2019

Sense of smell and quality of life in children with diabetes mellitus.

Int J Pediatr Otorhinolaryngol 2019 Aug 25;123:43-46. Epub 2019 Apr 25.

University of Pennsylvania, Perelman School of Medicine, Smell and Taste Center, Philadelphia, USA.

Introduction: Diabetes mellitus is one of the most common chronic systemic diseases seen in children. The increasing prevalence of Type 1 diabetes mellitus (T1DM) among children is alarming. Although olfaction has been found to be altered in some adult T1DM subjects, it is unknown whether this is the case in children and, if so, whether the dysfunction adversely influences their quality of life (QOL).

Methods: Using the Pediatric Smell Wheel (PSW), we measured the olfactory function of 30 T1DM patients and 30 healthy controls [mean ages = 13.1 & 13.0, respectively]. The Turkish version of the Pediatric Quality of Life Inventory (PedsQL) was also administered.

Results: The PSW scores were lower in the T1DM patients than in the controls (9.17 vs 10.37; p < 0.0001), although, in both cases, the scores fell within the normal range for individuals of their age (i.e., at or above 80%). Interestingly, such scores were lower in left-handed than in right-handed patients (8.00 vs 9.46; p = 0.001). Lower QOL indices were also found for the T1DM than for the controls for the domains of Emotional Function (p = 0.02), Social Function (p = 0.014), School Function (p = 0.011), and Psychosocial Status (p = 0.002). No significant associations were evident between PSW scores and disease duration and QOL scales.

Conclusions: Our study demonstrates, for the first time, that modest decrements in smell function are evident in children with TIDM.
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http://dx.doi.org/10.1016/j.ijporl.2019.04.033DOI Listing
August 2019

The Assessment of Serum Endocan Levels in Children With Juvenile Idiopathic Arthritis.

Arch Rheumatol 2018 Jun 16;33(2):168-173. Epub 2017 Oct 16.

Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.

Objectives: This study aims to evaluate the levels of serum endocan in children with juvenile idiopathic arthritis (JIA).

Patients And Methods: Sixty-seven children with JIA (30 males, 37 females; mean age 10.4±4.9 years; range 2 to 18 years) and a sex- and age- matched healthy control group of 39 children (16 males, 23 females; mean age 9.3±4.1 years; range 1 to 17 years) were recruited. Patients with JIA were divided into two groups as the clinically active JIA group (n=27) and inactive JIA group (n=40).

Results: The median serum endocan level in patients with JIA was significantly higher than in the control group (633.75 ng/L vs. 379.76 ng/L, p<0.01). Comparison between patients with active JIA and inactive JIA was not significant in terms of endocan levels (618.70 ng/L vs. 687.36 ng/L, p=0.34). There was a weak negative correlation between Childhood Health Assessment Questionnaire scores of patients with JIA and serum endocan levels.

Conclusion: The high level of serum endocan highlighted the endothelial damage in patients with JIA.
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http://dx.doi.org/10.5606/ArchRheumatol.2018.6528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117134PMC
June 2018

Magnetic resonance imaging during management of patients with transfusion-dependent thalassemia: a single-center experience.

Radiol Med 2018 Aug 16;123(8):572-576. Epub 2018 Apr 16.

Department of Radiology, Istanbul University Istanbul Faculty of Medicine, Millet Caddesi, 34098, Istanbul, Turkey.

Background: Cardiac and hepatic magnetic resonance imaging evaluation during treatment can tailor physicians' chelation therapy titrations.

Aim: The aim of the study was to assess the relationship of cardiac and hepatic T2* values with chelation therapy in patients with transfusion-dependent thalassemia (TDT).

Methods: A total of 106 patients with TDT who were followed up in Istanbul Medical Faculty Thalassemia Center were evaluated for the study. Forty-eight (45%) patients with TDT had more than one consecutive MRI examination. The patients were divided into three subgroups according to the cardiac T2* values as the high-risk group (T2* MRI < 10 ms), medium-risk group (T2* MRI 10-20 ms), and the low-risk group (T2* MRI > 20 ms).

Results: The majority of patients used DFX (deferasirox) (79%) and deferiprone (DFP) (17%). Approximately 80% of patients according to cardiac T2* value and 40% of patients according to hepatic T2* value were initially in the low-risk group. Patients with follow-up MRI examinations exhibited significant improvement in liver iron concentration, which correlated with an increase in hepatic T2* values. The decrease of liver iron concentration was prominent in the DFX group (p < 0.01). The serum ferritin level was significantly correlated with liver iron concentrations (rs = 0.65, p < 0.001), hepatic T2* value (rs = - 0.62, p < 0.001), but not with cardiac T2* value (rs = - 0.20, p = 0.07).

Conclusion: Cardiovascular and hepatic MRI is a useful follow-up tool during the assessment of risk groups and chelation therapy of patients with TDT. Consecutive MRI tests showed good monitoring of cardiac and liver iron overload.
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http://dx.doi.org/10.1007/s11547-018-0889-0DOI Listing
August 2018

Determinants of Increased Aortic Diameters in Young Normotensive Patients With Turner Syndrome Without Structural Heart Disease.

Pediatr Cardiol 2018 Apr 1;39(4):786-793. Epub 2018 Feb 1.

Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Factors associated with aortic dilation and dissection in patients with Turner syndrome (TS) remain unclear. We assessed magnetic resonance imaging-based aortic diameters at nine predefined anatomic positions and examined associations of increased aortic diameters with B-type natriuretic peptide (BNP), A-type NP (ANP), growth hormone treatment, insulin-like growth factor 1 (IGF1), and estrogen status. Forty-seven patients with TS aged 7.3-21 years and 34 healthy peers were enrolled in this study. Aortic diameters were higher in patients with TS at three positions than in controls (p < 0.05). History of GH treatment, pubertal status, and serum estradiol levels were not associated with increased aortic diameters. Patients with TS had higher plasma BNP and ANP levels than controls. BNP and IGF1 were independently associated with the increase in aortic diameters in TS at three positions of the ascending aorta (R = 0.361-0.458, p < 0.05 for all). At two positions of the descending aorta, only BNP emerged as an independent variable (R = 0.130-0.139, p < 0.05). We conclude that young, normotensive patients with TS had greater aortic diameters at several positions than healthy controls. BNP and IGF1 were independently associated with increased aortic diameters in TS.
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http://dx.doi.org/10.1007/s00246-018-1821-zDOI Listing
April 2018

Olfactory dysfunction and quality of life in patients with transfusion-dependent thalassemia.

Eur Arch Otorhinolaryngol 2017 Sep 12;274(9):3417-3421. Epub 2017 Jul 12.

University of Pennsylvania Perelman School of Medicine, Smell and Taste Center, Philadelphia, USA.

Transfusion-dependent thalassemia (TDT) is a group of thalassemia syndromes that require regular blood transfusions for survival. It is unknown whether the sense of smell of patients with TDT is affected, and if so, whether smell loss has an adverse effect on quality of life (QOL). Olfactory thresholds were measured using Snap & Sniff wands. QOL was assessed via the Short Form-36 (SF-36) questionnaire. Forty-two TDT patients from the Thalassemia Center in Istanbul Medical Faculty were tested (mean age 26.6 years), along with 42 healthy controls (mean age 28.0 years). Mean olfactory sensitivity was lower in the TDT patients than the controls (p < 0.0001). TDT was associated with lower mean QOL scores on the domains of physical function (p < 0.0001), physical role limitation (p = 0.011), and general health (p < 0.0001). Within the TDT group, significant correlations were present between the threshold scores and physical function, physical role limitation, emotional role limitation, and general health. Patients with TDT are less sensitive to odors than healthy controls and the lower olfactory test scores are related to lower quality of life, suggesting that decreased smell function is an additional complication of this disease.
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http://dx.doi.org/10.1007/s00405-017-4668-7DOI Listing
September 2017

Synchronous Solid Pseudopapillary Tumor and Insulinoma in an Adolescent MEN1 Patient Presenting with Diagnostic Dilemmas.

J Clin Res Pediatr Endocrinol 2017 Dec 30;9(4):375-379. Epub 2017 Jun 30.

İstanbul University İstanbul Faculty of Medicine, Department of Adolescent Medicine and Pediatrics, İstanbul, Turkey.

Multiple endocrine neoplasia (MEN1) is a rare autosomal dominant disorder characterized by primary hyperparathyroidism, enteropancreatic neuroendocrine tumors, and anterior pituitary adenomas. A 16-year-old male presented to the emergency outpatient clinic with tonic convulsions. Physical examination in the postconvulsive period was unremarkable and revealed a muscular, postpubertal adolescent. Biochemical tests at admission were consistent with hyperinsulinemic hypoglycemia and remarkable for elevated levels of liver transaminases and creatine kinase. Work-up for a potential inborn error of metabolism and Doppler ultrasound for congenital portal-hepatic shunt were negative. When the patient was questioned, he reported using the anabolic steroid stanozolol to strengthen his muscles. His enzyme levels normalized after cessation of stanozolol. Hypoglycemia did not recur on diazoxide therapy. Magnetic resonance imaging showed two discrete lesions in the pancreas. Distal pancreatectomy revealed two masses 1.1 and 1.4 cm in diameter: a solid pseudopapillary tumor and an insulinoma. The patient also had asymptomatic primary hyperparathyroidism. DNA sequence analysis of the MEN1 gene in the index patient and his father and brother revealed a previously reported "pW183S" heterozygous mutation. This case further adds to the "pancreatic tumor" phenotype of MEN1 with the presence of a solid pseudopapillary tumor. This case report also confirms the need to meticulously question drug abuse in adolescents presenting to clinics with diagnostic challenges.
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http://dx.doi.org/10.4274/jcrpe.4799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5785647PMC
December 2017

Evaluation and Treatment Results of Ovarian Cysts in Childhood and Adolescence: A Multicenter, Retrospective Study of 100 Patients.

J Pediatr Adolesc Gynecol 2017 Aug 3;30(4):449-455. Epub 2017 Feb 3.

Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Endocrinology Unit, Istanbul, Turkey.

Study Objective: To investigate the characteristics of children with ovarian cysts and evaluate treatment strategies.

Design: Retrospective study.

Setting: Eight pediatric endocrinology clinics, Turkey.

Participants: A total of 100 children and adolescents with ovarian cysts.

Interventions: Patient data collected via retrospective chart review. Patients were stratified according to age into 4 groups (newborns, 1-12 months, 1-8 years, and 8-18 years).

Main Outcome Measures: Special emphasis was given to torsion and tumor cases, concomitant diseases, treatment modalities, and problems during follow-up.

Results: Most newborns and infants were asymptomatic with the cysts being discovered incidentally; in girls ages 1-8, symptoms were common, including breast budding (47.1%, 16 of 34) and vaginal bleeding (29.4%, 10 of 34). Girls older than 8 years mostly presented with abdominal pain (31.6%, 12 of 38) and menstrual irregularity (21.1%, 8 of 38). Most of our patients were diagnosed with a simple ovarian cyst, but 9 patients were found to have ovarian tumors. Ovarian torsion was detected in 7 patients; 5 with large and 2 with small cysts (<20 mm). Two patients had central precocious puberty (CPP) at presentation and 5 patients developed CPP during follow-up. The surgical intervention rate was high (38%, 38 of 100), but was associated with earlier treatment year, and this association remained significant after adjusting for confounders (P = .035).

Conclusion: Most girls have simple cysts, which have a favorable prognosis without intervention; however, there might be coexisting pathologies or complications such as tumors, torsion, and CPP; hence these patients should be evaluated accordingly and treated with a multidisciplinary approach.
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http://dx.doi.org/10.1016/j.jpag.2017.01.011DOI Listing
August 2017

A 3 Year-Old Male Child Ingested Approximately 750 Grams of Elemental Mercury.

Balkan Med J 2016 Jul 1;33(4):467-9. Epub 2016 Jul 1.

Department of Pediatrics, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.

Background: The oral ingestion of elemental mercury is unlikely to cause systemic toxicity, as it is poorly absorbed through the gastrointestinal system. However, abnormal gastrointestinal function or anatomy may allow elemental mercury into the bloodstream and the peritoneal space. Systemic effects of massive oral intake of mercury have rarely been reported.

Case Report: In this paper, we are presenting the highest single oral intake of elemental mercury by a child aged 3 years. A Libyan boy aged 3 years ingested approximately 750 grams of elemental mercury and was still asymptomatic.

Conclusion: The patient had no existing disease or abnormal gastrointestinal function or anatomy. The physical examination was normal. His serum mercury level was 91 µg/L (normal: <5 µg/L), and he showed no clinical manifestations. Exposure to mercury in children through different circumstances remains a likely occurrence.
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http://dx.doi.org/10.5152/balkanmedj.2016.15197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001828PMC
July 2016

Evaluation of subclinical inflammation in familial Mediterranean fever patients: relations with mutation types and attack status: a retrospective study.

Clin Rheumatol 2016 Nov 23;35(11):2757-2763. Epub 2016 Apr 23.

Department of Pediatric Rheumatology, Istanbul Medical School, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey.

Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease of childhood and adulthood. Development of systemic amyloidosis and frequent attack influence quality of life and survival. There is sporadic evidence indicating subclinical inflammation in patients with FMF. We aimed to assess subclinical inflammation using neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) in pediatric patients with FMF in the attack-free period. In this retrospective study, we reviewed the files of all FMF patients in our pediatric rheumatology outpatient clinic in a tertiary center and enrolled those with sufficient clinical and laboratory data. We also enrolled 73 controls. We grouped the patients according to being in attack period or attack-free period. We compared CRP, NLR, PLR, and WBC (white blood cell) levels between different mutations and polymorphisms. We also compared patients in the attack period with those in attack-free period. We enrolled 61 patients in attack period, 509 patients in attack-free period, and 73 controls. There was no difference between patients with different mutations with respect to NLR or PLR levels in the attack-free period. However, CRP levels were higher in patients with homozygous exon 10 mutations, especially those with homozygous M694V mutations compared with other mutations. However, CRP levels were mostly normal in these patients. Our data are against the reported fact that patients with FMF have higher NLR or PLR levels in attack-free periods. However, CRP levels were higher in the presence of homozygous exon 10 mutations (in particular homozygous M694V mutations).
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http://dx.doi.org/10.1007/s10067-016-3275-0DOI Listing
November 2016

Evaluation of the glucocorticoid, mineralocorticoid, and adrenal androgen secretion dynamics in a large cohort of patients aged 6-18 years with transfusion-dependent β-thalassemia major, with an emphasis on the impact of cardiac iron load.

Endocrine 2016 Jul 2;53(1):240-8. Epub 2016 Feb 2.

Department of Adolescent Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.

The variable presence of adrenal insufficiency (AI) due to hypocortisolemia (HC) in patients with thalassemia is well established; however, the prevalence of adrenocortical hypofunction (ACH) in the zona glomerulosa and zona reticularis of the adrenal cortex is unknown. To establish the prevalence of ACH, we examined the cortisol response to 1-µg and 250-µg ACTH tests, plasma aldosterone (A)/plasma renin activity (PRA) ratio, and serum dehydroepiandrosterone sulfate (DHEAS) levels in a large cohort of patients with thalassemia, and to investigate the impact of total body iron load (TBIL) on adrenocortical function. The setting used was University hospital and government-based tertiary care center. One hundred twenty-one (52 females) patients with β-thalassemia major (β-TM) and 72 healthy peers (38 females) were enrolled. The patients underwent a 250-µg cosyntropin test if their peak cortisol was <500 nmol/L in a 1-µg cosyntropin test. Magnetic resonance imaging (MRI) was performed to assess the MRI-based liver iron content and cardiac MRI T2* iron. The associations between ACH and TBIL were investigated. The patients with thalassemia had lower ACTH, cortisol, DHEAS, and A/PRA values compared with the controls (p < 0.001). Thirty-nine patients (32.2 %) had HC [primary (n = 1), central (n = 36), combined (n = 2)], and 47 (38.8 %) patients had reduced DHEAS levels; 29 (24.0 %) patients had reduced A/PRA ratios. Forty-six (38.0 %) patients had hypofunction in one of the adrenal zones, 26 (21.5 %) had hypofunction in two adrenal zones, and 9 (7.4 %) had hypofunction in all three zones. Patient age and TBIL surrogates were significant independent parameters associated with ACH. Cardiac MRI T2* iron was the only significant parameter that predicted the severity of ACH at a cut-off of 20.6 ms, with 81 % sensitivity and 78 % specificity. Patients with thalassemia have a high prevalence of AI due to HC and zona glomerulosa and zona reticularis hypofunction. TBIL surrogates can predict ACH, but cardiac iron was the only surrogate that was adequately sensitive to predict the severity of ACH.
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http://dx.doi.org/10.1007/s12020-016-0872-2DOI Listing
July 2016

Relationship between clinical findings and genetic mutations in patients with familial Mediterranean fever.

Pediatr Rheumatol Online J 2015 Dec 12;13:59. Epub 2015 Dec 12.

Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.

Background: Familial Mediterranean fever (FMF) is one of the most frequent genetic diseases encountered in the Mediterranean region. We aimed to investigate the correlation between genetic mutations and the clinical findings in 562 patients with FMF.

Methods: In this retrospective cross-sectional study conducted with patients' files between 2006, and 2013, reverse hybridization assay for MEFV gene mutations was used and the 12 most frequent mutations were screened. Mutation types and clinical findings were compared with variance analysis.

Results: The mean age was 6.9 ± 3.4 years (range, 1.8-11.6 years). The most common symptom was fever (97.3%). Thirty-four of the patients (6.04%) were admitted with periodic fever only. Of these patients, M694V was the most common mutation type (73.5%). The percentage of the patients predominantly presenting with recurrent abdominal pain was 77.78% and the most frequent mutations were M694V and E148Q. The rate of arthritis and arthralgia was significantly higher in patients with M694V and E148Q mutations. Chest pain was reported more often in patients homozygous for M694V (61.4%). Pericardial effusion was documented in the echocardiography of 10.9% of the 229 children with chest pain. Some patients had both FMF and Henoch Schönlein purpura (HSP), and were more likely to harbor either homozygote M694V or E148Q mutations. The frequency of episodes was higher in patients with homozygous M694V mutations (number of attacks = 4.4 ± 1.6/month). Proteinuria was detected in 106 patients of cases (29.2%), at an average of 854 ± 145 mg/L. Most of the patients with proteinuria and elevated serum amyloid-A had homozygous M694V mutation.

Conclusion: The most common mutation in children in Turkey with FMF is the M694V mutation. Recurrent abdominal pain, arthritis or arthralgia, chest pain, and pericarditis were commonly seen in patients with M694V and E148Q mutations.
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http://dx.doi.org/10.1186/s12969-015-0057-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711108PMC
December 2015

Serum level of vitamin D and trace elements in children with recurrent wheezing: a cross-sectional study.

BMC Pediatr 2014 Oct 16;14:270. Epub 2014 Oct 16.

Department of Pediatrics, Istanbul University, Istanbul Faculty of Medicine, Capa, 34390 Istanbul, Turkey.

Background: We aimed to show the relationship between recurrence of wheezing and serum levels of vitamin D, zinc, and copper in wheezy children compared with a healthy group.

Methods: In this cross sectional study, seventy-three children with wheezing and seventy-five controls were included without a follow-up period. The clinical characteristics of the children were assessed, the asthma predictive index and temporal pattern of wheeze were determined. The serum levels of vitamin D, zinc, and copper were measured. Pearson correlation analysis was used to evaluate the relationship between homogeneously distributed variables.

Results: Thirty-two of the seventy-three children (43.8%) had more than three wheezing attacks (recurrent wheezing). The Asthma Predictive Index index was positive in 26 patients (35.6%). When classified to temporal pattern of wheeze, fifty-three of the study group (72.6%) had episodic wheezing and the remainder (27.4%) was classified as multiple-trigger wheezing. We found no overall significant difference between the study and control group in terms of vitamin D and trace elements . The vitamin D and zinc levels were significantly lower and serum copper and copper/zinc ratio was significantly higher in patients with recurrent wheezing (p =0.03, p <0.01, p =0.013, p <0.01, respectively) positive Asthma Predictive Index and multiple-trigger temporal pattern of wheeze compared with patients with non- recurrent wheezing, negative Asthma Predictive Index and episodic temporal pattern of wheeze.

Conclusion: It may be postulated that for the determination of asthma risk in patients with recurrent wheezing, the serum level of vitamin D, copper and zinc can be used as a routine biomarker alongside the Asthma Predictive Index and temporal pattern of wheeze.
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http://dx.doi.org/10.1186/1471-2431-14-270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286924PMC
October 2014

Attitudes among medical and nonmedical university students toward the survivors of childhood abuse.

Compr Psychiatry 2012 Aug 21;53(6):753-7. Epub 2012 Feb 21.

Istanbul, Ministry of Justice, Istanbul 34196, Turkey.

Objective: Childhood sexual abuse (CSA) is increasing, and current studies should address issues such as stigmas and casual attitudes that may be amenable to intervention. Thus, we aimed to investigate the effects of education on the attitudes of medical students toward CSA survivors.

Method: We divided medical students into 2 groups: preclinical and clinical medical students. We compare the attitudes of nonmedical students with the attitudes of medical students with respect to survivors of CSA. All participants were asked to complete a questionnaire about stigmatization.

Results: There were 572 students in our study, 347 of whom were enrolled in medical school. Of the 347 medical students, 151 were from the preclinical group, and 196 were from the clinical practice group. The remainder of the participants (n = 225) were in other fields of university. Of the medical students, 68.3% responded negatively about "asking a survivor of abuse to supervise their child for a few hours," whereas 62.7% of the nonmedical students responded negatively. When asked, "What would you think if your child wanted to marry a survivor of sexual abuse?", 72.9% of the medical students and 59.1% of the nonmedical students displayed negative attitudes toward that idea. Our research also found that significantly more preclinical students than clinical students would not want to be in a companionship/friendship with a CSA survivor at work (P = .015) or in their neighborhoods (P = .034).

Conclusion: Both medical and nonmedical students seem to have negative thoughts about sexual abuse survivors, particularly when the issue involves their own children and/or social situations. Thus, the medical professionals must be careful and should avoid over interpretations of findings on childhood abuse studies that may lead to stigmatization.
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http://dx.doi.org/10.1016/j.comppsych.2012.01.003DOI Listing
August 2012
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