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Öğe Assessment of biochemical bone markers of osteoporosis in children with thalassemia major(Bmc, 2022) Celik, Tanju; Sangun, Ozlem; Unal, Sule; Balci, Ali; Motor, SedatBackground Beta thalassemia major (beta-TM) is a common cause of skeletal morbidity and is associated with increased bone fracture risk, particularly in inadequately transfused children. The aim of this study was to investigate some potential biochemical markers as possible early predictors of BMD variations in children with beta-TM. Methods The study included 38 children with beta-TM and 40 sex-age matched controls. All patients were subjected to BMD assessment by dual-energy X-ray absorptiometry (DEXA). Serum beta-crosslaps (beta-CTx), osteoprotegerin (OPG), receptor activator of nuclear factor-kappa B ligand (RANKL), urinary deoxypyridinoline (DPD) and ferritin levels were compared between the groups. Results Serum OPG levels were significantly lower in thalassemic children than in controls. The mean ratio of RANKL/OPG was significantly higher in the thalassemic patients than in the control group. Osteoporosis was detected in 10 (3 female and 7 male) of 38 patients (26.3%) according to the femur Z score and in 6 of them (4 male and 2 female) (15.8%) according to the spine Z score. Conclusions Serum OPG concentrations can be used as a biochemical marker in screening patients with beta-thalassemia major for the development of osteoporosis.Öğe Cow's milk allergy in children: 9 years experience of Dr. Behcet Uz Children's hospital, Izmir(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2013) Unsal, Canan Sule; Gunay, Ilker; Nacaroglu, Hikmet Tekin; Asilsoy, Suna; Karadag, Ozlem; Celik, Tanju; Girit, SaniyeObjective: Cow's milk allergy is the most frequent food allergy in childhood. Delayed diagnosis may cause a number of systemic dysfunctions, while incorrect diagnosis may result in deficient nutrition of the mother and the child. As in other types of allergies, food allergy is also a growing problem in recent years. Our aim was to determine the characteristics of our patients allergic to cow's milk, and see if there was an increasing trend. Material and Methods: The study was of retrospective and cross-sectional design. Patient data were collected from Pediatric Allergy Department patient files. Cases of food allergy were reviewed and patients fulfilling the criteria of cow's milk allergy were included in the study. Results: A total of 105 cases with cow's milk allergy out of 264 food allergies who were followed up between 2003-2011 were investigated. Most of the patients were under 2 years of age (78.1%), were males (62.9%) and presented with a history of allergy (79.1%). IgE mediated cases constituted the majority (75.2%). More than half of the patients admitted in 2010 and 2011. This was mostly due to the increased number of patients less than twelve months of age (p= 0.015). Most frequently involved system was skin (67.5%) and multisystem involvement was 15.7% Conclusion: A detailed history is the key element of diagnosing cow's milk allergy. There is a considerable number of cases within the first year of life which may present with different signs and symptoms. Although not a life threatening situation, correct diagnosis is vital as nutrition is a key component in the development and growth of child.Öğe Evaluation of cases with diabetic ketoacidosis monitorized in intensive care units(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2011) Tutanc, Murat; Celik, Tanju; Basarslan, Fatmagul; Gunes, Ali; Konca, Capan; Yel, Servet; Bosnak, MehmetObjective: In this study, we have investigated the demographic and clinical characteristics of pediatric cases with diabetic - ketoacidosis (DKA) followed-up in intensive care units. Methods: This is a retrospective analysis of all patients' files with respect to their demographic factors as gender, complaints, age and clinical features. Mann Whitney U and chi-square statistical tests were performed. Results: The study group consists 16 female and 9 male children with a mean age of 9.9 +/- 3.7 years. The most frequent complaints of the cases were dyspnea, polydipsia, weight loss and polyuria in decreasing order of frequency. They admitted to the hospital because of respiratory distress, tachypnea tachycardia and acidosis. They treated by DKA protocol in the intensive care unit. We normalized Glasgow Coma Scores (GKS) in 12 +/- 5, blood sugar levels in 14 +/- 7, and blood gas levels in 14 +/- 7 hours. Any complication had not developed and the patients under glycemic control were discharged from the hospital with recommendations for outpatient follow-up. Conclusion: DKA cases could be treated rapidly and successfully thanks to accurate and rapid diagnosis followed by strict monitorization protocol. In conclusion we wanted to emphasize that monitorization of patients with DKA should be performed in pediatric intensive care units.Öğe Evaluation of the mean platelet volume in children with familial Mediterranean fever(Springer Heidelberg, 2012) Arica, Secil; Ozer, Cahit; Arica, Vefik; Karakus, Ali; Celik, Tanju; Gunesacar, RamazanTo evaluate the Mean Platelet Volume (MPV) levels in children diagnosed with familial Mediterranean fever (FMF), during attack and attack-free periods. The records of a total of 117 children with FMF, diagnosed using the Tel-Hashomer criteria, have been scanned. The study consisted of 53 patients during an attack (group 1), 64 patients in attack-free period (group 2), and 57 healthy controls (group 3). Erythrocyte sedimentation rate, C-reactive protein, white blood cell count, platelet count, and MPV levels were retrospectively recorded. The MPV and platelet values in FMF patients during attack (group 1) and FMF patients during attack-free periods (group 2) have been found to be significantly higher than those of the health control group (group 3). Positive correlation has been found between the MPV and platelet values in Group 1 and the disease's severity score (r = 0.224, and r = 0.268, respectively). Positive correlation (r = 0.528, and r = 0.485, respectively) has been also identified between MPV and blood platelet count in patients in Group 1 and 2. No correlation was found between the Colchicine treatment period and MPV (r = -0.005). The MPV values in the complete group of FMF diagnosed children have been found to be much higher compared to those in healthy children. As a consequence, we consider the MPV value as a useful marker that demonstrates the risk of early stage atherosclerosis in children with FMF.Öğe The importance of the M470V polymorphism(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2017) Celik, Tanju; Gunesacar, Ramazan; Balci, Ali; Unal, Sule; Aldic, Guliz; Eskici, Harika; Atilgan, NigarObjective: Several hundreds of cystic fibrosis transmembrane conductance regulator (CFTR) variants have been reported, however it is not known whether which one of them was causing the disease of cystic fibrosis (CF) or not. Information about CFTR genes carrying the M470 or the V470 allele are interesting. In this study, we aimed to investigate the clinical importance of M470V mutation in Antiochia region. Methods: A case-control study consisted of 145 children from whom CF gene study was requested because of recurrent respiratory tract infections, growth failure, chronic diarrhea and constipation. The parameters of patients with positive mutation were compared with negative ones as for gender, age, height, weight, annual number of upper and lower respiratory tract infections, parental consanguinity, sibling death, clinical and laboratory parametres. Results: In 63 of 145 patients (43.4%), heterozygous mutation, in 16 (11%) of them homozygous mutation was detected. All of the patients with mutation group had M470V mutation. The sweat test results of all patients were within normal limits. Mean age of those patients were 41.21 +/- 39.8 (min: 6 max: 192) months and 30 (38%) of them were girls. Thirty percent of the patients with mutation (n=17.7) had a familial history of cystic fibrosis, 2 a history of sibling death. In the mutation group, only annual number of infections, skin dryness, loss of weight, level of IgG and IgM were significantly higher (p<0.05). Conclusion: It was concluded that in M470V positive cases, the disease may cause clinical symptoms without affecting sweat test results, with less gastrointestinal but more respiratory symptoms, causing a more prominent loss of weight.Öğe Investigation of the clinical and hematological significance of the first observed hemoglobin Ernz variant [?123(H1) Thr>Asn] in the Turkish population(Tubitak Scientific & Technological Research Council Turkey, 2012) Gunesacar, Ramazan; Celik, Muhammet Murat; Ozturk, Oktay Hasan; Celik, Mustafa; Tumer, Cemil; Celik, TanjuAim: In this report, we aimed to investigate the clinical and hematological significance of the first observed hemoglobin Ernz variant in the Turkish population. Materials and methods: We identified the Hb Ernz variant in 3 nonrelated females (Probands 1, 2, and 3). Proband l's family was also included the study. Hematological data were obtained with an automated cell counter and routine methodology. The beta-globin gene was sequenced by automatic sequencing. Results: Proband 1 was detected as a combination of Hb Ernz/Hb S without any clinical symptoms. Her sister and brother had to be an Hb Ernz/Hb S combination. Her mother and father only showed Hb Ernz and Hb S, respectively. Proband 2 had the Hb Ernz variant with IVS-I 5nt homozygous alpha 2 gene mutation. Proband 3 had a heterozygous Hb Ernz variant. All subjects were clinically and hematologically normal but Proband 2 had low hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and high red blood cell distribution width levels. Conclusion: In the present study, the Hb Ernz variant is demonstrated for the first time in the Turkish population. Additionally, there is no published report in the world literature of Hb Ernz in combination with IVS-I 5nt homozygote mutation in the alpha-globin gene or Hb S variant. The present report shows that the Hb Ernz variant is not clinically or hematologically significant.Öğe Iodine, copper, zinc, selenium and molybdenum levels in children aged between 6 and 12 years in the rural area with iodine deficiency and in the city center without iodine deficiency in Hatay(Aves, 2014) Celik, Tanju; Savas, Nazan; Kurtoglu, Selim; Sangun, Ozlem; Aydin, Zeki; Mustafa, Didin; Ozturk, Oktay HasanAim: Thyroid diseases related with iodine deficiency are observed commonly in our country and in the world. In this study, we aimed to investigate iodine deficiency in urine and selenium, zinc, copper or molybdenum deficiencies which may accompany this in children aged between 6 and 12 years in two schools in the province of Hatay (endemic goitre region). Material and Methods: This study is a case-control field-study in which students aged between 6 and 12 years were included. One hundred fourteen subjects from the village of Tanisma related to the center of our province and 100 subjects from the city center of Hatay (Antakya) were included in the study. Iodine, selenium, zinc, copper and molybdenum levels were measured in the urine samples of the students included in the study. Results: Iodine deficiency was found with a severe (5%), moderate (18.4%) and mild degree (43%), respectively in the village of Tanisma. Mild iodine deficiency (7%) was found in the center of Hatay. No moderate and severe iodine deficiency was found in the control group. A significant difference was found between the groups in terms of urine iodine excretion (p < 0.001). A significant correlation was found between the levels of iodine, selenium, zinc and molybdenum (p < 0.05). A moderately positive correlation was found between iodine and selenium (p < 0.001). A moderately positive correlation was found between iodine and zinc levels (p < 0.001) and a weak correlation was found between iodine and molybdenum (p < 0.01). No significant correlation was found between iodine level and copper level (p > 0.05). Conclusions: Selenium and zinc deficiency may accompany iodine deficiency. Selenium and zinc deficiency should be considered in individuals who are found to have iodine deficiency especially in endemic goitre regions.Öğe Mean platelet volume can predict cerebroyascular events in patients with Sickle Cell Anemia(Professional Medical Publications, 2015) Celik, Tanju; Unal, Sule; Ekinci, Ozalp; Ozer, Cahit; Ilhan, Gul; Oktay, Gonul; Arica, VefikObjective: The purpose of this study was to determine the impact of mean platelet volume (MPV) on the frequency and severity of vaso-occlusive and cerebrovascular events in patients with sickle cell anemia (SCA). Methods: The 238 cases diagnosed with SCA were evaluated retrospectively with respect to the occurrence of painful crisis for the previous year. The incidence, severity and type of the vaso-occlusive crises of the patients with SCA between March 2010 and March 2011 were recorded. The last MPV values in patients who were free of erythrocyte transfusion for the last three months and who had no current vaso-occlusive crises were evaluated. All the patients were grouped according to the frequency of the crises for the previous year preceding the data collection. Group 1: 1 to 3 crises, Group 2: 4 to 5 and Group 3: 6 or more crises annually. Results: In accordance with the results obtained during the evaluation of the cases diagnosed with sicklecell anemia, MPV value was found to be significantly higher in patients with cerebrovascular events. Also MPV values increased with increasing incidence of the crises (1=0.297) (p=0.001). Conclusion: One of the contributing factors for this clinical heterogeneity may be related to the MPV values in patients with sickle cell anemia. The higher MPV values may be an early predictor of future cerebrovascular events in patients with sickle cell anemia and may require close follow-up and additional measures.Öğe Mean Platelet Volume in Children with Familial Mediterranean Fever and the Relationship with Attack Status, Colchicine Treatment and Gene Mutation(Modestum Ltd, 2014) Ustun, Nilgun; Ulasli, Alper Murat; Celik, Tanju; Yula, Erkan; Turhanoglu, Ayse DicleIncreased mean platelet volume (MPV) is a manifestation of platelet functions and activation, and accepted as a prognostic biomarker in patients with cardiovascular disease. We aimed to investigate MPV levels in pediatric Famillial Mediterranean Fever (FMF) patients during the attack and attack-free periods, and the effect of colchicine treatment and presence of M694V mutation. Thirty-five pediatric patients with FMF and 38 age-sex-matched healty controls were enrolled retrospectively into the study. Of the patients 11 (31%) had an ongoing attack, and 24 (69%) were in attack-free period. 26 (74%) patients were receiving colchicine and 16 (45.7%) had M694V gene mutation. There was no significant difference in platelet (PLT) and MPV between patients and healthy controls (p=0.196 and p=0.167 respectively). Mean PLT and MPV values of the patients during attack and attack-free period were also not significantly different (p=0.355 and p=0.118 respectively). However, MPV levels during an FMF attack were non-significantly lower than healthy control group (p=0.08). PLT and MPV levels were higher in patients receiving colchicine but the differences were not significant (p=0.097 and p=0.446 respectively). Mean MPV value of the FMF patients with M694V mutation was not significantly different than controls (p=0.773). In conclusion, this study reveals that pediatric FMF patients have similar MPV levels with healthy individuals even in the presence of M694V mutation. MPV as an early atherosclerosis marker, is not significantly elevated in this patient cohort. Regular treatment with colchicine and younger age may have a role in non-impaired platelet activation in FMF patients.Öğe Nocturnal enuresis in sickle cell disease and thalassemia major: associated factors in a clinical sample(Springer Japan Kk, 2013) Ekinci, Ozalp; Celik, Tanju; Unal, Sule; Oktay, Gonul; Toros, Fevziye; Ozer, CahitIn this study, we aimed to investigate the prevalence and associated factors of nocturnal enuresis in sickle cell disease (SCD) and thalassemia major (TM) patients in a single center from Turkey. One hundred and six patients, 51 (48.1 %) with TM and 55 (51.9 %) with SCD, and 80 age-matched healthy controls were included in the study. Semi-structured interviews were conducted with the caregivers of pediatric and adult patients. The interview included questions on nocturnal enuresis and psychosocial variables. Patients' hospital files were reviewed to search for disease-related factors. Twenty-eight of the patients (26.4 %) and three (3.7 %) of the controls had nocturnal enuresis. Younger age, TM diagnosis, family history of nocturnal enuresis and family problems were found to be more frequent in patients with nocturnal enuresis. Among the patients with SCD, frequencies of hospitalization and painful crises were found to be higher in those with enuresis. According to the binary logistic regression analysis, diagnosis of TM (p = 0.031, OR = 0.262) and younger age (p = 0.005, OR = 0.869) were found to be independent risk factors for nocturnal enuresis in the patient group. Nocturnal enuresis is a common problem in children and young adults with TM and SCD. Associated factors in both conditions will be clarified with future studies.Öğe Prevalance of anemia among children(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2012) Yazici, Selcuk; Celik, Tanju; Seyrek, KamilObjective: In this study, we aimed to determine the prevalance of anemia among patients at university hospital in Balikesir City. Methods: 563 cases, without any chronic illness, who had been examined at outpatient pediatrics clinic of our hospital were retrospectically evaluated for the prevalence of anemia prevelance by perusing hospital records. Results: 265 (47.1%) of 563 cases who were consulted to our hospital were female and 298 (52.9%) were male. The mean age of the patients was 5.9+/-4.2 (5 mos-18 yrs) years. The mean hemoglobin value was 12.5+/-1.2 mg/dl (8.3-18 mg/dl). Mean corpuscular volume (MCV) was detected as 78.9+/-5.7 fL (56.9-101.9 fL). Mean red cell distrubition width (RDW) was 13.9+/-1.6 % (7.3-31.3%). Signs of anemia were present in 117 (20.8%), and iron deficiency anemia in 35 (6.2%) cases. Conclusion: Although anemia is common at all ages, it is mostly seen in children under two years old, due to iron deficiency. Anemia affects growth, development and cognitive functions. Thus iron supplementation is essential for prophylaxis and treatment.Öğe Primary progressive tuberculosis in an adolescent presented with clubbing(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2011) Celik, Tanju; Tutanc, Murat; Davran, Ramazan; Arica, Vefik; Kose, MehmetTuberculosis is one of the most frequently encountered diseases in our country, and it should be taken into account in children presented with complaints of chronic respiratory airway diseases. We aimed to discuss the clinical, radiological, bronchoscopical and biopsy findings of primary progressive tuberculosis in a case presented with clubbing. A 15-year-old male adolescent admitted to our clinic with complaints of coughing, chest pain, weight loss, anorexia and weakness. When patients were physically examined, clubbing was seen on both hand fingers. On chest radiogram, densities compatible with lympadenopathy in paracardiac area and left lower lobe consolidation were seen. Acid-fast bacteria (AFB) were searched in the sputum. Bronchoscopical examination was done. In biopsy specimens and bronchoalveolar lavage fluid samples, growth of acid-fast bacteria were identified. Diagnosis was confirmed by bacterial culture. This case was presented to emphasize that the diagnosis of tuberculosis should be suggested as an etiologic factor for chronic lung disease when adolescents presented with weight loss, chronic coughing, night sweats, bloody sputum in addition to clubbing.Öğe The Safe and Effective Use of Methylphenidate in the Psychiatric Treatment of an Adolescent with Epidermolysis Bullosa(Cukurova Univ, Fac Medicine, 2013) Ekinci, Ozalp; Celik, Tanju; Dogramaci, Asena Cigdem; Toros, FevziyeEpidermolysis Bullosa is a group of inherited dermatological disorder with severe clinical symptoms. Children and adolescents with epidermolysis bullosa have been reported to experience psychosocial problems in addition to the symptoms associated with epidermolysis bullosa. Although children and adolescents with epidermolysis bullosa commonly have psychiatric symptoms, limited research has been conducted on the psychiatric treatment options. In this case report, psychiatric treatment and the safe and effective use of methylphenidate in the treatment of attention deficit hyperactivity disorder in an adolescent with epidermolysis bullosa will be discussed.Öğe Varicella Related Keratoconjunctivitis; Case Report(Aves, 2013) Unsal, Erkan; Celik, Tanju; Buyrukcu, Ayse Tekin; Kizilay, Osman; Eltutar, KadirChickenpox is the primary infection of Varicella-zoster virus (VZV) and is often seen in childhood with fever and a vesiculo-bullous rash and causes severe systemic illness and complications. In this article we aimed to present a case of keratoconjunctivitis due to chicken pox. A nine-year-old patient with chickenpox was examined in our clinic. Vesiculo-bullous lesions were present on the body and face. She had redness, pain, and tear complaints in her left eye. Keratoconjunctivitis was detected in the left eye at 7 o'clock. In this area, there were sectorial type conjunctival hyperemia and slight chemosis. Limbal vesicular lesions, punctate keratitis and anterior stromal infiltrate were detected. Topical acyclovir 3% (5x1) and prophylactic topical fusidic acid 1% (2x1) were administered to the patient. All complaints and findings showed improvement on the 7. day of the treatment. Varicella-zoster virus causes chickenpox and shingles. While chickenpox is the primary infection of VZV, recurrent Herpes zoster infections occur by reactivation of latent virus in the dorsal root ganglion. Chickenpox rarely affects the eye except for the typical eyelid lesions. However, a few conjunctival and corneal lesions, iridocyclitis, glaucoma, chorioretinitis and optic nerve lesions have been described. VZV dendrites are composed of plaques blistered from the surface of the cornea and swollen epithelial cells. Dendrites form branches or a medusa like pattern with conical ends. While antiviral treatment is not necessary in healthy children, a variety of antiviral treatments such as acyclovir, famciclovir and valacyclovir can be used in immune compromised patients. In our case, an adequate response to topical acyclovir treatment was obtained. Our case of varicella keratoconjunctivitis was successfully treated with topical acyclovir. There were no additional complications during follow-up. We want also to emphasize that, in varicella keratonjunctivitis, eye examinations should be repeated.
