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    Antioxidant enzyme activities, lipid peroxidation, and total antioxidant status in children with Henoch-Schonlein purpura
    (Springer, 2008) Ece, Aydin; Kelekci, Selvi; Kocamaz, Halil; Hekimoglu, Askin; Balik, Hasan; Yolbas, Ilyas; Erel, Ozcan
    The aim of this study was to assess the role of oxidative stress in the pathogenesis of Henoch-Schonlein purpura (HSP) vasculitis. The activities of catalase (CAT), arylesterase (ARYL), and paraoxonase (PON) as antioxidant enzymes and serum malondialdehyde (MDA) level as an indicator of lipid peroxidation, together with total antioxidant status (TAS), were measured in 29 children with HSP (mean age 9.3 +/- 2.7 years), both at the onset of the disease and at the remission period and in matched controls. Active-stage HSP had significantly higher MDA level (15.5 +/- 7.3 vs 7.8 +/- 3.9 nmol/l, respectively, P<0.001) and lower TAS (524 +/- 122 vs 699 +/- 122 mu mol Trolox Equiv/1, P< 0.001), PON (97 +/- 47 vs 136 +/- 95 U/1, P=0.042), ARYL (158 +/- 39 vs 212 +/- 52 U/1, P<0.001), and CAT (50 +/- 27 vs 69 +/- 20 U/1, P=0.002) activities compared with the control subjects. Although CAT (P>0.05) and PON (P>0.05) activities were found to be similar between active and remission stages of HSP, the active stage of the disease had significantly lower ARYL (P=0.011) and TAS (P=0.006) and higher MDA (P<0.001) values compared with remission period. Significant positive correlations were found between CAT and MDA (r=0.433, P=0.019) and between CAT and C-reactive protein (r=0.386, P=0.035) in the active stage of HSP. No significant differences were detected in oxidant/antioxidant parameters between patients with or without renal, gastrointestinal, or joint involvement (P>0.05). Increased oxidative stress and lipid peroxidation may play important roles in the pathogenesis of HSP vasculitis. Antioxidant therapeutic interventions in longlasting vasculitis and risk of atherosclerosis secondary to increased oxidant stress remain to be investigated.
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    Assessment of quality of life and psychosocial problems in children with Congenital Heart Disease
    (Cambridge Univ Press, 2024) Oztoprak, Meral Bulbul; Bilici, Meki; Dogac, Tugba; Akin, Alper; Ture, Mehmet; Balik, Hasan; Yilmaz, Kamil
    Objective: Congenital heart disease (CHD) is a condition that can significantly impact health-related quality of life due to the need for long-term follow-up and treatment. The purpose of this study was to analyse the quality of life of children diagnosed with CHD and to assess the relationship between the disease and their physical and mental well-being. Materials and Methods: The study involved 180 patients and 180 healthy controls. Both groups were divided into three age categories (5-7 years, 8-12 years, and 13-18 years), with 60 children in each age group. The researchers administered the Pediatric Quality of Life Inventory (PedsQL) to the participants, taking into account their age. Results: Comparisons between the patient and control groups showed that the patient group had significantly lower scores than the control group in terms of total quality of life scale score, physical health score, and psychosocial health score of the Pediatric Quality of Life Inventory (p < 0.001, p < 0.001, and p < 0.001). Quality of life was also compared between patients receiving and not receiving medication treatment. Patients receiving medication treatment had lower scores for total quality of life score, physical health score, and psychosocial health score of the Pediatric Quality of Life Inventory compared to the control group (p < 0.001, p = 0.005, and p < 0.001). Conclusion: Children with CHD experience a negative impact on their quality of life. Given the extended life expectancy resulting from new treatment options, it is important to monitor these children both physically and psychosocially and to implement activities aimed at improving their quality of life.
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    The association between electrocardiographic data and obesity in children and adolescents
    (Edizioni Minerva Medica, 2021) Ture, Mehmet; Akin, Alper; Unal, Edip; Kan, Ahmet; Balik, Hasan; Tas, Funda Feryal; Haspolat, Yusuf Kenan
    Background: There are not enough studies investigating the relationship between obesity and ECG abnormalities in children and adolescents. This study aims to investigate the relationship between obesity and electrocardiographic data in children and adolescents for early diagnosis to prevent arrhythmia or sudden death in later stages of life.Patients and Methods: A total of 65 children and adolescents with obesity applied to our pediatric endocrinology outpatient clinic with nonspecific complaints and without any known chronic illnesses; 76 healthy children and adolescents were included in the study. Anthropometric and laboratory data, blood pressure measurements, and 12-lead electrocardiography data of all participants were collected.Results: There was a statistically significant difference between the obese and the control group in terms of triglycerides, total cholesterol, high density lipoprotein, low density lipoprotein levels, and systolic blood pressure. According to electrocardiographic findings, there was a statistically significant difference between the two groups in terms of heart rate (p=0.008), PR duration (p<0.001), left ventricular hypertrophy (p=0.02), P maximum (p=0.04), P dispersion (p<0.001), QRS duration (p<0.001), QT minimum (p=0.007), QT maximum (p=0.03), QT dispersion (p=0.024), QTc minimum (p=0.002), QTc dispersion (p=0.003), Tp-e minimum (p=0.007), and Tp-e maximum (p=0.003) variables.Conclusion: There were significant differences between the electrocardiographic evaluation of obese group compared to the control group in our study, which may be associated with risk of cardiac arrhythmia. These differences require monitorization in terms of cardiac arrhythmia and risk of sudden death. Further studies with longer follow-up time are needed to support the potential clinical outcomes of our findings.
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    Ligation of patent ductus arteriosus through left anterior mini-thoracotomy in preterm infants
    (Cambridge Univ Press, 2023) Kilic, Yigit; Irdem, Ahmet Kuddusi; Doyurgan, Onur; Ozlem, Gul; Balik, Hasan; Salik, Fikret; Aldudak, Bedri
    Objective: Patent ductus arteriosus is an important cause of morbidity and mortality, especially in very low birth weight infants. The aim of the study is to report our single-centre short-term results of preterm patients who underwent ligation through left anterior mini-thoracotomy . Methods: Data of 27 preterm infants operated by the same surgeon who underwent Patent ductus arteriosus (PDA) closure with left anterior mini-thoracotomy technique between November 2020 and January 2022 at a single institution were reviewed. The patients were divided into two groups according to their weight at the time of surgery. Data on early postoperative outcomes and survival rates after discharge were collected. Results: Twenty-seven patients with a mean (+/- SD) gestational age of 25.8 (+/- 2.0) weeks and a mean birth weight of 1027 (+/- 423) g were operated using left anterior mini-thoracotomy technique. The lowest body weight was 480 g. Complications such as bleeding, abnormal healing of incision, or pneumothorax were not seen. There were 8 mortalities after the operation (29,6 %). The causes of the deaths were sepsis, necrotising enterocolitis, hydrops fetalis, hepatoblastoma, and intracranial bleeding. There was no statistically significant difference in the rates of complication between the groups. Conclusions: Left anterior mini-thoracotomy technique can be performed as the first choice when transcatheter intervention cannot be applied in preterm infants. It provides easy access to the PDA, a good exposure, minimal contact with the lungs, good cosmetic results in early and mid-term and shortens the operation time, especially in very low birth weight preterm babies. However, early ligation may be helpful to minimise the complications related to PDA.
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    Neutrophil activation, protein oxidation and ceruloplasmin levels in children with Henoch-Schonlein purpura
    (Springer, 2007) Ece, Aydin; Kelekci, Selvi; Hekimoglu, Askin; Kocamaz, Halil; Balik, Hasan; Yolbas, Ilyas; Erel, Ozcan
    The aim of this study was to investigate the role of neutrophil activation, protein oxidation and ceruloplasmin (CLP) in the pathogenesis of Henoch-Schonlein purpura (HSP), which has not been investigated previously. Serum activities of myeloperoxidase (MPO) and arylesterase (ARYL) and levels of free thiol groups, CLP and total oxidant status (TOS) were measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at active stage had significantly higher MPO activity (391 +/- 277 vs. 155 +/- 154 U/l, P<0.001), higher CLP (832 +/- 120 vs. 682 +/- 114 mg/dl, P<0.001) and TOS values (20.7 +/- 11.8 vs. 7.5 +/- 2.8 mu mol H2O2/l, P<0.001) than the controls, respectively. Patients had significantly lower ARYL activity (158x10(3) +/- 3x10(3) vs. 187x10(3) +/- 4 46x10(3) U/l, P<0.001) and lower free thiol levels (234 +/- 48 vs. 279 +/- 26 mu mol/l, P<0.001) than the controls, respectively. Significantly positive correlations were found between TOS and MPO (r=0.437, P=0.018) and TOS and CLP (r=0.409, P=0.028) at disease onset, whereas a negative correlation was found between MPO and thiol (r=-0.597, P=0.001) during remission. In conclusion, protein oxidation and neutrophil activation may play important roles in the pathogenesis of HSP. Further research is required to understand the potential linkage between oxidant stress and complications and to develop therapeutic strategies in HSP.
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    Paraoxonase, total antioxidant activity and peroxide levels in marasmic children
    (Pergamon-Elsevier Science Ltd, 2007) Ece, Aydın; Gurkan, Fuat; Celik, Fatma; Boşnak, Mehmet; Yel, Servet; Balik, Hasan; Erel, Ozcan
    Objectives: The aim of this study was to investigate the oxidant/antioxidant status, paraoxonase (PON) activity and leptin. levels in children with marasmic malnutrition. Design and methods: Thirty marasmic children (age 14.4 +/- 10.3. months) and 28 control subjects were included; Plasma PON activity, total antioxidant activity (TAO), total peroxide (TPX) and leptin,levels were measured. Results: Malnourished children had significantly. lower leptin.(3.6 +/- 1.1. vs. 11.8 +/- 4.5 ng/mL, P < 0.001), PON. activity (66.4 +/- 28.6 vs. 2213 +/- 31.6 IU/L, P < 0.001) and. TAO (1.44 +/- 0.12 vs. 2.45 +/- 0.61 mmol Trolox equiv/L, P < 0.001); and higher TPX (15.6 +/- 6.4 vs. 5.9 +/- 1.9 mu mol/L, P < 0.001) values than,in controls. Significant negative correlation was found between PON and TPX (P=0.040) and positive correlation between TAO and BMI (P= 0.034) in patients. No significant correlation was found between leptin and oxidam/antioxidant parameters (P > 0.05). Conclusions: Children with marasmic. malnutrition had increased. pro-oxidant and decreased antioxidant status. Extent of oxidative stress increases with malnutrition severity.. Antioxidants could be given during nutritional rehabilitation., (c) 2007 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
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    The relationship between electrocardiographic data and mortality in children diagnosed with dilated cardiomyopathy
    (Springer, 2020) Ture, Mehmet; Balik, Hasan; Akin, Alper; Bilici, Meki; Nergiz, Ahmet
    The mortality causes of patients followed up due to dilated cardiomyopathy (DCM) include complications related to heart failure, ventricular arrhythmia, and transplantation. This study aims to evaluate the electrocardiographic findings of patients diagnosed with dilated cardiomyopathy and determine its relationship with mortality. The electrocardiographic, clinical, and laboratory findings of patients diagnosed with dilated cardiomyopathy between January 1, 2012, and September 1, 2018, in our university's pediatric cardiology department were retrospectively evaluated. The electrocardiographic findings of surviving and exitus dilated cardiomyopathy patients were compared and their effect on mortality was investigated. Twelve of the total 85 patients diagnosed with dilated cardiomyopathy were deceased. According to the electrocardiographic findings of surviving and exitus patients, there was a statistically significant difference in terms of P maximum (Pmax), P dispersion (Pdis), QT dispersion (QTdis), QTc maximum (QTcmax), QTc dispersion (QTcdis), Tp-e maximum (Tp-emax), Tp-e dispersion (Tp-edis), and QRS time. Hypertrophy and ischemia findings of electrocardiography were also statistically significant. There was a statistically significant difference between the two groups according to the echocardiographic findings of left ventricular ejection fraction (LVEF), left ventricular shortening fraction (LVSF), left ventricular end-diastolic diameter (LVEDd), and left ventricular end-systolic diameter (LVESd) measurements. It is well known that children diagnosed with dilated cardiomyopathy are at greater risk of arrhythmia compared with normal children. Although previous studies have determined the relationship between mortality and a limited number of electrocardiographic findings, especially in adults, the relationship between electrocardiography findings of children diagnosed with DCM and mortality has not been investigated before in such detail, as in our study. Conclusion: In this study, the significant difference between the electrocardiographic data of deceased and surviving dilated cardiomyopathy patients suggests that electrocardiographic data should be evaluated in detail in order to determine the low and high risk of mortality in patients with dilated cardiomyopathy.What is Known:center dot Previous studies on the relationship between limited electrocardiography data of adult patients diagnosed with DCM and mortality have been determinedWhat is New:center dot ECG data has not been investigated in such detail in child DCM patients, as in our study.
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    Subclinical hypothyroidism and long QT
    (Wiley, 2018) Akin, Alper; Unal, Edip; Yildirim, Ruken; Ture, Mehmet; Balik, Hasan; Haspolat, Yusuf Kenan
    [Abstract Not Available]
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    Transcatheter Closure of Patent Ductus Arteriosus in Children with the Occlutech Duct Occluder
    (Springer, 2017) Bilici, Meki; Demir, Fikri; Akin, Alper; Ture, Mehmet; Balik, Hasan; Kuyumcu, Mahir
    The aim of this study was to evaluate the feasibility, efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with the Occlutech duct occluder (ODO) in children. We reviewed the clinical records of 71 patients who underwent percutaneous closure of PDA with an ODO between September 2014 and August 2016. The Occlutech duct occluder was applied to 71 patients during the study period (September 2014-August 2016), and the results were analyzed in this study. Forty-two of the patients were female and 29 male. The median age was 20.5 months (range, 6-194 months) and median weight was 16 kg (range, 6-68 kg). The PDA was classified as type A in 54 patients (76.1%), type E in 14 (19.7%), type C in 2 (2.8%) and type B in 1 (1.4%) based on the Krichenko classification. A standard ODO device was used for the transcatheter closure procedure in 66 patients and the long-shank ODO device in 5. In the echocardiographic measurement of PDA, the median smallest diameter was 2.7 mm (range, 1.5-7.0 mm), and in the angiographic measurement, the median smallest diameter was 2.5 mm (range, 1.5-6.5 mm). All 71 patients underwent successful PDA closure with the ODO. Angiography following the procedure showed complete closure in 47 patients (66.2%), mild residual shunt in 13 patients (18.3%) and a trivial shunt in 11 patients (15.5%). Color flow Doppler echocardiogpaphy at 24 h post-implantation showed that complete closure was achieved in 65 patients (91.5%), and 6 patients (8.5%) had mild residual shunt. All patients (100%) had complete closure at 30 days of follow-up. The results of this study showed that the Occlutech PDA occluder device is safe and effective in the closure of PDA. As the pulmonary artery side of the device is wider than the aortic side, protrusion toward the aortic side and embolization are prevented, but there is residual shunt in the early period, although this residual shunt disappeared after a few months.
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    Urinary levels of early kidney injury molecules in children with vitamin B12 deficiency
    (Soc Argentina Pediatria, 2016) Gunes, Ali; Aktar, Fesih; Tan, Ilhan; Soker, Murat; Uluca, Unal; Balik, Hasan; Mete, Nuriye
    The aim of this study was to investigate urine early kidney injury molecules, including human kidney injury molecule-1 (KIM-1), liver-type fatty-acid binding protein (L-FABP), N-acetyl-b-D-glucosaminidase A (NAG), and neutrophil gelatinase-associated lipocalin (NGAL) in children with vitamin B12 (cobalamin) deficiency (CD). Twelve children with vitamin B12 deficiency and 20 healthy matched controls were included. Hematologic parameters, serum urea, creatinine (Cr), electrolytes, B12 and folate levels were recorded. Estimated glomerular filtration rate (eGFR) was calculated. Urine protein, electrolytes, and urinary early markers were measured. Patients with CD had significantly higher urine electrolyte/Cr ratios (p < 0.05). Significantly higher urinary KIM-1/Cr, L-FABP/Cr, NAG/Cr and NGAL/Cr were found in CD group (p < 0.05). Significant negative correlations were found between levels of serum B12 and urinary markers in the patients (p < 0.05). Increased urinary kidney injury molecules and electrolytes in children with B12 deficiency suggest a possible subclinical renal dysfunction, which cannot be determined by conventional kidney function tests.