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    Assessment of epicardial adipose tissue thickness and the mean platelet volume in children with familial Mediterranean fever
    (Bmc, 2015) Uluca, Unal; Demir, Fikri; Ece, Aydin; Sen, Velat; Gunes, Ali; Aktar, Fesih; Tan, Ilhan
    Background: Familial Mediterranean fever (FMF) is an inflammatory disease, which is suggested to be associated with increased risk of atherosclerosis. Epicardial adipose tissue (EAT) thickness and the mean platelet volume (MPV) are parameters used in prediction of atherosclerotic risk in various conditions. These parameters were evaluated in children with FMF and compared with healthy controls. Methods: Forty-five patients with FMF and 54 age-and gender-matched healthy controls were assessed. Duration of symptoms, age at diagnosis, duration of delay in diagnosis, frequency and duration of FMF attacks, disease severity scores, response to colchicine therapy, MEditerraneanFeVer (MEFV) gene mutations, and MPV values were recorded. EAT thicknesses were measured by echocardiography. Results: Epicardial adipose tissue thicknesses of the children with FMF were found to be significantly greater than that of controls (5.1 +/- 1.4 vs. 4.5 +/- 0.9 mm, p = 0.036). FMF patients had significantly higher MPV values compared with the controls (7.8 +/- 1.1 vs. 7.3 +/- 1.4 fl, p = 0.044). Age at diagnosis, duration of delay in diagnosis, and MPV values were found to be correlated with EAT thickness in the patient group (r = 0.49, p = 0.001 for the former parameters and r = 0.32, p = 0.04 for MPV). Conclusion: Epicardial adipose tissue thickness and MPV values seem to be increased in children with FMF. These findings may indicate an increased risk of atherosclerosis in FMF patients.
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    Clinical and Laboratory Characteristics and Follow Up Results of 121 Children with Juvenile Idiopathic Arthritis
    (Modestum Ltd, 2013) Ece, Aydin; Sen, Velat; Yel, Servet; Gunes, Ali; Uluca, Unal; Tan, Ilhan; Karabel, Duran
    This study aimed to investigate the clinical and laboratory features of children with juvenile idiopathic arthritis (JIA) that followed up at Dicle University Hospital Department of Pediatrics. Totally, 121 (64 male, 57 female) children with the mean age of 10.0 +/- 4.1 (range, 1.5-1.8) years were included. The mean disease onset age was 7.9 +/- 3.8 (range, 0.8-15.4) years and the mean follow up period was 2.1 +/- 1.9 years. The percentages of JIA subtypes were as follows: Oligoarticular JIA 67 (55.4%), polyarticular 45 (37.2%), enthesitis related arthritis 5 (4.1%) and systemic JIA 4 (3.3%). The most common complaints were arthralgia (91.7%), fever (57.0%), fatigue (38.8%) and malaise (34.7%) and the most frequently involved joints were knee (74.4%), ankle (57.9) and wrist (48.8%). Complete remission were achieved in 28 (23.1%) and partial remission in 56 (46.3%), however 27 (21.3%) cases not responded to treatment satisfactorily. Significant risk factors for poor response to treatment with logistic regression were found as delay in treatment >= 6 months (Odds ratio, OR: 11.1; p=0.006), existence of thrombocytosis (OR: 7.5; p=0.009) and early disease onset (age<5 years) (OR: 18.1; p=0.004). In conclusion, JIA is a heterogeneous childhood disease with varied clinical manifestations. Early onset disease, delay in treatment and existence of thrombocytosis were the risk factors for an unfavorable outcome.
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    Cordycepin prevents postoperative formation of intra-abdominal adhesion in a rat model: An experimental study
    (Turkish Assoc Trauma Emergency Surgery, 2017) Arslan, Serkan; Zeytun, Hikmet; Basuguy, Erol; Ibiloglu, Ibrahim; Uygun, Ibrahim; Yilmaz, Ahmet; Tan, Ilhan
    BACKGROUND: The aim of the present study was to investigate whether cordycepin prevented adhesion formation in a rat model. METHODS: Rats were randomly assigned to 3 groups of 10 rats. Control group: The absence of adhesion was confirmed via laparotomy. Adhesion group: The cecum was removed from the abdomen and scraped with a dry gauze bandage until petechial hemorrhagic foci developed. Cordycepin group: The same surgical procedure was performed as in the adhesion group, and 10 mg/kg cordycepin was administered intraperitoneally. After 15 days, the rats were sacrificed humanely via cardiac blood withdrawal under anesthesia. The rats were then analyzed morphologically and histopathologically, and hydroxyproline (OH-p) and malondialdehyde (MDA) levels were measured. RESULTS: Macroscopic analysis revealed significantly less adhesion in the cordycepin group than in the adhesion group (p<0.01). Furthermore, significant histopathological improvement was also evident in the cordycepin group compared to the adhesion group (p<0.05). The levels of OH-p and MDA in blood and tissue were higher in the adhesion group than in the control group, and lower in the cordycepin group than the adhesion group. Interestingly, MDA level was significantly lower (blood: p<0.05; tissue: p<0.01) in the cordycepin group than in the adhesion group, whereas only tissue OH-p was significantly lower in the cordycepin group compared with the adhesion group (p<0.05). One rat in both adhesion group and cordycepin group died postoperatively. CONCLUSION: Results indicated that cordycepin effectively reduced adhesion in a rat abrasion model. Thus, this agent may be valuable to prevent postoperative adhesion.
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    Correlation of mean platelet volume, neutrophil-to-lymphocyte ratio, and disease activity in children with juvenile idiopathic arthritis
    (E-Century Publishing Corp, 2015) Gunes, Ali; Ece, Aydin; Sen, Velat; Uluca, Unal; Aktar, Fesih; Tan, Ilhan; Yel, Servet
    Juvenile idiopathic arthritis (JIA) is a chronic inflammatory arthritis characterized by periods of remission and relapse. Mean platelet volume (MPV) is an indicator of systemic inflammation. In the present study, we aimed to determine the association between mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet distribution width (PDW) and clinical measures of diseases activity in children with JIA. The study included 115 patients with JIA (64 with active disease and 51 with inactive disease) and 64 age-gender matched healthy control subjects. Routine laboratory methods were used to measure white blood cell count (WBC), platelet count (PLT), neutrophil count, lymphocyte count, hemoglobin (Hb), MPV, PDW, NLR, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in all subjects of both the patient and control groups. Active disease was associated with significantly increased MPV (8.23 +/- 1.16 fl) compared with inactive disease (7.00 +/- 1. 08 fl) and control subjects (6.77 +/- 1.08 fl) P<0.001, P<0.001, P=NS, respectively). NLR was significantly higher in patients with active (2.11 +/- 1.19) and inactive (2.03 +/- 1.51) disease relative to the control subjects (1.33 +/- 0.66) (P<0.001, P=0.017, respectively). Mean PDW was significantly higher in patients with active disease (17.84 +/- 1.06) compared with the control group (17.19 +/- 0.93) (P=0.01). Our results suggest that MPV may be a useful marker of disease activity in patients with JIA. Regular treatment may decrease platelet activation in JIA patients. However, NLR was not a predictive marker of disease activity in patients with JIA.
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    Determining the Independent Risk Factors and Mortality Rate of Nosocomial Infections in Pediatric Patients
    (Hindawi Ltd, 2016) Aktar, Fesih; Tekin, Recep; Gunes, Ali; Ulgen, Cevat; Tan, Ilhan; Ertugrul, Sabahattin; Kosker, Muhammet
    The objective of this study was to determine the rate, independent risk factors, and outcomes of healthcare-associated infections in pediatric patients. This study was performed between 2011 and 2014 in pediatric clinic and intensive care unit. 86 patients and 86 control subjects were included in the study. Of 86 patients with nosocomial infections (NIs), there were 100 NIs episodes and 90 culture growths. The median age was 32.0 months. The median duration of hospital stay of the patients was 30.0 days. The most frequent pathogens were Coagulase-negative Staphylococcus, Acinetobacter spp., Klebsiella spp., and Candida spp. Unconsciousness, prolonged hospitalization, transfusion, mechanical ventilation, use of central venous catheter, enteral feeding via a nasogastric tube, urinary catheter, and receiving carbapenems and glycopeptides were found to be significantly higher in NIs patients. Multivariate logistic regression analysis showed prolonged hospitalization, neutropenia, and use of central venous catheter and carbapenems as the independent risk factors for NIs. In the univariate analysis, unconsciousness, mechanical ventilation, enteral feeding, use of enteral feeding via a nasogastric tube, H-2 receptor blockers, and port and urinary catheter were significantly associated with mortality. In the multiple logistic regression analysis, only mechanical ventilation was found as an independent predictor of mortality in patients with NIs.
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    Echocardiographic diagnosis of double-chambered left ventricle
    (Springer Japan Kk, 2016) Bilici, Meki; Demir, Fikri; Akin, Alper; Guzel, Abdulmenap; Akdeniz, Osman; Tan, Ilhan
    Double-chambered left ventricle (DCLV) is a rare congenital abnormality in which the left ventricle is divided into two separate chambers by a septum or anomalous muscular structure. The chambers are observed mostly parallel to each other without stenosis, and less frequently in a superior-inferior arrangement. An asymptomatic girl is presented here who was diagnosed with DCLV on echocardiographic examination that was performed for the evaluation of cardiac murmur detected by a pediatrician. She has been followed up without treatment.
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    Evaluation of the Mean Platelet Volume in Children with Juvenile Idiopathic Arthritis
    (Modestum Ltd, 2014) Sen, Velat; Ece, Aydin; Uluca, Unal; Gunes, Ali; Tan, Ilhan; Tuncel, Tuba; Aktar, Fesih
    Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis in children. Mean platelet volume (MPV) is an indicator of platelet size and has been investigated as an inflammation marker in several diseases. This study was designed to investigate the MPV values in patients with JIA and healthy subjects, and determine the correlation between MPV, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The hospital records of a total of 40 children with JIA, diagnosed using the International League of Associations for Rheumatology (ILAR) criteria, and 40 healthy controls were enrolled into the study. White blood cell count (WBC), platelet count, CRP, ESR, and MPV levels were retrospectively recorded. Children with JIA had significantly higher MPV values (8.28 +/- 1.12 fL) compared to the control group (7.53 +/- 1.07 fL) (p=0.003). Significant correlations were found between MPV, ESR, and CRP in the JIA group (r=0.676, p<0.001 and r=0.430, p<0.006). In addition, a negative correlation was found between platelet count and MPV (r=-0.818, p<0.001) in JIA patients. There was no significant difference in WBC values between the patient and the control groups (p>0.05). Our results suggest that MPV levels may be a useful marker of inflammation and prognostic factor for atherosclerosis risk in pediatric JIA patients.
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    High frequency of E148Q sequence variation in children with familial Mediterranean fever in southeast Turkey
    (Soc Argentina Pediatria, 2015) Uluca, Unal; Ece, Aydin; Sen, Velat; Coskun, Salih; Gunes, Ali; Yel, Servet; Tan, Ilhan
    Objective: The aim of this study was to investigate the spectrum of Mediterranean fever (MEFV) gene mutations and genotype-phenotype correlation in children with familial Mediterranean fever (FMF) in southeast Turkey. Methods: A total of 507 children (274 females) with FMF and MEFV gene mutation(s) were included. A 15-year retrospective evaluation was conducted; parameters analyzed were: age, sex, age at symptoms onset, age at FMF diagnosis, delay between symptoms onset and diagnosis, FMF attack symptoms, and response to colchicine. Disease severity scores were calculated and MEFV mutation analysis was performed via real-time PCR for the 6 most frequent mutations. Children with comorbid diseases or tested negative for MEFV gene mutations were excluded to provide homogeneity. Results: A family history of FMF was found in 60.2% (n=305) of patients. The most common symptoms reported for FMF attacks were abdominal pain (98.0%), fever (93.9%) and arthralgia (47.3%); 75.0% of patients (n= 380) were heterozygous, 14.2% were homozygous (n= 72) and 10.8% were compound heterozygous (n= 55). The following MEFV gene mutation alleles were identified: E148Q (40.1%), M694V (25.9%), V726A (15.8%), R761H (7.4%), M680I (6.8%), and P369S (4.1%). The M694V subgroup had the lowest mean age of disease onset and the highest mean disease severity score, whereas the E148Q group had later mean disease onset and the lowest mean disease severity score (p<0.05). Conclusion: The highest E148Q mutation frequency and milder disease in the course of FMF in our study population may be due to geographic and ethnic background dissimilarities of southeast Turkey.
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    A Rare Cause of Neonatal Liver Failure: Neonatal Hemochromatosis
    (Duzce Univ, 2013) Uluca, Unal; Sivash, Ercan; Erkan, Melih Engin; Kervancioglu, Selim; Karakok, Metin; Tan, Ilhan
    Neonatal hemochromatosis (NH) is a severe rare liver disease in neonatal period associated with ekstrahepatic siderosis. This disease is characterized by hepatocellular insufficiency that presented with jaundice, hypoglycemia, hypoalbuminemia, low fibrinogen levels, thrombocytopenia, anemia, direct and indirect hyperbilirubinemia from the first days of life. Herein we reported a case with Rh incompatibility whose jaundice was noted at the first day of life and referred to our hospital for exchange transfusion, but thereafter diagnosed as NH and reviewed the literature in the view point of the latest developments related to the topic.
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    Urinary early kidney injury molecules in children with beta-thalassemia major
    (Taylor & Francis Ltd, 2015) Sen, Velat; Ece, Aydin; Uluca, Unal; Soker, Murat; Gunes, Ali; Kaplan, Ibrahim; Tan, Ilhan
    Background: The aim of this study was to investigate novel urinary biomarkers including N-acetyl-beta-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and liver-type fatty acid binding protein (L-FABP) in children with beta-thalassemia major (beta-TM). Materials and methods: Totally, 52 patients (29 boys, 23 girls) with beta-TM and 29 healthy controls (3-17 years) were included. Various demographic characteristics and blood transfusions/year, disease duration, and chelation therapy were recorded. Serum urea, creatinine, electrolytes, and ferritin and urinary creatinine, protein, calcium, phosphorus, sodium, potassium, and uric acid in first morning urine samples were measured and estimated glomerular filtration rate (eGFR) was calculated. Routine serum and urinary biochemical variables, urinary NAG to Creatinine (U-NAG/Cr), U-NGAL/Cr, UKIM-1/Cr, and UL-FABP/Cr ratios were determined. Results: Patients had similar mean serum urea, creatinine and eGFR levels compared with controls (p > 0.05 for all). The mean urinary protein to creatinine (U-Protein/Cr) ratio was significantly higher in patients compared to the healthy subjects (0.13 +/- 0.09 mg/mg and 0.07 +/- 0.04 mg/mg, respectively; p < 0.001). Significantly increased U-NAG/Cr (0.48 +/- 0.58 vs. 0.23 +/- 0.16, p = 0.026) and U-NGAL/Cr (22.1 +/- 18.5 vs. 11.5 +/- 6.17, p = 0.01) ratios were found in beta-TM patients compared with healthy controls. However, no differences were found in serum and urinary electrolytes or UKIM-1/Cr and UL-FABP/Cr ratios between patients and controls (p > 0.05). Significant correlations were found between urinary biomarkers and urinary electrolytes (p < 0.05). Conclusions: Our results suggest that urinary NAG and NGAL may be considered to be reliable markers to monitor renal injury in beta-TM patients.
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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.
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    Usefulness of Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio for Evaluation of Children with Familial Mediterranean Fever
    (Int Scientific Information, Inc, 2014) Uluca, Unal; Ece, Aydin; Sen, Velat; Karabel, Duran; Yel, Servet; Gunes, Ali; Tan, Ilhan
    Background: Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of serositis, fever, and rash. Clinical and subclinical inflammatory processes may contribute to atherosclerosis in FMF patients, with mean platelet volume (MPV) as a potential indicator for atherosclerosis risk and neutrophil-tolymphocyte ratio (NLR) as a marker for subclinical inflammation in these patients. In this study, we investigated whether MPV can be used as an indicator for atherosclerosis risk and if NLR is a marker for subclinical inflammation in FMF patients. Material/Methods: The study consisted of 75 FMF patients in attack, 157 attack-free patients, and 77 healthy controls. White blood cell count neutrophil-to-lymphocyte ratio, platelet count, MPV, PDW C-reactive protein levels, and erythrocyte sedimentation rate were recorded. Results: There were no significant differences between attack, attack-free, and control groups in terms of mean MPV and PDW value. NLR value was higher in the attack group. NLR value was similar in attack-free and control groups. Conclusions: We found that MPV and PDW values are similar in FMF patients and healthy controls. NLR was higher in FMF patients in the attack period. Therefore, our results suggest that MPV and PDW values do not predict atherosclerosis risk in pediatric FMF patients, and NLR may be an indicator for attack period but not attack-free period.