Browsing by Author "Ünal F."

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    The role of fecal calprotectin in investigating pediatric ulcerative colitis
    (2012) Ünal F.; Semizel E.; Serdar M.; Ecevit C.O.; Karaca Y.; Yilmaz E.M.; Kocaefe H.; Kasirga H.E.
    Introduction: Fecal calprotectin (FCP) can be found in high concentrations in inflammatory bowel disease due to the increase in leucocyte turnover in intestinal wall or increase of migration of neutrophils into the lumen. In this study, we aimed to determine the FCP values of the ulcerative colitis (UC) patients at the time of diagnosis and to investigate the applicability and effectiveness of this non-invasive method in the diagnosis of the disease, routinely. Materials and Methods: A total of 19 patients with UC (10 females, 9 males, age: 11.5±3.5 years old) whoose stool samples collected during the diagnosis period and 20 healthy controls (10 female, 10 male, age: 10.3±4.5 years old) were included in the study. Stool samples were collected for FCP analysis by ELISA method at the time of diagnosis and before the treatment period. Results: FCP values of the UC group were statistically higher than the control group. FCP values of the UC and control groups were 398.4 μg/gr stool (56.7-2450) and 19.4 μg/gr stool (2-81), respectively (p<0.005). FCP values of the patient group with mild activity index (n=8), and moderate-severe activity index (n=11) according to the Pediatric Ulcerative Colitis Activity Index were 267.6-μg/gr stool, and 435.2 μg/gr stool, respectively (r2: 0.40, p<0.05). There was not statistical difference between the FCP values of the patients with pancolitis (422.6 μg/gr stool) and with left-sided colitis, proctitis/sigmoiditis (371.7 μg/gr stool) (p>0.05). High CRP values (89.4%), elevation of erythrocyte sedimentation rate (84.2%), leukocytosis (73.6%), thrombocytosis (68.4%), anemia (89.4%), and hypoalbuminemia (52.6%) were found. Conclusions: FCP values of the UC patients were found to be statistically higher than the control group, and increase in FCP values has been observed with increasing disease activity. Therefore, we believe that the determination of FCP could be useful at the time of diagnosis and during follow-up of the patients with UC. © The Journal of Current Pediatrics, published by Galenos Publishing.
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    Retrospective evaluation of cases diagnosed with ulcerative colitis; [Ülseratif Kolit Tanılı Olgularımızın Retrospektif Olarak Deǧerlendirilmesi]
    (Galenos Yayincilik,, 2012) Ünal F.; Şahin G.; Cebe A.; Ayhan S.; Eren F.; Kasirga E.
    Introduction: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal canal characterised by remissions and exacerbations. This study aimed to make a retrospective evaluation of clinical and laboratory findings of patients being monitored with a diagnosis of IBD. Materials and Methods: Medical records of 18 patients with a diagnosis of IBD and 7 years of follow-up at our pediatric gastroenterology departments were investigated with respect to demographic data, complaints on presentation and accompanying diseases. Unusual findings from physical examination, endoscopic findings, histopathological findings and the applied treatments were examined. Results: The 18 patients (10 female, 8 male) included in this study had a mean age of 13.6±2.9 years and the mean time from onset of symptoms to diagnosis was 6.9±4.5 months. Seventeen patients were diagnosed with ulcerative colitis and 1 patient with intermediate colitis. There was a positive family history of the disease in 2 patients (11%). At the time of diagnosis, the most common complaints on presentation were found to be abdominal pain (100%), bloody diarrhea (94.5%) and tenesmus (44.4%). The most frequent laboratory findings were CRP positivity (89%), increased sedimentation rate (83.3%) and iron-deficient anaemia (77.7%). On colonoscopy, pancolitis involvement (66.6%) was most frequently encountered. Accompanying diseases to IBD were found to be familial Mediterranean fever (FMF) (11%), celiac disease (5.5%) and Heliobacter pylori gastritis (5.5%). One patient (5.5%) who did not respond to medical treatment for pancolitis involvement underwent a colectomy. Discussion: The number of diagnoses of IBD in childhood is gradually increasing. Nonetheless, it can be difficult to define diseases with non-specific symptoms and this may cause a delay in diagnosis. Because of the association of autoimmune diseases with IBD, despite appropriate therapy, diseases with no remission which lead to gastrointestinal inflammation, such as FMF, should be further investigated. © The Journal of Current Pediatrics, published by Galenos Publishing.
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    Diagnostic and therapeutic endoscopic approaches to upper gastrointestinal system bleeding in children; [Çocuklarda üst gastrointestinal sistem kanamalarına tanısal ve tedavi edici endoskopik yaklaşımlar]
    (Galenos Yayincilik,, 2012) Ünal F.; Şahin G.; Ecevit Ç.Ö.; Semizel E.; Cebe A.; Erdoǧan H.; Kasirga E.
    Introduction: Upper gastrointestinal system bleeding in children is always very important problems requiring further investigation. The aim of the study was to investigate retrospectively the etiologies of upper gastrointestinal bleeding, the therapeutic endoscopic approach to the bleeding, and the efficacy of the endoscopy in the treatment of pediatric age group. Materials and Methods: In this study, 139 (F/M: 63/76) cases diagnosed as upper gastrointestinal bleeding and followed up by the Department of Pediatric Gastroenterology were classified into groups according to the age, etiology, the presence of varicose veins, and history of drug ingestion. In addition bleedings caused by peptic ulcer disease were classified according to Forrest classification. Values of p<0.05 were of considered as significant. Results: Upper gastrointestinal bleedings were originated from varicose veins in 15.1% of patients and non-variceal origin in 70.5% of patients. The location of bleeding could not be determined in 14.4% of the patients. The history of drug ingestion was obtained most commonly between 3-9 ages. Sixty patients underwent the procedures of endoscopic band ligation (23.3%), endoscopic sclerotherapy (10%), endoscopic hemoclips application (25%), epinephrine injection (30%), polipectomy (5%), and cauterization (6.7%) according to the etiology. In terms of stopping the bleeding, there was no statistically significant difference between endoscopic hemoclips application and epinephrine injection (p>0.68). Discussion: Endoscopic procedure is very useful in both the determination of etiology of upper gastrointestinal bleeding and the treatment of upper gastrointestinal bleeding in childhood. © The Journal of Current Pediatrics, published by Galenos Publishing.
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    Plasma selenium levels in celiac disease patients on a gluten -free diet; [Glutensiz diyet alan çölyak hastası çocuklarda serum selenyum düzeyleri]
    (Galenos Yayincilik,, 2012) Ünal F.; Umman C.; Tok A.C.; Semizel E.; Ecevit C.O.; Özdemir S.; Taneli F.; Kasirga E.
    Introduction: Celiac disease (CD) is a gluten-induced enteropathy that results in malabsorption of nutrients such as selenium. A high incidence of malignancy in CD has been previously reported. Selenium is known to have a protective role against cancer. This study aimed to investigate whether there is an effect on serum selenium levels in children with CD on a gluten-free diet. Materials and Methods: Serum levels of selenium were studied in 17 children (mean age 5.64±3.30 years) with CD and 20 age-and gender-matched healthy children. CD was diagnosed according to ESPGHAN criteria. All the patients were clinically well and had been on gluten-free diets for 11.11±1.98 (mean±SE) months. All patients were fully consistent with the diet. The concentration of selenium was determined by a periodically validated atomic absorption spectrometer (Perkin Elmer AAS 700 system). Wet ashing procedure was used for all samples and controls. Results: In CD group one child's (5.8%), and in control group three children's (%15) serum selenium levels were found under normal limits. There was no statistically significant difference between serum selenium levels and the duration of gluten free diet (p>0.05). There was no statistically significant difference in serum selenium levels between celiac patients (124.19±12.31 μg/L) and control group (92.47±12.06 μg/L), (p>0.05). Discussion: It can be concluded that, normal levels of serum selenium in children with CD can be achieved with fully compatible gluten-free diet and a balanced diet which supplies daily selenium requirement. © The Journal of Current Pediatrics, published by Galenos Publishing.
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    Portal hypertension in childhood: Two centers experience and literature review; [Çocukluk çağında portal hipertansiyon: İki merkez deneyimi ve literatür incelemesi]
    (Galenos Yayincilik,, 2015) Appak Y.Ç.; Ünal F.; Kasırga E.
    Introduction: In this study, our objective is to make an assessment of the patients whom we have followed with portal hypertension. Materials and Methods: A total of 21 portal hypertension patients, followed between 2005 and 2013, were evaluated retrospectively with regards to demographic data, complaints leading to their application and treatments they received. Results: The average age of the patients was 9.3±5.3, 38.1% of the patients were female and 61.9% were male. Of the patients, 28.6% received portal hypertension diagnosis due to gastrointestinal system bleeding, 14.3% due to abdominal distention, 28.6% due to splenomegaly, 9.5% due to hepatosplenomegaly and 19% due to elevated liver function tests. The average age of receiving the diagnosis was 6.8±4.7 and duration of the follow-up was 3.4±1.7 years. Of the patients, 85.7% had esophageal varices according to the upper gastrointestinal system endoscopy and beta-blocker therapy was applied to all patients except for one. The follow-up of the patients revealed that 52.4% of them had gastrointestinal bleeding secondary to portal hypertension. The patients received sclerotherapy (4.8%), band ligation (19%), band ligation and sclerotherapy together (23.8%). One patient received Rex Shunt and two patients had distal splenorenal shunt. Conclusions: Variceal hemorrhage is the most important complication observed in the follow-up of the portal hypertension. Portal hypertension complications can be prevented with early diagnosis as a result of taking medical, endoscopic and surgical measures. © The Journal of Current Pediatrics, published by Galenos Publishing.
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    Relationship between duodenal histopathology and strong positive tissue transglutaminase antibodies in children with celiac disease; [Çölyak hastası çocuklarda duodenal histopatoloji ve güçlü pozitif doku transglutaminaz antikorları arasındaki ilişki]
    (Galenos Yayincilik,, 2015) Doğan G.; Ayhan S.; Yılmaz B.; Appak Y.Ç.; Dündar P.E.; Ecemiş T.; Ünal F.; Kasırga E.
    Introduction: In celiac disease (CD) strong positive tissue transglutaminase antibody (TTGA) levels (≥100 U/A) have been shown to almost always indicate villous atrophy. The aim of this study is to determine the sufficiency of ≥100 U/A Ig A type TTGA levels for diagnosis of CD. Materials and Methods: Results from duodenum biopsy performed due to positive TTGA in 197 children were retrospectively examined. IgA TTGA levels had a positive value of >18 U/A. Increases of 5 times or more than this threshold value (≥100 U/A) are accepted as strong positivity. CD diagnosis was made according to ESPGHAN criteria. A modified Marsh stage ≥2 was accepted as significant for CD. Results: Of the cases, 129 were female (65.5%) and 68 were male (34.5%). Duodenum histopathology was compatible with Marsh 0 for 1 case (0.5%), Marsh 2 for 17 cases (8.6%), Marsh 3a for 41 (20.8%), Marsh 3b for 81 (41.4%) and Marsh 3c for 57 (28.9%). The TTGA levels of 64 of the 197 cases (32.5%) were ≥100 U/A. In cases with strong positivity for TTGA the duodenum histology was compatible with Marsh 3 (villous atrophy) for 63 and Marsh 0 (normal histology) for 1 case (type 1 diabetic and asymptomatic for CD). For Marsh 3c TTGA levels ≥100 U/A had a sensitivity of 85.96% (95% CI: 74.2-93.7%), specificity of 89.29% (95% CI: 82.9-93.8%), positive predictive value of 76.56% (95% CI: 64.3-86.2%) and negative predictive value of 93.9% (95% CI: 88.4- 97.3%). Conclusions: This study showed that positive IgA TTGA levels (≥100 U/A) were almost always accompanied by Marsh 3 duodenal histopathological changes. Diagnosis of CD without biopsy may miss certain accompanying diseases, however in some cases with advanced examinations CD may be diagnosed by pediatric gastroenterology specialists without endoscopy. © The Journal of Current Pediatrics, published by Galenos Publishing.
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    The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T)
    (Taylor and Francis Ltd, 2019) Ercan E.S.; Polanczyk G.; Akyol Ardıc U.; Yuce D.; Karacetın G.; Tufan A.E.; Tural U.; Aksu H.; Aktepe E.; Rodopman Arman A.; Başgül S.; Bılac O.; Coşkun M.; Celık G.G.; Karakoc Demırkaya S.; Dursun B.O.; Durukan İ.; Fidan T.; Perdahlı Fiş N.; Gençoğlan S.; Gökçen C.; Görker I.; Görmez V.; Gündoğdu Ö.Y.; Gürkan C.K.; Hergüner S.; Tural Hesapçıoğlu S.; Kandemir H.; Kılıç B.G.; Kılınçaslan A.; Mutluer T.; Nasiroğlu S.; Özel Özcan Ö.; Öztürk M.; Öztop D.; Yalın Sapmaz S.; Süren S.; Şahin N.; Yolga Tahıroglu A.; Toros F.; Ünal F.; Vural P.; Perçinel Yazıcı İ.; Yazıcı K.U.; Yıldırım V.; Yulaf Y.; Yüce M.; Yüksel T.; Akdemir D.; Altun H.; Ayık B.; Bilgic A.; Hekim Bozkurt Ö.; Demirbaş Çakır E.; Çeri V.; Üçok Demir N.; Dinç G.; Irmak M.Y.; Karaman D.; Kınık M.F.; Mazlum B.; Memik N.Ç.; Foto Özdemir D.; Sınır H.; Ince Taşdelen B.; Taşkın B.; Uğur Ç.; Uran P.; Uysal T.; Üneri Ö.; Yilmaz S.; Seval Yılmaz S.; Açıkel B.; Aktaş H.; Alaca R.; Alıç B.G.; Almaidan M.; Arı F.P.; Aslan C.; Atabay E.; Ay M.G.; Aydemir H.; Ayrancı G.; Babadagı Z.; Bayar H.; Çon Bayhan P.; Bayram Ö.; Dikmeer Bektaş N.; Berberoğlu K.K.; Bostan R.; Arıcı Canlı M.; Cansız M.A.; Ceylan C.; Coşkun N.; Coşkun S.; Çakan Y.; Demir İ.; Demir N.; Yıldırım Demirdöğen E.; Doğan B.; Dönmez Y.E.; Dönder F.; Efe A.; Eray Ş.; Erbilgin S.; Erden S.; Ersoy E.G.; Eseroğlu T.; Kına Fırat S.; Eynallı Gök E.; Güler G.; Güles Z.; Güneş S.; Güneş A.; Günay G.; Gürbüz Özgür B.; Güven G.; Çelik Göksoy Ş.; Horozcu H.; Irmak A.; Işık Ü.; Kahraman Ö.; Kalaycı B.M.; Karaaslan U.; Karadağ M.; Kılıc H.T.; Kılıçaslan F.; Kınay D.; Kocael Ö.; Bulanık Koç E.; Kadir Mutlu R.; Lushi-Şan Z.; Nalbant K.; Okumus N.; Özbek F.; Akkuş Özdemir F.; Özdemir H.; Özkan S.; Yıldırım Özyurt E.; Polat B.; Polat H.; Sekmen E.; Sertçelik M.; Sevgen F.H.; Sevince O.; Süleyman F.; Shamkhalova Ü.; Eren Şimşek N.; Tanır Y.; Tekden M.; Temtek S.; Topal M.; Topal Z.; Türk T.; Uçar H.N.; Uçar F.; Uygun D.; Uzun N.; Vatansever Z.; Yazgılı N.G.; Miniksar Yıldız D.; Yıldız N.
    Aim: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. Method: A nation-wide, randomly selected, representative population of 5830 children (6–13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. Results: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. Conclusion: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group. © 2019, © 2019 The Nordic Psychiatric Association.
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    Familial mediterranean fever mutation analysis in pediatric patients with İnflammatory Bowel Disease: A multicenter study
    (AVES, 2021) Urganci N.; Ozgenc F.; Kuloǧlu Z.; Yüksekkaya H.; Sari S.; Erkan T.; Önal Z.; Çaltepe G.; Akçam M.; Arslan D.; Arslan N.; Artan R.; Aydoǧan A.; Balamtekin N.; Baran M.; Baysoy G.; Çakir M.; Dalgiç B.; Doǧan Y.; Durmaz O.; Ecevit C.; Eren M.; Gökçe S.; Gülerman F.; Gürakan F.; Hizli S.; Işik I.; Kalayci A.G.; Kansu A.; Kutlu T.; Karabiber H.; Kasirga E.; Kutluk G.; Hoşnut F.O.; Özen H.; Özkan T.; Öztürk Y.; Soylu O.B.; Tutar E.; Tümgör G.; Ünal F.; Ugraş M.; Üstündaǧ G.; Yaman A.
    Background: The aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases has been reported previously. Methods: Children with IBD (334 ulcerative colitis (UC), 224 Crohn's disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. Results: A total of 597 children (mean age: 10.8 ± 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/ heterozygous) in patients with UC (P < .05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P = .031, P = .045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P = .007). Conclusion: Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not have a high impact on inflammatory response and clinical outcome of the disease. Copyright © 2021 by The Turkish Society of Gastroenterology.
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    Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD
    (SAGE Publications Inc., 2022) Ercan E.S.; Unsel-Bolat G.; Tufan A.E.; Karakoc Demirkaya S.; Bilac O.; Celik G.; Kılıç B.G.; Akyol Ardic U.; Yalin Sapmaz S.; Aksu H.; Yolga Tahiroglu A.; Karacetin G.; Tural U.; Aktepe E.; Rodopman Arman A.; Başgül S.; Coşkun M.; Dursun O.B.; Durukan İ.; Perdahli Fiş N.; Gençoğlan S.; Gökçen C.; Sarı Gokten E.; Görker I.; Görmez V.; Yıldız Gündoğdu Ö.; Hesapçioğlu S.T.; Kandemir H.; Mutluer T.; Nasiroğlu S.; Özcan Ö.; Şahin N.; Toros F.; Perçinel Yazici İ.; Yazici K.U.; Yulaf Y.; Yüksel T.; Bilgic A.; Altun H.; Akdemir D.; Mazlum B.; Çakın Memik N.; Foto Özdemir D.; Üneri Ö.; Ünal F.
    Objective: This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children. Method: The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants. Results: The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses. Conclusion: Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD. © ©The Author(s) 2021.