Browsing by Author "Eren, E"

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    Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings
    Eren, E; Arslanoglu, S; Aktas, A; Kopar, A; Ciger, E; Önal, K; Katilmis, H
    The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS > 7 or RSI > 13 was considered reflux positive. Fleiss' kappa (kappa) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (kappa = 0.078), ventricular obliteration (kappa = 0.206), diffuse laryngeal edema (kappa = 0.204), and posterior laryngeal hypertrophy (kappa = 0.27), intermediate for laryngeal erythema/hyperemia (kappa = 0.42) and vocal fold edema (kappa = 0.42), and high for thick endolaryngeal mucus (kappa = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.
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    Mucosal trauma induced apoptosis in guinea pig middle ear: Comparision of hemostatic agents
    Eren, E; Basoglu, MS; Kulduk, E; Simsek, F; Inan, S
    Objective: The aim of this study is to compare the effects of the absorbable gelatin sponge (AGS), microporous polysaccharide hemospheres (MPH), and Ankaferd on wound healing after middle ear trauma and to evaluate their ototoxicity in an experimental guinea pig model. Methods: Middle ear mucosal trauma was created in 21 healthy adult guinea pigs. MPH, Ankaferd, and AGS were applied into the right tympanic bulla of the guinea pigs (7 ears for each treatment modality). The left ears of the seven animals were used as the sham group. At the fourth postoperative week (28-30 days), the guinea pigs were decapitated. Apoptosis was investigated, and the expression of Bc1-xl, Apaf, p53, cytochrome 3, and caspase 3 were evaluated. Results: The Ankaferd and AGS groups demonstrated significantly lower epithelial thickness, inflammation, and capillary dilatation than did the control group (p < 0.001, <0.001, /0.001, <0.001/, 0.005, and 0.005, respectively). A statistically significant decrease in Bc1-xl staining was observed in the middle ears of animals treated with MPH (p = 0.003). There was significantly higher caspase 3 expression in the Ankaferd and AGS groups than in the control group (p < 0.001 and p = 0.002, respectively). Conclusion: Light microscopy indicates that Ankaferd and AGS create less inflammation and increased caspase expression, which seems to induce inflammatory cell apoptosis. Ankaferd seems to be a promising hemostatic agent in otology. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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    Increased expression of VEGF, iNOS, IL-1β, and IL-17 in a rabbit model of gastric content-induced middle ear inflammation
    Basoglu, MS; Eren, E; Aslan, H; Kolatan, HE; Özbay, C; Inan, S; Karaca, F; Öztürkcan, S; Katilmis, H
    Objective: To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1 beta, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure. Methods: Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1 beta, and IL-17 expression. Experimental and control animals were examined using the same protocol. Results: The expression levels of VEGF, INOS, IL-1 beta, and IL-17 differed significantly between the experimental and control groups (p = 0.018, p = 0.010, p = 0.002, and p = 0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p = 0.132). Conclusion: This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1 beta, IL-17, and iNOS. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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    Diagnosis of allergic rhinitis: inter-rater reliability and predictive value of nasal endoscopic examination: a prospective observational study
    Eren, E; Aktas, A; Arslanoglu, S; Kopar, A; Ciger, E; Özkul, Y; Önal, K; Katilmis, H
    ObjectiveTo determine the inter-rater reliability of nasal endoscopic findings and the feasibility of diagnosis of allergic rhinitis based solely on symptoms and nasal endoscopy. DesignProspective observational study. SettingUniversity Teaching hospital. ParticipantsOne hundred and eight patients were referred from the allergy clinic included in the study. Main outcome measuresPredictive value of symptoms and nasal endoscopic examination to diagnose allergic rhinitis and inter-rater reliability of the examination were evaluated. ResultsLogistic regression analysis of patient symptoms and nasal examination findings revealed no significant predictive power for any of the symptoms or examination findings. The Fleiss coefficient of the three raters was calculated. Inter-rater variability among the three physicians demonstrated that mucosal oedema (=0,48, P<0.001), polypoid degeneration of the inferior turbinate tail (=0.48, P=0.01), nasal polyps (=0.96, P<0.001) and nasal septal deviation (=0.65, P=0.01) showed significant inter-rater agreement. A low coefficient (0.29) was found, and the inter-rater variability among physicians in interpreting the characteristics of nasal secretions was significant (P=0.04). The inter-rater variability among the three physicians suggested that turbinate hypertrophy (=0.31) and turbinate colour (=0.38) showed no significant inter-rater agreement. ConclusionsPatient symptoms and nasal endoscopy findings do not provide reliable diagnosis of allergic rhinitis. Turbinate colour and hypertrophy are believed to be related to allergic rhinitis; however, these were subject to marked inter-rater variability in this study.
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    The Frequency of Lysosomal Acid Lipase Deficiency in Children With Unexplained Liver Disease
    Kuloglu, Z; Kansu, A; Selbuz, S; Kalayci, AG; Sahin, G; Kirsaclioglu, CT; Demirören, K; Dalgiç, B; Kasirga, E; Önal, Z; Islek, A; Eren, E; Hosnut, FÖ; Urganci, N; Yaman, A; Özkan, T; Bozbulut, E; Dogan, G; Eksi Bozbulut, N; Dogan, G; Durmaz Ugurcan, Ö; Usta, AM; Arslan, D; Akçam, M; Isik, IA; Ecevit, ÇÖ; Usta, Y; Özgür, T; Özçay, F; Balamtekin, N; Öztürk, Y; Balamtekin, N; Öztürk, Y; Cantez, S; Gülerman, F; Üstündag, GH; Emiroglu, HH; Karacabey, N; Comba, A; Erdemir, G; Aydogan, AU; Gökçe, S; Kuyum, P; Gülsan, M; Tosun, MS; Tokgöz, Y; Güven, B; Yüksekkaya, H; Tümgör, G; Eren, M; Baran, M; Gümüs, M; Canan, O; Kocamaz, H; Gerenli, N; Çakir, M; Agin, M; Hizli, S; Dogan, Y; Çeltik, Ç; Deveci, U; Balci Sezer, O
    Objectives: Evidence suggests that lysosomal acid lipase deficiency (LAL-D) is often underdiagnosed because symptoms may be nonspecific. We aimed to investigate the prevalence of LAL-D in children with unexplained liver disease and to identify demographic and clinical features with a prospective, multicenter, cross-sectional study. Methods: Patients (aged 3 months-18 years) who had unexplained transaminase elevation, unexplained hepatomegaly or hepatosplenomegaly, obesity-unrelated liver steatosis, biopsy-proven cryptogenic fibrosis and cirrhosis, or liver transplantation for cryptogenic cirrhosis were enrolled. A Web-based electronic data collection system was used. LAL activity (nmol/punch/h) was measured using the dried blood spot method and classified as LAL-D(<0.02), intermediate (0.02-0.37) or normal (>0.37). Asecond dried blood spot sample was obtained from patients with intermediate LAL activity for confirmation of the result. Results: A total of 810 children (median age 5.6 years) from 795 families were enrolled. The reasons for enrollment were unexplained transaminase elevation (62%), unexplained organomegaly (45%), obesity-unrelated liver steatosis (26%), cryptogenic fibrosis and cirrhosis (6%), and liver transplantation for cryptogenic cirrhosis (<1%). LAL activity was normal in 634 (78%) and intermediate in 174 (21%) patients. LAL-D was identified in 2 siblings aged 15 and 6 years born to unrelated parents. Dyslipidemia, liver steatosis, and mild increase in aminotransferases were common features in these patients. Moreover, the 15-year-old patient showed growth failure and microvesicular steatosis, portal inflammation, and bridging fibrosis in the liver biopsy. Based on 795 families, 2 siblings in the same family were identified as LAL-D cases, making the prevalence of LAL-D in this study population, 0.1% (0.125%-0.606%). In the repeated measurement (76/174), LAL activity remained at the intermediate level in 38 patients. Conclusions: Overall, the frequency of LAL-D patients in this study (0.1%) suggests that LAL-D seems to be rare even in the selected high-risk population.
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    Mutation spectrum of GCK, HNF1A and HNF1B in MODY patients and 40 novel mutations
    Ozkinay, F; Isik, E; Simsek, DG; Aykut, A; Karaca, E; Ozen, S; Bolat, H; Atik, T; Saygili, F; Kartal, E; Gul, U; Anik, A; Tutunculer, F; Eren, E; Ozbek, MN; Bober, E; Abaci, A; Kirel, B; Ersoy, B; Buyukinan, M; Kara, C; Cakir, EP; Yildirim, R; Isguven, P; Dagdeviren, A; Agladioglu, SY; Dogan, M; Sangun, O; Arslanoglu, I; Korkmaz, HA; Temiz, F; Onay, H
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    Analysis of the GCK gene in 79 MODY type 2 patients: A multicenter Turkish study, mutation profile and description of twenty novel mutations
    Aykut, A; Karaca, E; Onay, H; Göksen, D; Çetinkalp, S; Eren, E; Ersoy, B; Çakir, EP; Büyükinan, M; Kara, C; Anik, A; Kirel, B; Özen, S; Atik, T; Darcan, S; Özkinay, F
    Maturity onset diabetes is a genetic form of diabetes mellitus characterized by an early age at onset and several etiologic genes for this form of diabetes have been identified in many patients. Maturity onset diabetes type 2 [MODY2 (#125851)] caused by mutations in the glucokinase gene (GCK). Although its prevalence is not clear, it is estimated that 1%-2% of patients with diabetes have the monogenic form. The aim of this study was to evaluate the molecular spectrum of GCK gene mutations in 177 Turkish MODY type 2 patients. Mutations in the GCK gene were identified in 79 out of 177. All mutant alleles were identified, including 45 different GCK mutations, 20 of which were novel.
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    Anthropometric findings from birth to adulthood and their relation with karyotpye distribution in Turkish girls with Turner syndrome
    Sari, E; Bereket, A; Yesilkaya, E; Bas, F; Bundak, R; Aydin, BK; Darcan, S; Dündar, B; Büyükinan, M; Kara, C; Adal, E; Akinci, A; Atabek, ME; Demirel, F; Çelik, N; Öakan, B; Özhan, B; Orbak, Z; Ersoy, B; Dogan, M; Atas, A; Turan, S; Göksen, D; Tarim, Ö; Yüksel, B; Ercan, O; Hatun, S; Simsek, E; Ökten, A; Abaci, A; Döneray, H; Özbek, MN; Keskin, M; Önal, H; Akyürek, N; Bulan, K; Tepe, D; Emeksiz, HC; Demir, K; Kizilay, D; Topaloglu, AK; Eren, E; Özen, S; Demirbilek, H; Abali, S; Akin, L; Eklioglu, BS; Kaba, S; Anik, A; Bas, S; Unuvar, T; Saglam, H; Bolu, S; Özgen, T; Dogan, D; Çakir, ED; Sen, Y; Andiran, N; Çizmecioglu, F; Evliyaoglu, O; Karagüzel, G; Pirgon, Ö; Çatli, G; Can, HD; Gürbüz, F; Binay, Ç; Bas, VN; Fidanci, K; Gül, D; Polat, A; Acikel, C; Cinaz, P; Darendeliler, F
    To evaluate the anthropometric features of girls with Turner syndrome (TS) at birth and presentation and the effect of karyotype on these parameters. Data were collected from 842 patients with TS from 35 different centers, who were followed-up between 1984 and 2014 and whose diagnosis age ranged from birth to 18 years. Of the 842 patients, 122 girls who received growth hormone, estrogen or oxandrolone were excluded, and 720 girls were included in the study. In this cohort, the frequency of small for gestational age (SGA) birth was 33%. The frequency of SGA birth was 4.2% (2/48) in preterm and 36% (174/483) in term neonates (P<0.001). The mean birth length was 1.3cm shorter and mean birth weight was 0.36kg lower than that of the normal population. The mean age at diagnosis was 10.1 +/- 4.4 years. Mean height, weight and body mass index standard deviation scores at presentation were -3.1 +/- 1.7, -1.4 +/- 1.5, and 0.4 +/- 1.7, respectively. Patients with isochromosome Xq were significantly heavier than those with other karyotype groups (P=0.007). Age at presentation was negatively correlated and mid-parental height was positively correlated with height at presentation. Mid-parental height and age at presentation were the only parameters that were associated with height of children with TS. The frequency of SGA birth was found higher in preterm than term neonates but the mechanism could not be clarified. We found no effect of karyotype on height of girls with TS, whereas weight was greater in 46,X,i(Xq) and 45,X/46,X,i(Xq) karyotype groups. (c) 2016 Wiley Periodicals, Inc.
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    Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART)
    Ecevit, MC; Özcan, M; Can, IH; Tatar, EC; Özer, S; Esen, E; Atan, D; Göde, S; Elsurer, C; Eryilmaz, A; Coskun, BU; Yazici, ZM; Dinç, ME; Ozdogan, F; Gunhan, K; Bilal, N; Korkut, AY; Kasapoglu, F; Türk, B; Server, EA; Çelebi, ÖÖ; Simsek, T; Kum, RO; Adali, MK; Eren, E; Aslier, NGY; Bayindir, T; Çetin, AC; Göker, AE; Güvenç, IA; Köseoglu, S; Özler, GS; Sahin, E; Yilmaz, AS; Güne, C; Yildirim, GA; Öca, B; Durmusoglu, M; Kantekin, Y; Özmen, S; Kubat, GO; Sanal, SK; Altuntas, EE; Selçuk, A; Yazici, H; Baklaci, D; Yaylaci, A; Hanci, D; Dogan, S; Fidan, V; Uygur, K; Keles, N; Cingi, C; Topuz, B; Çanakçioglu, S; Önerci, M
    Object: To prepare a national guideline for Oto-rhinolaryngologist who treat allergic rhinitis patients Methods: The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013- 2017) and randomized controlled studies published in last two years (2015- 2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. Results: A detailed guideline about all aspects of allergic rhinitis was created. Conclusion: The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.
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    Growth curves for Turkish Girls with Turner Syndrome: Results of the Turkish Turner Syndrome Study Group
    Darendeliler, F; Yesilkaya, E; Bereket, A; Bas, F; Bundak, R; Sari, E; Aydin, BK; Darcan, S; Dündar, B; Büyükinan, M; Kara, C; Mazicioglu, MM; Adal, E; Akinci, A; Atabek, ME; Demirel, F; Çelik, N; Özkan, B; Özhan, B; Orbak, Z; Ersoy, B; Dogan, M; Atas, A; Turan, S; Göksen, D; Tarim, Ö; Yüksel, B; Ercan, O; Hatun, S; Simsek, E; Ökten, A; Abaci, A; Döneray, H; Özbek, MN; Keskin, M; Önal, H; Akyürek, N; Bulan, K; Tepe, D; Emeksiz, HC; Demir, K; Kizilay, D; Topaloglu, AK; Eren, E; Özen, S; Demirbilek, H; Abali, S; Akin, L; Eklioglu, BS; Kaba, S; Anik, A; Bas, S; Ünüvar, T; Saglam, H; Bolu, S; Özgen, T; Dogan, D; Çakir, ED; Sen, Y; Andiran, N; Çizmecioglu, F; Evliyaoglu, O; Karagüzel, G; Pirgon, Ö; Çatli, G; Can, HD; Gürbüz, F; Binay, Ç; Bas, VN; Saglam, C; Gül, D; Polat, A; Açikel, C; Cinaz, P
    Objective: Children with Turner syndrome (TS) have a specific growth pattern that is quite different from that of healthy children. Many countries have population-specific growth charts for TS. Considering national and ethnic differences, we undertook this multicenter collaborative study to construct growth charts and reference values for height, weight and body mass index (BMI) from 3 years of age to adulthood for spontaneous growth of Turkish girls with TS. Methods: Cross-sectional height and weight data of 842 patients with TS, younger than 18 years of age and before starting any therapy, were evaluated. Results: The data were processed to calculate the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile values for defined ages and to construct growth curves for height-for-age, weight-for-age and BMI-for-age of girls with TS. The growth pattern of TS girls in this series resembled the growth pattern of TS girls in other reports, but there were differences in height between our series and the others. Conclusion: This study provides disease-specific growth charts for Turkish girls with TS. These disease-specific national growth charts will serve to improve the evaluation of growth and its management with growth-promoting therapeutic agents in TS patients.
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    Turner Syndrome and Associated Problems in Turkish Children: A Multicenter Study
    Yesilkaya, E; Bereket, A; Darendeliler, F; Bas, F; Poyrazoglu, S; Aydin, BK; Darcan, S; Dündar, B; Büyükinan, M; Kara, C; Sari, E; Adal, E; Akinci, A; Atabek, ME; Demirel, F; Çelik, N; Özkan, B; Özhan, B; Orbak, Z; Ersoy, B; Dogan, M; Atas, A; Turan, S; Göksen, D; Tarim, Ö; Yüksel, B; Ercan, O; Hatun, S; Simsek, E; ÖOkten, A; Abaci, A; Döneray, H; Özbek, MN; Keskin, M; Önal, H; Akyürek, N; Bulan, K; Tepe, D; Emeksiz, HC; Demir, K; Kizilay, D; Topaloglu, AK; Eren, E; Özen, S; Abali, S; Akin, L; Eklioglu, BS; Kaba, S; Anik, A; Bas, S; Ünüvar, T; Saglam, H; Bolu, S; Özgen, T; Dogan, D; Çakir, ED; Sen, Y; Andiran, N; Çizmecioglu, F; Evliyaoglu, O; Karagüzel, G; Pirgon, Ö; Çatli, G; Can, HD; Gürbüz, F; Binay, C; Bas, VN; Fidanci, K; Polat, A; Gül, D; Açikel, C; Demirbilek, H; Cinaz, P; Bondy, C
    Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45, X (50.7%), followed by 45, X/46, XX (10.8%), 46, X, i(Xq) (10.1%) and 45, X/46, X, i(Xq) (9.5%). Mean age at diagnosis was 10.2 +/- 4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45, X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosis) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto's thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan.
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