Browsing by Author "Ertan, P"

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    Metabolic and demographic characteristics of children with urolithiasis in Western Turkey
    Ertan, P; Tekin, G; Öger, N; Alkan, S; Horasan, GD
    Pediatric urolithiasis is an endemic disease in Turkey. We evaluated the clinical, radiological and metabolic features of children with urolithiasis in Western Turkey. We retrospectively reviewed the records of 85 children with urolithiasis who were followed-up between 2004 and 2010 in Pediatric Nephrology Department of Celal Bayar University, Manisa. The male/female ratio was 1.23/1. The mean age at diagnosis was 66.1 months (range 3-210 months). Family history of urolithiasis was found in 58 (68.2%) patients. 23 (27%) patients were born from consanguineous marriages. Stones were located in the upper urinary tract in 79 (92.9%) patients. In 66 (77.6%) patients, stones were single-sided and 41 (48.2%) patients had multiple stones. Calcium oxalate stones were the most common one among patients in whom stone analysis was performed (78.5%). Hypocitraturia was the most commonly detected urinary metabolic risk factor. In patients who were under 12 months of age at diagnosis, hypercalciuria was the most commonly seen urinary metabolic risk factor. At the end of follow-up period, 24 patients became free of stone disease and 4 patients had recurrence. In conclusion, metabolic abnormalities are common in pediatric stone patients and are strongly associated with recurrence. Considering that urolithiasis in children is an important risk factor for renal failure, early diagnosis, detailed metabolic evaluation and implementing appropriate treatment and follow-up protocols may prevent recurrence and renal damage.
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    Henoch-Schonlein purpura, post-streptococcal glomerulonephritis and acute rheumatic carditis after Group A β-haemolytic streptococcal infection
    Çamlar, SA; Soylu, A; Akil, I; Ünlü, M; Coskun, S; Ertan, P; Kavukçu, S
    Besides association with acute rheumatic fever (ARF) and acute glomerulonephritis (APSGN), in up to 40% of cases, Group A beta-haemolytic streptococcal (GABHS) infections are also implicated as a trigger for Henoch-Schonlein purpura (HSP). A 7-year-old girl with GABHS throat infection who developed HSP, APSGN and rheumatic carditis is reported. She presented with palpable purpura and arthritis in both ankles and later developed carditis characterised by mitral/aortic regurgitation and glomerulonephritis characterised by mixed nephritic/nephrotic syndrome. She had a raised anti-streptolysin titre (ASOT), blood urea nitrogen and creatinine and hypocomplementaemia (C-3), and renal biopsy demonstrated endocapillary and extracapillary proliferative glomerulonephritis with crescents. Immunofluorescence microscopy demonstrated a full house' of immunoglobulin and complement, viz. IgA+2, IgG+3, IgM+2, C(3)c+1, Clq+2 with predominantly IgG deposition. One week earlier, her 4-year-old sister had presented to another hospital with HSP complicated by microscopic haematuria, nephrotic-range proteinuria and gastro-intestinal involvement, and with raised ASOT and low C-3 levels. Although HSP has been associated with either ARF or APSGN, this is the first case of a child with HSP, ARF and APSGN in combination.
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    CAN URINARY BIOMARKERS SUCCEED DIAGNOSTIC VALUE OF RENAL SCINTIGRAPHY IN PATIENTS WITH URETEROPELVIC JUNCTION DISRUPTION?
    Gürer, DE; Yilmaz, Ö; Ertan, P; Eser, E; Taneli, F; Aras, F; Oran, A; Genç, A; Günsar, C; Sencan, A; Gürer, E; Taneli, C
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    ChatGPT-4o's performance on pediatric Vesicoureteral reflux
    Onder, ENA; Ensari, E; Ertan, P
    Introduction Vesicoureteral reflux (VUR) is a common congenital or acquired urinary disorder in children. Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence-driven platform offering medical information. This research aims to assess the reliability and readability of ChatGPT-4o's answers regarding pediatric VUR for general, non-medical audience. Materials and methods Twenty of the most frequently asked English- language questions about VUR in children were used to evaluate ChatGPT-4o's responses. Two independent reviewers rated the reliability and quality using the Global Quality Scale (GQS) and a modified version of the DISCERN tool. The readability of ChatGPT responses was assessed through the Flesch Reading Ease (FRE) Score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), ColemanLiau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Results Median mDISCERN and GQS scores were 4 (4-5) and 5 (3-5), respectively. Most of the responses of ChatGPT have moderate (55 %) and good (45 %) reliability according to the mDISCERN score and high quality (95 %) according to GQS. The mean + standard deviation scores for FRE, FKGL, SMOG, GFI, and CLI of the text were 26 + 12, 15+2.5, 16.3+2, 18.8+2.9, and 15.3+2.2, respectively, indicating a high level of reading difficulty. Discussion While ChatGPT-4o offers accurate and high-quality information about pediatric VUR, its readability poses challenges, as the content is difficult to understand for a general audience. Conclusion ChatGPT provides high-quality, accessible information about VUR. However, improving readability should be a priority to make this information more user-friendly for a broader audience.
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    Attention deficit and hyperactivity symptoms in children with monosymptomatic nocturnal enuresis
    Ertan, P; Gönülal, D; Sögüt, A; Yilmaz, Ö; Bozgül, A; Dinç, G; Aydemir, Ö; Yüksel, H
    Aim: Monosymptomatic nocturnal enuresis in children may cause psychological and behavioral problems. The aim of this study was to assess symptoms of attention deficit and hyperactivity in children with monosymptomatic nocturnal enuresis. Material and Method Fifty-seven children (23 male, 34 female) with monosymptomatic nocturnal enuresis and 57 healthy controls (25 male, 32 female) aged 6 to 12 years participated in the study. Conners' Parent Rating Scale-48 (CPRS), a 48-item multiple-choice questionnaire, was completed by the mothers to identify the attention deficit and hyperactivity symptoms in children. Results: Mean age of the children with enuresis was 8.54 +/- 2.18 years and that of the control group 9.12 +/- 2.13 years. Attention deficit score in the enuretic group was significantly higher than that in the control group (p=0.02). Hyperactivity scores were not significantly different between the groups (p=0.36). Bedwetting frequencies were not different between enuretic children with and without attention deficit or hyperactivity symptoms (p=0.06). Conclusions: Psychological and behavioral assessment may be indicated in children with monosymptomatic nocturnal enuresis since the results of this study demonstrate increased attention deficit symptomatology. (Turk Arch Ped 2010; 45: 37-40)
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    LAPAROSCOPIC TRANSPERITONEAL DISMEMBERED PYELOPLASTY BY UTILIZING V-LOC BARBED SUTURE
    Yilmaz, O; Taneli, C; Ertan, P; Gurer, E; Genc, A
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    Sleep quality and depression-anxiety in mothers of children with two chronic respiratory diseases: Asthma and cystic fibrosis
    Yilmaz, O; Sogut, A; Gulle, S; Can, D; Ertan, P; Yuksel, H
    Background
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    LY96, UPKIB Mutations and TLR4, CD14, MBL Polymorphisms in Children with Urinary Tract Infection
    Ertan, P; Berdeli, A; Yilmaz, O; Gonulal, D; Yuksel, H
    To evaluate genetic variations of innate immune system such as mannose binding lectin (MBL), Toll like receptor 4 (TLR4), CD14, LY96 (MD2) and Uroplakin 1B (UPK1B) genes in children with recurrent urinary tract infection (UTI). The study included 30 children with recurrent UTI and 30 healthy controls. Blood was drawn and analysed for genetic polymorphisms of MBL, TLR4 and CD14 genes by the PCR-RFLP method. Direct DNA sequencing analysis was performed for LY96 and UPK 1B gene mutation in 10 children from UTI group and 5 children from control group. TLR4 gene Thr399Ile polymorphism was not observed in any child. Genotype distribution and allele frequency of Asp299Gly polymorphism was similar in both groups (p = 0.55). Codon 54 polymorphism of the MBL gene was similar in UTI and control groups (p = 0.49). -159 CC/CT/TT genotypes of CD14 gene was similar between the two groups (p = 0.14). UPK1B and LY96 gene DNA sequence analysis was similar in UTI and control groups. This study is the first study in which different parts of the innate immune system were evaluated in UTI etiopathogenesis in Turkish children. The results did not point out a significant role of any of the genes evaluated in this study.
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    SPP1 Gene Polymorphisms Associated With Nephrolithiasis in Turkish Pediatric Patients
    Tekin, G; Ertan, P; Horasan, G; Berdeli, A
    Purpose: To investigate the association between SPP1 gene polymorphisms and nephrolithiasis. Materials and Methods: A total of 65 pediatric patients and 50 healthy controls were enrolled in this study. Two known polymorphisms of the SPP1 gene, c.240T > C and c.708C > T nucleotide substitutions, both of which were also known as synonymous aminoacid polymorphisms, D80D and A236A, respectively, at SPP1 gene cDNA level, were investigated. SPP1 gene polymorphism was evaluated using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method. Results: In c.240T > C polymorphism, C allele frequency [Odds Ratio (OR), 2.13; 95% Confidence Interval (CI), 1.170 to 3.880; P = .013] and CC genotype distribution (OR, 2.946; 95% CI, 0.832 to 10.431; P = .094) and in c.708C > T polymorphism, T allele frequency (OR, 2.183; 95% CI, 1.197 to 3.980; P = .011) and TT genotype distribution (OR, 3.056; 95% Cl, 0.861 to 10.839; P = .084) were found to be higher in the patient group. Conclusion: SPP1 polymorphisms were found to be associated with nephrolithiasis and it may be suggested that SPP1 gene polymorphism could be a useful marker for evaluation of the early genetic risk factor in childhood nephrolithiasis.
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    Clinical characteristics and follow-up results of the children with unilateral renal agenesis and hypoplasia
    Evrengül, H; Ertan, P; Serdaroglu, E; Yüksel, S
    Objective: Children with an inadequate number of nephrons have an increased risk of developing hypertension, proteinuria and chronic kidney disease in later life. This renal injury is caused by glomerular hyperfiltration. The aim of this study is to evaluate clinical characteristics and follow-up results of the children with unilateral renal agenesis and hypoplasia. Methods: We evaluated the clinical, radiological, and nuclear medicine findings of the children with unilateral agenetic or hypoplastic kidneys who were followed at Celal Bayar University School of Medicine and Dr. Behcet Uz Children's Hospital between 2005 and 2012. Results: The study consisted of 30 (60%) males and 20 (40%) females with a mean age of 8.9+/-4 years. A total of 25 patients were with renal agenesis and 25 with renal hypoplasia were diagnosed. On laboratory evaluation, mean serum creatinine level was 0.45+/-0.22 mg/dl and the mean estimated glomerular filtration rate (eGFR) was 144+/-30.3 ml/min. 29 patient (58%) had hyperfiltration according to an eGFR. Proteinuria and hypertension were noted in 1 (4%) patient. Urological anomalies were found in 15 patients (30%). Conclusion: Our study has determined that children with unilateral renal agenesis and hypoplasia had normal serum creatinine values. Howewer 29 patients (58%) had hyperfiltration according to eGFR. Because many children with hiperfiltration develop renal injury in later life, we emphasize the need for clinical follow-up in these patients starting at birth.
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    Association of FAS-670A/G and FASL-843C/T Gene Polymorphisms on Allograft Nephropathy in Pediatric Renal Transplant Patients
    Ertan, P; Mir, S; Ozkayin, N; Berdeli, A
    Objective: FAS and FASL polymorphisms are suggested to play an important role in tubulitis that is a major component of acute rejection. The aim of this study was to investigate the role of FAS-670A/G and FASL-843C/T gene polymorphisms on allograft nephropathy in pediatric renal transplant patients Methods: Fifty three patients (22 males 31 females) aged 2 to 20 years (mean 12.3 +/- 0.6) who had renal transplantation and fifty healthy control subjects (25 males 25 females) were enrolled in the study. Pearson's Chi Square test was used for the statistical analysis. Survival rates were estimated with the Kaplan Meier method. Age, sex, chronic renal failure etiology, treatment modality and duration and donor type were recorded. FAS-670A/G and FASL-843C/T gene polymorphisms were compared between renal transplant patients and normal healthy population as well as between renal transplant patients with and without acute rejection. Findings: FAS-670A/G genotypes or alleles were not significantly different between control and transplant patients and among transplant patients with and without acute rejection (P>0.05 for all). FASL-843C/T genotypes and alleles were not different between transplantation and control groups (P>0.05 for all). However, FASL-843C/T alleles were significantly different between patients with and without AR (P=0.02). The percentages of C allele were higher in children with acute rejection (68.8% vs 44.6%). Conclusion: FASL gene polymorphisms may play a major role in acute rejection while FAS polymorphisms have not been found to be different between patients with and without acute, renal graft rejection.
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    Information is Power: An Interventional Study on Parents of Children with Febrile Seizures
    Kizilay, DÖ; Kirdök, AA; Ertan, P; Ayça, S; Demet, MM; Polat, M
    Aim: Febrile seizures (FS) cause great fear and panic in the families. The majority of parents think that they may lose their child during a seizure, and feel anxious about the possibility of seizures recurring in the future. We believe that educating the families with high levels of anxiety due to FS may help to reduce the level of anxiety. In this study, we aimed to determine the needs of parents regarding FS, and the effect of education on FS on the approach and anxiety of the parents. Materials and Methods: In our study, we interviewed the parents of 113 children who suffered from FS. We conducted a survey aiming at detailed detection of knowledge, attitudes, thoughts and concerns of the families about FS, and their approaches to fever and FS. We also performed Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory to determine the levels of anxiety and depression of the parents. Results: In this study, we found that parents were misinformed and had misbeliefs suggesting that FS damage the brain and cause epilepsy, that they are life-threatening and electroencephalography, magnetic resonance imaging and computed tomography scans of the brain are required. We also determined a significant lack of information about interventions during a seizure and thus, a high level of anxiety. Conclusion: We concluded that parents provided with sufficient information and given psychosocial support have their anxiety levels significantly reduced, making them better in first aid practices and reducing their requests for unnecessary preventive interventions.
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    A Case of Henoch-Schonlein Purpura with P369S Mutation in MEFV Gene
    Ertan, P; Tekin, G; Sahin, GE; Kasirga, E; Taneli, F; Kandioglu, AR; Sözeri, B
    Background: Henoch-Schonlein purpura (HSP) is the most common vasculitis of childhood. HSP can affect multiple organs presenting with a characteristic rash in most of the patients. Familial Mediterranean Fever (FMF) is an inherited inflammatory disease common in mediterranean populations. HSP is the most common vasculitis seen in children with FMF. Case Presentation: A 16 year old boy was referred with history of abdominal pain lasting for 20 days. He was hospitalized and had appendectomy. Due to the persistence of his abdominal pain after surgery he was admitted to our hospital. His physical examination showed palpable purpuric rashes symmetrically distributed on lower extremities. Abdominal examination revealed periumbilical tenderness. Laboratory tests showed elevated erythrocyte sedimentation rate, C-reactive protein and fibrinogen. Urinalysis revealed microscopic hematuria and severe proteinuria. The fecal occult blood testing was positive. Based on these clinic findings, the patient was diagnosed as HSP with renal, gastrointestinal tract and skin involvement. We performed DNA analysis in our patient because he had diagnosis of vasculitis with severe symptoms and found that he was carrying heterozygote P369S mutation. Conclusion: Our case is noteworthy as it indicates that it may be important not to overlook presence of FMF mutations in patients with a diagnosis of severe vasculitis.
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    Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children
    Yilmaz, O; Tanriverdi, HI; Cayirli, H; Ertan, P; Sencan, A; Genc, A; Taneli, C
    Introduction Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures. Material and method We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (VLoc (TM), Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion. Results The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110 min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p = 0.001 and p = 0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p = 0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months. Conclusion In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.
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    Relationship between C-reactive Protein/Albumin Ratio and Subclinical Inflammation in Patients with Familial Mediterranean Fever
    Onder, ENA; Cam, FS; Ertan, P
    Background Familial Mediterranean Fever (FMF), which is characterised by recurrent episodes of fever with serositis, is associated with ongoing inflammation without clinical findings during attack-free periods, leading to amyloidosis, the most important complication of FMF. The objective of this study was to investigate the C-reactive protein/albumin ratio (CAR) as a marker to identify subclinical inflammation in symptom-free FMF children and compare the CAR with other systemic inflammatory markers such as mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/ lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). Material and Methods We included 100 patients and 70 healthy subjects. Hospital records were obtained to collect data on laboratory findings and genetic mutations. Results We found that the CAR levels of our FMF patients were significantly higher than those of the control group. We also evaluated that the CAR values had a higher area-under-thecurve value than the other systemic inflammation parameters including CRP, MPV, RDW, NLR, PLR based on Receiver-Operating Characteristics (ROC) analysis. Conclusion It is important to identify subclinical inflammation in FMF patients with simple, reliable, easily accessible markers to avoid amyloidosis. Although the CAR might be used to assess subclinical inflammation in paediatric FMF patients, the prognostic value of CAR is not superior to CRP. Merging CRP and albumin into a single index thus provides no additional benefit in detecting subclinical inflammation in FMF.
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    Outcomes of children with isolated antenatal hydronephrosis
    Onder, ENA; Yilmaz, O; Taneli, C; Ertan, P
    BackgroundAntenatal hydronephrosis (ANH) is one of the most common abnormalities detected during prenatal ultrasound. There is significant variability in the postnatal management of ANH. Our objective was to report the outcomes of patients with ANH, spontaneous resolution rates, surgical intervention rates, and factors contributing to these parameters.MethodsA total of 227 patients and 264 renal units with ANH were included in this study. We used the renal pelvis anteroposterior diameter and the Society for Fetal Urology grading system to classify and compare ANH as mild, moderate, and severe.ResultsThe patients' median follow-up period was 48 months (with a minimum of 6 months and a maximum of 136 months). Of the 264 renal units, 123 (46.6%) had mild, 101 (38.26%) had moderate, and 40 (15.15%) had severe antenatal hydronephrosis. The spontaneous resolution rate was 91.9% in the mild hydronephrosis group (n = 113), 81.2% (n = 82) in the moderate hydronephrosis group, and 37.5% (n = 15) in the severe hydronephrosis group. The patients with higher hydronephrosis grades required a longer time to resolve. Only one patient with a posterior urethral valve had reduced estimated glomerular filtration. None of the patients had proteinuria or hypertension.ConclusionAlthough the outcome of the patients with mild hydronephrosis was excellent, there was a progression of the disease, especially within the first 6 months, and 6% of our cases required surgical intervention. Additional prospective studies are needed to define the risk of urinary tract abnormalities with any degree of ANH.