Browsing by Author "Kasirga, E"

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    Retrospective Evaluation of Cases Diagnosed with Ulcerative Colitis
    Ünal, F; Sahin, 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.
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    Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease
    Yüksel, H; Yilmaz, O; Kirmaz, C; Aydogdu, S; Kasirga, E
    Gastroesophageal reflux disease (GERD) is commonly associated with asthma; however, frequency in nonatopic children with asthmatic symptoms is unknown. The aim of this study was to determine the frequency of gastroesophageal reflux (GER) in nonatopic children with asthma-like airway disease that recur despite conventional asthma treatment and to evaluate the clinical response to lansoprazole treatment. Twent-five nonatopic children aged between 1 and 16 years who have asthma-like airway disease and 25 healthy children were included in the study. All cases underwent 24h pH monitoring with dual. sensor catheters. Additionally, acid suppressor treatment was administered to patients diagnosed as having GERD and clinical response was evaluated. Major symptoms encountered in the patient group included wheezing and cough (88%, and 32%, respectively). Reflux episodes were more common in distal esophagus during the prone position (reflux index (RI) of 11.5 +/- 10.3 vs. 16.2 +/- 9.4 during supine vs. prone). ALL distal esophageal parameters were significantly higher in the patient group except number of reflux episodes lasting longer than 5 min (RI of 13.3 +/- 13.1 vs. 3.9 +/- 2.9 in the patient vs. control groups, respectively). There was a significant improvement in symptoms and requirement for medication with treatment (number of systems decreased from 2.3 +/- 0.6 to 0.4 +/- 0.6, P = 0.00). In conclusion, GERD is significantly more common in nonatopic children with asthma-Like airway disease compared to the controls and clinical improvement is significant after acid suppressor treatment. Thus, we suggest that children followed-up with the diagnosis of nonatopic asthma with recurrent exacerbations despite adequate asthma treatment have a high frequency of GER and that Lansoprazole treatment may be considered early in management. (c) 2005 Elsevier Ltd. All rights reserved.
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    Serum zinc as a factor predicting response to interferon-α2b therapy in children with chronic hepatitis B
    Özbal, E; Helvaci, M; Kasirga, E; Akdenizoglu, F; Kizilgünesler, A
    Although it has been unclear why more than 50% of children with chronic hepatitis B virus infection do not respond to interferon therapy, in some instances resistance to interferon probably is caused by an inability to stimulate appropriately cellular immune responses to hepatitis B virus. It is known that immune integrity is tightly linked to zinc status. We examined the relationship between serum zinc levels and response to interferon (INF)-alpha therapy in children with chronic hepatitis B. Twenty-five children with chronic hepatitis B infection were injected with 5 X 10(6) units/m(2) recombinant IFN-alpha 2b subcutaneously three times weekly for 9 mo. Children were followed for at least 9 mo after the end of therapy. Sustained response was obtained in eight (32%) patients. Although initial serum zinc and alanine aminotransferase levels were significantly higher; initial hepatitis B Virus (HBV)-DNA values, hepatic activity index, periportal necrosis, and fibrosis scores were significantly lower in sustained responders than in nonresponders. Mean baseline serum zinc, alanine aminotransferase and HBV-DNA values, histologic activity index, periportal necrosis, and fibrosis scores were predictive of response to IFN-alpha 2b therapy. These findings suggest that serum zinc levels might be used as a factor predicting response to interferon-alpha 2b therapy, and so may help in identifying those children with a better chance of response.
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    Clinical findings, child and mother psychosocial status in functional constipation
    Appak, YÇ; Sapmaz, SY; Dogan, G; Herdem, A; Özyurt, BC; Kasirga, E
    Background/Aims: Functional constipation (FC) is a common problem in childhood. In this study, we aimed to analyze the clinical and sociodemographic findings of patients with FC, parenting behaviors, and psychosocial states of children and parents. Materials and Methods: According to the Roma III diagnosis criteria, 32 patients with FC and 31 healthy controls were included. Patients' clinical and sociodemographic data set associated with constipation was determined. Strengths and Difficulties Questionnaire was used to screen the emotional and behavioral problems in children. To evaluate the parents and family, Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument were used. Results: Emotional and peer problems subscale scores, parental concerns as well as over-parenting attitude were found higher in patients. Significant difference was also observed between the groups in terms of mean score of authoritarian attitude dimensions. Attitude of hostility and rejection and marital discordance was found to be significantly high in patient families. Our study revealed a decrease in the constipation rate with the increasing education level of parents, higher rate of constipation in families with less income than expenses, and lower rate of working mothers in patients with constipation. Parents' depressive symptoms and anxiety level were determined to be considerably higher. Conclusion: A mother's low education level, low socioeconomic level, presence of psychological symptoms, and problems of parental attitude-primarily the authoritarian attitude-increase the risk of FC occurrence. Therefore, FC patients and their families should definitely undergo a psychosocial assessment.
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    Clinical significance of TT virus infection in children with chronic hepatitis B
    Kasirga, E; Sanlidag, T; Akçali, S; Keskin, S; Aktas, E; Karakoç, Z; Helvaci, M; Sözen, G; Kuzu, M
    Background: The pathogenic role of TT virus (TTV) is not clear in patients with chronic hepatitis B. The aims of the present study were to determine the frequency of TTV positivity in serum and saliva samples and the possible role of TTV in children with chronic hepatitis B. Methods: Sera and saliva from 29 healthy children and 25 children with chronic hepatitis B were tested for TTV-DNA by means of real-time polymerase chain reaction (PCR). Results: Fifty-two percent (13/25) of the serum samples and 32% (8/25) of the saliva samples were positive for TTV-DNA in children with chronic hepatitis B. In healthy non-transfused children, TTV-DNA was detected in 58% (17/29) of the serum samples and 41% (12/29) of the saliva samples. Six (46%) of 13 children with chronic hepatitis and 10 (59%) of 17 healthy children had TTV-DNA positivity both in serum and saliva samples. Two serum samples were negative for TTV-DNA while the saliva samples were positive for TTV-DNA in chronic hepatitis B and control groups. Mean age, sex, serum alanine aminotransferase levels, hepatitis B virus (HBV)-DNA values were similar in TTV-positive and -negative children with chronic hepatitis B. However, total histologic activity index (HAI), periportal necrosis and portal inflammation scores were significantly higher in children with HBV-DNA and TTV-DNA viremia (P = 0.013, P = 0.008, P = 0.015, respectively). Conclusions: Because total HAI, periportal necrosis and portal inflammation scores were higher in children with TTV coinfection, TTV infection may contribute to the progression of liver damage in children with chronic hepatitis B.
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    Should we worry about the eyes of celiac patients?
    Dogan, G; Sen, S; Çavdar, E; Mayali, H; Özyurt, BC; Kurt, E; Kasirga, E
    Purpose: In this article, we evaluate subfoveal choroidal thickness in celiac patients with respect to adherence to the gluten-free diet and nonadherence to the gluten-free diet, comparing with age and sex matched healthy controls using spectral-domain optical coherence tomography. Materials and Methods: A case-control study among 42 celiac patients and 42 healthy participants was conducted in the Department of Pediatric Gastroenterology. Celiac patients of our policlinics compliant with spectral-domain optical coherence tomography examination enrolled in the study. Celiac patients had been asked verbally about their adherence to gluten-free diet, were evaluated according to negative or positive EmA and anti-TG2 for defining adherence, and were divided into two groups (adherence to gluten-free diet and nonadherence to gluten-free diet). Results: Subfoveal choroidal thickness was thinner in EmA (+) or anti-TG2 (+) eyes than EmA(-) or anti-TG2 (-) eyes in celiac patients, but it was not statistically significant. The mean subfoveal choroidal thickness values in eyes with celiac disease, whose diagnosis time was longer than 60 months, were thinner than shorter group. Longer duration of gluten-free diet was associated with adherence difficulty and thinner choroidal thickness (r = -0.15, p = 0.34). Adherence to gluten-free diet was 88.2% for children below the age of 60 months and 57.1% for children older than 60 months. Conclusion: In conclusion, in addition to other extraintestinal manifestations of celiac disease, diagnosis time longer than 60 months in pediatric celiac patients, nonadherence to the gluten-free diet, and antibody positivity should be focused on during ophthalmologic examination and choroid measurement.
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    Efficacy of hepatitis B vaccination and interferon-α-2b combination therapy versus interferon-α-2b monotherapy in children with chronic hepatitis B
    Helvaci, M; Kizilgunesler, A; Kasirga, E; Ozbal, E; Kuzu, M; Sozen, G
    Background: Although interferon (IFN) has been approved in the treatment of chronic hepatitis B in children, it is effective only in 30-40% of patients. In some studies it has been suggested that therapeutic use of anti-hepatitis B virus (HBV) vaccine may be beneficial in patients with chronic hepatitis B. The aim of the present study was to compare the efficacy of hepatitis B vaccination and IFN-alpha-2b in combination and IFN-alpha-2b monotherapy in children with chronic hepatitis B. Methods: Fifty treatment-naive children with chronic hepatitis B infection were randomly assigned to receive either 5 million units/m(2) recombinant IFN-alpha-2b subcutaneously three times per week for 9 months, and pre-S2/S vaccine at the beginning and 4 and 24 weeks after initiation of IFN therapy (n = 25) or recombinant IFN-alpha-2b (5 million units/m(2) subcutaneously thrice weekly) alone for 9 months (n = 25). Children were followed for at least 6 months after the end of therapy. Results: There was no statistically significant difference in the mean alanine aminotransferase levels, histologic activity index and fibrosis scores between combination and IFN monotherapy groups at the end of the therapy and end of the follow-up period. When combination and monotherapy groups were compared, the mean HBV-DNA values were significantly reduced in combination group at the end of the therapy (P = 0.004), but no statistically significant difference was found at the end of the follow up. Sustained HBeAg seroconversion with clearance of HBV-DNA was obtained in 13 of 25 children (52%) treated with combination therapy, and in eight of 25 patients (32%) treated with IFN monotherapy (P = 0.251). Conclusion: Although the difference was statistically insignificant, the sustained response rates were better in the combination therapy group than in the monotherapy group. The potential benefit of combining IFN and hepatitis B vaccine should be investigated in further studies with different regimens of combination therapy. (C) 2004 Blackwell Publishing Asia Pty Ltd.
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    Respiratory Manifestations and Diagnosis of Gastroesophageal Reflux Disease in Children
    Kasirga, E; Glüen, F
    Extraosephageal reflux has been identified as a common pediatric disorder with airway symptoms. Extraosephageal reflux may cause manifestations as asthma, recurrent pneumonia, chronic cough, recurrent croup, otitis media, laryngomalacia and apnea. Multichannel intraluminal impedance and pH monitoring study has recently been shown that significant proportion of non- acid reflux may precede cough episodes in young children with chronic cough. Diagnostic testing with multichannel intraluminal impedance and pH monitoring should be reserved for those unresponsive to acid suppressive therapy. Impedance/ pH monitoring performed under proton pump inhibitor therapy may be useful to help elimination of extraesophageal reflux as the cause of persistent respiratory symptoms.
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    Efficacy of interferon-α2b treatment in children with chronic hepatitis B who have previously undergone therapy for cancer
    Kasirga, E; Isenlik, S; Aksoylar, S; Yaprak, I; Kansoy, S; Yüce, G
    Background: The aim of the present study was to evaluate the efficacy of treatment with recombinant interferon (IFN)-alpha 2b in 12 children with chronic hepatitis B who had previously undergone therapy for cancer. Methods: Nine children had acute leukemias and the other three children had solid tumors. The mean (+/-SD) age of the children was 8.4 +/- 3.8 years (range 4-16 years). All cases were hepatitis B virus (HBV)-DNA positive and 11 were hepatitis B e antigen (HBeAg) positive. One was anti-HBe positive (mutant strain). Four cases were anti-delta IgG positive. Liver biopsy revealed chronic hepatitis B in 11 patients and cirrhosis in one patient. Interferon-alpha 2b was given at a dose of 5 MU/m(2) three times a week, subcutaneously, for 12 months. Results: Elimination of serum HBV-DNA was obtained in three cases, but a further three patients demonstrated a marked decrease in HBV-DNA levels after therapy. Three of 11 patients seroconverted from HBeAg to anti-HBe. Alanine aminotransferase (ALT) levels returned to normal in three of nine cases in whom the ALT levels were high before treatment. At the end of therapy, the mean histologic activity index score was significantly diminished (P = 0.0039). Conclusions: In conclusion, a 12 month course of IFN-alpha 2b induces some beneficial effects on virologic, biochemical and histologic indices in children with chronic hepatitis B who have previously undergone therapy for cancer.
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    Clinical significance of low transaminase levels in children with inflammatory bowel disease
    Cakir, M; Sag, E; Dogan, G; Unal, F; Kasirga, E
    BackgroundLow alanine aminotransaminase (LALT) levels may be seen in patients with inflammatory bowel disease (IBD), but there has been no study about the frequency and its clinical significance. We aimed to analyze the frequency of LALT, and its clinical significance in children with IBD.MethodsThe study included the 89 patients with IBD without hepatobiliary involvement. LALT was defined as ALT levels <5 U/L. Demographic and clinical findings and outcome of the patients with and without LALT were compared.ResultsLALT was found 47.1% of the patients. At initial examination, it was more common in female patients (92.3 vs. 41.3%, P<0.001) and patients with CD (57.7 vs. 30.2%, P=0.01). 75% of the patients with penetrating Crohn's disease (CD) had LALT (P=0.002). Hemoglobin (10.42.1 vs. 11.7 +/- 1.9g/dL, P=0.01), folic acid (5.2 +/- 3.3 vs. 8.6 +/- 5.9ng/mL, P=0.02) and serum albumin levels (3.6 +/- 0.8 vs. 4.7 +/- 5g/dL, P=0.002) were significantly low in patients with LALT. LALT was associted with the disease relapse within 2weeks in 12 of the 16 patients with LALT whereas it was seen in 16 of the 73 patients without LALT during the follow-up (75 vs. 21.9%, P<0.001). Additionally, steroid dependency was more common in patients with LALT during the follow-up (62.5 vs. 12.3%, P<0.001).ConclusionsLALT is common in children with IBD especially in CD and associated with low hemoglobin, albumin and folic acid levels. It may be a marker of relapse and steroid dependency.
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    Should a booster dose be administered in children after mass immunization for hepatitis B?
    Tosun, S; Deveci, S; Kaplan, Y; Kasirga, E
    Background: Hepatitis B virus infection is a global health problem and vaccine-preventable disease, but the duration of the effects of HBV vaccination in infants is unknown. Objectives: The aim of this trial, which comprised children who had received 3 doses as part of the universal HBV immunization program and no additional doses, was to investigate anti-HBs titers and HBsAg status after 9 years. Patients and Methods: We performed a descriptive, cross-sectional field research study. The study sample, based on sociodemographics and minimum seroprevalence, was analyzed based on 10.00% +/- 1.50 (95% confidence interval) (1150 individuals); trial was realized in a total of 1279 children (623 females and 656 males). Anti-HBs titers were measured by micro-EIA (Dia Sorin-Italy); titers <10 lU/mL were negative, 10-49 IU/mL were low-positive, and >50 IU/mL were high-positive. For anti-HBs titers below protective levels, HBsAg was measured by micro-EIA. Results: In approximately half of the children (48.5% in those living in semiurban areas and 42.3% in urban areas), antibody titers were below protective levels. Conclusions: Mass HBV vaccination, which was implemented in Turkey in 1998, significantly decreases HBsAg positivity in childhood. Nevertheless, it might be necessary to administer a booster dose after 8-9 years in children, especially those in low socioeconomic areas or in whom irregular/insufficient immunization is suspected. (C) 2011 Kowsar M.P.Co. All rights reserved.
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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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    Metabolic predictors for early identification of fatty liver using doppler and B-mode ultrasonography in overweight and obese adolescents
    Ozkol, M; Ersoy, B; Kasirga, E; Taneli, F; Bostanci, IE; Ozhan, B
    The aims of our study were: (1) to evaluate the frequency of asymptomatic fatty liver disease (FLD) using both Doppler and B-mode ultrasound (US) in overweight and obese adolescents; (2) to compare metabolic findings of fatty liver (FL) assessed by two methods; and (3) to evaluate metabolic predictors of FL shown by these methods. Fifty-nine overweight and obese adolescents aged between 9.0 and 17.0 years and 41 non-obese healthy adolescents were included in this study. B-mode and right hepatic vein Doppler ultrasonography (US) were performed and anthropometric indices, lipid profiles, and adiponectin levels were evaluated in all adolescents. HDL-C levels were significantly lower in patients with FL detected by Doppler US compared to patients without FL (p < 0.05). HDL-C levels were inversely correlated with presence of FL assessed by two methods (r = -0.285, p = 0.004; r = -0.328, p = 0.001, respectively) and adiponectin levels were correlated with presence of FL only detected by B-mode US (r = -0.263, p = 0.008). Adiponectin levels were significantly lower in patients with FL than those without FL assessed by B-Mode US (p = 0.049). Multiple regression analysis revealed that HDL-C levels was the most important predictor of FL assessed by Doppler US (p = 0.027), while body mass index was the determinant of FL assessed by two methods (p < 0.001) in asymptomatic overweight and obese adolescents. It was found that FLD, identified by both B-mode and Doppler US, is seen frequently in asymptomatic overweight and obese adolescents. Elevated BMI is associated with increased risk of FL assessed by two ultrasonographic methods. When using Doppler US, low HDL-C levels can be used as a good predictor for presence of FLD in overweight and obese adolescents.
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    Inflammatory Myofibroblastic Tumor of the Colon with an Unusual Presentation of Intestinal Intussusception
    Appak, YC; Sahin, GE; Ayhan, S; Taneli, C; Kasirga, E
    Inflammatory myfibroblastic tumor (IMT), also known as inflammatory pseudotumor is unusual, benign solid tumor. This tumor is commonly reported in the lungs but can be present in extrapulmonary sites as well. We present the case of a 7-year-old girl with IMT in an unusual location. The patient was admitted with abdominal pain, and ultrasound showed a solid mass in the abdomen. She was operated and colocolic intussusception secondary to a mass was found. Histologic evaluation of mass revealed IMT.
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    Portal Hypertension in Childhood: Two Centers Experience and Literature Review
    Appak, YÇ; Ünal, F; Kasirga, 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.
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    Evaluation of the location of the anus by a modified technique in the neonate
    Genç, A; Taneli, C; Tansug, N; Kasirga, E; Yilmaz, D; Küçükoglu, T; Onag, A
    Purpose: The aim of the current study was to bring to notice the anterior displacement of the anus and to recommend the measurement of anal position index in the neonate by a modified method. Methods: Sixty newborns (34 girls and 26 boys) were taken into study, and the anal position index (API), which is the ratio of anus-fourchette (scrotum) distance to coccyx fourchette (scrotum) distance, was measured. To obtain the measurement, a transparent adhesive tape was placed along the midline on the long axis, covering the anus. The upper and lower tips and the center of the anal circle was marked and measured using a caliber. Results: API was found as 0.46 (SD +/- 0.08) and 0.53 (SD +/- 0.05) in female and male neonates, respectively. Because an index of 0.34 in girls and 0.46 in boys are considered abnormal, the 3 female babies in the study group with API indices of 0.18, 0.28, and 0.33 were subjected to further examination. The abnormality was seen not to be rare in the Aegean region. Conclusions: An abnormal index alone cannot be the sole cause of constipation mentioned in the literature and therefore not an indication for operation, Anal position index in the neonates could be measured more accurately by the current modified method. If an anterior location of the anus is found early in infancy the baby should undergo follow-up accordingly. J Pediatr Surg 37:80-82. Copyright, (C) 2002 by W B. Saunders Company.
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    The Association of Choledochal Cyst and Pancreatitis: A Case Report and Review of the Literature
    Appak, YÇ; Günsar, C; Dogan, G; Tarhan, S; Kasirga, E
    Choledochal cysts are relatively rare congenital anomalies which are characterized by dilatation of the extra-and/or intra-hepatic bile ducts. Pancreatic involvement before choledochal cyst operation might be a risk factor for postoperative pancreatitis. In this case report, we present a patient who had pancreatic enzyme elevation before choledochal cyst operation and who developed acute pancreatitis after surgery.
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    GASTROESOPHAGEAL REFLUX OR ASTHMA: WHICH COMES FIRST IN ATOPIC AND NONATOPIC CHILDREN?
    Yilmaz, O; Kasirga, E; Kader, S; Alkan, S; Yuksel, H