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Fabry disease is a rare, X-linked disease, caused by the deficiency of lysosomal and #945;-galactosidase. Clinical fetaures are; acroparesthesia, unexplained fever, hypohidrosis and angiokeratomas. Untreated cases die early from cardiac complications, renal insuffiency or stroke. Currently there is no cure for Fabry disease, enzyme replacement therapy is the only choice in this progressive disease. A 9-year-old boy admitted to the Dermatology Clinic with reddish papular skin lesions, joint pain and anhydrosis. Hystological examination of the skin biopsy revealed angiokeratoma. There was no renal dysfunction or proteinuria. Biochemical confirmation of Fabry disease was made by determining the deficient leukocyte and #945;-galactosidase activity. Subsequently, the patient's molecular analysis was identified a novel nonsense mutation c. 785G>T in the GLA gene. Enzyme replacement therapy with agalsidase beta was started. He is on enzyme replacement therapy for 8 years, significant improvement was obtained in severity and frequency of pain crisis and fatigue. We report this case to emphasize the importance of early diagnosis of Fabry disease restricted to dermatological findings, especially before renal and cardiac involvement occurs, while enzyme replacement therapy is now available. Also this patient is one of the first Fabry patients under enzyme replacement therapy in Turkey. [Cukurova Med J 2015; 40(Suppl 1): 156-160]

In newborns, hyperammonemia leads to encephalopathy which is usually characterized by vomiting, hypotonia, lethargy, seizures and coma. Continuous venovenous hemodiafiltration (CVVHDF) is a modality choice to treat acute decompensation in hyperammonemia. Here we report three newborn patients with hypotonia, convulsion and hyperammonaemia. In the first three days of life, their serum ammonia levels were 4609, 1023 and 1949 and #61549;g/ml. They were successfully treated with CVVHDF and serum ammonia levels subsequently decreased to 268, 164 and 65 and #61549;g/ml in the first 24 hours of treatment. The complications were mild hypothermia and anemia. [Cukurova Med J 2015; 40(Suppl 1): 161-166]

Purpose: Osteogenesis imperfecta is an inherited disorder of connective tissue. Children with this condition suffer from recurrent fractures, deformities, osteoporosis and pain. Over the recent years, pamidronate became the standard treatment choice. However the optimal dose and interval have not been defined yet. The main of this study was to compare of two different pamidronate regime. Materials and Methods: 12 patients aged 42.3 +/- 37.4 months were studied. At the beginning patients had received pamidronate infusion at a dose of 1.5 mg/kg/day once, every two months with duration of 23.5 +/- 9.0 months (first protocol), than switched to a dose of 1mg/kg/day for three consecutive days, every three months with duration of 18.5 +/- 5.1 months (second protocol). The bone mineral density Z-score was evaluated yearly. Results: Annual fracture rate decreased from 6.3 +/- 5.5 to 1.1 +/- 1.3 (p=0.001) in the first and from 1.1 +/- 1.3 to 0.0 +/- 0.0 (p

Purpose: The main objective of this study was to compare the treatments of calcitonin and pamidronate by clinical, biochemical, and radiological findings in children with osteogenesis imperfecta and evaluate the efficiency of pamidronate treatment. Patients and methods: A total of 12 patients, aged 41±38 (1-120) months were studied. Group 1 was consisted of six patients who had received intranasal calcitonin at a dosage of 4-6 U/kg three times a week before switching to pamidronate treatment. Group 2 was also consisted of six patients who had received only pamidronate infusion at a dosage of 0.5-2 mg/kg every two months. Results: Annual fracture rates decreased from 2.72 ± 0.80 to 0.40 ± 0.70 (p0.05), and from -3.08 ± -0.61 to -2.29 ± -0.56 in pamidronate group. The difference between the Z-scores of bone mineral density after calcitonin and pamidronate treatments was statistically significant (p

Glutaric aciduria type I is an autosomal recessive inherited disorder caused by the deficiency of glutaryl CoA dehydrogenase. The incidence of the disease is 1/100.000. Glutaryl CoA dehydrogenase gene is located on locus 19p13.2. More than 200 mutations have been described for this gene. Most common mutation in the population is C1240T. Clinical symptoms included neurological regression complications such as loss of sucking and swallowing reflexes choreoathetosis, seizures, rigidity and opisthotonos. In treatment high-carbohydrate, low-protein diet and carnitine is given. We would like to report this interesting case in order to present a new mutation for glutaric aciduria type I. [Cukurova Med J 2013; 38(4.000): 809-812]

Aim:Alkaptonuria (AKU) is an autosomal recessively inherited disease caused by a deficiency of homogentisate 1,2-dioxygenase. This enzyme converts homogentisic acid (HGA) into maleylacetoacetic acid in the tyrosine degradation pathway. The presence of HGA in urine, ochronosis (bluish-black pigmentation in connective tissues) and arthritis of the spine and the other large joints are the three major features of AKU. Nitisinone and a tyrosine-restricted diet are the treatment options. In this study, we evaluated the demographic and clinical characteristics and also the mutations of our AKU patients.Materials and Methods:This retrospective single centre study included 36 patients who were diagnosed as AKU between the years of 2002 and 2017 Çukurova University Faculty of Medicine, Department of Pediatrics, Division of Metabolism and Nutrition.Results:Thirty six AKU patients were included (17 female, 19 male) in our study. The mean age of the patients was 9.3±13.4 years (3 months-54 years). The major complaints were darkening of the urine (100%), ochronosis (11.1%), arthralgia (16.7%) and arthritis (8.1%). Darkening of the urine was firstly recognized at the age of 8.89±16.9 months (1-84 months). Eighteen (86%) patients had homozygous and 3 (14%) patients had compound heterozygous mutations in the HGD gene.Conclusion:AKU was the first inherited metabolic disease defined. The three main features are; darkening of the urine at birth which is followed by ochronosis (blue-dark pigmentation) clinically visible in the ear and alae of the nose and finally a severe ochronotic arthropathy of the spine and large joints at around the age of 50 years. Here we report on the clinical and genetic features of our patients at various ages.

Typical features of Netherton syndrome are congenital ichthyosiform erythroderma, atopic diathesis and trichorrhexis nodosa. Here in this report, we present a case with congenital ichthyosis with atopy presenting later. We wanted to discuss the importance of whole exome sequencing to diagnose the atypical presentations of common syndromes.

Amaç: Osteogenezis imperfekta bağ dokusunun kalıtsal bir hastalığıdır. Bu durumdaki çocuklar tekrarlayan kırıklar, deformiteler, osteoporosis ve ağrıdan yakınırlar. Son yıllarda pamidronat standart tedavi tercihi olmuştur. Ancak, optimal doz ve aralık henüz tam olarak belirlenmemiştir. Bu çalışmada amaç, iki farklı pamidronat tedavi rejiminin karşılaştırılmasıdır. Materyal ve Metod: Yaşları 42.3 ± 37.4 ay arasında değişen toplam 12 hastada yapıldı. Başlangıçta her iki ayda bir defa 1.5 mg/kg/gün dozunda 23.5 ± 9.0 ay pamidromat infüzyonu uygulandı (ilk protokol), daha sonra üçer aylık aralarla 3 gün üstüste 1 mg/kg/gün 18.5 ± 5.1 ay dozuna geçildi (ikinci protokol). Kemik mineral dansitesi z-skoru yıllık değerlendirildi. Bulgular: Yıllık kırık oranı ilk protokolde 6.3 ± 5.5"den 1.1 ± 1.3"e (p=0.001), ikinci protokolde 1.1 ± 1.3"den 0.0 ± 0.0"a (p

Amaç: Bu çalışmanın temel amacı osteogenezis imperfekta olan çocuklarda klinik, biyokimyasal ve radyolojik bulgular ile pamidronat ve kalsitonin tedavisinin karşılaştırılması ve pamidronat tedavisinin etkinliğinin değerlendirilmesidir. Materyal ve Metod: Yaşları 41±38 (1-120) ay arasında değişen toplam 12 hasta çalışmaya alındı. Grup 1 pamidronat tedavisine geçmeden önce 4-6 U/kg haftada üç defa intranazal kalsitonin tedavisi alan altı hasta oluşturdu. Grup 2, iki ayda bir sadece tek doz 0.5-2 mg/kg dozunda pamidronat alan altı hasta idi. Bulgular: Yıllık kırık oranları Grup 1"de 2.72 ± 0.80"den 0.40 ± 0.70"e (p

Glutarik asidüri tip I glutaril KoA dehidrogenaz enziminin eksikliğine bağlı olarak gelişen ve otozomal resesif olarak kalıtılan bir metabolik hastalıktır. İnsidansı yaklaşık 1/ 100,000 dir. Glutaril KoA dehidrogenaz enziminin geni kromozom 19p13.2 dedir. Bu gende 200 farklı mutasyon tanımlanmıştır. Toplumda en sık görülen mutasyon C1240 T dir. Mutasyon tipi hastalığın fenotipini etkilemekle beraber aralarında kesin bir ilişki bulunamamıştır. Klinikte makrosefali, emme ve yutma reflekslerinin kaybolması, oturamama, koreatetoz, nöbetler, rijidite ve opistotonus gibi nörolojik regresyon bulguları vardır. Tedavide yüksek karbonhidratlı, düşük proteinli diyet ve karnitin verilir. Bizde glutarik asidüri tip I nedeniyle takibimize giren bir hastada daha önce tanımlanmamış bir mutasyonu saptadığımız için ilginç bularak bildirdik.

Purpose: We investigated the neurological outcome of 38 late-diagnosed phenylketonuria patients with magnetic resonance imaging (MRI), electroencephalography (EEG), visual evoked potentials (VEP), intelligence quotients (IQ) and examined the correlation of these parameters with the age and the plasma phenylalanine levels of patients at diagnosis. Material and Methods: Thirty-eight late-diagnosed classic phenylketonuria patients were enrolled in the study. Plasma phenylalanine levels were measured by spectrofluorometric method. MRI was evaluated by a pediatric neuroradiologist. Ankara developmental screening inventory (ADSI) and Wechsler intelligence scale for Turkish children (WISC-R) test were performed to detect IQ scores. Porteus Mazo test adapted for Turkish children intelligence test were performed to all children. The EEG of all patients were recorded. VEP was used to measure the electrical activity in the brain to visual stimulus. Results: The high plasma phenylalanine levels and late-diagnosis were associated with low IQ scores, pathological EEG, and pathological VEP patterns. High PA levels were also associated with more serious white matter signal abnormalities. Conclusion: Our results demonstrated the impact of early diagnosis and low levels of phenylalanine at diagnosis on the intellectual, neurological development and visual outcomes. [Cukurova Med J 2016; 41(1.000): 21-27]