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Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized and frequently misdiagnosed non-IgE-mediated gastrointestinal food hypersensitivity disorder. We describe the first case of FPIES only to wheat confirmed by an oral food challenge (OFC). The male patient, who was breast fed for the first 2 months, and then was feeding with cow's milk-based formula until he became 4.5 months old, was given a tarhana soup (wheat and yoghurt) for the initial food trial. Two hours later, he started retching and vomited consecutively, suffering from watery diarrhea. He was taken to a medical center, where he was diagnosed acute gastroenteritis. He suffered from three more episodes after feeding wheat-containing foods. When the patient was 12 months old, an OFC with wheat was performed. Two hours after he had been challenged, he vomited repetitively, became lethargic, his systolic blood pressure dropped from 95 to 80 mm Hg and stool examination revealed eosinophils and leukocytes, which were negative before the challenge. The serum eosinophil count decreased from 460 to 270 mu L and the neutrophil count increased from 2,200 to 10,500 mu L at 6 h. The skin prick test with wheat extract, prick to prick test with whole wheat and serum-specific Ig E for wheat were negative. We conclude that FPIES can emerge with food in connection with eating habits or culture. In view of its potentially serious clinical course, it is critical to consider this diagnosis in young children presenting with acute onset of gastrointestinal symptoms or shock.

Incidence of food allergy (FA) during nursing period is 6–8% globally and It is reported %5,7 in Turkey. In our study, the aim is to determine whether the prevalence of food allergy (FA) increases in children vaccinated against rotavirus. The files of 681 infants who are still followed-up were retrospectively evaluated. Children who did not come to our clinic for all of their well-child follow-up visits were excluded from the study. Moreover, children diagnosed with allergy before vaccination and children with known gastrointestinal system disease were excluded from the study. The number of patients diagnosed with food allergy after being vaccinated against rotavirus was 12 (1.76%). Three children had a family history of allergy. Of 12 patients who were diagnosed after vaccination, 3 (n:104) were vaccinated with pentavalent vaccine and 9 (n:507) with monovalent vaccine. In the monovalent vaccination group, food allergy was found in 9 children (1.55%), and in the pentavalent vaccination group, food allergy was found in 3 children (2.88%). The difference between the two vaccination groups in terms of food allergy prevalence was not significant (p > .05). Although it is believed that food allergy, and even cow’s milk protein allergy (CMPA) prevalence increases in infants vaccinated against rotavirus, in this study, no significant increase was observed in the prevalence of food allergy after rotavirus vaccination. Both types of vaccine had similar rates to each other.

Natural disaster impact assessment is of the utmost significance for post-disaster recovery, environmental protection, and hazard mitigation plans. With their recent usage in landslide susceptibility mapping, deep learning (DL) architectures have proven their efficiency in many scientific studies. However, some restrictions, including insufficient model variance and limited generalization capabilities, have been reported in the literature. To overcome these restrictions, ensembling DL models has often been preferred as a practical solution. In this study, an ensemble DL architecture, based on shared blocks, was proposed to improve the prediction capability of individual DL models. For this purpose, three DL models, namely Convolutional Neural Network (CNN), Recurrent Neural Network (RNN), and Long Short-Term Memory (LSTM), together with their ensemble form (CNN–RNN–LSTM) were utilized to model landslide susceptibility in Trabzon province, Turkey. The proposed DL architecture produced the highest modeling performance of 0.93, followed by CNN (0.92), RNN (0.91), and LSTM (0.86). Findings proved that the proposed model excelled the performance of the DL models by up to 7% in terms of overall accuracy, which was also confirmed by the Wilcoxon signed-rank test. The area under curve analysis also showed a significant improvement (~4%) in susceptibility map accuracy by the proposed strategy.

BACKGROUND There has been no study evaluating the psychopathology in breastfeeding mothers of infants with food allergy (FA). OBJECTIVE The aim of the study was to investigate the relationship between dietary elimination and maternal psychopathology, specifically anxiety, depression, and mother-to-infant bonding, in breastfeeding mothers of infants with food allergy. METHODS Breastfeeding mothers following an elimination diet due to FA in their children aged 1-to-12 months were compared with the healthy controls. The physician-diagnosed FA group was divided into IgE-, non-IgE-mediated, and infants with some minor symptoms which were not enough to make the diagnosis of FA were classified as Indecisive symptoms for FA group. Mothers completed standardized questionnaires including Symptom Checklist 90R, Beck Depression/Anxiety Inventories (BDI/BAI), Postpartum Bonding Questionnaire (Bonding). RESULTS Of 179 mother and infants, 64 were healthy, 89 were FA, 16 were indecisive symptoms for FA. The mean age of the mothers and infants were 31.1 ± 4.7 years and 6.3 ± 3.6 months, respectively. The physician-diagnosed FA groups had higher scores for anxiety (p = .008), anger (p = .042), depression (p

In a retrospective review, we aimed to assess long-term growth in 17 patients (n = 11 males) with hereditary tyrosinaemia type I (HTI). Median age at assessment was 15.6 years (5.7–26.6 years) and median age at diagnosis was 1 month (range: 0–16 months), with 35% (n = 6/17) symptomatic on presentation. From the age of 8 years, there was a noticeable change in median height, weight, and body-mass-index [BMI]-z-scores. Median height-for-age z-scores were consistently ≤ −1 (IQR −1.6, −0.5) during the first 8 years of life but increased with age. Weight-for-age z-scores ranged between −1 to 0 (IQR −1.2, 0.1) in the first 8 years, then increased to &gt, 0.5 (IQR −0.3, 1.3) by age 16 years, and BMI-for-age z-scores ranged from 0 to 1 (IQR −0.7, 1.3) up to 8 years, and &gt, 1 (IQR −0.2, 1.9) until 16 years. The percentage of overweight and obesity was lowest in children aged &lt, 5 years, and consistently &gt, 40% in patients aged between 7 to 16 years. The prescribed total protein intake was associated with improved height growth (p &lt, 0.01). Impaired growth in early life improved with age achieving normal population standards. Further studies are needed to investigate factors that influence growth outcome in HTI patients.

WOS: 000481718600013, Objective: Leptospirosis is one of the most common zoonotic diseases worldwide. Transmission to humans usually occurs by mucosal inoculation of the bacteria or exposure of non-intact skin via contact with water or soil contaminated with urine or feces of rodents. Occupational groups such as farmers, rice plant workers, sewer workers, miners, hunters, military personnel, mariners, shepherds, milkers, slaughterhouse workers, veterinarians and laboratory personnel are under risk for leptospirosis. In this study, we aimed to determine the seroprevalence of leptospirosis in coal miners in Zonguldak region. Methods: Blood samples were obtained from total 185 volunteer coal miners, who worked in 5 coal mines of Turkish Hard Coal Authority in Zonguldak and Bartin provinces, during June and July 2013. Serum samples were stored at -80 degrees C. Additionally, we conducted an interview with each miner about demographical and epidemiological data such as age, location, duration of mining, other occupations, observing rodent or rodent excreta in the mine, noticing rodent contact with personal belongings or drinks or food in mine and hand hygiene compliance. Microscopic agglutination test (MAT), the reference diagnostic test for seroepidemiological studies of leptospirosis, was conducted in Spirochetal Diseases Diagnostic Laboratory, Veterinary Control Central Research Institute, Etlik, Ankara in June 2014. Anti-Leptospira antibody levels for 8 serotypes (Leptospira grippotyphosa Moskva V, L. australis Bratislava Jez Bratislava, L. canicola Hund Utrech IV, L. hardjo Hardjoprajitno, L. pomona Pomona, L. icterohaemorrhagiae Ictero 1, L. hebdomadis Hebdomadis ve L. patoc Patoc 1) was investigated with MAT. Results: All the miners were male and the mean age was 36 +/- 6. The mean duration of working in underground part of the mine was 11 +/- 6 years, the mean working hours was 44 +/- 6 hours a week on average. Distribution of the miners according to inhabiting location was 18.5% village, 50.3% county and 30.8% city. In addition to mining, some of the miners were also occupied with farming (7%), hunting (2.7%), seafaring (0.5%) and livestock raising (0.5%). 82.7% of the miners confirmed seeing rodents in the mine every day and 35.7% of the miners confirmed seeing rodent excreta in the mine. 68.1% reported observing sign of rodent bite on their clothes or food saving box. 91.9% of the miners reported that they saved their food in plastic or paper bags up to meal time. Hand washing rate in the mine was 76.2% among the miners and 94.3% of those were washing their hands without soap. Although, a risky environment for leptospirosis was defined, no seropositivity was detected in any of the serum samples of the miners. Conclusions: Miners reported risky environmental conditions and risky behavioral models for transmission of leptospirosis. However, no seropositivity was detected in any of the serum samples obtained from 185 miners in Zonguldak region.

Inflammation and coagulation are closely linked events. Thrombin is the key enzyme in coagulation system and also has roles in inflammation.The aim of our study was to evaluate thrombin generation in children with mild asthma.Forty-two children with mild asthma and 49 healthy children were included in the study. All patients performed spirometry. Thrombin generation tests (TGT) were performed with a calibrated automated thrombogram (CAT) in children without asthma exacerbation during the last six months. During CAT assay thrombogram curves were obtained. The area under the curve showed endogenous thrombin potentials and indicated the total amount of endogenous thrombin generated; the peak height showed the highest thrombin value, thrombin lag time and time to thrombin peak were measured.Thrombin lag time was significantly longer in children with asthma (3.98±1.2min) compared to those in the control group (3.29±0.6min) (p0.01). Children with asthma also had longer thrombin tail time compared to the control group (19.5±8.9min vs. 16.7±2.9min, p=0.02). Thrombin peak was inversely correlated with FEF 25-75 (r=-0.41, p0.01). Thrombin lag time was inversely correlated with FEF 25-75 (r=-0.39, p0.01).Inflammation in mild asthma seems to disturb coagulation but this disturbance may not be so strong as to increase thrombin levels and may only affect the initiation phase of thrombin generation.

Dysphagia is described as a geriatric syndrome that occurs more frequently with aging. It is associated with the deterioration in functionality however, it is usually ignored. Frailty is a geriatric syndrome that is recognized more with its well-known adverse consequences. Very recently, dysphagia has been suggested to accompany frailty in older adults. We aimed to investigate the association between dysphagia and frailty in the community dwelling older adults.Prospective, cross-sectional study.Geriatric outpatient clinic.Older adults aged ≥60 years.Dysphagia was evaluated by EAT-10 questionnaire and frailty by FRAIL scale. Handgrip strength (HGS) was evaluated by hand-dynamometer. Gait speed was evaluated by 4-meter usual gait speed (UGS). Nutritional status was assessed by mini-nutritional assessment-short form (MNA-SF).1138 patients were enrolled. Mean age was 74.1±7.3 years. EAT-10 questionnaire was answered by all and FRAIL-scale by 851 subjects. EAT-10 score15 points was regarded as significant dysphagia risk. The participants with EAT-1015 points were older when compared to the participants with EAT-10=15 points (p=0.002). Among participants with EAT-1015 points, women gender and neurodegenerative diseases were more prevalent (p=0.04, p=0.002; respectively); number of chronic diseases, number of drugs and FRAIL score were higher (p=0.001 for each), and HGS, UGS, MNA-SF scores were lower (p=0.002, p=0.01, p0.001; respectively). In multivariate analyses, the factors independently associated with presence of EAT-10 score15 were FRAIL score and the number of drugs.Dysphagia is associated with frailty irrespective to age, presence of neurodegenerative diseases, number of chronic diseases and drugs. To our knowledge, this is the largest serie in the literature providing data on independent association of dysphagia with frailty.

Amaç: Çalışmamızın amacı tip 2 diyabet tanısı almış yaşlı erişkinlerde kırılganlıkla ilgili faktörleri belirlemektir. Gereç ve Yöntem: Çalışmaya 65 yaş ve üstü, tip 2 diyabet tanısı almış 108 kişi dahil edildi. Katılımcıların kırılganlığı FRAIL anketi ile değerlendirilmiş, beslenme durumu Mini Beslenme Değerlendirme Kısa Formu (MNA-SF) ile, depresyon durumu Hasta Sağlığı Anketi-2 (PHQ2) ve Geriatrik Depresyon Ölçeği Kısa Formu (GDS-SF) ile değerlendirilirken, yaşam kalitesi EuroQol-5 Boyut (EQ5D) ve EQ VAS puanlaması ile, kişisel bakım durumları ise Günlük Yaşamın Temel Aktiviteleri (BADL) ve Günlük Yaşamın Enstrümantal Aktiviteleri (IADL) formları ile değerlendirilmiştir. Bulgular: Kırılgan grupta, kırılgan olmayanlara göre uyku sorunları, düşme korkusu, idrar kaçırma, PHQ2, GDS-SF ve EQ5D skorları anlamlı olarak yüksek; MNASF skoru ise anlamlı olarak düşüktü (p, Objective: Our study aimed to determine the factors related to frailty in elderly adults having been diagnosed with type 2 diabetes mellitus. Material and Method: A total of 108 people aged 65 and over, diagnosed with type 2 diabetes, were included in the study. The frailty of the participants was evaluated with the FRAIL questionnaire, their nutritional status was evaluated with the Mini Nutrition Assessment Short Form (MNA-SF), the depression status with the Patient Health Questionnaire-2 (PHQ2) and the Geriatric Depression Scale Short Form (GDS-SF), while the quality of life was evaluated with the EuroQol-5 Dimension (EQ5D) and Scoring the EQ-VAS, and personal care status were evaluated with Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) forms. Results: Sleep problems, fear of falling, presence of urinary incontinence, PHQ2, GDS-SF, and EQ5D scores were significantly higher; the MNASF score was significantly lower in the frail group than the values in the non-frail group (p

BACKGROUND: Adaptation to Turkish language and validation studies of Knee Injury and Osteoarthritis Outcome Score – Physical Function Short Form (KOOS-PS) and Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form (HOOS-PS) were done previously but responsiveness to changes of these questionnaires could not be tested in these studies. OBJECTIVE: The aim of this study was to assess the responsiveness of the Turkish versions of the KOOS-PS and HOOS-PS in a patient group who underwent knee or hip joint arthroplasty operation. METHODS: Sixty-three patients who underwent total knee arthroplasties and sixteen patients who underwent total hip arthroplasties for primary osteoarthritis were included in this study. The preoperative and 3-month postoperative KOOS-PS, HOOS-PS, and Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index hip and knee scores were collected from the hospital records, and the effect sizes (ESs) and standardized response means (SRMs) were calculated. RESULTS: The ESs and SRMs, respectively, were as follows: -1.954 and -2.156 for the KOOS-PS, -1.833 and -2.464 for the HOOS-PS, -4.848 and -4.210 for the WOMAC-knee, and -3.835 and -4.625 for the WOMAC-hip. CONCLUSIONS: The Turkish versions of the KOOS-PS and HOOS-PS exhibited strong responsiveness to change in the arthroplasty patients.

Background The consumption of lentil is common in the Mediterranean area and is one of the causes of IgE-mediated food allergy in many countries. Len c 1 is a well-defined allergen of lentil and approximately 80% of the patients with lentil allergy recognize the purified Len c 1 protein. We sought to identify IgE and IgG4 sequential epitopes of Len c 1 in patients with red and/or green lentil allergy. We also aimed to determine IgE and IgG4 binding differences between those patients who had outgrown or remained reactive to lentil. Methods Children with IgE-mediated lentil allergy were included in the study. We applied a microarray immunoassay to determine the characterization of positive IgE and IgG4 binding to Len c 1 epitopes in the patients' sera. Results The peptides specifically recognized by IgE and IgG4 antibodies were mainly detected between peptides 107 and 135 of Len c 1. The signal intensities of positive epitopes were significantly greater in reactive patients than tolerant ones (P = .008 for IgE and P = .002 for IgG4). Moreover, IgE and IgG4 antibodies bound largely the same sequential epitopes in patients who remained reactive or outgrew their allergy. Conclusion IgG4-binding epitopes in lentil allergy were identified and IgE and IgG4 binding to epitopes in both red and green lentils was compared. Our data regarding signal intensity differences between reactive and outgrown patients and overlap binding of IgE and IgG4 antibodies may be important for the development of more accurate diagnostic tests and understanding of natural tolerance development. David H. and Julia Koch Research Program in Food Allergy Therapeutics This study was supported in part by the David H. and Julia Koch Research Program in Food Allergy Therapeutics. WOS:000493798700001 31598994 Q1

Food allergies often develop after liver transplant, especially in young children. However, data are scarce on clinical characteristics and patient outcomes. When we evaluated our pediatric liver transplant patients over a 16-year period, food allergy incidence was 8% (19/236 patients). All patients with food allergies were

The most common causes of food allergy vary among countries according to the dietary habits and the frequency of consumption of foods. Legumes are important sources of protein that are widely consumed all over the world. The legume family includes lentils, chickpeas, beans, broad beans as well as peanuts and soybeans. Skin prick tests are generally considered safe. However, systemic reactions may develop during skin prick testing, Systemic reactions from skin testing are more frequent with food, drug, latex and venom allergens. Systemic reactions occur more frequently after prick to prick tests that are performed with fresh food than those with standard extracts. This paper reports a case with a history of anaphylaxis to lentils and peas. The patient was found to have type 1 reaction to chick peas, broad beans and green beans although she did not describe a reaction to these legumes in her history. The patient experienced anaphylaxis during skin testing with legumes when multiple tests were performed at the same time. There was no reaction when skin prick tests were performed in more than one session. The patient is noteworthy in this regard and discussed in detail.

To investigate vitamin D levels in patients with recurrent wheeze at early ages of childhood. In the present cross-sectional study, serum 25-hydroxy vitamin D [25 (OH)D], levels which is known as an indicator of vitamin D adequacy, was examined in infants with three or more wheezing attacks. A total of 186 infants with recurrent wheezing were included in the study along with 118 healthy control peers. The recurrent wheezing study participants were classified into two groups according to Asthma Predictive Index (API) positivity and compared to control subjects regarding their serum vitamin D status. The API negative group had the lowest mean serum 25 (OH)D level (n = 121; 22.71 ± 10.76 ng/ml) followed by API positive group (n = 65; 24.08 ± 9.02 ng/ml) compared to healthy group (26.24 ± 11.88 ng/ml) (p

Background: Little is known about the optimal dietary treatment for citrin deficiency. Our aim is to describe the management of UK citrin deficiency patients. Methods: A longitudinal retrospective review was performed. Data were collected from medical records on presenting signs and symptoms, dietary management and clinical outcome. Results: data were collected on 32 patients from 21 families. 50% were females (16/32). Median age at diagnosis was 4 y (5 days&ndash, 35 y) with 12 patients diagnosed in the neonatal period with neonatal intrahepatic cholestasis (NICCD), eight later in childhood (FTTDCD) and 12 by family screening based on index cases from five families. No patient had adult-onset type II citrullinemia. The patient age at the time of data collection was a median of 11 y (1&ndash, 44 y). 91% (29/32) of patients had normal physical and neurological development, 47% (15/32) experienced recurrent unexplained abdominal pain and 9% (3/32) episodes of hypoglycaemia. Siblings had different phenotypes (5 families had &gt, 1 affected patient). Most patients preferred high protein foods, limiting sugar-containing foods. Only 41% (13/32) were prescribed a low CHO, high protein, high fat diet (restriction varied) and two used medium chain triglyceride (MCT) supplements. No patient was prescribed drug therapy. Twenty-five per cent (8/32) of patients were underweight and 41% (13/32) had height &lt, &minus, 1 z-scores. Conclusions: patients presented with various phenotypes, symptoms and suboptimal growth. Symptoms and biochemical markers improved with age, but height remained low in some. More research is necessary to assess the effectiveness of dietary approaches in improving clinical outcomes and symptoms in citrin deficiency.

In a longitudinal retrospective study, we aimed to assess natural protein (NP) tolerance and metabolic control in a cohort of 20 Hereditary Tyrosinaemia type I (HTI) patients. Their median age was 12 years ([3.2&ndash, 17.7 years], n = 11 female, n = 8 Caucasian, n = 8 Asian origin, n = 2 Arabic and n = 2 Indian). All were on nitisinone (NTBC) with a median dose of 0.7 g/kg/day (range 0.4&ndash, 1.5 g/kg/day) and were prescribed a tyrosine (Tyr)/phenylalanine (Phe)-restricted diet supplemented with Tyr/Phe-free L-amino acids. Data were collected on clinical signs at presentation, medical history, annual dietary prescriptions, and blood Phe and Tyr levels from diagnosis until transition to the adult service (aged 16&ndash, 18 years) or liver transplantation (if it preceded transition). The median age of diagnosis was 2 months (range: 0 to 24 months), with n = 1 diagnosed by newborn screening, n = 3 following phenylketonuria (PKU) screening and n = 7 by sibling screening. Five patients were transplanted (median age 6.3 years), and one died due to liver cancer. The median follow-up was 10 years (3&ndash, 16 years), and daily prescribed NP intake increased from a median of 5 to 24 g/day. Lifetime median blood Tyr (370 &micro, mol/L, range 280&ndash, 420 &micro, mol/L) and Phe (50 &micro, mol/L, 45&ndash, 70 &micro, mol/L) were maintained within the target recommended ranges. This cohort of HTI patients were able to increase the daily NP intake with age while maintaining good metabolic control. Extra NP may improve lifelong adherence to the diet.

To assess the reliability and validity of Turkish version of SARC-F in regard to screening with current definitions of sarcopenia, muscle mass and functional measures. Cross-sectional study. Community-dwelling older adults aged >=65 years admitting to a geriatric outpatient clinic. Muscle mass (bioimpedance analysis), handgrip strength, usual gait speed, chair sit-to-stand test, functional reach test, short physical performance battery, SARC-F questionnaire, FRAIL questionnaire Sarcopenia was evaluated with 4 current different definitions: European Working Group on Sarcopenia in Older People’s (EWGSOP); Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia (IWGS) and Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD). After cross-cultural adaptation, 207 subjects were analysed in the clinical validation study. Mean age was 74.6±6.7 years, 67.6% were women. Against EWGSOP, FNIH, IWGS and SCWD definitions of sarcopenia, sensitivity of SARC-F were %25, 31.6%, 50% and 40%; specificity were 81.4%, 82.4%, 81.8% and 81.7%, respectively. Positive predictive values were between 5.1-15.4% and negative predictive values were 92.3-98.2%. Against parameters of low muscle mass, sensitivity were about 20% and specificity were about 81%. Against parameters of function; for low hand grip strength, sensitivity of SARC-F were 33.7% (for Turkish cut-off); 50% (for FNIH cut-off); specificity were 93.7% (for Turkish cut-off) and 85.8% (for FNIH cut-off). Against low UGS, poor performance in chair sit to stand test, functional reach test, SPPB and presence of positive frailty screening sensitivity were 58.3%, 39.2%, 59.1%, 55.2% and 52.1% while specificity were 97.3%, 97.8%, 88.1%, 99.3% and 91.2%, respectively. The psychometric performance of Turkish SARC-F was similar to the original SARC-F. It revealed low sensitivity but high specificity with all sarcopenia definitions. Sensitivity and specificity were higher for muscle function tests reflecting its inquiry and input on functional measures. Our findings suggest that SARC-F is an excellent test to exclude muscle function impairment and sarcopenia. SARC-F is relatively a good screening test for functional measures.

Introduction: 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) lyase deficiency is an autosomal recessive disorder that usually presents in the neonatal period with vomiting, metabolic acidosis, hypoglycemia and absent ketonuria. Few cases are reported in the literature, and optimal dietary management and long term outcome are not fully understood. Case report: We report a 2 year old girl with HMG-CoA-lyase deficiency who had limited fasting tolerance on a low protein diet, with several recurrent hospital admissions with severe hypoketotic hypoglycaemia and metabolic acidosis. We also review the dietary management and outcome of other reported cases in the literature. Discussion: In order to define optimal dietary treatment, it is important to collect higher numbers of case studies with detailed dietary management, fasting times and outcome.

Background/Aims: We evaluated our 16-year single-center experience of pediatric post-transplant lymphoproliferative disorder (PTLD) cases who underwent liver transplantation between 2001 and 2017. Materials and Methods: Of the 236 pediatric patients who underwent liver transplantation between 2001 and 2017, the clinical and laboratory data of eight patients diagnosed with PTLD were reviewed. The pre-transplant Epstein-Barr virus (EBV) status of 172 patients was also recorded. Results: The total incidence of PTLD was 3.4%. The incidence of PTLD was 10% in pre-transplant EBV immunoglobulin G (IgG)-seronegative patients and 0.8% in pre-transplant EBV IgG-seropositive patients. The mean age of the patients at liver transplantation was 2.71 +/- 3.21 years, and four patients were aged below 1 year at the time of transplantation. PTLD was diagnosed at 21.81 +/- 18.1 months after transplantation. The primary site of involvement was variable among patients: peripheral and mediastinal lymph nodes, stomach and intestine, transplanted graft, bone marrow, and nasopharynx. The eosinophil count varied greatly among patients, with a mean value of 524.62 +/- 679/mm3. Three patients had a food allergy and were administered an elimination diet at the time of PTLD diagnosis. Six patients had PTLD of B-cell origin. One patient died due to neutropenic sepsis during chemotherapy, whereas seven patients were followed up in full remission for 7.75 +/- 4 years. Conclusion: PTLD is a life-threatening complication of solid-organ transplantation with a heterogeneous clinical spectrum. Food allergy had a close association with PTLD. A close follow-up of patients with risk factors and an early diagnosis with appropriate treatment may lead to a better outcome.

Background: Recurrent wheeze (RW) is frequent in preschool children. Wheezing phenotypes, asthma predictive index (API), and modified API (mAPI) have been described for clinical purposes. Our aim was to examine whether inflammatory markers including serum angiopoietin (Ang)-1, Ang-2, and periostin levels differ according to wheezing phenotypes and mAPI. Materials and Methods: Ninety-eight children who were

Yilmaz, Ozlem/0000-0003-2971-283X; Harmanci, Koray/0000-0002-8494-648X; WOS: 000450089200003 PubMed: 30459513 Aim: It has been shown by a great number of studies that the correct use of adrenaline auto injectors prescribed to patients with anaphylaxis is associated with the design of the auto injector, in addition to training. The aim of this study was to compare the skills of adults in using two different auto injectors prescribed to patients with anaphylaxis. Material and Methods: Parents of patients aged between 1 and 18 years who referred to allergy outpatients were included in the study. Results: A total of 630 volunteers from nine centers were included in the study. Four hundred fifty-seven (72.5%) of the participants were females and 235 (37.3%) were undergraduates. The rate of showing all the steps of auto injector trainers correctly e by the participants was found as (60.2%) (n=379) for EpiPen and 42.9% (n=270) for Penepin (p

Vitellogenin is the dominant contributor to vertebrate egg yolk. All fishes produce vitellogenins as crucial embryonic nutrients. During oogenesis, oocytes grow by orders of magnitude while vitellogenin delivers to their ooplasm most of the materials needed to build and sustain a new life. The past 20 years have seen major advances in our understanding of the multiplicity, evolution, structure and functions of fish vitellogenins and their receptors, especially from a molecular perspective and with a view toward utilization of the knowledge for the betterment of finfish aquaculture, fisheries management and biomedical research. The present article covers these fascinating developments.

Objectives/Hypothesis To examine and compare the neuroprotective effects of dexamethasone, oxytocin, and resveratrol administration on regeneration after facial nerve crush injury in a rat model. Study Design Prospective, randomized, controlled animal study. Methods A crush-type facial nerve injury was performed on the right side of all rats (injury group [IG]), whereas there was no injury on the left side (sham group [SG]). These main groups were divided into five subgroups: 1) no medicine (control); 2) physiological serum; 3) dexamethasone; 4) oxytocin; and 5) resveratrol (Res) administered (intraperitoneal injection) for 28 days. Functional recovery was evaluated by daily eye-blink reflex and facial electromyography. Nerve–muscle degeneration and regeneration, apoptosis, and intercellular connections were evaluated in histopathological and immunohistochemical examinations. Results Recovery time of the postinjury eye-blink reflex demonstrated faster recovery in IG + Res when compared with the other subgroups. In peak-to-peak amplitude values, a significant increase was observed in the dexamethasone (P = 0.007) and oxytocin subgroups (P = 0.004) and was even more apparent in the resveratrol subgroup (P < 0.001). Nerve regeneration is apparent in the resveratrol subgroup. Apoptotic changes were evaluated immunohistochemically with TUNEL and Caspase 3 and 6 antibodies staining. Caspase 3 and 6 immunoexpressions of resveratrol and oxytocin subgroups were moderate when compared with dexamethasone subgroup. Except for the resveratrol subgroup, which had an increase in expression, the majority of subgroups were similar to SG in terms of intercellular connections (Connexin 32 and 43). Conclusion Resveratrol leads to the best outcome after facial nerve crush injury in rats when compared with dexamethasone and oxytocin, even though these agents demonstrate a significant improvement in facial nerve regeneration. Level of Evidence N/A. Laryngoscope, 125:E356–E364, 2015

Background: There has been no study investigating nonsteroidal anti-inflammatory drugs (NSAIDs)-exacerbated respiratory disease (NERD) exclusively in childhood. Therefore, in the current study, the authors aimed to evaluate the diagnostic features, clinical characteristics, and follow-up of adolescents diagnosed with NERD. Methods: The patients who were consecutively diagnosed with NERD between January 2011, and November 2013, included in the study. Oral provocation test (OPT) with at least 2 different NSAIDs was used to confirm NSAID hypersensitivity in patients with underlying asthma/chronic rhinosinusitis/nasal polyps. All patients were followed regularly in 3-month intervals by the Pediatric Allergy and Otorhinolaryngology Department for asthma, allergic rhinitis, or chronic rhinosinusitis with or without nasal polyps. Results: A total of 10 adolescents with NERD were included in the study. The mean age of the patients at the time of diagnosis was 14.9 ± 1.5 years. Hives or angioedema accompanied respiratory complaints induced by NSAIDs. The mean duration of follow-up was 28.9 ± 12.4 months. All patients had asthma except 1 with asymptomatic bronchial hyperreactivity. Asthma of patients was well-controlled with moderate dose of inhaled corticosteroids. Chronic rhinosinusitis with or without nasal polyps developed in 2 patients. Aspirin desensitization was required in these 2 patients with recurrent nasal polyps. Conclusion: NERD in childhood has much more favorable clinical characteristics and course than in adulthood. Few adolescents with NERD refer with typical chronic upper respiratory tract complaints. The asthma component seems to be mild and is well controlled in the short-term follow-up. C � 2015 ARS-AAOA, LLC.

The Turkish Catastrophe Insurance Pool (TCIP) is one of the best practices of public-private partnerships in an emerging market designed to reduce economic losses from disasters. This paper reviews the application of this compulsory mechanism along with data relating to the performance of the scheme following recent earthquakes in Turkey. We also consider the current perceptions of Turkish society towards the TCIP and how they can be enhanced. Our conclusions aim to assist stakeholders in government, homeowners, insurance companies, media, banks and civil society to appreciate the value of the system and key actions necessary to improve it. Language: en

Sarcopenia is a well-identified process of aging known to cause functional deterioration, falls, fractures, frailty and mortality. Considering the global aging population, sarcopenia assessment has become a public health priority because its early detection is expected to prevent or decrease adverse outcomes through commencement of therapeutic measures. Therefore, the diagnosis of sarcopenia mediated by effective screening is expected to become particularly important. Being very practical with clearly demonstrated value to predict sarcopenia-related adverse outcomes, SARC-F questionnaire stands as one of the best tools to evaluate sarcopenia in every day practice. SARC-F has originally been created in English. Considering the variety of languages in Europe, it seems very valid to adapt and validate this tool in different European languages. This report is written to explain the details of the final consensus methodology suggested for SARC-F validation, thereby guiding and helping the research teams in their studies.

Sarcopenia is one of the prevalent geriatric syndromes that adversely affects the functionality in the older adults. The diagnosis of sarcopenia requires documentation of decreased muscle mass and decreased muscle strength or physical function. The implication of user-friendly and inexpensive methods that could be used to assess sarcopenia in real-life settings is suggested in a recent debate paper. For muscle mass assessment, bioelectric impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA) were described as having the same ease for muscle mass assessment in terms of applicability. However, BIA is easier to perform, has greater availability, inexpensive, and does not require specialist trained staff. The authors proposed the use of DXA as primary tool to assess muscle mass in the primary care setting. However, BIA is recommended as a first-line method both in research and clinical practice by EWGSOP. Regarding its much easier applicability, we conclude that BIA is a more practical method for muscle mass assessment in the primary care setting than the DXA. Thus, we suggest that BIA could be the method of choice for muscle mass assessment in the primary care setting.

Kanıta Dayalı Tıp (KDT) hasta bakımı ileilgili alınan kararlarda mevcut en iyi kanıtların dikkatli, şeffaf ve akılcıkullanımıdır. Sağlık bakımının daha karmaşık ve daha pahalı olduğu ve hastabeklentilerinin arttığı günümüzde optimal sonuç elde etmek, klinikuygulamalardaki farklılıkları azaltmak, daha kaliteli hizmet verebilmek veetkin ve maliyet etkin bir sağlık hizmet kültürünü teşvik etmek için KDT’agereksinim vardır. Kanıta dayalı tıp uygulamalarının sadece klinisyenleri değil aynı zamanda sağlık politikacılarını dayakından ilgilendirmektedir. Kanıta dayalı tıbbın öneminin artması ile birliktasağlık politikası alanında “Kanıta Dayalı Sağlık Politikası” kavramı ortayaçıkmıştır. Bu kavram, sağlık politikacılarının topluma sunacağı sağlıkhizmetinin amaç, yöntem ve içerik olarak düzenlenmesini, alternatiflerarasından güncel veriler ışığı altında ortam koşullarının gözeterek kararvermesini ve toplum yararına politik hedefler belirleme ve açıklaması’ anlamınagelmektedir. Günümüzde kanıta dayalı sağlık politikalarının belirlenmesindesağlık teknolojilerinin değerlendirilmesi önemli bir araç olmuştur. Bu derlemede kanıta dayalı tıbbın tanımı, unsurları ve buuygulamaya neden ihtiyaç duyulduğundan bahsedilerek, kanıta dayalı sağlıkpolitikalarının en önemli araçlarından biri olan sağlık teknolojilerinin değerlendirilmesi ele alınacaktır., Evidence based medicine (EBM) is thetransparent and rational use of the best evidence available to make decisionsabout patient care. Today, health care has become more complicated andexpensive, patient demands have increased and EBM is needed to obtain optimalresults, to reduce the differences across clinical practices, to provide highquality services and to promote an efficient and cost-effective health careculture. Evidence based medicine practices concern the health policy makers aswell as clinicians. As evidence based medicine gained importance in the fieldof health policy making the concept of “Evidence Based Health Policy” hasemerged. This intent of this concept is for health politicians to moderate thepurposes, methods and contents of health care offered to the public, to makedecisions between alternatives considering up-to-date information andconsidering the setting, and to identify and announce political goals thatbenefit the public. Today it serves as an important means of identifyingevidence based health policies and assessing health technologies.In this review, the definition,components, and grounds for evidence based medicine will be discussed, andhealth technology assessment which is one of the most important instruments ofevidence based health policies will be examined.

Isotretinoin is used for the treatment of various acne lesions that are resistant to other treatments. The most frequent rheumatologic side effect of isotretinoin is transient muscle and/or joint pains. Here, we report a case with bilateral wrist and metacarpophalangeal joint arthritis and unilateral sacroiliitis associated with isotretinoin usage to attract attention, particularly from physiatrists, rheumatologists and dermatologists, to this rare adverse effect of isotretinoin.

Background The effect of the type of Hymenoptera on the severity of systemic reactions (SRs) is a controversial issue. The aim of the present study was to evaluate demographic, clinical, diagnostic, and therapeutic features of moderate-to-severe SRs in children with venom hypersensitivity and to compare the role of the honeybee and wasp stings in these reactions. Methods Data on children with moderate-to-severe SRs after a Hymenoptera sting were retrospectively collected for a 17-year period. Results A total of 55 children with moderate-to-severe SRs (wasp: 44, honeybee: 11) to venom stings were included in the study. In the honeybee group, comorbid allergic rhinitis and any type of atopic disease was more frequent compared to the wasp group (p = 0.009 and p = 0.01, respectively). In 50.9% of the children, family history of SR to the same venom type was higher in the honeybee group (p = 0.02). Dyspnea was more frequent in the wasp, and cyanosis was more frequent in the honeybee compared to each other (p = 0.02 and p 0.05 for each). Conclusion Moderate-to-severe SRs with honeybee and wasp venoms in children may differ in the severity of respiratory symptoms/signs at presentation, in addition to comorbidity of atopic diseases and family history of the SRs.

Background Although symptoms and signs of allergic rhinitis (AR) and nonallergic rhinitis (NAR) are similar, treatment and follow-up are different. We aimed to find predictive factors that can be used in primary health care to differentiate AR from NAR. Methods We made a retrospective analysis of cases aged 6–18 years old who were diagnosed as having chronic rhinitis within a 1-year period. Skin-prick tests were done and severity of rhinitis symptoms was recorded on a visual analog scale in all patients. Results There were 472 cases whose medical records were complete and included in the analysis. The median age was 11 (interquartile range [IQR], 5) years. AR was diagnosed in 363 patients (76.9%) and was different from NAR with respect to: median age (p = 0.042), seasonality of the symptoms (p = 0.002), persistent symptoms (p = 0.003), moderate/severe according to visual analogue scale (VAS) score (p = 0.017), conjunctivitis (p < 0.001), parental history of AR (p = 0.026), rhinorrhea (p < 0.001), sneezing (p = 0.005), mucosal pallor (p = 0.004), and response to antihistamines (p = 0.035). All parameters with a significance of p < 0.1 between AR and NAR were included in logistic regression analysis. Seasonality, sneezing, moderate/severe rhinitis, and response to antihistamines were identified as significant independent parameters to differentiate AR from NAR. Conclusion Features of rhinitis patients with seasonality, sneezing, moderate/severe rhinitis, and response to antihistamines may help in differentiation of AR from NAR at the primary care level.

Aim The aim of this study was to compare the health-related quality of life and functional status of patients with psoriasis (Ps), psoriatic arthritis (PsA) and control subjects. Method Eighty patients with PsA, 40 patients with Ps and 40 healthy subjects were included. Physical functions were evaluated with the Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) while life satisfaction was evaluated with the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire. The Disease Activity Score 28 (DAS28), Disease Activity Index for the Assessment of Reactive Arthritis (DAREA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP), Maastrich Ankylosing Spondylitis Enthesitis Score (MASES) and visual analog scale-pain were calculated. Results The HAQ-S data revealed that physical functional status in the PsA group was worse than the Ps and control groups (mean scores: 0.5 ± 0.5, 0.2 ± 0.5 and 0.1 ± 0.3, respectively). The PsAQoL data revealed a worse quality of life in the PsA and Ps groups than in the control group but the same quality of life in the PsA and Ps groups (mean scores: 6.9 ± 5.4, 7 ± 5.9 and 3.3 ± 4.2, respectively). Both the HAQ-S and PsAQoL data were found to be moderately to weakly correlated with disease activity measures (DAS28, DAREA, BASDAI, ASDAS-CRP), pain and enthesitis. Conclusion Patients with Ps and PsA had worse quality of life and patients with PsA had worse functional status than healthy individuals. Although Ps patients with arthritis had a worse functional status than the ones without arthritis, quality of life according to PSAQoL was found to be similar between them.

WOS: 000351333600005, PubMed ID: 25618113, Background. To determine the effects of different intraabdominal pressure (TAP) on the ovaries in a laparoscopic rat model. Objectives. The aim of the study was to determine the effects on the ovaries of different intraabdominal pressures (TAP) in laparoscopic surgery in a rat model. Material and Methods. Thirty-two post-pubertal nonpregnant Sprague-Dawley rats were divided randomly into four groups. In the control group, no intraabdominal pressure (TAP) was applied. In Group Pp10 and Group Pp15, an TAP of 10 and 15 mm Hg, respectively, were applied by carbon dioxide insufflation for 60 min, and a 30-min desufflation was carried out. In Group IPp15, a 15 mm Hg TAP was applied for 10 min, and then CO2 was desufflated for 10 min. After this ischemic preconditioning, IAP was established at 15 mm Hg for 60 min, after which CO2 was desufflated for 30 min. Erythrocyte and ovarian tissue maiondialdehyde (MDA) and histopathologic damage scores were evaluated. Results. In Groups Pp10 and Pp 15, ovarian tissue MDA values were significantly increased compared to the control group. In Groups Pp10 and Pp15, erythrocyte MDA values were significantly increased when compared to Group IPp15 and the control group. Ovarian histopatological assesment scores were significantly higher in Group Pp15 than in Groups Ppl 0 and IPp15. Conclusions. Pneumoperitoneum causes injuries to abdominal organ such as the ovaries. The ischemic preconditioning method is more effective in reducing oxidative stress due to laparoscopic pneumoperitoneum than lowpressure pneumoperitoneum methods

Neuroblastoma is a severe pediatric tumor characterized by poor prognosis. Identification of novel molecular targets and diversion of investigations on new drug trials is mandatory for cancer therapy. In this study, vinorelbine tartrate, lithium chloride, clomipramine, and medroxyprogesterone acetate are used for the possible new treatment modalities in neuroblastoma cells. Notch and c-kit are novel molecules in cancer research, and Notch pathway is one of the emerging molecules in the neuroblastoma pathogenesis. Cytotoxic effects of these drugs at different time points, with different doses were studied in the SH-SY5Y human neuroblastoma cell line. Analysis of Notch and c-kit signaling with immunohistochemistry were constituted in multicellular tumor spheroids, and morphologic investigation was performed for digital imaging of cancer stem cells (CSCs) with electron microscopy. Size kinetics of spheroids was also determined after drug treatment. Results showed that all drugs were cytotoxic for neuroblastoma cells. Yet, this cytotoxic action did not correlate with the inhibitory effects in cell signaling. Neuroblastoma spheroids showed increased immunoreactivity of Notch signaling and c-kit. Altered ultrastructural CSCs morphology was observed after clomipramine and medroxyprogesterone acetate treatment compared with other drugs. Lithium chloride showed cellular membrane destruction for both CSCs and the remaining population. In this study, independent effects of cytotoxicity in tumor cells with respect to CSCs were determined. Redundant cells, which are the bulk population in tumor a compound, destroyed with therapy, were neither a target for treatment nor a remarkable investigation of cancer.

Acute urticaria is an immune-inflammatory disease, characterised by acute immune activation. There has been increasing evidence showing that vitamin D deficiency is associated with increased incidence and severity of immune-inflammatory disorders.The aim of this study was to evaluate serum vitamin D levels in acute urticaria.We enrolled 30 children with acute urticaria and 30 control subjects. Concentrations of 25-hydroxyvitamin D [25(OH)D], a biomarker of vitamin D status, were measured in serum of acute urticaria patients and compared with the control group.There were no significant differences in baseline variables (age, gender, weight) between the groups. Vitamin D deficiency (20ng/ml) was significantly higher in patients with acute urticaria than in control patients. Serum 25(OH)D levels were significantly lower in the study group compared to those in the control group (13.1±4.3 vs 28.2±7.4ng/mL, p0.05). Moreover, we found negative correlation between mean duration of acute urticaria and serum vitamin D levels (p0.01).This study revealed a significant association of lower serum 25(OH)D concentrations with acute urticaria and an inverse relationship with disease duration. These findings may open up the possibility of the clinical use of vitamin D as a contributing factor in the pathogenesis of acute urticaria and a predictive marker for disease activity in acute urticaria. A potential role of vitamin D in pathogenesis and additive therapy in acute urticaria needs to be examined.

Objective: The prevalence of asthma is increased in obese individuals. There is no concrete evidence that an increase in body mass index is associated with a loss of pulmonary function in childhood asthma. Our aim was to investigate the effect of obesity, atopy, and sex on pulmonary function in asthmatic children. Materials and Methods: This study is a cross-sectional analysis in children with mild persistent asthma. A total of 76 obese and 55 lean children with asthma were recruited. All of the participants were assessed by pulmonary function tests. Skin prick tests including common aeroallergens were performed to all patients. Results: No differences were found in pulmonary function test parameters between obese and lean patients with asthma. In obese patients with asthma, the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) was significantly lower in nonatopic (92.1+/-6.4) than in atopic patients (95.5+/-5.3, p=0.02). We also demonstrated that FEV1/FVC was significantly lower in nonatopic obese patients (92.1+/-6.4) than in nonatopic lean patients with asthma (95.6+/-4.7, p=0.05). Conclusion: Obesity does not seem to be affecting pulmonary function in children with well-controlled mild persistent asthma. However, airways of nonatopic obese asthmatics are negatively affected.

To evaluate serum vitamin D levels in cases of recurrent respiratory infections and chronic cough and to investigate the effect of vitamin D therapy on recurrence of the diseases. This prospective observational study was performed by comparing serum vitamin D levels in children with recurrent respiratory infections, chronic cough and healthy children. One-hundred-one children with chronic cough, ninety-eight children with recurrent respiratory infections and one-hundred-twenty-four healthy children were enrolled in the study. A structured questionnaire was completed to collect data on demography, diet, duration of breastfeeding, vitamin D supplementation and family history for allergic diseases. In patients with low serum vitamin D levels (