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Author(s): Ahmet Taner Elmas [sup.1] , YilmazYilmaz Tabel [sup.1] , Ayse Selimoglu [sup.2] , Senay Kenç [sup.2] , Ramazan Kutlu [sup.3] Author Affiliations: (Aff1) 0000 0001 0024 1937, grid.411650.7, Department [...]

Author(s): Ahmet Taner Elmas [sup.1], Yilmaz Tabel [sup.1], Ayse Selimoglu [sup.2], Senay Kenç [sup.2], Ramazan Kutlu [sup.3] Author Affiliations: (1) 0000 0001 0024 1937, grid.411650.7, Department of Pediatric Nephrology, Faculty [...]

The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-α 2b (10 MU/m2) thrice/weekly alone for 6 months. In the second ( n = 60) and third groups ( n = 60), IFN-α was used for 6 months (5 MU/m2) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 ± 93 IU/L, 101 ± 64 IU/L and 92 ± 42 IU/L, respectively ( P > 0.05). At the end of the therapy, ALT values decreased to 82 ± 111 IU/L, 38 ± 41 IU/L and 29 ± 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups ( P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar ( P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups ( P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-α monotherapy group, no significant difference was found in the complete response ratios of all three groups. [ABSTRACT FROM AUTHOR]

Objective: Liver transplantation offers a quality life chance for children and adolescents who have a serious liver disease. Chronic illness, invasive interferences, hospitalization of the transplantation and stay in the intensive care unit, medication compliance and side effects, and complications after transplantation cause a significant degree of mental stress and may lead to a deterioration of mental health. This study aimed to evaluate the psychological difficulties of children after liver transplantation. Methods: This randomized controlled trial included 48 liver transplant patients between 4-18 years of age who had received liver transplants in the İnonu University Turgut Ozal Medical Center transplant unit, 37 patients with chronic liver disease and 50 healthy children and adolescents. Families of children and adolescents participating in this study filled the sociodemographic data form and parents form of Strength and Difficulties Questionnaire (SDQ). Literate children age seven years and older and adolescents answered The Child Posttraumatic Stress Disorder Symptom Scale (CPSS); those 11 years and over answered SDQ self-report form. Results: There was no difference between the three groups in terms of age and gender (p<0.05). Comparing CPSS scores of the groups, there was no significant difference between chronic liver disease and transplant patients groups; it was determined that chronic liver disease and transplant patient groups scored significantly higher than the healthy group (p<0.05). Significant differences were not detected in terms of GGA-total and subscale scores between the three groups. Conclusion: The results of this study suggest that the mental state of children with chronic liver disease and liver transplant is similar to healthy controls. However, the presence of symptoms of posttraumatic stress disorder in children in the two groups suggested that they are at risk in this regard. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primarily intended for gastroenterology, endocrinology, metabolism diseases, cardiology, internal medicine, pediatric specialists, and family medicine specialists., Competing Interests: The authors have no conflict of interest to declare., (© Copyright 2023 by Hepatology Forum.)

Objective: Posterior reversible encephalopathy syndrome (PRES) is characterized by typical radiologic findings in the posterior regions of the cerebral hemispheres and cerebellum. The symptoms include headache, nausea, vomiting, visual disturbances, focal neurologic deficits, and seizures. The aim of this study is to evaluate the clinical and radiological features of PRES in children and to emphasize the recognition of atypical features., Materials & Methods: We retrospectively examined 23 children with PRES from Mar 2010-Apr 2015 in Inonu University Turgut Ozal Medical Center in Turkey. We compared the clinical features and cranial MRI findings between underlying diseases of PRES., Results: The most common precipitating factors were hypertension (78.2%) and medications, namely immunosuppressive and antineoplastic agents (60.8%). Manifestations included mental changes (100%), seizures (95.6%), headache (60.8%), and visual disturbances (21.7%) of mean 3.6 (range 1-10) days' duration. Cranial magnetic resonance imaging (MRI) showed bilateral occipital lesions in all patients, associated in 82.6% with less typical distribution of lesions in frontal, temporal or parietal lobes, cerebellum, corpus callosum, basal ganglia, thalamus, and brain stem. Frontal involvement was predominant, observed in 56.5% of patients. Clinical recovery was followed by radiologic resolution in all patients., Conclusion: PRES is often unsuspected by the clinician, thus radiologists may be the first to suggest this diagnosis on an MRI obtained for seizures or encephalopathy. Atypical MRI finding is seen quite often. Rapid diagnosis and treatment are required to avoid a devastating outcome.