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Amaç: Akut gastroenterit (AGE), erken ve doğru tedavi edilmediğinde özellikle çocuklarda yüksek morbidite ve mortalite ile seyredebilen ve tüm dünyada sık görülen bir enfeksiyondur. Çocukluk döneminde en sık Rotavirüsler, Adenovirüsler, Norovirüsler AGE’lere neden olmaktadır. Viral enfeksiyonların hızlı tanısında, immünokromatografik (ICT) veya ELISA temelli yöntemler tercih edilmekte iken, son yıllarda multipleks polimeraz zincir reaksiyonu (PZR) testleri de laboratuvarlarda kullanılmaya başlanmıştır. Bu çalışmada Rotavirus, Adenovirus ve Norovirus tanısında immünokromatografik yöntem ve PZR yöntemi ile elde edilen sonuçların karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya AGE tanılı hastaların ICT yöntemi ile Rotavirus ve/veya Adenovirus pozitif olarak saptanan 67 gaita örneği ve ICT yöntemi ile viral, bakteriyel, paraziter etkenler açısından negatif bulunan 17 gaita örneği dâhil edildi. Bu örneklerde Rotavirus, Norovirus RNA’sı ile Adenovirus DNA’sı multipleks PZR kiti kullanılarak araştırıldı. Bulgular: ICT yöntemi ile örneklerin 62’sinde (%73,8) Rotavirus pozitif iken, gerçek zamanlı PZR yöntemi ile 49’unda (%58,5) Rotavirus pozitif bulundu. ICT yöntemi ile örneklerin beşinde (%5,9) Adenovirus pozitif bulunurken, multipleks gerçek zamanlı PZR yöntemi ile 40’ında (%47,6) Adenovirus pozitif tespit edildi. Örneklerin 11’inde (%13) Norovirus pozitif saptandı. Sonuç: En sık karşılaşılan viral gastroenterit etkenleri olan Rotavirus ve Adenovirus tanısı için çok yaygın olarak ICT kullanılmaktadır. Ancak çalışmamızda da görüldüğü üzere; bu tür olgularda Norovirüs gibi diğer gastroenterit etkeni virüslerin de klinik tablodan sorumlu olabileceği göz ardı edilmemelidir. Rotavirus ve Adenovirus tanımlamasında ICT ve PZR yöntemleri arasında anlamlı ancak düşük düzeyde korelasyon saptandı.

Although the new coronavirus disease (COVID-19) has a wide variety of complications, one of the least common of these is pneumomediastinum. In pneumomediastinum, which is defined as the presence of free air in the mediastinum, clinically dyspnea, chest pain and subcutaneous emphysema are observed. Here, we present a case of spontaneous pneumomediastinum in a patient infected with COVID-19 without any risk factors., Yeni Koronavirüs Hastalığı’nın (COVID-19) çok çeşitli komplikasyonları olmakla birlikte, bunlardan en az görülenlerden biri de pnömomediastinumdur. Mediastinumda serbest hava bulunması olarak tanımlanan pnömomediastinumda, klinik olarak nefes darlığı, göğüs ağrısı ve cilt altı amfizemi izlenir. Biz burada hiçbir risk faktörü olmadığı halde COVID-19 ile enfekte bir hastada gelişen spontan pnömomediastinum vakasını sunuyoruz.

Gastric (foveolar) metaplasia (GM) in the duodenum occurs in many cases where duodenitis develops histologically. However, few studies have investigated the presence of GM in celiac patients. This study aimed to determine the prevalence of GM and its relationship with clinicopathological parameters in untreated pediatric celiac patients. Duodenal biopsy specimens of 153 pediatric cases were analyzed. MUC5AC immunohistochemical staining was applied to all cases to detect GM. The patient group was evaluated in terms of the disease activity score (DAS), neutrophilic activity score (NAS), eosinophilic infiltration, and presence of intramucosal Brunner glands. The rate of GM was 53.4% in the control group and 98.8% in the patient group. GM was observed as diffuse morphology at a rate of 4.1% (n:3) in the control group and 55% (n:44) in the patient group (p

Background and study aims Wilson’s disease (WD) is a complex disorder related to copper metabolism and neurological involvement may lead to swallowing disorders . The purpose of this study was to evaluate swallowing function in pediatric patients with WD by using videofluoroscopic swallowing study (VFSS). Patients and methods A total of 21 patients were included in the study, prospectively. The VFSS was conducted to evaluate swallowing function of the patients. The penetration-aspiration scale (PAS) was used to assess penetration-aspiration severity. Results According to the VFSS, abnormal results were detected in nine patients (42.9%) with WD. Of these nine patients, oral phase dysfunction was present in one patient, laryngeal penetration was present in one patient and moreover, abnormal esophageal body function was detected in all nine patients. Of these nine patients, five had neurological presentation at the time of diagnosis, and remaining four patients had hepatic presentation. Mean PAS score of the patients was 1. Conclusion The current study results suggest that subclinical swallowing dysfunction may be observed in patients with either neurological or hepatic WD. Further studies are necessary to reveal the real incidence of esophageal phase problems of swallowing function in pediatric patients with WD.

Objective: Famotidine is an H2 receptor antagonist (H2RA) and has been shown to have antiviral properties in in-vitro studies. Pantoprazole is one of the proton pump inhibitors (PPI). In this study, it was aimed to compare the efficacy of Famotidine with Pantoprazole in the treatment of COVID-19.Material-method: Patients who were hospitalized and given famotidine and pantoprazole treatment for at least 48 hours were included in the study. Demographic, clinical and laboratory findings of the patients were analyzed retroprospectively from the patient files. While the primary endpoints were the need for an intensive care unit (ICU) and death, the secondary endpoints were the absence of the need for oxygen support, fever to normal levels, and length of hospital stay.Results: A total of 179 Covid-19 patients (85 (47.5%) famotidine, 94 (52.5%) pantoprazole) were included in the study. Demographic findings and other symptoms except dyspnea were similar in both groups (p> 0.05). Dyspnea, chronic diseases, and the number of patients given steroids were higher in those who were given pantoprazole (p 0.05). The number of days with fever, duration of hospitalization, and the number of days requiring oxygen support was less in those given famotidine (p, Amaç: Famotidin, bir H2 reseptör antagonistidir ve in vitro çalışmalarda antiviral özelliklere sahip olduğu gösterilmiştir. Pantoprazol, proton pompası inhibitörlerinden biridir. Bu çalışmada, COVID-19 tedavisinde Famotidinin ile Pantaprazolun etkinliğinin karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Çalışmaya en az 48 saat famotidin ve pantaprazol tedavisi verilen ve hastanede yatan hastalar dâhil edildi. Hastaların demografik, klinik ve laboratuvar bulguları hasta dosyalarından geriye dönük olarak incelendi. Hastalar famotidin grubu ve pantoprazol grubu olarak iki gruba ayrıldı. Gruplar yoğun bakım ihtiyacı ve ölüm oranları açısından karşılaştırıldı. Ayrıca gruplar arasında taburculukta oksijen saturasyonu normal olan hasta sayısı, oksijen desteğine ihtiyaç duyulan gün sayısı, ateşli gün sayısı ve hastanede kalış süresi değerlendirildi.Bulgular: Çalışmaya toplam 179 Covid-19 hastası (85 famotidin grubu, 94 pantoprazol grubu) dâhil edildi. Demografik bulgular ve dispne dışındaki diğer semptomlar her iki grupta benzerdi. Pantoprazol verilenlerde dispne, kronik hastalıklar ve steroid verilen hasta sayısı daha yüksekti. Mortalite ve YBÜ ihtiyacı her iki grupta benzerdi (sırasıyla; p=0.25, p=0.26). Famotidin verilenlerde ateşli gün sayısı, hastanede kalış süresi ve oksijen desteği gerektiren gün sayısı daha azdı (sırasıyla; p=0.04, p=0.003, p=0.014).Sonuç: Famotidin, hastanede tedavi gören COVID-19 hastalarında yoğun bakım ihtiyacını ve mortaliteyi azaltmadı. Hastalık şiddetini ve ölüm oranını azaltmak için yeni tedavilere ihtiyaç vardır.

Background/aim: It is very important for the efficient use of limited capacity and the success of treatment to predict patients who may need ICU with high mortality rate in the Covid-19 outbreak. In our study, it was aimed to investigate the value of the radiological involvement on initial CT in demonstrating the ICU transfer and mortality rate of patients. Materials and methods: All PCR-positive patients were included in the study, whose CT, PCR, and laboratory values were obtained simultaneously at the time of first admission. Patients were divided into 4 groups in terms of the extent of radiological lesions. These groups were compared in terms of intensive care transfer needs and Covid-related mortality rates. Results: A total of 477 patients were included in the study. Ninety of them were group 0 (no lung involvement), 162 were group 1 (mild lesion), 89 were group 2 (moderate lesion), and 136 were group 3 (severe lung involvement). A significant relationship was found between the extensiveness of the radiological lesion on CT and admission to intensive care and mortality rate. As the initial radiological involvement amounts increased, the rate of ICU transfer and mortality increased. The mortality rates of the groups were 0%, 3%, 12.3%, and 12.5%, respectively, and the difference was significant (p < 0.001). Similarly, the ICU transfer rates of the groups were 2.2%, 5.6%, 13.5%, and 17.7%, respectively, and the difference was significant (p < 0.001). Conclusion: In conclusion, in our study, the strong relationship between the initial radiological extent assessment and the need for intensive care and mortality rates has been demonstrated, and we believe that our results will make a significant contribution to increase the success of the health system in predicting patients who may progress, helping clinicians and managing pandemics.

Background/aim Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Turkey on March 10, 2020 and the number of the patients are increasing day by day. Coronavirus disease 2019 (Covid-19) has high mortality rates in intensive care units (ICUs). We aimed to describe the demographic characteristics, comorbidities, treatment protocols, and clinical outcomes among the critically ill patients admitted to the ICU of our hospital. Materials and methods This cohort study included 103 consecutive patients who had laboratory confirmed Covid-19 and admitted to ICU of Sakarya University Training and Research Hospital between March 19 and April 13, 2020. The final date of the follow-up was April 18. Results The mean age of the patients was 69.6 ± 14.1 years. Most of the patients had increased CRP (99%), serum ferritin (73.8%), d-dimer (82.5%), and hs-troponin levels (38.8%). 34 patients (33%) had lymphocytopenia, 24 patients (23.3%) had thrombocytopenia. 63 patients (61.2%) developed acute respiratory distress syndrome (ARDS), 31 patients (30.1%) had acute kidney injury, and 52 patients (50.5%) had multiple organ dysfunction syndrome (MODS) during follow-up. Sixty-two patients (60.2%) received mechanical ventilation. As of April 18, of the 103 patients, 52 (50.5%) had died, 30 (29.1%) had been discharged from the ICU, 21 (20.4%) were still in the ICU. Conclusions Covid-19 has high mortality rates in ICU. Patients with elevated procalcitonin, hs-troponin, d-dimer, and CRP levels and lower platelet count at admission have higher mortality.

Objective: The aim of this study was to investigate the efficacy of favipiravir (FVP) in severe COVID-19. Materials and methods: This is a retrospective study of 142 COVID-19 patients with severe pneumonia signs, who received inpatient treatment between March 15 and May 20, 2020. The patients were divided into two groups according to the use of FVP treatment; group 1 (n = 99) included patients who treated with FVP and group 2 (n = 43) who didn’t receive FVP. Results: Mean age was 66.47 ± 11.89 in group 1, and 68.58 ± 14.78 in group 2. Forty patients (40.4%) in group 1 and 22 (51.2%) in group 2 were treated in the intensive care unit (P > 0.05). The proportion of eosinophil, tendency of increasing thrombocyte counts and eosinophil/neutrophil ratio in FVP group was significantly higher than non-FVP group (p < 0.05). In Group 1, patients had significantly reduced erythroid series, and elevated uric acid levels as side effects of FVP. With respect to complications during hospitalization, there was no significant difference among the groups for mechanical ventilator requirement, acute kidney injury, dialysis requirement, and sepsis (P > 0.05). The mortality rates in Group 1 (n = 26 [26.3%]) were lower than those in group 2 (n = 16 [37.2%]), but it was not statistically significant. Conclusion: While the treatment of COVID-19 pneumonia options was limited during the initial stages of the pandemic, the FVP may be effective in severe cases. To confirm this effect, randomized controlled studies are needed in patients of all disease severities.

Wilson hastalığı (WH), bakır metabolizmasının otozomal resesif geçişli bir bozukluğudur. Etkilenen çocuklar asemptomatik olabilir ve bu tanı koymayı zorlaştırır. Bu çalışmada WH'li hastaların klinik, laboratuvar, histopatolojik ve genetik özellikleri ve izlem sonuçlarını değerlendirmeyi amaçladık. Çalışmamıza Ocak 2010-Aralık 2020 tarihleri arasında WH tanısı konulan hastalar dahil edilmiştir. Başvuru şikayetleri, fizik muayene bulguları, akrabalık ve aile öyküsü, laboratuvar, genetik, histopatolojik değerlendirme sonuçları, tedavi ve izlem sonuçları kayıt altına alındı.18 aileden toplam 21 hasta [ortanca yaş 9,5 (1-14) yıl, 10 kız] dahil edildi. 11 (%52,4) hastada Kayser-Fleischer halkası tespit edildi. 15 hastada serum seruloplazmin (100 µg/gün idi. Bakır, 18 karaciğer biyopsisinin 9'unda rhodanin ile pozitif olarak boyandı. Karaciğer bakır içeriği tüm hastalarda >50 µg/g olup, 3 hastada 50-250 µg/g ve 15 hastada > 250 µg/g idi. 18 hastada genetik değerlendirme yapıldı ve 4 hastada ATP7B geninde heterozigot mutasyonlar, 6 hastada kombine heterozigot mutasyonlar ve 8 hastada homozigot mutasyonlar saptandı. Nörolojik bulguları olan iki hasta ve aile taraması ile tanı konulan üç asemptomatik hasta dışında, tümü karaciğer bulguları ile başvurdu. Takiplerde 2 hastada nörolojik tutulum saptandı. 16 hastada D-penisilamin ve çinko sülfat kombine tedavileri, aile taraması ile tanı konan presemptomatik bir hastaya çinko sülfat monoterapisi, nörolojik tutulumu olan dört hastada trientin ve çinko sülfat kombine tedavileri uygulandı. 15 hastada ortalama 8,3 (4-23) ayda transaminaz değerleri normale döndü. Kayser-Fleischer halkası, on bir hastanın yedisinde medyan 32,8 ayda (10-81) kayboldu. Başvuru anında fulminan karaciğer yetmezliği ile başvuran iki hastadan birine karaciğer nakli yapılırken, diğerine transplantasyona gerek kalmadan plazmaferez ve şelasyon tedavisi uygulandı. Asemptomatik transaminaz yükselmesinden akut karaciğer yetmezliğine kadar her türlü karaciğer hastalığının ayırıcı tanısında Wilson hastalığı düşünülmelidir. Erken tanı ve tedavi çok önemli olduğundan tanı konulan hastalarda aile taraması mutlaka önerilmelidir., Wilson disease (WD) is an autosomal recessive disorder of copper metabolism. Affected children may be asymptomatic, makes the diagnosis more difficult. In this study, we aimed to evaluate the clinical, laboratory, histopathological and genetic characteristics, and outcomes of the patients with WD. Our study includes patients who were diagnosed with WD between January 2010 and December 2020. The presenting complaints, physical examination findings, consanguinity and family history, laboratory, genetic, histopathological evaluation results, treatment and outcomes were all recorded. A total of 21 patients from 18 families [median age 9.5 (1-14) years, 10 girls] were included. Kayser-Fleischer ring was detected in 11 (52.4%) patients. Serum ceruloplasmin (100 µg/day in 17 patients. Copper was positively stained with rhodanine in 9 of the18 liver biopsies. Liver copper content was >50 µg/g dry weight in all patients, 50-250 µg/g in 3 patients and >250 µg/g in 15 patients. Genetic evaluation was available in 18 patients and revealed heterozygous mutations in the ATP7B gene in 4 patients, combined heterozygous mutations in 6, and homozygous mutations in 8. Except for two patients with neurological findings and three asymptomatic patients who were diagnosed by family screening, all were presented with liver findings. Neurological involvement was also detected in 2 patients during follow up. D-Penicillamine and zinc sulfate combined treatments were used in 16 patients, zinc sulfate monotherapy was given to a presymptomatic patient diagnosed with family screening, and trientine and zinc sulfate combined therapies were used in four patients with neurological involvement. Transaminase values returned to normal in a median of 8.3 (4-23) months in 15 patients. The Kayser-Fleischer ring disappeared in a median of 32.8 months (10-81) in seven out of eleven patients. While liver transplantation was performed in one of the two patients who presented with fulminant hepatic failure at admission, the other was followed up with plasmapheresis and chelation therapy without the need for transplantation. Wilson disease should be considered in the differential diagnosis of all kinds of liver diseases ranging from asymptomatic elevation of transaminases to acute liver failure. Since early diagnosis and treatment are very important, family screening should definitely be recommended in diagnosed patients.

Eosinophilic gastroenteritis is an inflammatory disease characterized by pathologic eosinophilic infiltration of any portion of the gastrointestinal tract. Depending on the involved site and layer of eosinophilic infiltration, symptoms and signs are heterogeneous. This manuscript reports two patients who presented with acute upper gastrointestinal tract bleeding and protein-losing enteropathy signs, and were diagnosed as having eosinophilic gastroenteritis. Upper endoscopy revealed an appearance of mucosal pseudomass in both patients. Both patients achieved satisfactory clinical improvement with an elimination diet and proton pump inhibitor treatment.

Background and Aims: Although most of the upper gastrointestinal system bleedings are self-limited, it can be life threating in a small portion of patients. The aim of this study is to determine the risk factors predicting clinically significant upper gastrointestinal system bleeding in children.Material and Method: Patients with upper gastrointestinal system bleeding and aged between 0-18 years old were enrolled. Age at diagnosis, gender, amount of bleeding, hemathemesis, melena, complaints, accompanying diseases, medication that is prone to bleeding, vital signs, capillary refill time and phsical examination findings were recorded. Hemogram, biochemistry, coagulation tests, endoscopic findings, erythrocyte transfusion, medical and/or endoscopic treatments applied, follow-ups in emergency or service and final diagnosis of bleeding were recorded. Patients with ≥ 8 points according to Sheffield scoring system defined as clinically significant upper gastrointestinal system bleeding and data were compared between groups.ResultsFifty five children [29 (52.7%) girls, 26 (47.3%) boys; mean 8.4±5.4 years] were enrolled to the study. Seventeen children (26.8%) had clinically significant gastrointestinal system bleeding. We detected anemia in 22 children, high blood urea nitrogen level in 20 children, low count of erythrocyte in 14 children and hypoalbuminemia in 5 children at presentation. Patients with significantly upper gastrointestinal bleeding more commonly have symptoms of melena (%76.5 vs. %21.1, p, Giriş ve Amaç: Üst gastrointestinal sistem kanaması çocukluk çağında çoğunlukla hafif olmakla birlikte, hayatı tehdit eden ciddi kanama şeklinde de görülebilmektedir. Bu çalışmada klinik olarak anlamlı üst gastrointestinal sistem kanamasına işaret eden bulguların ve risk faktörlerinin belirlenmesi amaçlandı.Gereç ve Yöntem: Çalışmaya üst gastrointestinal sistem kanaması tanısı alan, 0-18 yaş aralığında çocuklar alındı. Tanı anındaki yaşı, cinsiyeti, kanama miktarı, hematemez, melena varlığı, başvuru anındaki yakınmaları, eşlik eden hastalıkları, kanamaya yatkınlık yaratan ilaç kullanımı, vital bulguları, kapiller dolum zamanı ve sistemik fizik muayene bulguları kaydedildi. Laboratuvar tetkiklerinden hemogram, biyokimya, koagülasyon testleri, endoskopik işlem bulguları, eritrosit transfüzyonu sayısı, uygulanan medikal ve/veya endoskopik tedaviler, acilde ya da serviste izlemleri ve kanama açısından konulan son tanısı kaydedildi. Sheffield skorlamasına göre 8 puan ve üzeri alanlar anlamlı üst gastrointestinal sistem kanaması olanlar olarak gruplandı, veriler gruplar arasında karşılaştırıldı. Bulgular: Elli beş çocuk [29 (%52.7) kız, 26 (%47.3) erkek; ortalama tanı yaşı 8.4±5.4 yıl] çalışmaya alındı. Başvuru anında 22 hastada anemi, 20 hastada kan üre azotu yüksekliği, 14 hastada eritrosit sayısında düşüklük, 5 hastada hipoalbüminemi vardı. Anlamlı kanaması olan 17 hastada; melena (%76.5 vs. %21.1, p

Aim: Evidences showed that coronavirus disease 2019 (COVID-19) can cause increased coagulopahty due to many different mechanisms. We aimed to identfy features of patients newly diagnosed pulmonary embolism (PE) during COVID pneumonia and evaluate prognosis of those patients. Method: We conducted a multicenter retrospective study and examined files of patients who was diagnosed with PE within 45 days after or at the same time the diagnosis of COVID pneumonia. Results: 38 (36,9%) of patients was women and mean age was 59,8 years. 47 (45,6%) of patients had severe COVID pneumonia and 43 (41,7%) of patients had bilateral expansive infiltrations. 62 (60,2%) of patients had at least one comorbidity and macrophage activation syndrome occured 16 (15,5%) of all patients. In the 33 (32%) of patients, PE was diagnosed at the same time with COVID pneumonia. Mean PE occuring time was 8,8 days after COVID diagnosis. 37 (35,9%) of patients was taking anticoagulant prophylaxis. D-dimer levels of patients was 5,5 times the upper limit of normal at the beginning of the COVID pneumonia and 9,7 at the diagnosis of PE. Most of patients had thrombus in the bilateral or unilateral segmental/subsegmental arteries. 60 (58,3%) of patients had low PE early mortality risk. For PE treatment 79 (76,7%) of patients used low moleculer weight heparin, 16 (15,5%) unfractioned heparin and 8 (7,8%) direct oral anticoagulant. 7 (6,8%) of patients needed thrombolytic therapy. Mortality rate was 7,8%. Conclusion: We revealed characteristics of patients newly diagnosed PE during COVID pneumonia. Further studies ar needed to assess incidence of PE and factors releated with mortality in those patients.

Microvillus inclusion disease (MVID; MIM #251850), is a rare life-threatening secretory and malabsorptive diarrhea of infancy due to mutations in the MYO5B gene. A 6-day-old male patient was referred to our neonatal intensive care unit for profuse diarrhea beginning on the 2nd day of life causing 17% weight loss, metabolic acidosis and hyponatremia. Our patient had a homozygous mutation in the MYO5B gene. On 110th day of life, mesenchymal stem cell treatment (1x106 cells trans duodenal and 2x106 cells intravenous) was administered. Although fluid and electrolyte requirements did not decrease after stem cell therapy, the rate of blood stream infections was reduced. Small bowel transplantation using cadaveric intestine was performed at the age of 20 months. Unfortunately, the infant died of sepsis one month after transplantation. In this case report, results of stem cell therapy in a newborn infant with MVID were presented and discussed with the relevant literature., Mikrovillus inklüzyon hastalığı (MİH), Miyosin 5B genindeki mutasyonlara bağlı oluşan sekretuvar ve osmotik diyare ile seyreden hayatı tehdit edici bir hastalıktır. Mezenkimal kök hücre (MKH) tedavisi intestinal yetmezlikte sınırlı sayıda olguda uygulanmıştır ancak MİH’de sadece hayvan çalışmaları bulunmaktadır. Altı günlük erkek bebek postnatal 2. günde başlayan, ishal, metabolik asidoz ve hiponatremi nedeniyle yenidoğan yoğun bakım ünitemize kabul edildi. 36 hafta 4 günlük, 2960 g olarak doğan bebeğin diyareye bağlı iki kardeş ölüm öyküsü vardı. Olgumuzda MYO5B geninde homozigot mutasyon tespit edildi. Enteral beslenme kesilerek total parenteral beslenme başlandı. Bebeğin yüksek sıvı (350 cc/kg/gün), sodyum (20-25 meq/kg/gün) ve bikarbonat (12-18 meq/kg/gün) ihtiyacı mevcuttu. Postnatal 110. gününde hastaya MKH tedavisi (1x106 Ü transduodenal ve 2x106 Ü IV) uygulandı. Kök hücre tedavisi sonrası her ne kadar sıvı ve elektrolit gereksinimleri azalmasa da sepsis sıklığında azalma gözlendi. Bebek 20 aylıkken kadavradan ince barsak nakli yapıldı, ancak nakilden bir ay sonra sepsis nedeniyle eksitus oldu.

COVID-19 hayatimiza girdigi tarihten beri sosyal hayatimizi, calisma hayatimizi, yasayisimizi, hastabakim hizmetlerini, arastirmalarimizi ve hatta davranis tarzimizi etkiledi. Ustelik bu oyle bir salgin kisadece bir ulkede degil, butun dunya ulkelerinde ayni zamanda ve benzer yogunlukta etkilendi. Adetaulkelerin saglik sistemleri bircok sorunla sinanmistir. Salgin sirasinda bircok bilinmeyen denklem ic iceidi. Salgin basinda o kadar cok bilinmeyenimiz vardi ki hastalara nasil yaklastigimizi, nasil tedavi verecegimizive hangi ilaclarin verilmesi gerektigini henuz net bir sekilde bilmiyorduk. Gecen sure zarfindabircok arastirma ve bircok deneyim bizim hastaliga karsi nasil davranmamiz gerektigini ogretti.Salgin sirasinda bilgi kirliliginin ne kadar zarar verebilir oldugunu yasayarak ogrendik. Ayrica, salginbize asi savaslarini gosterdi. Salgindan kurtulmak icin kullandigimiz asilarin ne kadar degerli oldugunu,gelismis ulkelerin nasil asi savaslarina girdigini ve asilama ile beraber salgin dinamiklerinin nasil degistiginigorduk.2020 ve 2021 yillari salgin yillari olarak tanimlanacaktir. Bu salgin sirasinda saglik calisanlarinindogru bilgilere ulasmasinin cok degerli oldugunu gorduk. Elinizdeki bu kaynak, salgini bizzat yasayarakelde edilen tecrubelerini paylasip olusturulmaya calisilmistir. Kitabin olusturulmasinda emegi olan tumarkadaslarimiza icten tesekkurlerimizi arz ediyoruz. Bu kitabin okuyuculara fayda getirmesini diliyoruz.Bu kitabi, cani pahasina COVID-19 ile savasan ve hayatini kaybeden tum saglik calisanlarina armaganediyoruz.Saglicakla kalin. Prof. Dr. Oguz KARABAYDoc. Dr. Hamad DHEIRDoc. Dr. Selcuk YAYLACI

SUMMARY OBJECTIVE: This study aims to investigate and compare the coagulation parameters of coronavirus disease 2019 (COVID-19) patients with mortal and nonmortal conditions. METHODS: In this study, 511 patients diagnosed with COVID-19 were included. Information about 31 deceased and 480 recovered COVID-19 patients was obtained from the hospital information management system and analyzed retrospectively. Whether there was a correlation between coagulation parameters between the mortal and nonmortal patients was analyzed. Descriptive analyses on general characteristics of the study population were performed. Visual (probability plots and histograms) and analytical methods (Kolmogorov–Smirnov and Shapiro–Wilk test) were used to test the normal distribution. Analyses were performed using the SPSS statistical software package. RESULTS: Out of 511 patients, 219 (42.9%) were females and 292 (57.1%) were males. There was no statistically significant difference between males and females in terms of mortality (p=0.521). In total, the median age was 67 (22). The median age was 74 (13) in the nonsurvivor group and 67 (22) in the survivor group, and the difference was statistically significant (p=0.007). The D-dimer, prothrombin time, international normalized ratio, neutrophil, and lymphocyte median age values with p-values, in the recovered and deceased patient groups were: 1070 (2129), 1990 (7513) μg FEU/L, p=0.005; 12.6 (2.10), 13.3 (2.1), p=0.014; 1.17 (0.21), 1.22 (0.19), p=0.028; 5.51 (6.15), 8.54 (7.05), p=0.001; and 0.99 (0.96), 0.64 (0.84), p=0.037, respectively, with statistically significant differences. CONCLUSIONS: As a result of this study, D-dimer, prothrombin time, and international normalized ratio increase were found to be associated with mortality. These parameters need to be closely monitored during the patient follow-up.

Inlet patch (IP) is an area of heterotopic gastric mucosa located in proximal esophagus. Although the majority of IP are asymptomatic, they may be associated with digestive and respiratory symptoms. We aimed to assess prevalence, endoscopic and histopathological findings, clinical significance and outcome of inlet patch in children.The patients with histopathologically proven IP and aged between 0-18 years old were enrolled. Demographic data, clinical symptoms, endoscopic and histopathological findings, treatment modality, and outcomes were collected from medical records. Retrospective review of 2674 esophagogastroduodenoscopy records revealed 11 (0.41%) children. Eight of our patients had a solitary patch whereas others had two (n=1) or three (n=2). Histopathological evaluation revealed that 9 patients had fundic and 2 patients had antral type gastric mucosa. One patient with hematemesis and other with dysphagia had hyperemic patchy areas of which were colonized by H. pylori. Inlet patch was the only pathological endoscopic finding in 4 patients with a single symptom each: heartburn, dysphagia, hematemesis and hoarseness. Symptoms were completely resolved with PPI treatment in 8 children. Helicobacter pylori eradication was achieved in all infected patients. No respiratory symptom was recorded except hoarseness in one patient. No complications like perforation, stenosis or dysplasia that might be related to IP were recorded at follow-up. We suggest that an IP may accompany or may be responsible for digestive symptoms in children and PPI treatment is effective. Endoscopist should be aware of this condition, especially if the patient has dyspeptic symptoms and normal endoscopic findings.

Hastalar tarafindan iyi tolere edilebilen, yeterli bir bagirsak temizliginin uygulanabilmesi, iyi kalitede ve guvenilir bir kolonoskopi yapilabilmesi acisindan onem tasimaktadir. Calismamizda, cocuk hastalarda polietilen glikol (PEG) gibi ozmotik bir bagirsak temizleyici ile daha az kullanilan sodyum fosfat (SF) gibi uyarici bir ajanin etkinligini ve kullanilabilirligini karsilastirmayi amacladik. Hastanemizde, Ocak 2016 ve Aralik 2019 yillari arasinda kolonoskopi yapilmis ve kolonoskopi hazirlik rejimi olarak PEG veya SF kullanilmis olan cocuk hastalarimizin kayitlarini geriye donuk olarak degerlendirdik. Bagirsak temizliginin kullanilabilirligi (tolerabilite), ilacin kullanim kolayligi ve karin agrisi, bulanti, kusma, bas donmesi gibi yan etkileri ve bunlarin siddetini sorgulayan bir anket ile degerlendirildi. Bagirsak temizliginin kalitesi, temizligi ve sivi miktarini degerlendiren Ottawa olcegi ile belirlendi. Ottawa olcegi, kolonoskopi video kayitlarindan kor bir sekilde ve geriye donuk olarak olculdu. Ortalama yaslari 12,3±4,2 yas olan toplam 145 hasta (65 erkek, %44,8) calismaya alindi. Doksan uc (%64,1) hastada PEG, 52 hastada (%35,9) SF kullanilmisti. Hastalarin ortalama yaslari PEG grubunda (11,2±4,6 yas) SF grubuna (14,2±2,7 yas) gore anlamli olarak dusuktu (p

Objective:Pleural effusion is frequently encountered in patients with lung cancer. Malignant-benign differentiation of the fluid is very important for treatment decision because malignant fluid is considered as the inoperability criterion. However, this distinction is not clinically feasible and may require a cytological examination of the fluid via invasive procedures. The aim of this study was to determine whether there was any difference between laboratory results of malignant and benign pleural fluids.Methods:We retrospectively evaluated 135 patients with cytologically diagnosed lung cancer and underwent benign-malignant differentiation of pleural effusion. Benign and malignant groups were compared in terms of fluid biochemistry, blood gas and cell count.Results:One hundred four patients were male, 31 were female and the mean age was 63.5±11.4 years. Histologically adenocarcinoma was determined as the most common (56%). Right pleural effusion was present in 58.5% of the patients. Malignant effusion rate was higher in females (malign/benign; female: 21/10, male: 48/56). Albumin, protein, erythrocyte count (RBC) and hematocrit (HCT) values in pleural fluid were higher in the malignant group (p=0.001, p=0.018, p=0.009 and, p=0.016, respectively). Cut-off value for albumin: 2.85 and odds ratio (OR): 2.02; for HCT 4.7 and OR: 6.25; for RBC 300 and OR: 6.25; for protein 4.45 and OR: 2.08.Conclusion:In our study, we found that the values of albumin, HCT, RBC and protein in pleural fluid were higher in malignant pleural effusion.

Rhizopus microsporus is a rare infectious agent that belongs to the class Zygomycetes and the group Mucorales. Major risk factors for infections caused by Rhizopus microsporus are uncontrolled diabetes, hematological malignancies, organ transplantation, steroid use, and malnutrition. Rhizopus microsporus is a rare infectious agent in immunocompetent people. The aim of this study is to present pleural R. microsporus complex in a patient with no risk factors.

INTRODUCTION The risk of TB is increased in patients with chronic kidney disease (CKD) when compared with individuals with normal renal function. We aimed to determine tuberculin skin test (TST) response and the factors which might affect the response in patients with CKD undergoing dialysis in this study. METHODS The purified protein derivative solution was administered to the patients and the diameter of induration was measured. Additionally, the age, gender and smoking status of the patients were interrogated. Comorbidities were recorded both by patients' self-reports and data from the hospital files. The number of Bacille Calmette-Guerin (BCG) scars was recorded by checking both shoulders. FINDINGS The study was conducted with a total of 371 patients (194 men and 177 women). The mean age was 60.09 ± 15.88, TST was 6.99 ± 6.9, duration of dialysis was 4.44 ± 4.5 (3.8-0.1,24). A total of 229 patients have comorbodities (61.7%, the most frequent was hypertension). Logistic regression model was performed. Gender, vitamin D treatment and high parathormone (PTH) levels remained in the final stage of the analysis and vitamin D intake and PTH levels were detected to be statistically significant (P = 0.002, 0.007, respectively). DISCUSSION This study is the first study which showed a correlation between TST negativity and increased PTH levels and receiving vitamin D treatment. Starting from this point, it was concluded that PTH may suppress the immune system and especially cellular immunity.

Background This study aimed to determine the in vitro efficacy of IV fosfomycin against extensively drug-resistant Enterobacterales strains and the effect of glucose 6-phosphate on sensitivity results. Material method Thirty-two extensively drug-resistant Klebsiella pneumonia strains were included in the study. Detection of the carbapenemase genes was performed using the Gene-Xpert® System Carba R® kit. IV fosfomycin susceptibility was performed using the agar dilution method. In our study, to see the effect of glucose 6-phosphate (G6-P) on sensitivity results, our agar dilution method was repeated using Muller-Hinton Agar medium without G6-P. Results All of the strains studied had carbapenemase production, and the strains were resistant to all drugs, including carbapenems, piperacillin-tazobactam, ceftriaxone, and ceftazidime. Fosfomycin resistance was detected in 3 (9.3%) of all strains. When the sensitivity test is repeated without using glucose 6-phosphate; In 82.7% of the fosfomycin susceptible strains, fosfomycin resistance was detected. With the Gene-Xpert® System, the association of NDM-1 in 46.8%, OXA-48 in 18.7%, KPC in 3.1%, and NDM-1 + OXA-48 in 21.8% of the strains were detected. While OXA-48 was detected in 1 of the resistant strains, none of the viable genes were detected in 2 of them. Conclusion Our study has shown that IV fosfomycin may be an essential alternative option in treating infections caused by common resistant strains. It should be kept in mind that accurate results may not be obtained unless G6-P is used in the agar dilution method used in in vitro susceptibility studies of fosfomycin.

Background and aim We aim to evaluate serum vitamin D levels, vitamin D receptor (VDR) expression in the intestinal epithelium, and their relation with epithelial barrier proteins and bone metabolism in children with Celiac disease (CD). Methods Immunostaining for VDR, Claudin-2 and E-cadherin was performed in duodenal samples of the patients with CD and controls. H-score [∑Pi(I + 1)] where I is the intensity score and Pi is the corresponding percentage of stained cells was calculated for each samples. The clinic, laboratory and histopathological findings were compared between patients and controls. Results Thirty-six patients with CD and age and sex matched 36 controls were enrolled. 25-OH vitamin D levels were significantly lower in the patient group compared to the control group. The mean bone mineral density (BMD) value was significantly lower in patients with vitamin D deficiency compared to patients with normal vitamin D level. H-scores for both VDR and Claudin-2 were significantly lower in patient group when compared to the control group. H-scores for VDR, Claudin-2 and E-cadherin were significantly lower in patients with vitamin D deficiency compared to patients with normal vitamin D level. There were positive correlations between 25-OH vitamin D level and H-scores for VDR, E-cadherin and Claudin-2 in patient group. Conclusions Our findings showed that vitamin D deficiency is common among children with CD. Expression of VDR and epithelial barrier proteins Claudin-2 and E-cadherin which have important roles in paracellular pathway, was decreased in children with CD in correlation with histological findings of disease severity. Furthermore, deficiency of vitamin D was related to decreased expression of VDR and epithelial barrier proteins E-cadherin and Claudin-2. These findings indicate that paracellular pathway structures responsible for calcium absorption are disturbed in CD which is aggravated by vitamin D deficiency.

Hyaline fibromatosis syndrome (HFS), resulting from ANTXR2 mutations, is an ultra-rare disease that causes intestinal lymphangiectasia and protein-losing enteropathy (PLE). The mechanisms leading to the gastrointestinal phenotype in these patients are not well defined. We present two patients with congenital diarrhea, severe PLE and unique clinical features resulting from deleterious ANTXR2 mutations. Intestinal organoids were generated from one of the patients, along with CRISPR-Cas9 ANTXR2 knockout, and compared with organoids from two healthy controls. The ANTXR2-deficient organoids displayed normal growth and polarity, compared to controls. Using an anthrax-toxin assay we showed that the c.155C&gt, T mutation causes loss-of-function of ANTXR2 protein. An intrinsic defect of monolayer formation in patient-derived or ANTXR2KO organoids was not apparent, suggesting normal epithelial function. However, electron microscopy and second harmonic generation imaging showed abnormal collagen deposition in duodenal samples of these patients. Specifically, collagen VI, which is known to bind ANTXR2, was highly expressed in the duodenum of these patients. In conclusion, despite resistance to anthrax-toxin, epithelial cell function, and specifically monolayer formation, is intact in patients with HFS. Nevertheless, loss of ANTXR2-mediated signaling leads to collagen VI accumulation in the duodenum and abnormal extracellular matrix composition, which likely plays a role in development of PLE.

Objectives: To compare various treatment methods of postpneumonic empyema (PPE) in children. Methods: Six hundred eighty one (302 females and 379 males) pediatric PPE patients were studied at two different centers between 2000 and 2016. The average age was 4.8 years that ranged from 30 days to 15 years. The patients were considered in six groups. The initial treatments, thoracentesis (group A), chest tube drainage (group B), fibrinolytic therapy (group C), decortication following chest tube drainage (group D), video-assisted thoracoscopic surgery (VATS) (group E) and primary operation without chest tube drainage (group F), were applied to the patients. Results: Success rates were 100%, 47.3%, 82.7%, 100%, 100%, and 100% for thoracentesis, chest tube drainage, fibrinolytic treatment, chest tube drainage, decortication following chest tube drainage, VATS and primer operation, respectively. The overall response rate of fibrinolytic therapy was 82.7% (n = 67). Fourteen of 81 (17.2%) patients who went through fibrinolytic instillation did not respond to treatment; these recovered after the application of thoracotomy and VATS. In addition to decortication pulmonary resections were performed in 15 patients. Overall mortality rate was 1.32%. There was no operative mortality. Postoperative morbidity included wound infection in 22, delayed expansion in 17, and atelectasis in 40 patients. Conclusions: Chest tube drainage can be said to be an efficient and safe primary treatment for PPE in children. In cases when chest tube drainage fails to satisfy, decortication with thoracotomy can be applied well with low mortality and morbidity rates.

Son yıllarda risk faktörlerindedeğişiklikler, tanı ve tedavi yöntemlerinde gelişmeler nedeni ile safra taşıtanısıyla izlenen hastaların demografik verileri, başvuru yakınmaları,görüntüleme bulguları, risk faktörleri, tedavi rejimleri ve tedaviyeyanıtlarının değerlendirilmesi amaçlanmıştır. Eskişehir OsmangaziÜniversitesi’nde 2008-2018 yılları arasında kolelitiazis tanısı ile izlenen çocuklarındemografik özellikleri, aile öyküleri, altta yatan hastalıkları, ilaçkullanımları, semptomları, labaratuvar ve görüntüleme bulguları, uygulananmedikal ve cerrahi tedavi yöntemleri kaydedildi. Ursodeoksikolik asit (UDCA)tedavisini en az 6 ay süreyle alanlar tedavi açısından değerlendirmeye alındıve taşın tamamen kaybolması tedaviye yanıt olarak kabul edildi. 79 çocuk [32erkek (%40), 47 kız (%60); ortalama 8 yaş 10 ay] çalışmaya alındı. Hastalardan39’unda (% 49.3) taş oluşumu için bir risk faktörü vardı: En sık obezite(%21.5), daha sonra ilaç (% 17.7, seftriakson) ve hemolitik hastalıklar (%10.1, 4 herediter sferositoz, 1 G6PD eksikliği, 2 talasemi majör ve 1 orakhücreli anemi) tespit edildi. Hastaların %57’sinde biliyer semptomlar (sağ üst kadran-epigastrikağrı, bulantı, kusma, sarılık, yağlı besin intoleransı) görülürken, % 43’ü iseasemptomatikti. Toplam 70 hastanın (%88) en az 6 ay UDCA tedavisi (15-20mg/kg/gün) aldığı ve izlemde 41’inde (%58) taşın kaybolduğu görüldü. On üçhastaya (%16.4, ortalama yaş 145.7±40 ay) kolesistektomi uygulandı. Sonuçolarak çocuklarda kolelitiazisin %50’sinin nedeni belli olmadığı, en sık riskfaktörünün obezite olduğu, puberte öncesi ve sonrası bulgularda farklılıkolmadığı, sıklıkla semptomatik oldukları, UDCA yanıtlarının yüksek ve özellikleseftriaksona bağlı taşlarda daha belirgin olduğu görüldü., We aimed to evaluate demograficfeatures, symptoms, imaging findings, risk factors, treatment modalities andresponse to treatment of children with cholelithiasis due to changes in riskfactors and development in diagnosis and treatment methods in recent years. Thisretrospective study was conducted in Eskişehir Osmangazi University School ofMedicine Pediatric Gastroenterology and Hepatology Department between January2008 and December 2018. The ethics committee of Eskişehir Osmangazi Universityapproved the study. Demografic features, symptoms, imaging findings, riskfactors, treatment modalities and response to treatment of children withcholelithiasis were recorded. Patients who received UDCA teratment at least for6 months were enrolled the study. Treatment responce was defined as dissolvingof stone completely. Seventy nine children [32 (40%) boys, 47 (60%) girls; mean8 years and 10 months] were enrolled the study. Among the 79 pediatricpatients, 39 patients had at least 1 risk factor [ obesity (21.5%), lithogenicdrug (17.7%) ve hemolytic disease (10.1%, 4 hereditary sferocytosis, 1 G6PDdeficiency, 2 talassemia major ve 1 sickle cell anemia)]. Fifty seven per centof patients have biliary symptoms (right upper quadrant pain, nause, vomiting,jaundice and intolerance with fatty meal) while 43% were asymptomatic. Seventypatients were received UDCA therapy at least 6 months and resolution of gallstonewas seen in 41 (58%). Thirteen patients (16.4%, mean age 145.7±40 months) weretreated by laparoscopic cholecystectomy. As a result, it was observed that 50%of cholelithiasis was not known in children, and the most common risk factorwas obesity, and there was no difference between pre- and post-pubertal groups,and they were frequently symptomatic, and UDCA responses were higher andespecially in ceftriaxone-dependent stones.

Background/aim Sonographic assessment of diaphragm structure and function would be a useful clinical tool in patients with chronic obstructive pulmonary disease (COPD). Our aim was to determine the muscle thickness of the diaphragm and the usefulness of clinical practice in patients with COPD. Materials and methods The diaphragmatic thickness of 34 COPD patients and 34 healthy subjects was measured during tidal volume (Tmin) and deep inspiration (Tmax) on both sides using a B-mode ultrasound. The body mass index and the modified Medical Research Council (mMRC) index values were reported. Results There was no correlation among TminR (P = 0.134), TminL (P = 0.647), TmaxR (P = 0.721), and TmaxL (P = 0.905) between the patients with COPD and the control group. There was also no significant difference between diaphragmatic thickness and COPD severity, respiratory function (P = 0.410), and frequency of exacerbations (P = 0.881) and mMRC (P = 0.667). Conclusion Diaphragmatic dysfunction in COPD is related to mobility restriction rather than muscle thickness.

Objective Microvillus inclusion disease (MVID; MIM #251850), is a rare life-threatening secretory and malabsorptive diarrhea of infancy due to mutations in the Myosin 5B (MYO5B) gene. Most of the patients die before achieving the opportunity of bowel transplantation due to electrolytes and renal tubular function disturbances and complications of parenteral nutrition. In this case report, results of stem cell therapy in a newborn infant with MVID were presented and discussed with the relevant literature. Case report A 6-day-old male patient was referred to our NICU for profuse diarrhea beginning on the postnatal 2nd day after birth, metabolic acidosis and hyponatremia. He was born at 36+4 gestational weeks as the fourth child of nonconsanguineous parents. Second and third siblings died at 2 and 3,5 months due to complications of intractable diarrhea. Third child’s exom sequencing identified a homozygous, disease-causing nonsense variant C.4399C>T (p.Gin1467*) in the MYO5B gene. Both parents were heterozygous for the mutation and they did not accept prenatal diagnosis. Our patient was also affected by homozygous mutation in MYO5B gene. With the knowledge of past history, total parenteral nutrition was started and maximum effort was directed to maintain fluid and electrolyte equilibrium. Patient had high fluid (350 ml/kg/day), sodium (20–25 meq/kg/day) and bicarbonate requirements (12–18 meq/kg/day). On 110th day of life mesenchymal stem cells (1x106 U transduodenal and 2x106 U IV) were administered. Although fluid and electrolyte requirements did not decrease after 2 months of follow up after stem cell therapy, the rate of blood stream infections was reduced. Discussion and Conclusion In MVID, mutations in the MYO5B gene which encodes a protein called myosin Vb contribute to the dysfunction of enterocytes. Survival rate is less than 25% at the age of 9 months. Mortality rate is also high after bowel transplantation. Recently, stem cell therapy was presented as a promising alternative strategy for overcoming the current limitations of intestinal failure treatment. We concluded that, the reason why our patient did not benefit from the treatment was rapid turnover of the intestine epithelial cells and the lack of receptive surface caused by the genetic defect. Furthermore, using modified intestinal stem cells instead of mesenchymal stem cells may be more beneficial. In our patient, decreased incidence of infection with probable immunomodulatory effects of stem cells was the secondary gain.

WOS: 000389085400001, PubMed ID: 27980399, Purpose: We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables. Patients and methods: All patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydin province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. Results: A total of 3,095 patients with 5,237 exacerbations (mean age, 71.9+/-10.5 years; 2,434 males and 661 females) were evaluated. For 880 of the patients (28.9%), or 3,852 of the exacerbations (73.1%), at least one comorbid disease was recorded. The mean cost of each exacerbation was $808.5+/-1,586, including $325.1+/-879.9 (40.7%) for hospital stays, $223.1+/-1,300.9 (27.6%) for medications, $46.3+/-49.6 (0.9%) for laboratory expenditures, and $214+/-1,068 (26.5%) for other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. The cost of each exacerbation was $1,014.9 in patients with at least one comorbidity, whereas it was $233.6 in patients without comorbidity (P65 years, female gender, hospitalization in an intensive care unit, invasive or noninvasive mechanical ventilation, and a long duration of hospitalization were all found to be significant factors in increasing total costs during the exacerbations requiring hospitalization (P

Objective: Body mass index (BMI) is used as a basic parameter in assessing obesity. However, BMI is not sensitive in the assessment of body fat percentage (BFP) and body fat distribution (BFD). The aim of this study is to determine the effect of BFP and BFD on the pulmonary functions and compare this effect with BMI. Methods: This study was conducted with a total of 170 volunteers. BMI, waist-to-hip ratio (WHR), and BFPs of healthy normal weight, overweight, and obese individuals were measured and their pulmonary function tests were statistically compared with each other. Results: There was no significant relationship between BMI increase and pulmonary function test results of the individuals. There were sig nificant correlations between BFP increase and forced expiratory volume (FEV 1 %) and forced expiratory flow between 25% and 75% of FVC (FEF25–75%). In the male patients, FEV 1 % value was negatively correlated with waist circumference. In female patients, WHR was positively correlated with FEV 1 /forced vital capacity (FVC), FEV 1 /FVC%, whereas it was negatively correlated with FEV 1 % values. Conclusion: Because the widely used BMI is incapable of distinguishing BFP and BFD, it can be insufficient for evaluating the lung functi ons.Therefore, determining the body composition is important in the evaluation of obese individuals.

We aimed to examine the frequency of functional gastrointestinal disorders (FGIDs) among pediatric patients with epilepsy and the association of FGIDs with epilepsy characteristics.Patients with epilepsy aged between 4 and 18 years old were enrolled. Age- and sex-matched healthy children were taken as the control group. Children with cerebral palsy, history of abdominal surgery, gastrointestinal disorders, medication affecting gastrointestinal system motility, recent gastrointestinal infection, and those on the ketogenic diet were excluded from the study. Rome IV symptom-based criteria were used to screen FGIDs. Frequencies of FGIDs were compared between patients with epilepsy and controls. Additionally, epilepsy type, seizure frequency, and antiepileptic drug (AED) requirements were also compared between patients with and without FGIDs.During the study period, 78 children [41 girls, age between 4 and 17 years, mean ± standard deviation (SD): 11.5 ± 4.3 years] with epilepsy were included in the study. The mean age at epilepsy onset was 7.8 ± 3.7 years, and mean disease duration was 5.1 ± 3.9 years. The most common epilepsy type was focal (74.3%), followed by generalized (25.7%). There was at least one of the FGIDs in 26 children in the patient group and 15 children in the control group (33.3% vs. 19.2%, p 0.001). The most common FGID in the patient group was irritable bowel syndrome (IBS), which was significantly higher than the control group. While aerophagia and rumination syndrome were not seen in either group, cyclic vomiting syndrome was seen only in the patient group. When the patients with and without FGIDs were compared, there was no difference between the groups in terms of epilepsy type, frequency of seizure, type, and the number of drugs used.We found that children with epilepsy have a higher prevalence of FGIDs when compared with age- and sex-matched healthy controls. Our results suggest that children with epilepsy, especially complaining of gastrointestinal symptoms, should be screened for FGIDs.

Background/aim: Oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). Smoking is the leading source of oxidants in lungs. However, it is currently unknown why some individuals are more resistant to the detrimental effects of smoking and do not develop COPD. The aim in this study is to measure and compare the oxidant/antioxidant balance between in non-COPD individuals who smoke and COPD patients who smoke. Materials and methods: Included in the study were 137 patients with COPD and 102 healthy individuals. Participants were divided into groups as COPD patients (former and current smokers), non-COPD individuals who smoke and non-smokers healthy persons. In the following stage, the total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels were measured in serum for all participants. Results: In the current-smoker COPD group, the level of oxidant status were significantly higher than the former-smoker COPD group (p < 0.001). Similarly, oxidant levels were significantly high in current-smoker healthy group than never smoker healthy group. According to these results TOS was associated with especially smoking status rather than COPD. Antioxidant status were similar between former-smoker COPD group and current-smoker COPD group. The antioxidant levels were found significantly low in current-smoker COPD patients, compared to the current-smoker non-COPD individuals (p = 0.007). Nevertheless, no significant difference was found in OSI levels between two groups. Briefly, high TOS and OSI values were correlated with only smoking, independently from COPD. Conclusion: It was concluded that there are complex pathogenetic mechanisms, including genetic and individual variations other than oxidant/antioxidant balance, involved in the development of smoking-related COPD. TOS and OSI values are not predictive parameters for the development of COPD, but high level of TAS in non-COPD smokers is promising for future studies. (C) 2019 Elsevier Inc. All rights reserved. Sakarya University Scientific Research FoundationSakarya University [2014/0806014] This work was supported by Sakarya University Scientific Research Foundation (Project number: 2014/0806014). WOS:000498324600014 31371032 Q2