Ahmet Basturk

Does alfa lipoic acid prevent liver from methotrexate induced oxidative injury in rats

PURPOSE To determine the antioxidant and anti-inflammatory effects of alfa lipoic acid (ALA) on the liver injury induced by methotrexate (MTX) in rats. METHODS Thirty two rats were randomly assigned into four equal groups; control, ALA, MTX and MTX with ALA groups. Liver injury was performed with a single dose of MTX (20 mg/kg) to groups 3 and 4. The ALA was administered intraperitonealy for five days in groups 2 and 4. The other rats received saline injection. At the sixth day the rats decapitated, blood and liver tissue samples were removed for TNF-α, IL-1β, malondialdehyde, glutathione, myeloperoxidase and sodium potassium-adenosine triphosphatase levels measurement and histological examination. RESULTS MTX administration caused a significant decrease in tissue GSH, and tissue Na+, K+ ATPase activity and which was accompanied with significant increases in tissue MDA and MPO activity. Moreover the pro-inflammatory cytokines (TNF-α, IL- β) were significantly increased in the MTX group. On the other hand, ALA treatment reversed all these biochemical indices as well as histopathological alterations induced by MTX. CONCLUSION Alfa lipoic acid ameliorates methotrexate induced oxidative damage of liver in rats with its anti-inflammatory and antioxidant effects.

Acute vanishing bile duct syndrome after the use of ibuprofen.

We present a case report of a 7-year-old patient who developed toxic epidermal necrolysis (TEN) and vanishing bile duct syndrome (VBDS) after oral ibuprofen intake. Acute VBDS is a rare disease with unknown aetiology, often presenting with progressive loss of the intrahepatic biliary tract. TEN is an immune complex-mediated hypersensitivity reaction involving the skin and mucosa, which is induced by drugs or infectious diseases, sometimes leading to systemic symptoms. The patient in this case report was treated with supportive care, a steroid and ursodeoxycholic acid, with complete recovery observed by the end of the 8th month. This case report suggests that ibuprofen can cause acute vanishing duct syndrome.

Efficacy of synbiotic, probiotic, and prebiotic treatments for irritable bowel syndrome in children: A randomized controlled trial.

BACKGROUND/AIMS Irritable bowel syndrome (IBS) is an important health problem that presents serious social burdens and high costs. Our study investigated the efficacy of synbiotic (Bifidobacterium lactis B94 with inulin), probiotic (B. lactis B94), and prebiotic (inulin) treatment for IBS in a pediatric age group. MATERIAL AND METHODS This study was randomized, double-blind, controlled, and prospective in design and included 71 children between the ages of 4 and 16 years who were diagnosed with IBS according to the Rome III criteria. The first group received synbiotic treatment [5×109 colony forming units (CFU) of B. lactis B94 and 900 mg inulin]; the second group received probiotic treatment (5×109 CFU B. lactis B94), and the third group received prebiotic treatment (900 mg inulin) twice daily for 4 weeks. RESULTS Probiotic treatment improved belching-abdominal fullness (p<0.001), bloating after meals (p=0.016), and constipation (p=0.031), and synbiotic treatment improved belching-abdominal fullness (p=<0.001), bloating after meals (p=0.004), constipation (p=0.021), and mucus in the feces (p=0.021). The synbiotic group had a significantly higher percentage of patients with full recovery than the prebiotic group (39.1% vs. 12.5%, p=0.036). CONCLUSION Administration of synbiotics and probiotics resulted in significant improvements in initial complaints when compared to prebiotics. Additionally, there was a significantly higher number of patients with full recovery from IBS symptoms in the synbiotic group than in the prebiotic group. Therefore, the twice daily administration of synbiotics is suggested for the treatment of children with IBS.

Investigation of the efficacy of synbiotics in the treatment of functional constipation in children: a randomized double-blind placebo-controlled study

BACKGROUND/AIMS The aim of this study was to demonstrate the efficacy of synbiotic (Lactobacillus casei, L. rhamnosus, L. plantarum, and Bifidobacterium lactis and prebiotics [fiber, polydextrose, fructo-oligosaccharides, and galacto-oligosaccharides]) treatment in children with functional constipation. MATERIALS AND METHODS This study was performed in patients aged 4-18 years, and the patients were diagnosed to have functional constipation according to the Roma III diagnostic criteria. In this prospective study, the first group received synbiotic and the second group received a placebo. At the end of 4 weeks, patients were questioned about the initial symptoms. Patients who showed improvement in the initial symptoms at the end of the 4-week treatment period were considered to completely benefit from the treatment and those with some improvement in initial symptom were considered to partially benefit from the treatment. RESULTS The synbiotic and placebo groups comprised 72 and 74 patients, respectively. The mean age in the whole study group was 9.18±3.48 years with a male:female ratio of 1:21. After 4 weeks of treatment, significant improvement was not observed in any of the findings in the placebo group. Conversely, a significant improvement was observed in the weekly number of defecations, abdominal pain, painful defecation, and pediatric Bristol scale (p≤0.001) in the synbiotic group. Complete benefit from the treatment was achieved in 48 (66.7%) and 21 (28.3%) patients in the synbiotic and placebo groups, respectively, and a significant difference was observed between the groups (p≤0.001). CONCLUSION Our studies have shown that the use of synbiotics in the treatment of functional constipation in children is beneficial.

The incidence of HLA-DQ2/DQ8 in Turkish children with celiac disease and a comparison of the geographical distribution of HLA-DQ

Introduction Celiac disease (CD) is an auto-immune enteropathy that occurs in genetically pre-disposed people as a result of the consumption of gluten-containing foods. Aim To identify the incidence of HLA-DQ2 and HLA-DQ8 observed in children with CD. Material and methods In this study, we focused on children ranging in age from 2 to 18 years and diagnosed with celiac disease. In our patients diagnosed with CD, in addition to tissue transglutaminase antibodies (anti-tTG), we also evaluated HLA-DQ2 B1 and HLA-DQ8 B1 alleles using the method of polymerase chain reaction (PCR)/sequence-specific oligonucleotide probes (Luminex®). The detection of 0201/0202 for HLA-DQ2 allele and 0302 for HLA-DQ8 allele was accepted as a positive result. Results The mean age of our patients with celiac disease was 7.42 ±3.18 years, and the female/male ratio was 1.5/1. Seventy-six percent of our patients were HLA-DQ2 and/or HLA-DQ8 positive, 67% were HLA-DQ2 positive, and 25% were HLA-DQ8 positive. Nevertheless, 24% of them were HLA-DQ2 and HLA-DQ8 negative. The incidence of HLA-DQ2 in the control group was 18.8% with a significant difference compared to the HLA-DQ2 incidence in the patient group (67%) (p < 0.05). Similarly the HLA-DQ8 incidence in the control group (5.7%) was significantly lower than the incidence in the patient group (25%) (p < 0.05). Conclusions The incidence of the patients diagnosed with CD, who are HLA-DQ2 and HLA-DQ8 negative, varies among different populations.

Gastritis Associated with Initially Pediatric Crohn's Disease and Ulcerative Colitis

Purpose The aim of this study is to determine the involvement of the upper gastrointestinal system (GIS) in patients diagnosed with Crohns disease (CD), ulcerative colitis (UC), and non-inflammatory bowel disease (IBD) and to compare their differences. Methods This study included patients aged between 2 and 18 years who underwent colonoscopy and esophagogastroduodenoscopy (EGD) for the first time due to the prediagnosis of IBD. In EGD, samples were taken from duodenum, antrum, corpus, and esophagus; and gastritis, duodenitis, and esophagitis were identified through histopathologic examination. The data gathered the ends of the research were compared between IBD with non-IBD groups and between CD-UC with non-IBD groups, and the presence of significant differences between groups were determined. Results In our study, 16 patients were diagnosed with CD, 13 with UC, 3 with undeterminate colitis, and 13 with non-IBD. In the histopathological examination of the groups, GIS involvement was found in 94.1% of patients diagnosed with IBD and in 38.5% of non-IBD patients. Moreover, the difference was found to be statistically significant (p=0.032). No significant difference was found between the CD and UC groups. Gastritis was mostly observed in 93.8% of CD-diagnosed patients, 76.8% of UC-diagnosed patients, 81.2% of IBD-diagnosed patients, and 38.5% of non-IBD-diagnosed patients. On the other hand, significant differences were found between CD and non-IBD groups (p=0.03), UC and non-IBD groups (p=0.047), and IBD and non-IBD groups (p=0.03). Conclusion The results of the study show that gastritis was highly observed in UC- and CD-diagnosed patients than in non-IBD-diagnosed patients.

Pediatric Liver Transplantation: Our Experiences

OBJECTIVE The aim of our study was to evaluate our liver transplant pediatric patients and to report our experience in the complications and the long-term follow-up results. MATERIALS AND METHODS Patients between the ages of 0 and 18 years, who had liver transplantation in the organ transplantation center of our university hospital between 1997 and 2016, were included in the study. The age, sex, indications for the liver transplantation, complications after the transplantation, and long-term follow-up findings were retrospectively evaluated. The obtained results were analyzed with statistical methods. RESULTS In our organ transplantation center, 62 pediatric liver transplantations were carried out since 1997. The mean age of our patients was 7.3 years (6.5 months-17 years). The 4 most common reasons for liver transplantation were: Wilsons disease (n=10; 16.3%), biliary atresia (n=9; 14.5%), progressive familial intrahepatic cholestasis (n=8; 12.9%), and cryptogenic cirrhosis (n=7; 11.3%). The mortality rate after transplantation was 19.6% (12 of the total 62 patients). The observed acute and chronic rejection rates were 34% and 4.9%, respectively. Thrombosis (9.6%) was observed in the hepatic artery (4.8%) and portal vein (4.8%). Bile leakage and biliary stricture rates were 31% and 11%, respectively. 1-year and 5-year survival rates of our patients were 87% and 84%, respectively. CONCLUSION The morbidity and mortality rates in our organ transplantation center, regarding pediatric liver transplantations, are consistent with the literature.

Rotavirus gastroenteritis and a rare case accompanying acute pancreatitis

Pancreatitis in children is inflammation of the pan-creas gland which presents with epigastric abdominal pain and elevated levels of digestive enzymes, and it is an important cause of mortality and morbidity [1]. Although hyperamylasemia and hyperlipasemia are relatively frequently seen in gastroenteritis, pancreatitis is very uncommon [2]. Rotavirus infection and pancreatitis together are seen very rarely [3]. In this article, we present a case where rotavirus gastroenteritis was accompanied by acute pancreatitis which presented with acute diarrhea. A 5-year-old male patient presented with abdominal pain, vomiting and diarrhea. In his history, he had diarrhea that started 5 days ago, vomiting and epigastric pain which became worse in the last 2 days. Family history did not reveal anything. Physical examination showed nothing apart from epigastric tenderness and increased bowel movement sounds. Laboratory results showed he-moglobin (Hb) 12.5 g/dl (normal range: 12–16), leuko-cytes (WBC) 3700/mm 3 (normal range: 4800–10 800), lymphocytes 1000/mm 3 (normal range: 1300–3500), neutrophils 1930/mm 3 (normal range: 2060–7020), eosinophils 40/mm 3 (normal range: 0–420), platelets (PLT) 272 000/mm 3 (normal range: 150 000–450 000), alanine aminotransferase (ALT) 187 U/l (normal range: 0–41), aspartate transaminase (AST) 100 U/l (normal range: 0–40), g-glutamyl transferase (GGT) 38 U/l (normal range: 10–61), total bilirubin 0.26 mg/dl (normal range: 0.1–1.2), direct bilirubin 0.12 mg/dl (normal range: 0–0.2), prothrombin time (PT) 13.12 s (normal range: 10.4–14), international normalized ratio (INR) 1.15, activated partial thromboplastin time (aPTT) 18.5 s (normal range: 21–36.5), C-reactive protein (CRP): 23 mg/dl (normal range: 0–0.5), pancreatic amylase 1230 U/l (normal range: 28–100), lipase 810 U/l (normal range: 13–60). Total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol , very low-density lipoprotein (VLDL) cholesterol, triglycerides, serum electrolytes, kidney function tests, urine analysis, and hepatic markers were all normal. Abdominal ultrasound (USG) demonstrated a mildly enlarged edematous pancreas and ultrasonography one month later showed that this had normalized. Stool samples were positive for rotavirus antigen and negative for adenovirus antigen using the VIKIA Rota-Adeno immuno-chromatographic test (bioMérieux). Oral intake was stopped and total parenteral nutrition was started along with intravenous lansoprazole. During the follow-up, the patient was doing well and control laboratory results showed ALT 42 U/l, AST 56 U/l, GGT 24 U/l, total bilirubin 0.5 mg/dl, direct bil-irubin 0.1 mg/dl, CRP 0.3 mg/dl, pancreatic amylase 42 U/l, lipase 24 U/l. He was switched to full oral feeding by incrementally increasing oral intake. The patient was discharged and followed by the …

Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children

Purpose Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. Methods The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. Results Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. Conclusion The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

Niemann-pick type a: A rare case presenting with late onset bleeding due to Vitamin K deficiency

Vitamin K Deficiency Bleeding (VKDB) is seen rarely and it may be life-threatening during early infancy. VKDB is classified according to bleeding times as early (0-1 day), classical (1-7 days) and late (8 days to 6 months). Undiagnosed cholestasis is usually present in the late type in which the bleeding commonly starts in 3-8 weeks. Niemann Pick disease is a type of lysosomal storage disease associated with special storage cells which are very similar to foamy histiocytes which occurs due to sphingomyelin build-up. It’s known that cholestasis may develop and go away on its own among new-born with type A or C of the disease. PT and aPTT were prolonged in 2-month-old patient who presented with umbilical bleeding which happened three times after 1-month-old. Cholestasis was investigated and diagnosed which is a risk factor for late type VKDB. Bleeding had not repeated after Vitamin K administration. The patient was diagnosed with Niemann-Pick Type A by showing a new homozygos mutation in SMPD1 gene after advanced investigations because of liver and spleen enlargement despite cholestasis was regressing during follow-up. This article is presenting a rare case diagnosed with Niemann-Pick Type A for the first time presented with umbilical bleeding due to Vitamin K deficiency. Pam Med J 2017;10(2):192-195