Erhun Kasirga

Current therapeutic approaches in childhood chronic hepatitis B infection: A multicenter study

Background and Aim:  The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection.

Changes in seroprevalence of hepatitis A in children and adolescents in Manisa, Turkey

Background : Hepatitis A virus (HAV), being an enteric transmitting virus wide world, occurs mostly in children of developing countries. However, the virus has recently been seen in adolescents and young adults worldwide. The aim of the present study was to evaluate the seroprevalence of the HAV infection in children and adolescents in Manisa, Turkey, and to verify whether the increased incidence of HAV infection in other parts of the world and Turkey generally is also true for the area of Manisa.

Retinol and α-tocopherol concentrations in breast milk of Turkish lactating mothers under different socio-economic status

Retinol and α-tocopherol levels in breast milk of Turkish mothers under different socio-economic status were investigated. Mature milk samples were collected from 92 lactating mothers living in İzmir and in Manisa, cities of Turkey, who were at 60–90 days of the lactating period. Socio-economic, anthropometric, and dietary data were collected by means of a questionnaire. The body mass index was used to determine the nutritional status. The retinol and α-tocopherol contents of breast milk were determined by high-performance liquid chromatography; the concentration of α-tocopherol was 9.84 µg/ml whereas retinol levels were 81.5 µg/100 ml. The questionnaire survey was used to determine the level of these vitamins in the daily ration of the women. No significant differences were found in terms of milk retinol and α-tocopherol levels for the variables income, educational level and mothers’ body mass index.

Clinical significance of TT virus infection in children with chronic hepatitis B

Abstract Background : The pathogenic role of TT virus (TTV) is not clear in patients with chronic hepatitis B. The aims of the present study were to determine the frequency of TTV positivity in serum and saliva samples and the possible role of TTV in children with chronic hepatitis B.

Intramedullary spinal cord abscess suspected of Brucella infection

A 15-year-old girl was admitted with complaints of backache, intermittent fever, night sweating and was unable to walk without support. In the previous 6 months, she had intermittent fever and lower back pain. She had been admitted to a hospital outside of the city with lower back pain, progressive weakness in all limbs and difficulty in walking. Seven days before admission to the outside of the city hospital, the patient developed a low-grade fever and malaise. Three days before admission the patient developed lower back pain which irradiated to the lower limbs, mainly as sciatica. Before admission to our hospital, the patient was initially treated with tetracycline, streptomycin and trimethoprim-sulfamethoxazole for brucellosis, however her signs and symptoms did not decrease after this therapy regimen. She had consumed cheese that was made from raw goats’ milk for 1 year. Her examination revealed that temperature, blood pressure, heart and respiratory rates were normal. Her higher mental functions were undisturbed. There was no neck stiffness. Cranial nerves were normal. Muscle power was generally reduced, both in legs (two out of five according to the muscle strength scale) and arms (four out of five according to the muscle strength scale). 5 However, the weakness of lower extremities were more evident. Both of her legs were paretic and she could not walk without support. The tendon reflexes of the upper extremities were normal. The patella reflex was absent bilaterally. The Babinski sign was present bilaterally. Sensitivity was diminished below the twelfth thoracic vertebra (T12). Routine laboratory test results were uneventful. Standard tube agglutination testing (Wright agglutination titer = 1/160), 2-mercaptoethanol (ME) Wright agglutination (titer = 1/160) and the Rose Bengal test for antibodies to Brucella were positive. The agglutination titer for Brucella in cerebrospinal fluid (CSF) was positive (Wright agglutination titer = 1/640, 2ME Wright agglutination titer = 1/640). Analysis of CSF revealed a normal pressure, a white blood cell count of 320/mm 3

Efficacy of hepatitis B vaccination and interferon-α-2b combination therapy versus interferon-α-2b monotherapy in children with chronic hepatitis B

Background:  Although interferon (IFN) has been approved in the treatment of chronic hepatitis B in children, it is effective only in 30–40% of patients. In some studies it has been suggested that therapeutic use of anti‐hepatitis B virus (HBV) vaccine may be beneficial in patients with chronic hepatitis B. The aim of the present study was to compare the efficacy of hepatitis B vaccination and IFN‐α‐2b in combination and IFN‐α‐2b monotherapy in children with chronic hepatitis B.

COEXISTENCE OF SYMPTOMATIC IRON-DEFICIENCY ANEMIA AND DUODENAL NODULAR LYMPHOID HYPERPLASIA DUE TO GIARDIASIS: Case Report

Iron-deficiency anemia due to iron malabsorption and duodenal nodular lymphoid hyperplasia (NLH) has been described in children with Giardia intestinalis infection. Also, symptomatic iron-deficiency anemia is rarely encountered in male adolescents. A 14-year-old boy underwent esophagogastroduodenoscopy for investigation of symptomatic iron-deficiency anemia (hemoglobin 5.8 g/dL, mean corpuscular volume 65.3 fL, serum ferritin < 1.5 ng/mL). He had a sufficient diet for iron and recurrent bouts of diarrhea without melena. At upper endoscopy, duodenal mucosa was diffusely nodular. Histopathologic evaluation of biopsy samples from the duodenum revealed infection with Giardia intestinalis. His anemia improved with metronidazole and iron treatment.

Serum zinc as a factor predicting response to interferon-α2b therapy in children with chronic hepatitis B

Although it has been unclear why more than 50% of children with chronic hepatitis B virus infection do not respond to interferon therapy, in some instances resistance to interferon probably is caused by an inability to stimulate appropriately cellular immune responses to hepatitis B virus. It is known that immune integrity is tightly linked to zinc status. We examined the relationship between serum zinc levels and response to interferon (INF)-α therapy in children with chronic hepatitis B. Twenty-five children with chronic hepatitis B infection were injected with 5 × 106 units/m2 recombinant IFN-α 2b subcutaneously three times weekly for 9 mo. Children were followed for at least 9 mo after the end of therapy.Sustained response was obtained in eight (32%) patients. Although initial serum zinc and alanine aminotransferase levels were significantly higher; initial hepatitis B Virus (HBV)-DNA values, hepatic activity index, periportal necrosis, and fibrosis scores were significantly lower in sustained responders than in nonresponders. Mean baseline serum zinc, alanine aminotransferase and HBV-DNA values, histologic activity index, periportal necrosis, and fibrosis scores were predictive of response to IFN-α 2b therapy. These findings suggest that serum zinc levels might be used as a factor predicting response to interferon-α 2b therapy, and so may help in identifying those children with a better chance of response.

Inflammatory myofibroblastic tumor of the colon with an unusual presentation of intestinal intussusception.

Inflammatory myfibroblastic tumor (IMT), also known as inflammatory pseudotumor is unusual, benign solid tumor. This tumor is commonly reported in the lungs but can be present in extrapulmonary sites as well. We present the case of a 7-year-old girl with IMT in an unusual location. The patient was admitted with abdominal pain, and ultrasound showed a solid mass in the abdomen. She was operated and colocolic intussusception secondary to a mass was found. Histologic evaluation of mass revealed IMT.

Diagnostic Yield of Upper Gastrointestinal Endoscopy in the Evaluation of Iron Deficiency Anemia in Older Children and Adolescents

Iron deficiency anemia (IDA) is frequent in childhood. Inadequate nutrition and gastrointestinal malabsorption are the frequent causes of IDA in children. But reduced iron absorption and insidious blood loss from the gastrointestinal tract has been identified as the most frequent causes of IDA in older children and adolescents. Therefore the authors evaluated the frequency and etiologies of the upper gastrointestinal system pathologies causing IDA in older pediatric population. Patients with known hematological or chronic diseases, heavy menstrual flow, and obvious blood loss were excluded from the study. Forty-four children between the ages of 9.5 and 17.5 years and diagnosed with IDA were enrolled. They underwent upper gastrointestinal endoscopy and biopsy from esophagus, stomach, and duodenum. Mean age and hemoglobin (Hb) levels of study group (32 boys, and 12 girls) were 14.6 ± 2.0 years and 7.9 ± 1.8 g/dL, respectively. Only 1 patient had a positive serology testing with anti-tissue transglutaminase and small bowel biopsy correlating with celiac disease. Endoscopy revealed abnormal findings in 25 (56.8%) patients (21 endoscopic antral gastritis, 2 active duodenal ulcers, and 2 duodenal polyps). Helicobacter pylori (HP) infection was identified by using antral histopathological evaluation in 19 of 44 children (43.2%). In 2 of duodenal samples, one patient had celiac disease, and the other one was diagnosed as giardiasis. In conclusion, there are different etiologies resulting in IDA in older children and adolescents. When older children and adolescents are found to have iron deficiency, HP infection and other gastrointestinal pathologies should be ruled out before iron deficiency treatment.