Gülay Çiler Erdağ

A Retrospective Analysis of Acute Gastroenteritis Agents in Children Admitted to a University Hospital Pediatric Emergency Unit

Background: Acute gastroenteritis is responsible observed in all age groups, especially infants and children. The etiology and clinical course of acute gastroenteritis may vary with age and etiological agents. In developing countries, the morbidity and mortality associated with infectious diarrhea is higher in children younger than five-years-of-age. Objectives: The aim of this study was to determine the prevalence and seasonal distribution of the major agents of acute gastroenteritis in children who were admitted to a Turkish university hospital pediatric emergency unit during 2009. Patients and Methods: Seasonal distribution within a one year period and quantitative distribution were analyzed with demographic data and laboratory findings. A total of 644 subjects were enrolled in the study, with a mean age of 4.14 years. Pathogens were detected in 183 (28.4%) stool samples in children less than 16 years, admitted with acute gastroenteritis. Results: Pathogens were detected in 184 (28.4%) stool samples. The age distributions of the cases were 0 - 24 months (n = 59), 2 - 5 years (n = 100), and > 5 years (n = 25). The detection rate of rotavirus, norovirus and adenovirus were; 12.7% (75/588), 9.8% (51/520) and 4.9% (28/575), respectively. Bacterial agents were detected in 36 cases. The main agent was norovirus in the 0 - 24 months group (n = 25, 42.4%), and rotavirus for ages 2 - 5 years (n = 43, 43%) and > 5 years. On the monthly distribution, cases of rotavirus were found to be more frequent in the first four months of the year. Discussion: Viruses were the major pathogens in all age groups. Norovirus was the leading pathogen in the first two years. For the age groups 2 - 5 years and 6 - 16 years, rotavirus was the major pathogen.

Promoter Methylation in Epithelial-Enriched and Epithelial-Depleted Cell Populations Isolated from Breast Milk

Background: Breast cancer is the most frequently diagnosed cancer among Turkish women and both the incidence and associated mortality appear to be increasing. Of particular concern is the percentage of young women diagnosed with breast cancer; roughly 20% of all breast cancer diagnoses in Turkey are in women younger than 40 years. Increased DNA methylation in the promoter region of tumor suppressor genes is a promising molecular biomarker, and human milk provides exfoliated breast epithelial cells appropriate for DNA methylation analyses. Comparisons between DNA methylation patterns in epithelial (epithelial-enriched) and nonepithelial (epithelial-depleted) cell fractions from breast milk have not been reported previously. Objective: In the present study, we examined promoter methylation of 3 tumor suppressor genes in epithelial-enriched and epithelial-depleted cell fractions isolated from breast milk of 43 Turkish women. Methods: Percentage methylation in the promoter region of Rass association domain family 1 (RASSF1), secreted frizzle related protein 1 (SFRP1), and glutathione-S-transferase class pi 1 was determined by pyrosequencing of the epithelial-enriched and epithelial-depleted cell fractions. Results: Pyrosequencing identified a few subjects with significantly increased methylation in 1 or more genes. There was little correlation between the 2 cell fractions within individuals; only 1 woman had increased methylation for 1 gene (SFRP1) in both her enriched and depleted cell fractions. Methylation was positively associated with age for SFRP1 (epithelial-depleted fraction) and with body mass index for RASSF1 (epithelial-enriched cell fraction), respectively. Conclusion: Overall, results show that the methylation signals vary between different cell types in breast milk and suggest that breast milk can be used to assess DNA methylation patterns associated with increased breast cancer risk.

A Survey Study on Families Child Car Safety Seats Usage and Awareness

ÖZET Amaç: Bu çalışmada, ebeveynlerin çocuk oto güvenlik koltuğu (ÇOGK) kullanım oranları ve bu konu hakkındaki bilgi düzeyleri değerlendirildi. Gereç ve Yöntemler: Bu çalışmaya, çocuk polikliniğine başvuran 250 ebeveyn alındı. “Sosyodemografik özellikler”, “çocuk oto güvenlik koltuğu (ÇOGK) kullanımını etkileyen faktörler”, “ÇOGK kullanımı” ve “ÇOGK kullanımı ile ilgili bilgiler” hakkındaki 22 soruluk anket, yüz yüze görüşme yöntemiyle uygulandı. Varyans analizine yönelik olarak t-test, sürekli değişkenler için iki ortalama arasındaki farkın önemlilik testi kullanıldı. Kesikli ve kategorik değişkenlere yönelik olarak ki-kare testi uygulandı. Bulgular: Ebeveynlerin %93.6’sı ÇOGK hakkında bilgi sahibi olup, %80.8’i ÇOGK kullanıyor, %12.8’i ise kullanmıyordu. Gelir düzeyi yüksek olan ebeveynlerin ÇOGK kullanım oranı yüksekti (p < 0,05). Ebeveynlerin eğitim durumu da ÇOGK kullanımı ile doğru orantılıydı (p < 0,05). ÇOGK’nin doğru yerleşimini ailelerin %98’i biliyordu. ÇOGK’nu çocuğun yaşına uygun olarak değiştiren ebeveynlerin oranı %53.5 idi. Yaşa uygun olarak değiştirilmesi gereksinimi hakkındaki bilgi düzeyi geliri orta ve iyi düzeyde olanlarda ve babanın eğitimi yükseköğrenim düzeyinde olanlarda daha yüksekti (p < 0,05). ÇOGK kullanmanın kanuni zorunluluk olduğunu bilenlerin oranı %88.6 idi. ÇOGK hakkındaki bilgiyi ebeveynlerin %37’si internetten, %33’ü medya yoluyla, %27’si ise çevresindeki kişilerden edinmişti. Hekim tavsiyesiyle bilgi sahibi olanların oranı oldukça düşüktü (%3). Sonuç: Ebeveynlerin eğitim ve gelir düzeylerindeki artış ÇOGK kullanımını artırarak çocuk yaralanma ve ölümlerini azaltabilir. Tıp öğrencilerine tıp eğitiminde ve ebeveynlere rutin çocuk vizitlerinde çocuk güvenliği ve ÇOGK kullanımı hakkında bilgi verilmelidir CAYD 2014;1(2):87-95. Anahtar Kelimeler: Aile, bilgi düzeyi, çocuk oto güvenlik koltuğu, trafik kazaları

Abstract 3646: Promoter methylation in epithelial cells isolated from breast milk of women from Istanbul, Turkey.

Current models of assessing breast cancer risk do not adequately predict whether an individual woman will develop breast cancer. Assessment of healthy tissue for epigenetic changes that result in silencing of tumor suppressor genes may provide a more accurate assessment of individual breast cancer risk. Breast milk is an underutilized source of epithelial cells from non-symptomatic women that can be used for risk assessment. In the present pilot study, we examined promoter methylation of three tumor suppressor genes in epithelial cells isolated from breast milk of Turkish women. Forty-three women living in Istanbul, Turkey were recruited to complete a health and reproductive history questionnaire and to donate a single milk sample. Women ranged in age from 19 to 43 years old, had an average of 2 children (range: 1-5), a mean age at first birth of 25 years (range: 16-36), and a mean BMI of 26 (range 19.3-33.6). Nine percent reported smoking and thirty two percent reported exposure to second-hand smoke. Three of the 43 women had a family history of breast cancer, while four women reported having a family history of ovarian cancer. Each woman donated a single breast milk sample, with a mean volume of 17 ml (S.D. 11.6 ml, range: 2-49 ml), which was processed within 12 hours of donation. Epithelial cells were isolated from the milk via immunomagnetic beads. The breast milk samples yielded an average of 320,000 epithelial cells (S.D. 480,000, range: 10,000-2,600,000), from which DNA was extracted. Utilizing the extracted epithelial DNA, promoter methylation of three tumor suppressor genes; Rass association domain family 1(RASSF1), secreted frizzle related protein 1(SFRP1), and glutathione-S-transferase class pi 1 (GSTP1), was determined by pyrosequencing. For RASSF1 the average promoter methylation was 6.3% (n= 33); there were two outliers whose average methylation was 54.48%. For SFRP1 the average promoter methylation was 5.7 % (n= 17) with one outlier at 53.4% methylation. For GSTP1, the mean methylation was 4.4% (n= 29), with two outliers whose average methylation was 16.9%. Methylation scores were not correlated with any of the demographic factors, such as second hand smoke exposure, age or BMI. As expected of non-symptomatic breast tissue, promoter methylation scores were in general low; however, outlier scores suggest that promoter methylation may be useful in assessing risk. Long-term follow-up is required to evaluate the predictive value of promoter methylation in tumor suppressor genes. Citation Format: Eva P. Browne, Elizabeth C. Punska, Signem E. Dinc, Ayca Vitrinel, Gulay C. Erdag, Douglas L. Anderton, Kathleen F. Arcaro, Bayram Yilmaz. Promoter methylation in epithelial cells isolated from breast milk of women from Istanbul, Turkey. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3646. doi:10.1158/1538-7445.AM2013-3646

871 Frequency of Norovirus Infection in Children with Acute Gastroenteritis

Background and Aims Noroviruses are one of the common causes of acute gastroenteritis and have a great impact on child health. The aim of this study was to determine the prevalence of Norovirus in children with acute gastroenteritis in 2009 and 2010. Methods Fecal samples were collected from children under 16 years of age who were suffering from acute gastroenteritis. All the children were referred to Yeditepe University Hospital, located in Istanbul. Norovirus was detected using immunochromatography. Results Norovirus infection was detected in 112 of the 1027 collected samples (10.9%). Most of the positive cases were between 1 and 24 months of age (n=75, 67%). The rate of norovirus infection peaked in winter in 2010 (in winter and spring: n=57, 92%), however, the rates were not significantly different between seasons in 2009 (in winter and spring: n=26, 52%, in summer: n=23, 46%). We did not detect any positive cases in late summer and autumn in 2010. Conclusions This study improves our epidemiological knowledge of the prevalence of Norovirus in Istanbul. Immunochromatography is preferable, that provides rapid diagnosis. The prevalence of Norovirus is similar but seasonal distribution is different between two years. Most of the cases were < 24 months of age. Because this virus is transmitted by contaminated food or water, and transmitted by personal contact, we recommend improved training in hygiene to reduce the incidence of Norovirus infection in children. Like Rotavirus, Norovirus vaccine can be developed to prevent infection.

1527 Seizure Worsening Caused by Low Serum Valproate Levels from an Interaction between Valproate and Meropenem

Background Meropenem is a carbapenem antibiotic, has a broad spectrum of antimicrobial activity. Valproate is widely used in the treatment of epileptic seizures in children. In last years, low serum concentrations of valproate were reported in children and adults receiving concomitant administration with meropenem. We present an interaction of meropenem with valproate in an epileptic child, leading to seizure exacerbations owing to the rapidly-lowering of serum valproate concentration. Case Report This report describes a 14-year-old epileptic girl inpatient who received concurrent treatment with meropenem and valproate for the treatment of lobar pneumonia, pleuresia and epilepsy, respectively. In this patient, an increase of seizure frequency and somnolence were observed after addition of meropenem on the treatment, and a rapid decline of valproate serum concentrations was observed after two dose meropenem. This event was the most likely cause of increased seizure frequency. The dosage of valproate was increased and meropenem was stopped. Two days later, the seizures stopped. Five days later, the serum valproate concentrations increased to three fold and four week later, they increase to therapeutic levels. The seizures were considered to be probably related to the concurrent administration of meropenem and valproate. Conclusion To avoid drug interaction that reduces the serum concentration of valproate, meropenem should not be used in epileptic patients using valproate for the treatment of epilepsy. If concominant administration is essential, serum valproate levels should be monitorized frequently.