Semra Sökücü

Does interferon and ribavirin combination therapy increase the rate of treatment response in children with hepatitis C

Background Interferon-&agr; was the first accepted treatment of chronic hepatitis C. In recent years, adding ribavirin has produced better response rates in adult patients than monotherapy with interferon-&agr;. Whether adding ribavirin also improves treatment results in pediatric patients remains unclear. Methods Twelve patients were given 3 million U/m2 subcutaneous interferon-&agr; three times weekly and 15 mg/kg oral ribavirin daily, and 10 patients were given only 3 million U/m2 subcutaneous interferon-&agr; three times weekly for a total of 12 months. Results The dropout rate was 22.8% (25% for patients receiving combination treatment versus 20% for those receiving monotherapy). At the end of treatment, viral clearance was achieved in 50% of the patients who received combination treatment versus 30% of those who received monotherapy. After 12 months of posttreatment follow-up, sustained response rates were 30% and 41.7%, respectively. Of those who responded to treatment, 66.7% had received ribavirin whereas 37.5% of nonresponders had received ribavirin therapy. Conclusion Adding ribavirin to interferon treatment improved end-of-treatment response rates in children with chronic hepatitis C. Tolerance of treatment was similar to tolerance of monotherapy. However, studies of greater numbers of pediatric patients with longer follow-up periods are necessary to determine prolonged sustained response.

Salt and water homeostasis during oral rehydration therapy

Changes in sodium balance and urinary and stool output during orally administered rehydration therapy were studied in 22 well-nourished Turkish infants, aged 2 to 13 months, with acute diarrhea mainly of viral origin. The infants randomly received a rehydration solution containing either 90 mmol Na/L (ORS90) or 40 mmol Na/L (ORS40). Slight transient hypernatremia was noted in a few infants receiving ORS90, and slight transient hyponatremia in a few infants receiving ORS40. In both groups, sodium balance increased most rapidly during the first 12 hours of rehydration, and then more slowly because of increased urinary as well as stool sodium output. Sodium balance was always more positive after ORS90 than after ORS40, but the difference did not change much from 12 to 36 hours after therapy was started. Changes in fractional sodium excretion, urinary K/Na quotient, and urinary aldosterone-creatinine quotient were used as indexes of changes in sodium balance. All values were interpreted to indicate that the sodium deficit on admission was corrected within 12 to 18 hours after ORS90 and, in most cases, after 24 to 36 hours after ORS40. Both groups of infants responded well to orally administered rehydration therapy from the clinical viewpoint.

Long-term outcome after sclerotherapy with or without a beta-blocker for variceal bleeding in children.

Background : Esophageal variceal bleedingis a life‐threatening complication of portal hypertension. Optimal treatmentfor the prophylaxis of variceal rebleeding in children has not yetbeen determined. In the present study, we aimed to compare the long‐termefficacy of endoscopic sclerotherapy with or without oral beta‐blockertherapy in the secondary prophylaxis of variceal bleeding.

Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension.

Background: Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT). Methods: This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50). Fifty healthy children were also selected for the control group. Electrocardiography and echocardiography were used to evaluate cardiac functions. Corrected QT (QTc) ≥ 0.45 was accepted as prolonged on electrocardiography. The study group was divided into 3 groups: cirrhotic, noncirrhotic, and control. Then, the CCMP group was created according to the diagnostic criteria. Latent CCMP was diagnosed in the presence of prolonged-QTc along with a minor criterion (tachycardia). Manifest CCMP was diagnosed in the presence of at least 2 major criteria (prolonged-QTc along with abnormal echocardiographic findings). Moreover, in this study, the risk factors for CCMP were investigated. Results: The CCMP group included 10 cases (20%). Nine of these cases had latent CCMP (18%), and the remaining one (2%) had manifest CCMP. All of the cases with CCMP had cirrhosis and ascites. None of the patients with CCMP had severe cardiac symptoms, but they were already using some cardioprotective drugs such as propanolol and spironolactone. As risk factors for CCMP, pediatric end-stage liver disease scores, Child-Pugh scores, and ascites grades were found to be significant for the determination of CCMP. The most important risk factor was ascites severity (P = 0.001, odds ratio 9.4). Conclusions: Approximately 20% of children with PHT have CCMP. A detailed cardiac examination should be carried out periodically in children with cirrhotic PHT, especially in the presence of ascites and high Child-Pugh score.

The role of the non-invasive serum marker FibroTest-ActiTest in the prediction of histological stage of fibrosis and activity in children with naïve chronic hepatitis B infection.

Abstract The aim of this study was to investigate whether the non-invasive serum marker FibroTest–ActiTest (FT–AT) reliably predicts the histological stage of fibrosis and/or activity, and decreases the need for a liver biopsy. Twenty-five children with naïve chronic hepatitis B were analyzed for haptoglobin, α2-macroglobulin, apolipoprotein A1, bilirubin, γ-glutamyl transferase, and alanine aminotransferase activity, and the FT–AT scores were computed. FT–AT scores were compared with histological data. FT predicted insignificant fibrosis in 14/23 (61%) patients at a cut-off level of 0.31. Nine patients (36%) had significant histological fibrosis, but none were predicted by FT. There was no correlation between FT scores and histological stage of fibrosis (r: −0.221, p = 0.228). All 4 patients with significant histological activity had corresponding significant activity in AT (100%). Fifteen out of the 19 patients (78.9%) with significant activity in AT had insignificant histological activity. At the cut-off level of 0.36, AT predicted insignificant activity in all 6 patients (100%). There was no correlation between AT scores and histological activity (r: 0.245, p = 0.237). According to histological data, 12 patients were candidates for treatment, but FT–AT did not predict 3 of them (25%). FT–AT does not appear ready for use in detecting either the stage of fibrosis or activity in children with chronic hepatitis B.

Human herpes virus type 8-associated Kaposi sarcoma in a pediatric liver transplant recipient

Çeltik C, Ünüvar A, Aydoğan A, Gökçe S, Öztürk G, Güllüoğlu M, Yılmaz G, Türkoğlu S, Anak S, Sökücü S, Durmaz Ö. Human herpes virus type 8‐associated Kaposi sarcoma in a pediatric liver transplant recipient.
Pediatr Transplantation 2011: 15: E100–E104.

Investigation of impaired carbohydrate metabolism in pediatric liver transplant recipients.

Abstract:  OGTT was performed in 28 liver transplants maintained with tacrolimus to investigate carbohydrate metabolism and assess risk factors for development of PTDM. None had PTDM that was detected by OGTT. Early PTDM in four cases (14.3%) resolved in follow‐up. Five new cases (17.9%) demonstrated DCM (DCM  = IGT ± hyperinsulinemia). Fasting measurements were normal in two hyperinsulinemic cases. With one (20%, p > 0.05) exception none of the children with DCM were overweight or had a family history of diabetes. All five (100%) children with DCM had been given high cumulative dosage of steroids 18 (78.3%) – without DCM (p > 0.05). The median age of children with DCM was greater [4.3 (12.7–18.0) vs. 7.0 (2.3–18.0) yr, p < 0.01] and duration of follow‐up longer [5.3 (2.3–7.0) vs. 2.5 (0.7–7.3) yr, p < 0.05]. Four children (80%) with DCM were pubertal (p < 0.05). However, neither age nor duration of follow‐up or pubertal stage had significant effect on DCM development. Early PTDM is a transient phenomenon and is not predictive for future development of diabetes. DCM is frequently observed in liver transplanted children. Albeit the children with DCM were given high cumulative dose of steroids, were older, mostly were pubertal, and had longer duration of follow‐up, we cannot draw firm conclusions on effects of the risk factors on carbohydrate metabolism because of the small sample size and relatively short duration of follow‐up. Unlike fasting measurements, OGTT can detect all children with DCM.