Taner Ozgur

Comparison of the efficacy of serum amyloid A, C-reactive protein, and procalcitonin in the diagnosis and follow-up of necrotizing enterocolitis in premature infants

PURPOSE The aim of this study was to compare the efficacy of serum amyloid A (SAA) with that of C-reactive protein (CRP), and procalcitonin (PCT) in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants. METHODS A total of 152 infants were enrolled into this observational study. The infants were classified into 3 groups: group 1 (58 infants with NEC and sepsis), group 2 (54 infants with only sepsis), and group 3 (40 infants with neither sepsis nor NEC, or control group). The data including whole blood count, CRP, PCT, SAA, and cultures that were obtained at diagnosis (0 hour), at 24 and 48 hours, and at 7 and 10 days were evaluated. RESULTS A total of 58 infants had a diagnosis of NEC. Mean CRP (7.4 ± 5.2 mg/dL) and SAA (46.2 ± 41.3 mg/dL) values of infants in group 1 at 0 hour were significantly higher than those in groups 2 and 3. Although the area under the curve of CRP was higher at 0 hour in infants with NEC, there were no significant differences between groups with respect to the areas under the curve of SAA, CRP, and PCT at all measurement times. Levels of SAA decreased earlier than CRP and PCT in the follow-up of NEC (mean SAA levels were 45.8 ± 45.2, 21.9 ± 16.6, 10.1 ± 8.3, and 7.9 ± 5.1 mg/dL at evaluation times, respectively). Levels of CRP and SAA of infants with NEC stages II and III were significantly higher than those with only sepsis and/or NEC stage I. CONCLUSIONS Serum amyloid A, CRP, and PCT all are accurate and reliable markers in diagnosis of NEC, in addition to clinical and radiographic findings. Higher CRP and SAA levels might indicate advanced stage of NEC. Serial measurements of SAA, CRP, and PCT, either alone or in combination, can be used safely in the diagnosis and follow-up of NEC.

Neonatal outcomes of premature infants born to preeclamptic mothers

OBJECTIVE Only limited studies with conflicting results are available on neonatal morbidity and mortality in infants born to preeclamptic mothers. The objective of this study was to evaluate neonatal morbidity and mortality in premature infants born to preeclamptic mothers. METHODS Premature infants who were admitted to Uludag University, School of Medicine, Neonatal Intensive Care Unit between June 2006 and December 2007 were included in this study. The infants were evaluated according to their demographic characteristics and neonatal morbidities. RESULTS Fifty-one infants born to preeclamptic mothers (study group) and 33 gestational age- and gender-matched infants born to normotensive mothers (control group) were included in this study. No statistical difference was found between the two groups in terms of demographic characteristics. However, frequency of neutropenia, duration of mechanical ventilation, and neonatal sepsis rates were found to be significantly higher in the study group compared with those of the control group. Although the rates of other neonatal morbidities such as bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage and necrotising enterocolitis were found to be higher in the study group, the difference was not statistically significant. Mortality rates were also found to be similar in both groups. CONCLUSIONS The infants born to preeclamptic mothers had significantly higher rates of neutropenia and sepsis. There were no significant difference in terms of other neonatal morbidities and neonatal mortality between the study and the control group.

Helicobacter pylori Infection in Children: Nutritional Status and Associations with Serum Leptin, Ghrelin, and IGF-1 Levels

Helicobacter pylori is associated with gastrointestinal diseases such as gastritis, peptic ulcers, malignancy and lymphoma, and extra‐gastrointestinal conditions. H. pylori infection is negatively associated with childrens growth. Chronic inflammation of the stomach that results in the loss of appetite and, dysregulation of neuroendocrine hormones such as leptin, and ghrelin are the probable reasons of this negative association. The objective of this study is to determine the serum levels of leptin, ghrelin, and IGF‐1 in H. pylori‐infected children and their relations with growth.

Do Liver IL-12 Levels Predict Sustained Response to IFN-α Therapy in Children with Chronic Hepatitis B?

The aim of this study is to investigate the immunoregulatory role of interleukin-12 and interferon-gamma in children with chronic hepatitis B who are treated with interferon-alpha therapy. The patients were divided into 2 groups: Group I included 16 children with naive chronic replicative hepatitis B infection, and Group II included 6 children who are inactive hepatitis B virus (HBV) carriers. Group I received interferon-alpha subcutaneously (10 mU/m(2)/dose), 3 times a week during 4 months. Initial serum alanine aminotransferase (ALT) levels, hepatitis B serologic markers, serum interleukin-12 and interferon-gamma levels were measured. In Group I, laboratory tests were re-evaluated in the second and fourth months. Liver biopsy was performed in all patients and samples were used for tissue interleukin-12 level evaluation and histopathological examination. Hepatic activity index (HAI) and serum interferon-gamma were significantly higher in Group I (P < 0.05). Initial tissue interleukin-12 levels in Group I were low but a significant increase was observed at the fourth month (P < 0.05). While responder patients in Group I had marked elevation of tissue interleukin-12 levels, nonresponders did not reveal considerable changes at the fourth month evaluation. A negative correlation was found between serum HBV-DNA copies and interferon-gamma levels prior to therapy (P < 0.01, r: -0.66). The analysis of cytokine levels with serum transaminases demonstrated a positive correlation between the tissue interleukin-12 levels at the fourth month and serum ALT levels at the beginning and second month of the therapy (r: 0.77, P < 0.05 and r: 0.92, P < 0.05, respectively). This is the first study emphasizing the relationship between tissue cytokine levels and therapy success. Understanding the course of chronic hepatits B in the pediatric population will help us to clarify some debates on the treatment.

Mannose-binding lectin gene polymorphism and chronic hepatitis B infection in children

Background/Aims: Mannose-binding lectin (MBL) is a member of innate immune system that activates complement system through lectin pathway. MBL deficiency is associated with susceptibility to infectious diseases. In this study, the relation between MBL gene polymorphism and chronic hepatitis B infection in children is evaluated. Patients and Methods: The study included 67 children with chronic hepatitis B and 99 healthy controls. The hepatitis B patients were divided into immuntolerant, chronic inactive, and treatment groups according to their laboratory findings. MBL gene codon 52, 54, and 57 polymorphisms were studied with polymerase chain reaction in all patients and controls. The associations of MBL gene polymorphism with clinical, laboratory, and histopathologic findings were evaluated. Results: Homozygous codon 54 polymorphism of MBL was found significantly higher in chronic hepatitis B patients than controls. Rate of the polymorphism was similar in all groups and, responsive and nonresponsive patients in the treatment group. Conclusions: The hepatitis B patients who are homozygous for codon 54 of MBL are prone to develop chronic infection. Longitudinal studies with larger groups are needed.

PO-0103 Evaluation Of The Paediatric Patients With Gastrointestinal Bleeding: Experience Of A Tertiary Centre

Introduction Gastrointestinal bleeding (GB) can be seen in children of all ages and it is one of the frequent application reason to paediatric gastroenterologists. Even though the causes of bleeding differs according to age groups, it may become life-threatening depending on the severity of the bleeding. Aim The aim of the study was to determine the demographical and etiological factors of patients who admitted to our clinic with upper or lower gastrointestinal bleeding. Material and method 94 patients, were included to the study, admitted to Uludag University Faculty of Medicine Paediatric Gastroenterology department with upper or lower gastrointestinal bleeding between January 2010 and June 2013. Patients’ files were evaluated retrospectively. Results The number of patients with upper gastrointestinal bleeding (UGB) was 53, average ages of these patients was 11.1 years (2–18 years), 45.3% were female and 54.7% were male, respectively. At the aetiology of these bleeding cases H.pylori were detected in 18.8%, peptic or duodenal ulcer were detected in 10 patients (range of ages 10–18 years, average 12 years) and H.pylori was detected in only two patients with ulcer. While all gastric mucosa were hyperemic in 26 patients, distal esophagitis or duodenitis were detected also in 23 patients with UGB. Esophageal variceal bleeding was the cause of 4 patients with UGB and chronic renal failure was associated to bleeding in one patient. Barrett’s oesophagus was detected histologically in 10 and 13 years of age two patients. Four patients had a history of nonsteroidal anti-inflammatory drug use prior to bleeding. Henoch-Schonlein disease was diagnosed in 7 years old male patient. Bleeding was the first symptom of this disease in this case and purpura was occurred after 4 days of bleeding. The remaining 41 cases were called idiopathic bleeding. Range of the ages of 41 patients with lower gastrointestinal bleeding (LGB) was 11.1 years and 24 patients were male (58.5% male, 41.5% female, respectively). Ulcerative colitis was diagnosed histologically in 9 patients (21.9%). Polip in rectum or sigmoid colon was detected in 6 patients, nonspesific chronic inflammation was reported pathologically in patients with polip and there were no family history for polip in these patients. Colonoscopy was normal in 13 patients (31.7%) with LGB. Conclusion Chronic gastritis was detected majority in aetiology of the patients with UGB and we thought that bad dietary habits had great importance in these cases. 21.9% cases with LGB were diagnosed with ulcerative colitis. All cases were evaluated, there were no death because of bleeding at the prognosis of these patients. Discussion Gastrointestinal bleeding is one of important reason for reference of tertiary centre in children. Considering the frequency of H.pylori positivity in our society, 18.8% were found to be positive in cases with UGB. Although the vast majority of patients with LGB were idiopatic, ulcerative colitis plays an important role in patients with LGB.

PO-0104 Different Clinical Spectrum Of Cytomegalovirus Hepatitis In Infants

Background and aim Cytomegalovirus (CMV) is, a member of the herpes viridae family, found widely in nature and the most common congenital infection in newborns. The average incidence of CMV infection in newborn infants is 1%. Irreversible signs of central nervous system involvement (microcephaly, deafness, mental-motor retardation) develops in 5–10% congenitally infected infants. Signs of perinatal infections, hepatosplenomegaly, pneumonia, hepatitis, are seen, but in this period neurological sequelae are rare. In this study, CMV-infected patients who were admitted to our clinic within 3 months were examined. Methods Between the date of December 2013 and February 2014, in total five CMV infection (min 45 days, max 2 years–4 months old) have been detected at Uludag University, Faculty of Medicine, Department of Paediatric Gastroenterology. Three of those patients admitted with jaundice and other two patients were detected during the pancytopenia aetiology and vomiting aetiology investigation. In our series, which consist of developed CMV hepatitis cases due to different etiological reasons, retrospective examination is conducted with clinical and laboratory findings. Results Biliary atresia was detected in three patients. One is by intraoperative cholangiography and other two, as evidenced by histopathology. In the fourth case, CMV infection was detected simultaneously with vitamin B12 deficiency during pancytopenia investigation. In the fifth patient, performed liver transplantation due to neonatal hepatitis, CMV infection was detected during investigating for vomiting and elevated aminotransferase levels in outpatient control. In one of the cases of biliary atresia with microcephaly, deafness and mental-motor retardation was considered due to congenital CMV infection. Other cases were evaluated as perinatally infection. Five patients were given ganciclovir therapy. Duration of the therapy was; six weeks for patient with congenital CMV infection and two weeks for the other four patients. Conclusion Biliary atresia were seen in all our cases with cholestasis and there is importance of seeing it with CMV hepatitis which, in our conclusion, requires comprehensive studies. In addition, seeing these patient in such a short period of time was found interesting in epidemiological perspective.