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Öğe Autoimmune hepatitis associated with celiac disease in childhood(Lippincott Williams & Wilkins, 2010) Tosun, Mahya Sultan; Ertekin, Vildan; Selimoglu, Mukadder Ayse[Abstract Not Available]Öğe Bone mineral density of children with Wilson disease - Efficacy of penicillamine and zinc therapy(Lippincott Williams & Wilkins, 2008) Selimoglu, Mukadder Ayse; Ertekin, Vildan; Doneray, Hakan; Yidirim, MustafaObjectives: Osteoporosis accompanying chronic liver disease is well known; however, the exact prevalence is unknown. No data on bone mineral density (BMD) of children with Wilson disease (WD) have been published so far. In this study, we aimed to investigate the prevalence of osteoporosis in childhood WD and to observe the probable positive effects of penicillamine and zinc therapy on osteoporosis. Methods: Thirty-one children with newly diagnosed WD and sex and age-matched 16 healthy children were included. Mean age was 9.0 +/- 3.2 years (2 to 16 y). Bone mineral content (BMC) and BMD were measured on admission and in 13 cases they were reassessed after 1 year of treatment with penicillamine and zinc. Results: Mean BMD, BMC, and Z scores of the patients were significantly lower than those of healthy children: 0.52 +/- 0.09 versus 0.72 +/- 0.09 (P = 0.001), 19.27 +/- 13.01 versus 29.67 +/- 14.23 (P = 0.009), and 2.33 +/- 1.28 versus -0.12 +/- 0.31 (P = 0.001), respectively. The prevalence of osteopenia and osteoporosis in children with WD was found as 22.6% and 67.7%, respectively. BMD and BMC levels were higher in children with neurologic involvement. The severity of the disease had no effect on the mentioned parameters. One year under treatment with penicillamine and zinc did not significantly alter the mentioned parameters. Conclusions: In this first study investigating the prevalence of osteoporosis in children with WD, we found an extremely high prevalence. Because of nonbeneficial effect of routine treatment of WD on osteoporosis, we emphasize the necessity of screening of bone mineralization and additional therapeutic approach for those children.Öğe Breast-feeding duration and childhood acute leukemia and lymphomas in a sample of Turkish children(Lippincott Williams & Wilkins, 2006) Altinkaynak, Sevin; Selimoglu, Mukadder Ayse; Turgut, Ahmet; Kilicaslan, Buket; Ertekin, VildanObjectives: Whether breast-feeding is associated with decreased incidence of the lymphoid malignancies in children is uncertain. We evaluated childhood acute leukemia and lymphoma in relation to duration of breast-feeding. Methods: We investigated this issue in a case-control study comprising 137 patients, aged I to 16 years, with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin or non-Hodgkin lymphoma, in addition to 146 controls matched for age and sex. Results: The median duration of breast-feeding among patients was shorter than that of controls (10 vs 12 months). Patients with ALL and AML had shorter mean breast-feeding duration compared with healthy children (P = 0.001 and P < 0.001, respectively). The shortest mean breast-feeding duration was noted in the children with AML. Breast-feeding for a duration of 0 to 6 months, when compared with feeding of longer than 6 months, was associated with increased odds ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (Cl) = 1.17-5.101, AML (OR = 6.67 95% Cl = 1.32-33.69), Hodgkin lymphoma (OR 3.33, 95% Cl = 0.60-18.54), non-Hodgkin lymphoma (OR 1.90, 95% Cl = 0.68-5.34) and overall (OR = 2.54, 95% Cl = 1.51-4.26). Conclusions: Our findings suggest that breast-feeding of more than 6 months is protective against childhood lymphoid malignancies, especially for AML and ALL.Öğe Craniofacial features of children with celiac disease(Lippincott Williams & Wilkins, 2013) Selimoglu, Mukadder A.; Kelles, Mehmet; Erdem, Tamer; Ertekin, Vildan; Karabiber, Hamza; Selimoglu, ErolBackground and goalsGrowth retardation is one of the most important signs of childhood celiac disease (CD); however, it is not very well known whether craniofacial growth is also affected. We aimed to carry out a detailed craniofacial morphological study to derive a conclusion on the craniofacial features of children with CD.Participants and methodsEighty-four 2-16-year-old children with biopsy-proven CD and 84 age-matched and sex-matched healthy children were included. Of these, 37 children (44.0%) had been newly diagnosed and 47 (56.0%) were on a gluten-free diet. Anteroposterior and lateral photographs were evaluated using the Scion Image software program for the measurements of the distances between reference points on the face.ResultsExcept for nasofrontal angle (nfa), nasolabial angle (nla), pronasale height (prnh), nasal dorsum height (ndh), and nasal radix height (nrh), all measurements were significantly greater in patients compared with controls. In celiac children, all facial proportions except forehead/face height (t-gl/t-gn) and nose length/face height (n-ns/t-gn) were significantly different from those of controls. Except for nla, prnh, ndh, nrh, t-gl/t-gn, face height to total face height ratio (sn-gn/t-gn), n-sn/t-gn, ear length to face height ratio (s-sba/t-gn), and face width to face height ratio (z-z/t-gn), all measurements were statistically different in those on a gluten-free diet and newly diagnosed children.ConclusionMost of the facial measurements and proportions of celiac children were different from those of controls. Our data confirm those of a previous study reporting that the forehead proportion is not altered in childhood CD. Pathophysiological mechanisms underlying these alterations are not clear but disruptions of growth during certain critical periods may be responsible.Öğe Dermatological signs in Wilson's disease(Wiley, 2009) Seyhan, Muammer; Erdem, Teoman; Selimoglu, Mukadder A.; Ertekin, VildanBecause no data on skin and mucosal findings of patients with Wilson's disease have been published so far, the aim of the present study was to investigate the prevalence of mucosal and skin findings in childhood Wilson's disease and to determine its specific dermatological findings, if any exist. Thirty-seven 4-17-year-old children with Wilson's disease were included. A complete skin, scalp skin, mucous membrane and nail examination was performed. Of the children, 26 (70.3%) had at least one dermatological finding. Twenty-five (67.6%), five (13.5%), nine (24.3%) had at least one skin, mucosal and nail finding, respectively. The most prevalent dermatological diagnosis of the Wilson's disease patients was xerosis (45.7%). The presence of dermatological findings was not related to drug usage, severity of the disease, or malnutrition. The duration of the disease was not different in patients with or without dermatological findings. The frequency of skin findings alone, however, was high in relatively newly diagnosed patients (< 2 years). Dermatologist should be aware of the various dermatological manifestations of Wilson's disease, because a careful and objective skin, mucosa, nail and hair examination may be indicative of a diagnosis of Wilson's disease, particularly in early cases.Öğe Do children with Wilson's disease have distinct craniofacial morphology? A cephalometric study(Elsevier Ireland Ltd, 2013) Kilic, Nihat; Sumbullu, M. Akif; Ertekin, Vildan; Catal, Gulhan; Cakur, Binali; Oktay, Husamettin; Selimoglu, Mukadder AyseObjectives: Patients with Wilson's disease (WD) develop osseous changes such as osteoporosis, spontaneous fractures, areas of sclerosis and demineralization of maxillary and mandibular bones, and neurologic symptoms including swallowing dysfunctions, which may affect dento-facial growth. However, dento-maxillo-facial structures of these patients have never been investigated. The present study aimed to discover if subjects with WD have different dentofacial structures. Methods: Lateral cephalometric films of 13 children (5 males and 8 females) with WD and of 15 normal subjects (6 males and 9 females) were evaluated. Mean ages of the patients and controls were 12.62 +/- 3.09 years and 12.01 +/- 1.38 years, respectively. Lateral cephalometric cranial films of all subjects were taken in the same cephalostat in a habitual and unstrained body posture. Thirteen linear and 11 angular parameters were measured to describe the craniofacial characteristics of the subjects. Results: Statistical analysis showed that there is no statistically significant difference between parameters of normal children and children with WD, with the exception of palatal plane inclination. The inclination of palatal plane was higher in children with WD than in normal subjects. Conclusions: Children with WD and healthy children have approximately the same dento-maxillo-facial structures. However, increased palatal plane inclination may be a finding of WD. (C) 2013 Elsevier Ireland Ltd. All rights reserved.Öğe Effects of interferon-? therapy on insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in children with chronic hepatitis B(Karger, 2009) Ertekin, Vildan; Tosun, Mahya Sultan; Orbak, Zerrin; Selimoglu, Mukadder Ayse[Abstract Not Available]Öğe Fecal Calprotectin Concentration in Celiac Disease(Lippincott Williams & Wilkins, 2010) Ertekin, Vildan; Selimoglu, Mukadder Ayse; Turgut, Ahmet; Bakan, NuriGoals: We aimed to determine fecal calprotectin (FC) concentration and its relation with histopathologic findings of children with celiac disease (CD) and to observe the probable alterations under gluten-free diet (GFD). Background: As FC is regarded as a marker of inflammation in the gastrointestinal tract, we hypothesized that it might be increased in untreated CD. Study: The study included 29 newly diagnosed patients with CD (mean age: 6.6 +/- 0.6 y) and sex and age-matched 10 healthy children. All of the children with CD admitted to the hospital were classical form who has chronic diarrhea and failure to thrive. The degree of mucosal damage was graded according to the modified Marsh criteria. FC concentration was determined by enzyme-linked immunosorbent assay method on admission and after 1 year of GFD. Results: Mean FC concentration of children with CD on admission and of healthy children were 13.40 +/- 8.5 and 4.3 +/- 3.3 mg/L, respectively (P = 0.004). FC concentration under GFD was 4.6 +/- 2.7 mg/L and there was a significant statistical difference between untreated patients and those under GFD for 1 year (P = 0.001). There was no statistical difference between FC concentration of those under GFD and healthy children (P = 0.8). Mean FC concentrations of children with total-villous atrophy and partial-villous atrophy were significantly different (13.8 +/- 9.3 mg/L vs. 3.7 +/- 1.8 mg/L, P = 0.005). Conclusions: It was found that FC concentration is increased in childhood CD, related to the severity of histopathologic findings and responsive to GFD. The pathogenetic mechanism by which FC is increased in CD should be investigated in further studies.Öğe Intestinal tuberculosis mimicking Crohn's disease(Elsevier Science Inc, 2007) Ertekin, Vildan; Selimoglu, Mukadder Ayse; Okcu, Nihat; Orbak, Zerrin; Guendogdu, Cemal[Abstract Not Available]Öğe Is There Need for a New Hepatitis B Vaccine Schedule for Children with Celiac Disease?(Baqiyatallah Research Center, 2011) Ertekin, Vildan; Tosun, Mahya Sultan; Selimoglu, Mukadder AyseBackground: Celiac disease (CD) is an autoimmune disease characterized by immune-mediated inflammatory damage of the small intestinal mucosa, precipitated by the ingestion of gluten-containing foods. Since human leucocyte antigen DQ2 (HLA-DQ2) is a marker of nonresponsiveness to hepatits B virus (HBV) vaccine, CD may also be associated with this nonresponsiveness. Objectives: The aim of this study was to compare the responses to HBV vaccine between children with CD and healthy children. we also investigated the relationship between the patients' responses to hepatitis B vaccine, the clinical presentation of CD, and dietary compliance in the patients. Patients and Methods: We recruited 52 children with CD and 20 age- and sex-matched healthy children who received HBV vaccination according to the standard immunization schedule. The production of specific antihepatitis B surface antigen (HBsAg) antibodies was evaluated in all patients and control participants. Subjects with less than 10 IU/L anti-HBs were considered nonresponders to the vaccination. Results: 31 of the 52 patients (59.6%) were female and 21 (40.4%) were male. The mean age of the CD patients was 10.7 +/- 4 years (range, 4-18 years). Anti-HBs titers were positive in 32(61.5%) patients and negative in 20 (38.5%) patients, while they were positive in 18 (90%) of the children in the control group (P < 0.05). We found statistically significant differences between negative anti-HBs titers, clinical presentation of CD, and dietary compliance in patients with CD (P < 0.05). Conclusions: Nonresponsiveness to hepatitis B vaccination was more frequently found in children with CD than in the control group. Therefore, the response to HBV vaccination should be investigated in children with CD, and a different immunization schedule may need to be developed. Further, compliance to the prescribed gluten-free diet (GFD) may improve the immune response to HBV vaccination in children with CD. (C) 2011 Kowsar M.P.Co. All rights reserved.Öğe Oral findings in children with celiac disease(Tubitak Scientific & Technological Research Council Turkey, 2012) Ertekin, Vildan; Sumbullu, Muhammed Akif; Tosun, Mahya Sultan; Selimoglu, Mukadder Ayse; Kara, Mustafa; Kilic, NihatAim: To investigate whether Turkish children with celiac disease (CD) show dental enamel defects (DEDs), recurrent aphthous stomatitis (RAS), teeth missing, and xerostomia, and to compare the results with age- and sex-matched healthy children. Materials and methods: The oral cavity was explored in 81 patients with CD (mean age 8.7 +/- 3.7 years; age range 2.5 to 17 years) and in 20 healthy controls. Enamel defects, teeth missing, RAS, and xerostomia were established. Results: Forty-three (53.1%) celiac patients and 5 (25%) control subjects had enamel defects. Enamel defects occurred more frequently in patients (P = 0.025) compared to controls. Regarding RAS, 39 (48.1%) patients and 1 (5%) control had aphthous ulcers (P = 0.0001). Teeth missing and xerostomia were detected in 11(13.6%) and 47 (58%) patients, respectively. Patients with xerostomia were significantly greater in number compared to healthy children (P = 0.008). In the present study, the prevalence of DEDs, RAS, and xerostomia was greater in celiac patients than in healthy controls. Conclusion: Early recognition of children with specific DEDs, RAS, and xerostomia and thus their referral to pediatricians might help in early diagnosis of CD.Öğe Prevalence of Celiac Disease in a Sample of Turkish Children With Epilepsy(Elsevier Science Inc, 2010) Ertekin, Vildan; Selimoglu, Ayse; Tan, Hueseyin; Konak, Murat[Abstract Not Available]Öğe Serum ghrelin levels in children with primary protein-energy malnutrition(Wiley, 2008) Altinkaynak, Sevin; Selimoglu, Mukadder A.; Ertekin, Vildan; Kilicarslan, BuketBackground: Ghrelin, an appetite-stimulating peptide, increases in cachectic conditions. It probably reflects peripheral nutritional status and influences nutrient intake and growth. The aim of the present study was to determine serum ghrelin levels in children with primary protein-energy malnutrition (PEM) and to find if any correlation exists between serum ghrelin levels and the clinical presentation of those patients. Methods: Twenty-eight children with primary PEM and 10 healthy children were included. Serum fasting ghrelin levels were measured using radioimmunoassay. Results: Mean serum ghrelin level of healthy children and those with PEM were 107.7 +/- 40.1 pg/mL and 141.6 +/- 123.8 pg/mL, respectively (P < 0.001). Ghrelin levels were independent of age and sex (P > 0.05). Ghrelin was negatively correlated with body mass index in healthy children (P < 0.01), but not in those with PEM (P > 0.05). Mean serum ghrelin level of children with moderate malnutrition was higher than that of children with severe malnutrition (199.2 +/- 154.1 pg/mL vs 98.4 +/- 74.3 pg/mL, P < 0.05). Mean serum ghrelin levels of patients with kwashiorkor, marasmic kwashiorkor, and marasmus were 127.9 +/- 97.8 pg/mL, 138.7 +/- 95.8 pg/mL, and 162.3 +/- 185.0 pg/mL, respectively (P > 0.05). Conclusion: Serum ghrelin level is higher in patients with PEM, especially in those with marasmus, compared to healthy children. Although this observation suggests that ghrelin helps to fight malnutrition in children, it is obvious that further studies are needed to clarify the exact pathogenetic mechanism regarding this condition.Öğe Treatment results of chronic hepatitis B in children: a retrospective study(Turkish J Pediatrics, 2010) Selimoglu, Mukadder Ayse; Ertekin, Vildan; Karabiber, Hamza; Turgut, Ahmet; Gursan, NesrinSelimoglu MA, Ertekin V, Karabiber H, Turgut A, Gursan N. Treatment results of chronic hepatitis B in children: a retrospective study. Turk J Pediatr 2010; 52: 360-366. In this retrospective study, we aimed to share our experience with different treatment modalities for chronic hepatitis B in a series of children. The study included 126 children (mean: 9.5+/-3.8 years). Normalization of alanine aminotransferase (ALT), loss of hepatitis B virus (HBV)-DNA and hepatitis B e antigen (HBeAg), and development of antibody to HBeAg (anti-HBe) altogether at the end of the treatment was considered as end of therapy response (ETR). Seroconversion ongoing one year after the cessation of therapy was considered as sustained response. Of the total children, 90 (71.4%) were treated, whereas the remaining were just followed-up. High-dose interferon (IFN)-alpha (10 MU/m(2)) alone, standard-dose IFN-alpha (6 MU/m(2)) plus lamivudine (4 mg/kg/d), high-dose IFN-alpha plus lamivudine, or lamivudine alone was used, IFN-alpha thrice weekly for six months, and lamivudine daily for one year. Of children who had completed their treatment, 34 (37.8%) achieved ETR. Sustained response rate was 36.7%. Response rates were different in the different treatment groups (p: 0.01). The highest response rate was observed in those who received standard-dose IFN-alpha plus lamivudine treatment (61.5%). Of children without treatment, one (2.8%) had anti-HBe seroconversion. Standard-dose IFN-alpha plus lamivudine treatment was found superior to the other treatment modalities. Predictors of ETR were similar to those found in previous studies.
