Effect of proton pump inhibitors on vitamin b12, iron, calcium and magnesium absorption

Proton pompa inhibitörleri, dünyada en sık kullanılan ilaç gruplarından birisidir. Çocuklarda ve erişkinlerde mide asidiyle ilişkili hastalıkların tedavisinde en etkili ilaçtır. Kullanım sıklığının yıldan yıla artması ile sistemik yan etkilerinin olabileceği gündeme gelmiştir. Erişkinlerde yapılan çalışmalarda, proton pompa inhibitörü kullanımının B12 vitamini ve minerallerin emilimine etkilerine dair farklı sonuçlar elde edilmiştir. Çocuklarda PPi kullanımın yan etkisi ile yapılan çalışmalar kısıtlıdır. Bu çalışmada, proton pompa inhibitörü kullanan çocuklarda B12 vitamini, demir, kalsiyum ve magnezyum eksikliğini saptamak ve ilaç kullanım süresi ile B12 vitamini, mineral eksikliği ilişkisini değerlendirmek amaçlanmıştır. Çalışma; Mart 2013- Haziran 2014 tarihleri arasında Gazi Üniversitesi Tıp Fakültesi Pediatrik Gastroenteroloji polikliniğine başvuran, yaşları 4-18 yıl arası, gastroözefagial reflü ve dispepsi tanılı olup en az 3 ay süre ile proton pompa inhibitörü kullanan 100 hastada yapılmıştır. Hastalar, ilaç kullanım sürelerine göre; kısa süreli ilaç kullanımı (3-6ay) ve uzun süreli ilaç kullanımı (>6 ay) olmak üzere iki gruba ayrılmıştır. Hastaların serum B12 vitamini, homosistein, demir, demir bağlama kapasitesi, kalsiyum, fosfor, alkalen fosfotaz, magnezyum ve idrar metilmalonik asit düzeyleri değerlendirilmiştir. Hastalara diyet ile vitamin ve mineral alımlarını değerlendirmek için beslenme anketi yapılmıştır. Hastaların serum vitamin B12 düzeyi eksikliği %12 olup, ilaç kullanımı süresi ile anlamlı korelasyon yoktur. Serum B12 vitamin düzeyi normal iken; MMA ve homosistein düzeyi yükselen hastalar da B12 vitamini eksikliği kabul edildiğinde, B12 vitamini eksikliği sıklığı artmaktadır ve uzun süre ilaç kullanan grupta B12 vitamini eksikliği daha sık görülmektedir. Demir eksikliği sıklığı %47 olup, ilaç kullanım süresi ile anlamlı korelasyon bulunmamıştır. Çalışma grubunda klinik olarak anlamlı kalsiyum, fosfor ve magnezyum eksikliği saptanmamıştır. Çalışmamızda; uzun süreli ilaç kullanan grupta, kısa süreli ilaç kullanan gruba göre ortalama B12 vitamini düzeyin düşük, homosistein düzeyi yüksek, kalsiyum ve fosfor düzeyleri düşük olduğu için; çocuklarda PPİ tedavisi öncesi ve uzun süre kullanımı sırasında B12 vitamini, demir, kemik metabolizması parametrelerinin taranmasının uygun olabileceğini düşünmekteyiz. Çocuklarda daha geniş çaplı, tedavi öncesi ve sonrası vitamin ve mineral düzeylerinin değerlendirildiği, objektif ve daha ayrıntılı beslenme anketlerinin yapıldığı çalışmalara ihtiyaç vardır.Proton pump inhibitors (PPI) are now one of the most widely used drugs and one of the most potent medications available to reduce gastric acid secretions in children and adults. Widespread use of PPI brought out questions about systemic adverse and side effects. Studies on adult population showed various effects of PPI, on the absorption of vitamin B12 and minerals. However, there are limited studies on the effects of PPI in children. The purpose of this study is, to investigate whether PPI use is associated with vitamin B12, iron, calcium and magnesium deficiency, and to determine the relationship between duration of drug useand vitamin B12 and mineral deficiency. A total of 100 children, who used PPI for at least 3 months due to dyspepsia or gastroesophageal reflux disease were included in the study. Patients were aged between 4 and 18 years. Patients were divided into two groups regarding the duration of PPI treatment. Patients who had PPI treatment for 3-6 months were placed in short-term group and the ones who had PPI treatment for more than six months were placed in long-term group. Serum vitamin B12, homosistein, iron, calcium, phosphorus, magnesium levels, total iron binding capacity, and urine methylmalonic acid (MMA) levels of all patients were measured. A questionnaire was developed to determine the approximate dietary vitamin and mineral intake. Serum levels of vitamin B12 deficiency was detected in 12% of all children, however, there was no significant correlation with duration of drug use. When the patients, who had normal serum vitamin B12 levels with elevated MMA and homosistein levels, are considered as vitamin B12 deficient, vitamin B12 deficiency was found to be significantly more common in long-term group. 47% of patients had iron deficiency, but there was no correlation between iron deficiency and the duration of PPI treatment. In the study group, no patient was found to have clinically significant calcium, phosphorus and magnesium deficiency. In conclusion, our results show that long-term PPI treatment is associated with decreased average vitamin B12, calcium and phosphor levels, and elevated homocysteine levels in serum. Therefore, we think that, screening of vitamin B12, iron and bone metabolism parameters before and during long-term PPI treatment in children may be logical. Cohort studies with greater sample sizes, which evaluate serum vitamin and mineral levels before and during PPI treatment, are needed to reveal all possible effects of PPI treatment on vitamin and mineral absorption. Moreover, future studies should be supported with more detailed examination of dietary intake

Electroencephalography Findings in Acute Encephalopathy

WOS:000616394600020Acute encephalopathy is a common pediatric emergency during childhood. Although different new modalities have been developed for the evaluation of cerebral functions, electroencephalography (EEG) still has most frequently used method. EEG changes observed in acute encephalopathy are as follows; background changes, periodic discharges, rhythmic discharges, interictal epileptiform discharges, ictal epileptiform discharges. Accurate identification of these changes is determinative in terms of clinical approach, choice of treatment and the prediction of the final outcome. in this article, EEG changes in acute encephalopathy are reviewed

Trombositlere taksol’ün etkisi

Taksol antikanser bir ilaç olup mikrotübüller üzerinden etki göstererek hücre mitozunu engellemektedir.Son yıllarda Taksol intraarteriyel stent kaplanmasında kullanılarak, subakut tromboz ve neointimal hiperplaziye bağlı olarak gelişen restenozisi önemli ölçüde azaltmıştır. Subakut trombozun oluşumunda trombosit aktivasyonu ve agregasyonu önemlidir. Bu çalışmada Taksol'ün fibrinojen reseptörü GpIIb\IIIa (glikoprotein IIb\IIIa) ve trombosit aktivasyonu üzerine etkileri flov sitometrede incelendi. Ayrıca Taksol'ün trombosit agregasyonuna in vitro etkisi agregometrede çalışıldı. Çeşitli Taksol konsantrasyonlarında ADP (adenozin difosfat), kollagen ve adrenalin agonistleri kullanılarak Taksol'ün trombosit agregasyonu üzerindeki etkisi incelendi. Taksol, artan konsantrasyonlarına bağlı olarak agonistlerle indüklenen primer ve sekonder trombosit agregasyonunu inhibe etmiştir. Flov sitometrik analizler için yedi sağlıklı olgudan kan 1/9 oranında sitratlı tüplere alındı. PRP tam kanın 150 g de 15 dakika santrifügasyonu ile elde edildi. Trombosit aktivasyonu çalışmak için trombosit aktivasyon markerı olan CD42b (GpIb) antikoru, Taksol'ün fibrinojen reseptörü GpIIb\IIIa üzerindeki etkisini incelemek üzere CD61 (GpIIIa) antikoru kullanıldı.Farklı Taksol konsantrasyonlarında tam kandaki trombositlere bağlanan CD61 antikor yüzdesi önemli oranda düşmüştür. Aynı şekilde tam kandaki trombositlere bağlanan CD42b antikor yüzdesi de düşmüştür (aktivasyon artmıştır).PRP (platelet rich plasma) deki trombositlere bağlanan CD61 ve CD42b antikor yüzdeleri, PRP'nin farklı Taksol konsantrasyonlarıyla inkübasyonundan sonra düşme göstermiştir.Sonuç olarak bu çalışmada, Taksol'ün trombosit aktivasyonunu arttırırken trombositlere bağlanan %CD61 düzeyini düşürdüğü gözlenmiştir. Bu bulgu Taksol'ün trombosit aktivasyonunu arttırırken fibrinojen bağlanma bölgesi GpIIIa yı bloke ettiğini düşündürmektedir. Taksol'ün ADP, kollagen, adrenalin indüklü trombosit agregasyonunu inhibe etmesi de bu düşünceyi doğrulamaktadır.EFFECT OF TAXOL ON PLATELETSSUMMARYTaxol is an anticancer drug which effects on microtubules and blockes mitosis.In recent years Taxol has been used in intraarterial stent coating and inhibits neointimal hyperplasia and subacute thrombosis.Platelet aggregation and activation are important in the formation of subacute thrombosis. In this study, we have examined Taxol's effects on fibrinogen receptor GpIIb\IIIa and platelet activation in whole blood and PRP by flow cytometry. We also measured the Taxol's effect on platelet aggregation by Lumi-aggregometer. Taxol's effects on ADP, collagen and adrenalin induced platelet aggregation were studied in the presence of different Taxol concentrations. Agonist induced primary and secondary platelet aggregation were inhibited by increased Taxol concentrations. For flow cytometric analysis citrated whole blood samples were obtained from seven healthy subjects and PRP (platelet rich plasma) was prepared from blood by santrifugation at 150g for 15 minutes. To study the platelet activation, CD42b (GpIb) antibody, to examine the effect of Taxol on platelet GpIIb/IIIa receptor, CD61(GpIIIa) antibody were used.In increased Taxol concentrations, CD61 and CD42b percentages in whole blood was found to be decreased significantly. In PRP, CD61 and CD42b percentages also decreased after incubation with increased concentrations of Taxol solutions.In conclusion, Taxol effects on platelet functions. The striking observation was that while Taxol was increasing the platelet activation, it decreased CD61 binding to platelets. When platelet activation with Taxol increased, the fibrinogen binding sites might have been suppressed by Taxol. These findings suggest that the binding sites of Taxol on platelets might be GpIIb-IIIa. ADP, collagen and adrenalin induced platelet aggregation inhibited by Taxol also supports this phenomenon

A Rare Cause of Reversible Splenial Lesion Syndrome (RESLES): Benign Convulsions with Mild Gastroenteritis

Transient lesions involving the splenium of corpus callosum is defined as reversible splenial lesion syndrome (RESLES). Benign convulsions with mild gastroenteritis is a rare condition which may be associated with RESLES. Since the prognosis is excellent, the awareness of this association is important to prevent unnecessary investigations and anti-epileptic drug therapy

Spike wave characteristics and temporal spike evolution on serial EEG in childhood epilepsy with centrotemporal spikes

Purpose: To assess the spike characteristics and temporal spike evolution on serial EEG of children with childhood epilepsy with centrotemporal spikes (CECTS) treated with anti-seizure medication. Methods: The study cohort consisted of 127 children with CECTS divided into three groups based on anti-seizure medication responsiveness: group I: seizure-free with monotherapy (n: 61, 48%), group II: seizure-controlled with monotherapy (n: 52, 41%) and group III: seizure-controlled with dual therapy (n: 14, 11%). The clinical profiles and sequential four-year follow-up visual EEG recordings of the children were evaluated. Each EEG was reanalyzed with three spike characteristics on the epochs: (1) spike-wave rate, (2) spike topography, and (3) spike localization. We calculated the spike clearance velocity, which is defined as a decrease in the spike-wave rate over time in four-year sequential follow-up EEGs. Results: There was no statistical significance across the study groups with respect to initial EEG spike characteristics (spike-wave rate, spike localization, and spike topography). Seizure recurrence occurred in 15 patients (12.8%) who discontinued anti-seizure medication. There was no statistically significant difference between the spike characteristics on EEG just before the discontinuation of anti-seizure medication and seizure recurrence. However, the spike clearance velocity was significantly slower in group III than in group I in four-year sequential follow-up EEGs (p = 0.002). A statistically significant decrease in the mean spike-wave rate was observed in group I in the first year of anti-seizure medication (p0.001). The spike clearance velocity was also more prominent during the second year of treatment in group II and the third year of treatment in group III. However, the spike clearance velocity was not different across the anti-seizure medication groups (oxcarbazepine, valproic acid, and levetiracetam). Conclusion: Spike clearance velocity might be a valuable EEG marker to guide anti-seizure medication in children with CECTS

Elementary teachers’ views about their roles in curriculum development and evaluation process: The case of Denizli

AbstractThe purpose of this study is to determine the elementary teachers’ participation level to curriculum development process and their views about their own roles on this process. The study was designed as a descriptive study based on the survey model. Semi-structured interview form was used for the study. The questions were prepared according to “The Program Evaluation Forms” that were sent to schools by Ministry of National Education and offers were taken from curriculum and instruction professionals. The form consists of 12 questions five of which are personal ones. The participants of the study are 15 (8 female, 7 male) elementary school teachers working at schools from low, middle and upper socioeconomic levels in Denizli. Each interview lasted approximately 25minutes and notes were taken by the researches. Content analysis was used to analyze the data. Interviews were transferred to computer and thirteen pages of raw data were obtained. After that, raw data texts were grouped based on the interview questions and data was analyzed

Dirençli Epilepsinin Tedavi Edilebilir Bir Nedeni: Piridoksin Bağımlı Epilepsi

Amaç: Piridoksin bağımlı epilepsi, tipik olarak bebeklik veya erken çocukluk döneminde inatçı nöbetler ile seyreden nadir görülen otozomal resesif bir hastalıktır. Nöbetler geleneksel antiepileptik tedavilere dirençli olup, farmakolojik dozda piridoksine yanıt verir. Bu çalışmada Piridoksin Bağımlı Epilepsi (PBE) tanısı ile izlediğimiz altı hastanın klinik ve genetik özelliklerini sunmayı amaçladık.Gereç ve Yöntemler: Çocuk Nöroloji Bilim Dalı’nda piridoksin bağımlı epilepsi tanısı ile izlenen altı olgunun klinik ve genetik özellikleri ile prognozu retrospektif olarak değerlendirildi.Bulgular: Çalışmaya alınan hastaların 5’i erkek, 1’i kız olup, yaş ortalaması 6.83±3.71 yıldı. Nöbet başlangıç yaşı ortalama 22.33±31.77 (3-90 gün) olup, bir hasta (n:4) hariç diğerleri yenidoğan döneminde başlamıştı. Üç hastada fokal motor nöbet, 2 hastada jeneralize motor nöbet ve 1 hastada epileptik spazm izlendi. Hastaların vitamin B6 tedavisi bir hasta hariç erken dönemde başlandı. Erken dönem tedavi başlanan bir hasta dışında diğer hastalarda mental retardasyon, stereotipik hareketler ve otistik bulgular izlendi. Yapılan moleküler genetik analizde 5 farklı mutasyon saptanmıştır [2 olguda homozigot c.1597delG (p.Ala533ProfsTer18), 1 olguda homozigot c.781 A>G (p.Met261Val),1 olguda birleşik heterozigot c.328C>T (p.Arg110Ter)/c.1566-1G>T, 1 olguda heterozigot c.328C>T (p.Arg110Ter) ve 1 olguda heterozigot c.1356 A>C (p.Lys452Asn)].Sonuç: Piridoksin Bağımlı Epilepsi tedavi edilebilir epilepsi nedenlerinden biri olup açıklanamayan dirençli nöbetleri olan bebeklerde mutlaka düşünülmeli ve terapotik dozda piridoksin tedavisine başlanmalıdır

Cerebral folate transporter deficiency: a potentially treatable neurometabolic disorder

Cerebral folate deficiency (CFD) syndrome is a rare treatable neurometabolic disorder with low levels of the active form of folaten in cerebrospinal fluid (CSF) arising from different causes such as FOLR1 gene mutations or autoantibodies against the folate receptor-alpha (FR) protein that can block folate transport across the choroid plexus. It is characterized by late infantile onset refractory seizures, ataxia, movement disorder, and unexplained global developmental delay. Here, we report a patient diagnosed with autistic spectrum disorder, followed by refractory myoclonic-atonic seizures, ataxia, and loss of motor skills over time. A homozygous missense (c.665A > G) mutation in FOLR1 gene and extremely low CSF 5-methyltetrahydrofolate level led to the diagnosis of CFD. Although she was initiated on combined oral and intravenous high doses of folinic acid treatment at 6 years of age, mild improvement was achieved in terms of epileptic seizures and motor skills. It is important that CFD should be kept in mind in cases with refractory myoclonic-atonic seizure and folinic acid treatment should be started as soon as possible