Probiotics and Prebiotics in Infancy

Nutrition is important in every period of life, but it has a special importance in infancy when growth is the fastest. Infancy is the period in which children grow and develop the fastest. Breast milk is the best food for the newborn and contains all the necessary nutrients to support the baby's development. Exclusive breast milk is the preferred feeding method for all newborn babies, especially for the first six months, and provides complete nutrition to support growth and development in the early stages of life. In addition, breast milk provides the baby with many bioactive compounds such as oligosaccharides (natural prebiotics), immune cells and bacteria (natural probiotics) and their metabolites (natural postbiotics). Probiotics, which are accepted as functional foods, are attracting more and more attention every day because of their proven positive effects on human health. In this review, the place and importance of probiotics and prebiotics in infancy will be discussed

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Duodenokolik fistül

Gastrointestinal fistüllerin çoğu inflamatuvar barsak hastalığı, malignite, peptik ülser ve pankreatit ile ilişkilidir, fakat akut veya iyatrojenik gastrointestinal fistüller cerrahi girişimler sonrasında da gelişebilir. Bu olgu sunumunda kusma, ishal ve malnütrisyon bulguları ile başvuran 7 yaşında erkek hastada duodenokolik fistül saptandı. Fistülün önceki apendektomi ile ilişkili olabileceği veya apendektomi öncesi veya stress nedeni ile operasyon sonrası gelişmiş bir duodenal ülsere bağlı olabileceği düşünüldü. Hastada duodenokolik fistül cerrahi olarak kaldırıldı ve uygun beslenme ile desteklendi. Bu yüzden, operasyon öyküsü olan, malnütrisyon ve malabsorpsiyon bulguları ile başvuran hastaların tanısında gastrointestinal fistüller düşünülmelidir.Most of the gastrointestinal fistulas appear in connection with inflammatory bowel disease, malignancy, peptic ulcer and pancreatitis, but acute or iatrogenic gastrointestinal fistulas can also develop in the aftermath of surgical interventions. In this case report, the examination of the 7-year-old male patient admitted with symptoms of vomiting, diarrhea and malnutrition showed that he had duodenocolic fistula. Fistula considered to be connected with previous appendectomy operation or may also be associated with duodenal ulcer which may develop before appendectomy or with stress after the operation. The patient was treated by an operation to clear off the duodenocolic fistula and by support of appropriate nutrition. Therefore, gastrointestinal fistulas should be considered as diagnosis for the patients who have a history of previous operation and admitted with symptoms of malnutrition and malabsorption

Çölyak hastalığı ve eozinofilik özefajit birlikteliği: Bu iki hastalık için bir tesadüf mü?

Çölyak hastalığı ve eozinofilik özefajit genellikle ayrı gastrointestinal hastalıklar olarak değerlendirilmekle beraber birliktelikleri beklenenden çok daha fazladır. Burada pozitif çölyak serolojisi olan ve endoskopik patoloji sonucunu ile Marsh sınıflamasına göre çölyak hastalığı tip 3c olarak değerlendirilen 5 yaşında kız hastayı sunmaktayız. Diğer taraftan hastanın özefagus mukoza biyopsi örneklerinde her sahada 100 den fazla eozinofilisi mevcuttu ve hasta eozinofilik özefajit olarak da değerlendirildi. Çölyak hastalığı ve eozinofilik özefajit arasındaki ilişki kesin değildir. Bununla birlikte çölyak hastalığı olan çocuklarda eozinofilik özefajit birlikteliğine dikkat edilmesi gerekmektedirCeliac disease and eosinophilic esophagitis are usually considered to be separate gastrointestinal diseases; however, it appears that they may coexist more often than would be expected. We report the case of a 5-year-old girl who had positive celiac serology and was assessed as having type 3c celiac disease according to the Marsh classification with endoscopic pathology. However, the patient s eosinophils were more than 100 per high-power field in esophageal mucosal biopsy specimens and she was evaluated as having eosinophilic esophagitis as well. The relationship between celiac disease and eosinophilic esophagitis is not clear. Nevertheless, coexistence of eosinophilic esophagitis needs to be considered in children with celiac disease

The Abernethy Malformation: A Rare Cause of Congenital Extrahepatic Portacaval Shunt

Abernethy malformasyonu birçok farklı klinik bulgu ile görülebilen çok nadir bir splanknik venöz sistem anomalisidir. Bu olgu sunumunda klinik bulgusu olmadan tetkikler sonucunda rastlantısal olarak Abernethy malformasyonu saptanan ve karaciğerde kitleleri bulunan 5 aylık kız olgu sunulmaktadır. Malformasyonun klinik bulguları ve olası komplikasyonların önemi vurgulanmaktadır.The Abernethy malformation is a rare anomaly of the splanchnic venous system with a widely variable clinical presentation. In this case report we presented a 5-month-old girl where liver masses and the Abernethy malformation were incidentally detected without clinical symptoms as a result of investigations. Clinical findings of the malformation and the importance of potential complications are emphasized

Portal hypertension in childhood: Two centers experience and literature review

Giriş: Bu çalışmada portal hipertansiyon (PHT) nedeni ile izlediğimiz hastalarımızın değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2005-2013 yılları arasında izlenen toplam 21 PHT’li hasta retrospektif olarak demografik verileri, başvuru nedenleri ve uygulanan tedaviler açısından değerlendirilmiştir. Bulgular: Çalışmaya alınan hastaların ortalama yaşı 9,3±5,3 yıl olup, %38,1’i kız, %61,9’u erkek idi. Hastaların %28,6’sının gastrointestinal sistem (GİS) kanaması, %14,3’ünün karında şişlik, %28,6’sının splenomegali, %9,5’inin hepatosplenomegali ve %19’unun karaciğer fonksiyon testlerinde yükseklik nedeni ile başvuru sonrası PHT tanısı aldığı görüldü. Ortalama tanı yaşı 6,8±4,7 yıl, ortalama izlem süresi 3,4±1,7 yıl idi. Üst GİS endoskopisinde hastaların %85,7’sinde özofagus varisleri saptanmış, bir hasta dışında tüm hastalara beta bloker tedavi başlanmıştır. Hastaların izlemleri süresince %52,4’ünde PHT sekonder GİS kanaması görülmüştür. Hastaların %4,8’ine skleroterapi, %19’una bant ligasyonu, %23,8’ine bant ligasyonu ve skleroterapi beraber uygulanmıştır. Bir hastaya rex şantı ve iki hastaya distal splenorenal şant yapılmıştır. Sonuç: PHT takibinde varis kanaması en önemli komplikasyondur. Hastalarda erken tanı ile medikal, endoskopik ve cerrahi önlemlerin alınması sonucu portal hipertansiyon komplikasyonları engellenebilir.Introduction: In this study, our objective is to make an assessment of the patients whom we have followed with portal hypertension. Materials and Methods: A total of 21 portal hypertension patients, followed between 2005 and 2013, were evaluated retrospectively with regards to demographic data, complaints leading to their application and treatments they received. Results: The average age of the patients was 9.3±5.3, 38.1% of the patients were female and 61.9% were male. Of the patients, 28.6% received portal hypertension diagnosis due to gastrointestinal system bleeding, 14.3% due to abdominal distention, 28.6% due to splenomegaly, 9.5% due to hepatosplenomegaly and 19% due to elevated liver function tests. The average age of receiving the diagnosis was 6.8±4.7 and duration of the follow-up was 3.4±1.7 years. Of the patients, 85.7% had esophageal varices according to the upper gastrointestinal system endoscopy and beta-blocker therapy was applied to all patients except for one. The follow-up of the patients revealed that 52.4% of them had gastrointestinal bleeding secondary to portal hypertension. The patients received sclerotherapy (4.8%), band ligation (19%), band ligation and sclerotherapy together (23.8%). One patient received Rex Shunt and two patients had distal splenorenal shunt. Conclusions: Variceal hemorrhage is the most important complication observed in the follow-up of the portal hypertension. Portal hypertension complications can be prevented with early diagnosis as a result of taking medical, endoscopic and surgical measures

Effects of Chronic Gastritis on Sleep and Quality of Life in Adolescents

Aim: This study aims to evaluate the sleep quality and the quality of life (QoL) of adolescents with chronic gastritis, and determine the related factors. Materials and Methods: This study included patients who were diagnosed with chronic gastritis both clinically and histopathologically. the Pittsburgh Sleep Quality Index and Epworth Sleepiness scale were used to assess sleep quality, and the Pediatric Quality of Life Inventory was used to assess QoL. the control group included healthy volunteers with no chronic diseases and no gastrointestinal system complaints. Results: Fifty-six patients with gastritis and 55 healthy volunteers were included. the patients with gastritis were found to have significantly lower overall QoL subscale, and total scale scores, except for the social functioning total score. Except for the subjective sleep quality, significant differences were seen between the groups in the sleep quality subscale, total scale, and sleepiness scale averages. the total score of the sleep quality scale was significantly higher in patients who had lower incomes than expenditure. There were no significant differences between the obese or overweight patients with gastritis and the rest of the gastritis patients in the study sample. There were no significant differences found between the Helicobacter pylori positive and negative gastritis patients in terms of the total QoL and sleepiness scale scores. Conclusion: This study is important because it is the first study in adolescents in this respect. the sleep and QoL scores of those adolescents with chronic gastritis were lower than the control group

Çocuklarda Latent Tüberküloz Tanısında Tüberkülin Deri Testi ve İn Vitro İnterferon-Gama Salınım Testinin Karşılaştırılması

Amaç:&nbsp;Çocukluk çağında latent tüberküloz enfeksiyonu (LTBE), yaşamın bir döneminde aktif tüberküloz (TB) hastalığı gelişme riski yönünden önemlidir. Mycobacterium tuberculosis ile enfeksiyonun belirlenmesinde yararlanılan tüberkülin deri testinin (TDT) yorumlanması güçtür. İn vitro interferon-gama (IFN-γ) salınımını ölçen testler ile bu güçlüklerin giderilmesi amaçlanmaktadır. Bu çalışmada, LTBE açısından araştırılan çocuklarda IFN-γ salınım testi TDT endürasyonları ile karşılaştırılmaktadır.&nbsp;Gereç ve Yöntemler:&nbsp;QuantiFERON-TB Gold in Tube (QFT-Gold IT) testi ile periferik kan T hücrelerinde Mycobacterium tuberculosis'e özgül ESAT-6, CFP-10 ve TB7.7 antijenlerine karşı önceden duyarlanması olup olmadığı araştırılan 7 ay ile 15 yaş arası 54 çocuk çalışmaya alınmıştır. TDT uygulanmış olan bu hastalar, endürasyon ölçümlerine göre 10-14 mm ve ≥15 mm olmak üzere iki gruba ayrılmıştır. Her iki grup QFT-Gold IT test pozitifliği yönünden karşılaştırılmıştır.&nbsp;Bulgular:&nbsp;TDT endürasyonu 10-14 mm olan 21 çocuğun 2 (%9,5)'sinde, endürasyonu ≥15 mm olan 33 çocuğun 2 (%6)'sinde QFT-Gold IT testi pozitif bulunmuştur. İzoniazid profilaksisi, TDT endürasyonlarına göre olguların %64,8'ine başlanmış olup bu çocukların %91,4'ünde QFT-Gold IT testi negatiftir. TDT pozitifliği ile QFT-Gold IT testi pozitifliği arasındaki tutarlılık %38,9 olarak saptanmıştır.&nbsp;Sonuç:&nbsp;BCG aşısının rutin uygulandığı ve TDT yanlış pozitiflik oranının yüksek olduğu topluluklarda, IFN-γ salınımına dayanan testler çocuklarda kesin LTBE tanısının konulabilmesinde yardımcı olacaktır</p

The Association of Choledochal Cyst and Pancreatitis: A Case Report and Review of the Literature

Choledochal cysts are relatively rare congenital anomalies which are characterized by dilatation of the extra-and/or intra-hepatic bile ducts. Pancreatic involvement before choledochal cyst operation might be a risk factor for postoperative pancreatitis. In this case report, we present a patient who had pancreatic enzyme elevation before choledochal cyst operation and who developed acute pancreatitis after surgery