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 Comparison of Reported Ingested Paracetamol Dose with Serum Blood Concentrations and Their Relationship with N-Acetylcysteine Administration: A Retrospective Study of 117 Patients

Introduction:We aimed to compare the patient reported ingested and blood paracetamol concentrations (BPC) and to investigate the indications for N-acetylcysteine (NAC) administration in referred patients.Methods:This is a retrospective study of acute paracetamol intoxications (API) at the tertiary paediatric emergency department (ED) between June 2015-June 2019. We evaluated the demographics, cause of intoxications, reported doses (mg/kg), BPCs (8/4/12/16 and/or 24th hours). Indications of antidote usage and referral to ED were accepted as BPC >150 mg/kg.Results:Overall, we reviewed 117 cases of acute API. The mean age was 8.97 (±6.0) years, and 68.3% were female. The reported ingested of paracetamol (RIP) median dose was 2725 mg (mean 138±51.9 mg/kg). Adolescents had a significantly higher RIP than that of younger subjects (p150 mg/kg, physicians at the first healthcare facility tended to administer activated charcoal (90.9%), gastric lavage (68%) and intravenous NAC (48%). The referring healthcare facility physicians-initiated NAC particularly for patients who reported ingesting >150 mg/kg (p=0.001).Conclusion:RIP doses should not be used to determine the need for NAC. The antidote should be used in centres where BPCs are not available or in a group of patients who cannot be transferred to a referral centre within the first eight hours

Evaluation of Vascular Involvement in Children with Celiac Disease

Aim:Celiac disease is associated with an increased risk of cardiovascular disease due to inflammation and autoimmunity involved in its pathophysiology. We aimed to evaluate vascular involvement in children with celiac disease based on their augmentation index, carotid pulse wave velocity, carotid intima-media thickness, echocardiographic findings, and blood pressure.Materials and Methods:This cross-sectional and controlled study was performed at a single center between 2018 and 2019. The study population consisted of 44 patients with celiac disease who had been on a gluten-free diet for at least one year.Results:We compared celiac patients with a healthy group. While the celiac patients had significantly higher carotid intima media thickness and carotid pulse wave velocity values, there was no difference in the augmentation index values. There was no significant difference in carotid artery intimal medial thickness, augmentation index and carotid pulse wave velocity values between the diet-compliant and non-compliant groups.Conclusion:Although hypertension was not detected, arterial stiffness and carotid intima media thickness measurements were higher in the celiac disease patients compared to the healthy controls. This showed that these parameters can be used in early vascular damage assessment. These measurements, which are non-invasive and repeatable, can be a guide for the monitoring of the development of preclinical atherosclerosis in the follow-up of the pediatric patients diagnosed with celiac disease

GestaltMatcher Database - A global reference for facial phenotypic variability in rare human diseases

The most important factor that complicates the work of dysmorphologists is the significant phenotypic variability of the human face. Next-Generation Phenotyping (NGP) tools that assist clinicians with recognizing characteristic syndromic patterns are particularly challenged when confronted with patients from populations different from their training data. To that end, we systematically analyzed the impact of genetic ancestry on facial dysmorphism. For that purpose, we established the GestaltMatcher Database (GMDB) as a reference dataset for medical images of patients with rare genetic disorders from around the world. We collected 10,980 frontal facial images - more than a quarter previously unpublished - from 8,346 patients, representing 581 rare disorders. Although the predominant ancestry is still European (67%), data from underrepresented populations have been increased considerably via global collaborations (19% Asian and 7% African). This includes previously unpublished reports for more than 40% of the African patients. The NGP analysis on this diverse dataset revealed characteristic performance differences depending on the composition of training and test sets corresponding to genetic relatedness. For clinical use of NGP, incorporating non-European patients resulted in a profound enhancement of GestaltMatcher performance. The top-5 accuracy rate increased by +11.29%. Importantly, this improvement in delineating the correct disorder from a facial portrait was achieved without decreasing the performance on European patients. By design, GMDB complies with the FAIR principles by rendering the curated medical data findable, accessible, interoperable, and reusable. This means GMDB can also serve as data for training and benchmarking. In summary, our study on facial dysmorphism on a global sample revealed a considerable cross ancestral phenotypic variability confounding NGP that should be counteracted by international efforts for increasing data diversity. GMDB will serve as a vital reference database for clinicians and a transparent training set for advancing NGP technology.</p

Cholelithiasis Developing after Rapid Weight Loss in an Adolescent

Gallbladder and bile duct stones are rarely diagnosed conditions during childhood. However, the number of diagnosed patients has begun to increase due to widespread use of ultrasound in recent years. Hemolytic disease, inflammatory bowel disease, parasites, parenteral nutrition, diabetes, cystic fibrosis, metabolic diseases, chronic liver disease, rapid weight loss, and drug use may lead to cholelithiasis. In this paper, we present a 16-year-old girl who had lost weight due to improper diet and was admitted to the pediatric emergency room with the complaints of vomiting and abdominal pain, and then, was diagnosed with cholestasis and cholelithiasis

Peroxiredoxins and Hypoxia-Inducible Factor-1α in Duodenal Tissue: Emerging Factors in the Pathophysiology of Pediatric Celiac Disease Patients

Celiac disease (CD) is an autoimmune enteropathy. Peroxiredoxins (PRDXs) are powerful antioxidant enzymes having an important role in significant cellular pathways including cell survival, apoptosis, and inflammation. This study aimed at investigating the expression levels of all PRDX isoforms (1–6) and their possible relationships with a transcription factor, HIF-1α, in the small intestinal tissue samples of pediatric CD patients. The study groups consisted of first-diagnosed CD patients (n = 7) and non-CD patients with functional gastrointestinal tract disorders as the controls (n = 7). The PRDXs and HIF-1α expression levels were determined by using real-time PCR and Western blotting in duodenal biopsy samples. It was observed that the mRNA and protein expression levels of PRDX 5 were significantly higher in the CD patients, whereas the PRDX 1, -2, and -4 expressions were decreased in each case compared to the control group. No significant differences were detected in the PRDX 3 and PRDX 6 expressions. The expression of HIF-1α was also significantly elevated in CD patients. These findings indicate, for the first time, that PRDXs, particularly PRDX 5, may play a significant role in the pathogenesis of CD. Furthermore, our results suggest that HIF-1α may upregulate PRDX-5 transcription in the duodenal tissue of CD

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

Bilirubin Levels at 1st and 3rd Postoperative Months are Significant in Determining the Success of the Kasai Portoenterostomy

Aim: The aim of this retrospective study was to determine the indicators of survival with native liver (NLS) of patients operated for biliary atresia (BA). Materials and Methods: This review included 53 BA patients in a 13-year period. There were two groups: (1) NLS and (2) necessitating transplantation. Age at operation, and bilirubin levels on the 7th day, 1st and 3rd months postoperatively were recorded. Mann-Whitney U and logistic regression analysis were used for statistical analysis for NLS and liver transplantation (LTx). Results: Kasai portoenterostomy (KPE) was performed on 38 patients, and 15 were directed to LTx due to cirrhotic liver at presentation. Twenty-three of 38 patients with KPE survived with native liver, and 15/38 patients required LTx during follow-up. Mean age at portoenterostomy for NLS and necessitating LTx was 54.43 +/- 24.64 and 68.33 +/- 24.35 days respectively (p>0.05). The 1st and 3rd month bilirubin levels were lower in the NLS group (p<0.01). The 1St month and 3rd month bilirubin levels after KP were significant predictors for survival with NLS. A cut-off value of 5.7 mg/dL bilirubin level at the 1st month predicted the necessity of transplantation after KPE with a sensitivity of 83.3% and specificity of 78.9%. Conclusion: Bilirubin levels of the 1st and 3rd months are reliable predictors for the success of portoenterostomy