Purpose: The aim of this study was to compare the frequency of functional gastrointestinal diseases (FGIDs) in juvenile idiopathic arthritis (JIA) patients with healthy control children.
Materials ...and Methods: This case-control study includes 193 children with JIA followed-up between October 2012 to April 2019 and 139 healthy control children. Demographic features, disease characteristics, treatment modalities were collected retrospectively. Laboratory parameters were recorded at the study enrollment. FGIDs diagnosis were assessed by utilizing Rome IV criteria. Gender, age at disease onset, laboratory parameters, treatment modalities, and clinical status of the disease were compared between the groups.
Results: The mean age at study enrollment was 12.05±4.05 and 9.01±3.97 years in children with JIA and healthy control group, respectively. The frequency of FGIDs was significantly higher in JIA patients (13.7%, n=19) than in healthy control group (21.8%, n=42). There was no statistical significance between JIA patients and healthy control group in terms of FGIDs subtypes. Demographic and clinical parameters did not differ between JIA patients grouped according to FGIDs presence.
Conclusion: FGIDs is more frequent in JIA patients than healthy controls. Further studies are needed to support our results.
Amaç: D vitamini kalsiyum metabolizması ve iskelet sağlığında önemli rol oynayan bir hormondur. Ayrıca D vitamininin iskelet sağlığı dışı birçok fonksiyona sahip olduğu bilinmektedir. Karaciğer, ...vitamin D metabolizmasına katılan başlıca organlardan biridir. Son yıllarda yapılan çalışmalar kronik karaciğer hastalığına sahip hastalarda vitamin D eksikliğinin ve yetersizlik prevalansının yüksek olduğunu ortaya koymuştur. Ancak çocukluk çağında bu konuda az sayıda çalışma mevcuttur.
Gereç ve Yöntem: Kronik karaciğer hastalığı tanısı ile izlenen çocukların vitamin D düzeyleri ve tedavi yanıtları geriye dönük olarak dosyalarından değerlendirilmiştir. Dört yıllık dönemde izlenen 17 (%34) kız, 33 (%66) erkek olmak üzere toplam 50 hastanın dosya kaydı verilerine ulaşıldı.
Bulgular: Çalışmaya alınan 50 hastanın tanı anındaki yaş ortalamaları 7,83 (±3,70) yıl olup 29’unda (%48) D vitamin düzeylerinde eksiklik veya yetersizlik saptandı (ortalama 25-OH vitamin D: 12,79 (± 4,63) ng/ml). Tedavi sonrası vitamin D düzeyi eksik veya yetersiz olan hastaların %82,8’inde düzelme sağlanırken, 5 hastada (%17,2) yeterli cevap yoktu. Kolestaz durumunda tedaviye verilen cevabın azaldığı görüldü.
Sonuç: Kronik karaciğer hastalığı nedeniyle izlenen hastalardaki vitamin D düzeyleri düşük olabileceğinden, bu açıdan hastaların incelenmesi ve tedavi edilmesi gerekmektedir. Bu durum mevcut hastalığı için de bir destek sağlamaktadır.
Pediatric patients frequently require deep sedation or general anesthesia for colonoscopy. This study was designed to compare the sedative efficacy of remifentanil–ketamine combination with ...propofol–ketamine combination in children undergoing colonoscopy.
Seventy patients, between 2 and 16 years of age, scheduled for diagnostic colonoscopy were randomly allocated into two groups. Remifentanil–ketamine group received intravenous ketamine 2mg.kg−1 and remifentanil 0.25μg.kg−1 combination, followed by 0.1μg.kg−1.min−1 remifentanil infusion. Propofol–ketamine group received intravenous propofol 1 and 2mg.kg−1 ketamine combination, followed by 1mg.kg−1.h−1 propofol infusion. In the case of children discomfort (cry, movement, and cough), remifentanil 0.1μg.kg−1 in the remifentanil–ketamine group or propofol 0.5mg.kg−1 in the propofol–ketamine group were administered to improve children discomfort. Despite the therapy given above, if children still experience discomfort, 1mg.kg−1 of ketamine was administered as a rescue drug, regardless of the group. Ramsay sedation score, hemodynamic variables, drug requirements, gastroenterologists’ satisfaction, colonoscopy duration, recovery time, and side effects were recorded throughout the procedure and the recovery period.
The percentage of patients with a Ramsay sedation score of 4 or higher during the procedure was 73.5 and 37.1% in remifentanil–ketamine and propofol–ketamine groups, respectively (p=0.02). Systolic and diastolic blood pressure variables were significantly higher only after induction in the remifentanil–ketamine group than in the propofol–ketamine group (p=0.015).
Coadministration of ketamine with either remifentanil or propofol effectively and safely provides sedation and analgesia in children undergoing colonoscopy. Sedation scores were significantly better in remifentanil–ketamine group than in propofol–ketamine group.
Os pacientes pediátricos com frequência precisam de sedação profunda ou anestesia geral para colonoscopia. Este estudo foi desenhado para comparar a eficácia sedativa da combinação de remifentanil-cetamina e de propofol-cetamina em crianças submetidas à colonoscopia.
Setenta pacientes, entre 2–16 anos de idade, programados para colonoscopia diagnóstica foram alocados randomicamente em dois grupos. O grupo remifentanil-cetamina recebeu a combinação de 2mg.kg−1 de cetamina por via intravenosa e 0,25μg.kg−1 de remifentanil; seguido de infusão de remifentanil (0,1μg.kg−1.min−1). O grupo propofol-cetamina recebeu a combinação de 1mg.kg−1 de propofol e 2mg.kg−1 de cetamina; seguido de infusão de propofol (1mg.kg−1.h−1). Em caso de desconforto das crianças (choro, movimento e tosse), remifentanil (0,1μg.kg−1) seria administrado ao grupo remifentanil-cetamina ou propofol (0,5mg.kg−1) ao grupo propofol-cetamina. A despeito da terapia acima citada, caso as crianças ainda sentissem desconforto, cetamina (1mg.kg−1) seria administrada como fármaco de resgate, independente do grupo. Escore de sedação de Ramsay, variáveis hemodinâmicas, necessidade de medicamentos, satisfação dos gastroenterologistas, duração da colonoscopia, tempo de recuperação e efeitos colaterais foram registrados durante o procedimento e o período de recuperação.
O percentual de pacientes com escore 4 ou mais na escala de sedação de Ramsay durante o procedimento foi de 73,5% e 37,1% nos grupos remifentanil-cetamina e propofol-cetamina, respectivamente, (p=0,02). As variáveis, pressão arterial sistólica e diastólica, foram significativamente maiores no grupo remifentanil-cetamina do que no grupo propofol-cetamina, mas somente após a indução (p=0,015).
A coadministração de cetamina com remifentanil ou propofol fornece sedação e analgesia de forma eficaz e segura em crianças submetidas à colonoscopia. Os escores de sedação foram significativamente melhores no grupo remifentanil-cetamina que no grupo propofol-cetamina.
Hepatopulmonary syndrome(HPS)is characterized as a triad:liver disease,intrapulmonary vascular dilatation and arterial hypoxemia.HPS is reported to be present in 4%to 32%of adult patients with ...end-stage liver disease and in 9%-20%of children.The pathogenesis of HPS has not been clearly identified.Portal hypertension causes impairment in the perfusion of the bowel and increases the enteral translocation of Gram(-)bacteria and endotoxins.This stimulates the release of vasoactive mediators,such as tumor necrosis factor-alpha,heme oxygenase-derived carbon monoxide and nitric oxide.Genetic alterations have not been associated with this syndrome yet;however,cytokines and chemokines have been suggested to play a role.Recently,it was reported that cumulated monocytes lead to the activation of vascular endothelial growth factor-dependent signaling pathways and pulmonary angiogenesis,which plays an important role in HPS pathogenesis.At present,the most effective and only radical treatment is a liver transplant(LT).Cirrhotic patients who are on the waiting list for an LT have a shorter survival period if they develop HPS.Therefore,it is suggested that all cirrhotic cases should be followed closely for HPS and they should have priority in the waiting list.
Acute graft-versus-host disease is a common complication of allogeneic hematopoietic stem cell transplantation and is a major cause of morbidity and mortality. Systemic steroid therapy is the ...first-line treatment for acute graft-versus-host disease, although about half of patients will become refractory to treatment. We aimed to evaluate treatment options by reviewing available alternatives for patients with steroid-refractory acute graft-versus-host disease by comparing data from recently published studies. We retrospectively studied the safety and efficacy of treatment in 22 children with steroid‐dependent/refractory acute GVHD between the years 2010 and 2023. Seven (31.8%) out of 22 patients with acute graft-versus-host disease were still alive. The seven surviving patients have been followed for an average of 1141 (±403) days. 15 non-responders with grade III/IV acute graft-versus-host disease died from causes associated with acute graft-versus-host disease and/or other conditions. Among 15 patients who died, the number of patients who received all three treatments, MSC, ECP and infliximab, was 5 (33%). The most common cause of death was infection (8 cases in 15 patients, 53.3%). Other causes of death were gastrointestinal hemorrhages (n=5, 33.3%), and intracranial hemorrhages (n=2, 13.3%). When factors causing morbidity were evaluated, it was observed that three patients developed posterior reversible encephalopathy syndrome, two patients developed hepatic veno-occlusive disease, and one patient developed hypertension. The estimated probability of survival after 1 year was 31.8%, and the median survival was 655 days. We believe that it would be crucial to show the safety and efficacy of novel treatments in comprehensive, randomized clinical trials.
Background
Infections with gastric Helicobacter spp. are associated with gastritis, peptic ulceration, and malignancies. Helicobacter pylori is the most prevalent Helicobacter species colonizing the ...human stomach. Other gastric non‐H. pylori helicobacters (NHPHs) have been described in 0.2%‐6% of human patients with gastric disorders. Nevertheless, due to difficulties in the diagnosis of NHPH infections and lack of routine screening, this is most likely an underestimation of their true prevalence. To the best of our knowledge, no studies have been performed in the presence of Helicobacter spp. in children suffering from gastric disorders in Southern Turkey.
Materials and methods
In total, 110 children with gastric complaints were examined at the Cukurova University Balcali hospital, Turkey. Gastroscopy was performed to evaluate the presence of gastric mucosal lesions. Biopsies of the pyloric gland zone were taken for histopathological analysis, rapid urease testing, and presence of Helicobacter spp. DNA by PCR.
Results
Based on the PCR results, the prevalence of Helicobacter spp. was 32.7% (36/110). H. pylori was found in 30.9% (34/110), H. suis in 1.8% (2/110), and H. heilmannii/H. ailurogastricus in 0.9% (1/110) of the human patients. A mixed infection with H. pylori and H. suis was present in one patient. The presence of mucosal abnormalities, such as nodular inflammation, ulceration, and hyperemia, as well as gastritis, was significantly higher in Helicobacter spp. positive patients.
Conclusion
Helicobacter pylori, H. suis, and H. heilmannii/H. ailurogastricus were present in children with gastric complaints. Infection with these pathogens may be involved in the development of gastritis and ulceration.
We analyzed the nationwide pediatric inflammatory bowel disease (PIBD) registry (1998-2016), to evaluate the nutritional status at the time of diagnosis.
Nine types of nutritional status by the ...combination of weight-for-length (<2 years)/body mass index (>2 years) and length/height-for-age with three categories (<-2, -2 to 2, and >2 SD) were described. Malnutrition was defined by WHO criteria. Univariate and multivariate regression analysis was used to identify risk factors for malnutrition.
In total, 824 IBD patients (498 Ulcerative colitis (UC); 289 Crohn's Disease (CD); 37 Indeterminate Colitis (IC); 412 male; the median age 12.5 years) were eligible. The prevalence of eutrophy, wasting/thinness, stunting, overweight, tall stature, concurrent wasting/thinness and stunting, tall stature with overweight, tall stature with wasting/thinness, and short stature with overweight were 67.4%, 14.9%, 6.6%, 3.1%, 3.2%, 3.3%, 1.1%, 0.4%, and 0.1%, respectively. The prevalence of malnutrition was 32.7%, indicating a higher prevalence in CD (p < 0.001). Incidence of overweight was less common in the CD than UC and IC (p < 0.001). Multivariate analysis revealed that age of onset (>10 years), prepubertal stage, severe disease activity, perianal involvement, and high C reactive protein level were independently associated with malnutrition in pediatric IBD.
We showed the frequency of nutritional impairment in PIBD. The percentage of overweight subjects was lower than the other studies. The age of onset, disease activity, CRP level, perianal involvement, and pubertal stage were associated with a higher risk for developing malnutrition. Our results also confirmed that CD patients are particularly vulnerable to nutritional impairment.
ClinicalTrials.gov Identifier: NCT04457518.
Aim
This study aimed to investigate parenchymal changes in the liver in paediatric patients with cystic fibrosis (CF) and to analyse diagnostic performance of two‐dimensional shear wave elastography ...(2D‐SWE) for the detection of hepatic involvement.
Methods
Patients with CF treated and followed at our centre were evaluated prospectively. All patients underwent liver tissue stiffness (TS) measurements by 2D‐SWE, in addition to routine clinical assessments, laboratory work‐up and abdominal ultrasound imaging. Data from patients with CF were compared with healthy control subjects.
Results
This study included 39 patients with CF and 37 healthy controls. Patients had a mean body weight of 29.9 (16.6–55) kg, mean age of 9 (5–17) years, mean height of 130 (107–172) cm and a mean body mass index of 16.1 (12.8–21.4) kg/m2. Average SWE values of the liver were 1.02 (0.70–1.60) m/s in patients with CF (n = 39) and 0.89 (0.60–1.35) m/s in healthy controls (n = 37). Cystic fibrosis patients had significantly increased tissue stifness by liver elastography compared to controls (P = 0.005).
Conclusion
Parenchymal liver changes may occur early in cystic fibrosis, which cannot be detected by conventional ultrasonography but may be demonstrated by 2D‐SWE. Based on this cross‐sectional study, 2D‐SWE may be a promising, simple and non‐invasive modality for objective monitoring of patients with cystic fibrosis who require lifelong follow‐up, by providing numerical data for tissue stiffness early in the disease.
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