Abstract Background To evaluate the cytokine profile in gingival crevicular fluid (GCF) and serum of pediatric inflammatory bowel disease (IBD) patients and determine the cluster patterns of cytokines. Methods Fifty IBD patients and 21 systemically healthy children were enrolled in the study. The GCF samples were collected from the participants during periodontal examination and periodontal indices were recorded. Based on activity indexes and response to conventional treatment, patients with IBD were further categorized into subgroups as: remission, active disease, and treatment‐resistant. Serum samples were obtained from IBD patients to determine serum levels of cytokines. The levels of pro‐ (interleukin (IL)‐1β, IL‐12, IL‐21, IL‐22, IL‐23, IL‐17A, IL‐17F) and anti‐inflammatory (IL‐4, IL‐10) cytokines in serum and GCF were measured using Enzyme‐linked Immunosorbent Assay (ELISA) kits. Results Among 50 IBD patients, 58% were in remission, 20% had active disease, and 22% were defined as treatment‐resistant. The severity of gingival inflammation measured by the criteria of Löe had increasing trends in IBD patients with active disease and treatment resistance. GCF IL‐1β level was lower and GCF IL‐4 and GCF IL‐23 levels were higher in IBD patients compared to healthy controls. In the active disease group, more cytokine clusters occurred compared to the control group and other IBD subgroups, as explained by increased cytokine‐cytokine interactions. Conclusions Considering the increased complexity of cytokine interactions and the increased severity of gingival inflammation in patients with active disease, it can be concluded that disease activity might have an impact on gingival inflammation in pediatric patients with IBD.
Genislemis spektrumlu beta laktamaz (ESBL) ureten mikroorganizmalarla gelisen uriner sistem enfeksiyonlari (USE'ler) onemli bir saglik sorunudur. ESBL pozitif mikroorganizmalarla gelisen USE'si olan cocuklarin klinik ve laboratuvar ozelliklerini ve ESBL pozitif enfeksiyon acisindan risk faktorlerini degerlendirmek icin planlanan calismamiza 0-17 yas grubundaki toplumdan kazanilmis USE'si olan vakalar (158 hastanin ESBL pozitif 178 atagi; 162 hastanin ESBL negatif 166 atagi) dahil edilmistir. ESBL pozitifligi erkeklerde daha fazladir (p=0,046). Idrarda koku ve huzursuzluk ESBL pozitif grupta, hematuri ise ESBL negatif grupta daha fazla bulunmustur (p=0,006 ve p=0,019). Semptom suresi ESBL pozitif grupta daha uzundur (p<0,001). Idrar incelemesinde lokosit sayisi ESBL negatif grupta daha fazladir (p=0,001). Lokositoz ve periferik yaymada polimorfonukleer lokosit hakimiyeti ESBL pozitif grupta daha az saptanmistir (p=0,002 ve p<0,001). Her iki grupta en fazla izole edilen bakteri E. coli'dir. ESBL pozitif grupta aminoglikozidlere, kinolonlara, nitrofurantoine, TMP-SMZ'ye direnc daha fazladir. Altta yatan uriner sistem hastaligi, USE icin profilaktik antibiyotik kullanimi ve son 3 ay icinde hastanede yatis hikayesi ESBL pozitif USE gelisiminde bagimsiz risk faktoru olarak belirlenmistir. ESBL pozitif USE gelisme riskinin altta yatan bir uriner sistem hastaligi varliginda 2,22 kat (p=0,013), profilaktik antibiyotik kullaniminda 2,71 kat (p=0,01) ve son 3 ay icinde hastanede yatma durumunda 3,35 kat (p=0,006) arttigi belirlenmistir. ESBL pozitif grupta negatif gruba gore ultrasonografide daha fazla anormal bulgu saptanmistir (p=0,005). ESBL pozitif gruptaki hastalarin hastanede daha uzun sure yattigi belirlenmistir (p=0,044). USE'si olan cocuk hastalar degerlendirilirken ESBL pozitif hastalarin klinik ozelliklerinin farklilik gosterebilecegi goz onunde bulundurulmalidir. Altta yatan uriner sistem hastaligi olan, profilaktik antibiyotik kullanan ve son 3 ayda hastanede yatan cocuklarda antibiyotik secimi artmis ESBL pozitif enfeksiyon riski dikkate alinarak yapilmalidir.
Dietary copper restriction in Wilson's disease is recommended mostly for 1 year or until showing normal liver enzymes. Little is known about the effect of long-term copper restriction on copper and nutritional status in the body. The relationship between daily copper consumption and serum and urine copper parameters, liver enzymes, and dietary contents was investigated.In this study, 32 pediatric Wilson's disease patients who had been on treatment at least for 12 months were included. Clinical features, liver enzymes, serum total copper concentrations, non-ceruloplasmin bound copper concentrations, adjusted copper concentrations, 24-hour urine copper excretions, and macro- and micronutrient consumptions were analyzed.In total, 27 patients reported following copper-restricted diets, while daily copper consumption was low only in 7 patients (21.9%). Total copper concentrations and non-ceruloplasmin-bound copper concentrations were low at 78.1% and 53.1%, respectively. All but one adjusted copper concentration were within normal limits. Total copper concentrations, adjusted copper concentration, and non-ceruloplasmin-bound copper concentrations correlated with each other but none correlated with urine copper excretions. Daily copper consumption was inversely correlated with total copper concentrations (P = .041, r = -0.363) but not correlated with non-cerulo plasmin-bound copper concentrations and adjusted copper concentrations. There was no relationship between liver enzymes and daily copper consumption and serum and urine copper parameters. High fat consumption with low fiber and vitamin B6 was more common in low daily copper consumption group (P = .033, P = .029, P = .007, respectively).Daily copper consumption may be the least effective or non-effective factor on liver enzymes in Wilson's disease. Prolonged copper restriction may result in unintentional dietary imbalance. Avoidance of undernutrition and high-fat meals, as well as enrichment of the meals with vitamin B6 and fiber, should be encouraged during copper-restricted diets.
Magnetic resonance elastography (MRE) has been used to stage liver fibrosis in adults. We aimed to assess the agreement between the Ishak scoring system and magnetic resonance elastography-measured liver stiffness (MRE-LS) in children. This study included all the children who underwent abdominal MRE and liver biopsies between February 2018 and January 2021. The correlation between MRE-LS and Ishak fibrosis stage, MRE parameters, and clinical and biochemical markers affecting this relationship was investigated.A total of 52 patients (31 male; a median age of 11.8 years) were included in the study. The MRE-LS values were significantly different between Ishak fibrosis stages (p = 0.036). With a cut-off value of 2.97 kilopascals, MRE-LS had sensitivity, specificity, PPV, NPV and accuracy values of 90.9%, 82.9%, 58.8%, 97.1%, and 84.6%, respectively, for differentiating mild/moderate fibrosis (F0, 1, 2, 3) from severe fibrosis (F ≥ 4). Although MRE-LS was moderately correlated with Ishak fibrosis score and histological activity index and weakly correlated with aspartate aminotransferase, hepatic steatosis, and R2*, only Ishak fibrosis score was a significant predictor of MRE-LS. MRE-measured spleen stiffness was weakly correlated with the Ishak fibrosis score.MRE has high sensitivity and specificity for evaluating liver fibrosis in children. MRE may be used to evaluate liver fibrosis in pediatric patients.
