Person: TUTAR, ENGİN
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TUTAR
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ENGİN
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Publication Open Access Pankreas fizyolojisi ve fonksiyonları(Nobel Yayın Dağıtım, 2022-04-01) ŞAHİN AKKELLE, BİLGE; TUTAR, ENGİN; Şahin Akkelle B., Tutar E.Publication Open Access Reactive oxygen species and chemokines: Are they elevated in the esophageal mucosa of children with gastroesophageal reflux disease?(W J G PRESS, 2008) ÇELİKEL, ÇİĞDEM; Tutar, Engin; Ertem, Deniz; Unluguzel, Goksenin; Tanrikulu, Sevda; Haklar, Goncagul; Celikel, Cigdem; Ademoglu, Evin; Pehlivanoglu, EnderAIM: To determine the role of inflammatory cytokines and reactive oxygen species (ROS) in childhood reflux esophagitis. METHODS: A total of 59 subjects who had complaints suggesting GERD underwent esophagogastroduoden oscopy. Endoscopic and histopathologic diagnosis of reflux esophagitis was established by Savary-Miller and Vandenplas grading systems, respectively. Esophageal biopsy specimens were taken from the esophagus 20% proximal above the esophagogastric junction for conventional histopathological examination and the measurements of ROS and cytokine levels. ROS were measured by chemiluminescence, whereas IL-8 and MCP-1 levels were determined with quantitative immunometric ELISA on esophageal tissue. Esophageal tissue ROS, IL-8 and MCP-1 levels were compared among groups with and without endoscopic/histopathologic esophagitis. RESULTS: Of 59 patients 28 (47.5%) had normal esophagus whereas 31 (52.5%) had endoscopic esophagitis. In histopathological evaluation, almost 73% of the cases had mild and 6.8% had moderate degree of esophagitis. When ROS and chemokine levels were compared among groups with and without endoscopic esophagitis, statistical difference could not be found between patients with and without esophagitis. Although the levels of ROS, IL-8 and MCP-1 were found to be higher in the group with histopathological reflux esophagitis, this difference was not statistically significant. CONCLUSION: These results suggest that the grade of esophagitis is usually mild or moderate during childhood and factors apart from ROS, IL-8 and MCP-1 may be involved in the pathogenesis of reflux esophagitis in children. (C) 2008 The WJG Press. All rights reserved.Publication Open Access Korozif-kostik madde maruziyeti nedeniyle başvuran çocuklarda endoskopik bulguların değerlendirilmesi: Retrospektif araştırma(2023-03-01) ŞAHİN AKKELLE, BİLGE; KARAOĞLU, SALİH; TUTAR, ENGİN; ERTEM ŞAHİNOĞLU, DENİZ; ŞAHİN AKKELLE B., Volkan B., Dursun C., Korkmaz B., KARAOĞLU S., TUTAR E., ERTEM ŞAHİNOĞLU D.Objective: Accidental caustic ingestions cause damagecomplications in the gastrointestinal tract. In our study, the characteristics of children who underwent endoscopy due to caustic ingestions were evaluated. Material and Methods: The demographic, clinic, endoscopic data of symptomatic children who underwent endoscopy due to caustic ingestions between 2016-2021 were reviewed. According to Zargar classification, patients with normal or mild findings on endoscopy were defined as Group 1; those with moderate/severe findings on endoscopy were defined as Group 2. The data of the two groups were compared. Results: The mean age of 284 patients included in our study was 42±41 months, and 58.4% of them were male. The most frequently exposed caustic agents were household cleaning chemicals (87.3%). Most of the caustic agents exposed were alkaline (78.9%) and 64.3% were in granule form. Esophageal corrosive damage compatible with at least Grade 2a was found in 26.1% of the patients. Complaints of drooling, dysphagia were more frequent in Group 2 compared to Group 1 (p<0.05). There was a statistically significant difference between the groups in terms of the chemical properties of exposed agents. In the follow-up, esophageal stenosis was detected in 2.8% of the patients and pyloric stenosis was detected in 1 patient. Conclusion: The results of our study showed that drooling and dysphagia symptoms are important in predicting esophageal damage in caustic ingestions, but oropharyngeal examination findings may be misleading. Preventive medicine approaches, inspections and sanctions for corrosive chemicals that are produced, sold, stored improperly are important in preventing these accidents.Publication Open Access Bowel Preparation for Colonoscopy in Children: 1 Day PEG-3350 with Bisacodyl versus 3 Day Sennosides(KARGER, 2019) ERTEM ŞAHİNOĞLU, DENİZ; Tutar, Engin; Bayrak, Nevzat Aykut; Volkan, Burcu; Ertem, DenizBackground and Objectives: Bowel preparation (BP) for colonoscopy is a challenging procedure in children and different regimens have been used for this purpose. Polyethylene glycol (PEG) is the most preferred agent in recent years. The primary aim of this study was to evaluate the efficacy of 1-day PEG-3350 with bisacodyl (PEG-B) and comparing it with 3-day sennosides A+B. Method: In this prospective, randomized, and single-blinded study, children aged 2-18 years were included in the PEG-B group for 1 day or in Senna group for 3 days. The effectiveness of BP was assessed according to the Ottawa and Boston BP scales, compliance and adverse effects were also recorded. Pre- and post-preparation biochemistry were obtained for investigation of safety of both regimens. Results: Successful BP was observed in 88.3% (n = 53/60) of PEG-B and 86% (n = 55/64) of Senna groups according to Boston scale, and it was 85% (n = 51/60) and 84.4% (n = 54/64), respectively, according to Ottawa scale. The cecal intubation rate was 96.7% (n = 58/60) in the PEG-B group and 93.8% (n = 60/64) in the Senna group. Ease of administration and disturbance in regular daily activities was better in the PEG-B group (p < 0.05). There was no major adverse event and biochemical abnormality in both groups. The correlation between Ottawa and Boston scales was found to be excellent (r(2) = -0.954, p < 0.01). Conclusions: The efficacy, safety, and adverse effect profile of 1-day BP with PEG-B regimen was found to be similar to 3-day sennosides regimen, however, the PEG-B regimen had advantages such as short duration, ease of administration, and better patient comfort. Also, high correlation rate between the Boston and Ottawa scales in pediatric patients was remarkable. (c) 2019 S. Karger AG, BaselPublication Open Access Broadly effective metabolic and immune recovery with C5 inhibition in CHAPLE disease(NATURE RESEARCH, 2021-02) ÖZEN, AHMET OĞUZHAN; Ozen, Ahmet; Kasap, Nurhan; Vujkovic-Cvijin, Ivan; Apps, Richard; Cheung, Foo; Karakoc-Aydiner, Elif; Akkelle, Bilge; Sari, Sinan; Tutar, Engin; Ozcay, Figen; Uygun, Dilara Kocacik; Islek, Ali; Akgun, Gamze; Selcuk, Merve; Sezer, Oya Balci; Zhang, Yu; Kutluk, Gunsel; Topal, Erdem; Sayar, Ersin; Celikel, Cigdem; Houwen, Roderick H. J.; Bingol, Aysen; Ogulur, Ismail; Eltan, Sevgi Bilgic; Snow, Andrew L.; Lake, Camille; Fantoni, Giovanna; Alba, Camille; Sellers, Brian; Chauvin, Samuel D.; Dalgard, Clifton L.; Harari, Olivier; Ni, Yan G.; Wang, Ming-Dauh; Devalaraja-Narashimha, Kishor; Subramanian, Poorani; Ergelen, Rabia; Artan, Reha; Guner, Sukru Nail; Dalgic, Buket; Tsang, John; Belkaid, Yasmine; Ertem, Deniz; Baris, Safa; Lenardo, Michael J.CHAPLE disease is a lethal syndrome caused by genetic loss of the complement regulatory protein CD55. Lenardo, Ozen and their colleagues report that blockade of C5 complement activation in a small cohort of pediatric patients with CHAPLE disease reduced gastrointestinal pathology and restored their immunity and growth. Complement hyperactivation, angiopathic thrombosis and protein-losing enteropathy (CHAPLE disease) is a lethal disease caused by genetic loss of the complement regulatory protein CD55, leading to overactivation of complement and innate immunity together with immunodeficiency due to immunoglobulin wasting in the intestine. We report in vivo human data accumulated using the complement C5 inhibitor eculizumab for the medical treatment of patients with CHAPLE disease. We observed cessation of gastrointestinal pathology together with restoration of normal immunity and metabolism. We found that patients rapidly renormalized immunoglobulin concentrations and other serum proteins as revealed by aptamer profiling, re-established a healthy gut microbiome, discontinued immunoglobulin replacement and other treatments and exhibited catch-up growth. Thus, we show that blockade of C5 by eculizumab effectively re-establishes regulation of the innate immune complement system to substantially reduce the pathophysiological manifestations of CD55 deficiency in humans.Publication Metadata only What is the diagnostic utility of endoscopic scoring systems in children?(AVES, 2013) ÇELİKEL, ÇİĞDEM; Tutar, Engin; Kutluk, Gunsel; Bayrak, Nevzat Aykut; Celikel, Cigdem Ataizi; Pehlivanoglu, Ender; Ertem, DenizBackground/aims: The aim of this study was to evaluate the consistency of the Savary-Miller, the Hetzel-Dent and the Los Angeles endoscopic classification systems and to compare them with the esophageal histopathology in children. Material and Methods: Children between the ages of 5-17 years who underwent esophagogastroduodenoscopy were included in the study. The endoscopic reports and the still images of the esophagus were reclassified by the same gastroenterologist according to the Savary-Miller, Hetzel-Dent and Los Angeles scoring systems. The esophageal biopsies were also reevaluated by the same pathologist and the consistency between endoscopic and histopathologic esophagitis was evaluated. Results: A total of 113 out of 192 pediatric patients were included in the study. Seventy-three patients (64.6%) had esophagitis according to the Hetzel-Dent classification, whereas only 20 (17.7%) patients were defined as having esophagitis according to the other two classification systems. The consistency between the Savary-Miller and Los Angeles classifications was excellent (kappa: 0.92) but the agreement between the Hetzel-Dent and Savary-Miller and between the Hetzel-Dent and Los Angeles classifications were poor. A total of 82 patients (72.6%) had histopathological esophagitis, and there was a weak consistency between all 3 endoscopic scoring systems and the histopathology. Conclusions: Since pediatric patients have milder esophagitis than in adults, the use of endoscopic scoring systems developed for adults seems to be inapplicable for children. The inclusion of minimal endoscopic changes in endoscopic scoring systems by using more sensitive and novel endoscopic techniques would increase the sensitivity of these scoring systems in children.Publication Open Access Successful treatment of fasciola hepatica with metronidazole in a child: A case report(2022-11-01) KEPENEKLİ KADAYİFCİ, EDA; YAPICI, ÖZGE; BATU, UTKU; TUTAR, ENGİN; Ergenç Z., Kepenekli Kadayifci E., Yakut N., Yapıcı Ö., Batu U., Tutar E.Fasciola hepatica is a zoonotic liver trematode that usually causes infection in cattle and sheep, and is transmitted to humans by consuming water and aquatic plants contaminated with metacercaria. The detection of Fasciola eggs in stools, serological evaluation and radiological evaluation are essential for diagnosis. Triclabendazole is the first-line therapy for fascioliasis. However, as triclabendazole is not an easily accessible drug in countries such as Turkey, it reveals a quest for alternative therapies. In this report, we present a 10-year-old boy with fascioliasis successfully treated with a course of metronidazole 1.5 g/ day for 3 weeks in 2020. During the follow-up, eosinophilia and radiological findings completely recovered. Here we report a case of pediatric fascioliasis that was cured with metronidazole successfully.Publication Open Access Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts(2022-11-01) KARADAĞ SAYGI, NAİME EVRİM; KARADAĞ, BÜLENT TANER; DURMUŞ KOCAASLAN, FATMA NİHAL; TUTAR, ENGİN; Umay E., Eyigör S., Giray E., Saygi E. K., Karadağ B. T., Kocaaslan N. D., Yuksel D., Demir A. M., Tutar E., Tıkız C., et al.Background Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. Methods This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). Results In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts\" responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. Conclusions This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.Publication Metadata only Global multi-stakeholder endorsement of the MAFLD definition(2022-05-01) YILMAZ, YUSUF; TUTAR, ENGİN; Méndez-Sánchez N., Bugianesi E., Gish R. G., Lammert F., Tilg H., Nguyen M. H., Sarin S. K., Fabrellas N., Zelber-Sagi S., Fan J., et al.In this paper, we describe non-abelian gauge bundles with magnetic and electric fluxes on higher dimensional noncommutative tori. We give an explicit construction of a large class of bundles with nonzero magnetic \"t Hooft fluxes. We discuss Morita equivalence between these bundles. The action of the duality is worked out in detail for the four-torus. As an application, we discuss Born-Infeld on this torus, as a description of compactified string theory. We show that the resulting theory, including the fluctuations, is manifestly invariant under the T-duality group SO(4,4;Z). The U-duality invariant BPS mass-formula is discussed shortly. We comment on a discrepancy of this result with that of a recent calculation.Publication Metadata only Familial Mediterranean Fever Mutation Analysis in Pediatric Patients With Inflammatory Bowel Disease: A Multicenter Study(AVES, 2021) TUTAR, ENGİN; Urganci, Nafiye; Ozgenc, Funda; Kuloglu, Zarife; Yuksekkaya, Hasan; Sari, Sinan; Erkan, Tulay; Onal, Zerrin; Caltepe, Gonul; Akcam, Mustafa; Arslan, Duran; Arslan, Nur; Artan, Reha; Aydogan, Aysen; Balamtekin, Necati; Baran, Masallah; Baysoy, Gokhan; Cakir, Murat; Dalgic, Buket; Dogan, Yasar; Durmaz, Ozlem; Ecevit, Cigdem; Eren, Makbule; Gokce, Selim; Gulerman, Fulya; Gurakan, Figen; Hizli, Samil; Isik, Ishak; Kalayci, Ayhan Gazi; Kansu, Aydan; Kutlu, Tufan; Karabiber, Hamza; Kasirga, Erhun; Kutluk, Gunsel; Hosnut, Ferdag Ozbay; Ozen, Hasan; Ozkan, Tanju; Ozturk, Yesim; Soylu, Ozlem Bekem; Tutar, Engin; Tumgor, Gokhan; Unal, Fatih; Ugras, Meltem; Ustundag, Gonca; Yaman, AytacBackground: the aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases hos been reported previously. Methods: Children with IBD (334 ulcerative colitis (UC), 224 Crohn's disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. Results: A total of 597 children (mean age: 10.8 +/- 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/heterozygous) in patients with UC (P <.05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P=.031, P=.045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P=.007). Conclusion: Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not hove a high impact on inflammatory response and clinical outcome of the disease.
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