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 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 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 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.Publication Open Access Constrictive pericarditis diagnosed following liver transplantation(MARMARA UNIV, FAC MEDICINE, 2021-10-31) ŞAYLAN ÇEVİK, BERNA; Cetiner, Nilufer; Cevik, Berna Saylan; Tutar, Engin; Erolu, Elif; Koray, A. K.; Akalin, FigenConstrictive pericarditis is frequently diagnosed during evaluation of the patients for hepatosplenomegaly and easily missed if not considered in differential diagnosis. Herein, we present a patient diagnosed with constrictive pericarditis during his investigation for impaired liver functions and right heart failure one year after liver transplantation. A thirteen-year-old boy presented with abdominal distention, dyspnea and fatigue. He had undergone liver transplantation due to liver failure in the previous year, and the symptoms had recurred in the last three months. Physical examination revealed normal heart sounds. Abdominal distention and ascites were present. Cardiothoracic index and pulmonary vascular markings were normal on chest X-ray. Echocardiography showed biatrial dilatation. Thickening of the pericardium with calcifications was demonstrated by thorax computerised tomography. High pulmonary wedge pressure and equalization of end-diastolic pressures were found during catheter-angiography. Pericardiectomy was performed, histopathology was compatible with chronic fibrinous pericarditis. The patient improved dramatically after surgery, the right heart failure findings resolved, and the liver graft functions turned to be normal. Constrictive pericarditis must be considered in differential diagnosis of hepatosplenomegaly, liver dysfunction and right heart failure since surgical treatment is possible and lifesaving.Publication Open Access Çocukluk çağı çölyak hastalığında tanısal faktörlerin değerlendirilmesi: tanımlayıcı retrospektif araştırma(2022-10-01) ŞAHİN AKKELLE, BİLGE; TUTAR, ENGİN; ERTEM ŞAHİNOĞLU, DENİZ; Şahin Akkelle B., Volkan B., Tutar E., Ertem Şahinoğlu D.ÖZET Amaç: Son yıllarda artan farkındalık ve tanı olanaklarıyla çölyak hastalığı (ÇH) tanısı alan hasta sayısının arttığı düşünülmektedir. Çalışmamızda yıllara göre ÇH tanı sıklığının ve tanıya katkıda bulunan faktörlerin değerlendirilmesi hedeflenmiştir. Gereç ve Yöntemler: Çalışmamızda, 2010-2015 ve 2016-2021 yılları arasında ÇH tanısı alan çocuk hastalar sırasıyla Grup 1 ve Grup 2 olarak tanımlandı. Hastalar demografik özellikleri, semptomları, komorbiditeleri, refere edildikleri merkezler açısından değerlendirildi ve veriler gruplar arasında karşılaştırıldı. Bulgular: Çalışmaya dâhil edilen 257 hastanın %37,4’ü (n=96) Grup 1’i oluşturmaktaydı. Tipik/atipik semptomların sıklığı gruplar arasında benzerdi (p>0.05). Tarama sonucu tanı alan asemptomatik hasta oranı Grup 1’de %14,6, Grup 2’de %31,1’di ve gruplar arasındaki fark anlamlıydı (p<0,05). Taramayla tanı alan hastaların çoğunluğu Tip 1 diabetes mellitus tanılı hastalardan (%57,6) oluşmaktaydı. Grup 1’deki hastaların %41,7’sinde, Grup 2’deki hastaların %35,2’sinde ilk başvuru çocuk gastroenteroloji polikliniğine yapılmıştı. Genel pediatri polikliniklerinden refere edilen hasta oranları her iki grupta benzerken, diğer yan dal polikliniklerinden refere edilen hasta oranında son 6 yıllık dönemde artış saptandı. Sonuç: Çalışmamızın sonuçlarına göre son yıllarda ÇH tanısı alan olgu sayısı artmıştır. ÇH ilişkili atipik semptomlar konusunda 1.basamak sağlık hizmetleri veren hekimlerde farkındalığın artması ve tarama programları, yeni vakaların teşhisi için en önemli kaynaklardır.Publication Open Access Pediatrik çölyak hastalarında glutensiz diyet tedavisine uyumu etkileyen faktörlerin değerlendirilmesi(2022-08-01) ŞAHİN AKKELLE, BİLGE; TUTAR, ENGİN; ERTEM ŞAHİNOĞLU, DENİZ; Şahin Akkelle B., Tutar E., Ertem Şahinoğlu D.Amaç: Çölyak hastalığının günümüzde bilinen tek tedavi şekli ömür boyu glutensiz diyet tedavisidir ve hastalığın yönetimindeki en önemli sorun diyete uyumsuzluktur. Bu çalışmada, çocukluk çağında tanı almış çölyak hastalarında diyet tedavisini etkileyen faktörlerin değerlendirilmesi amaçlanmıştır. Bireyler ve Yöntem: Bu çalışmada, çölyak hastalığı tanısı almış ve en az bir yıldır takipli olan 8-18 yaş arasındaki rastgele seçilmiş 92 hasta kesitsel olarak değerlendirilmiştir. Hastaların demografik ve klinik özellikleri, ailelerinin sosyal yapısı ve glutensiz diyet hakkındaki bilgileri incelenmiştir. Hastaların diyete uyumu güncel serum anti-tTG IgA düzeylerine bakılarak değerlendirilmiştir. Seroloji sonucuna göre hastalar, diyete uyumlu ve uyumsuz olarak 2 gruba ayrılmış ve veriler karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen 92 hastanın güncel yaş ortalaması 13.1±3.5 yıl’dır. Anti-tTG IgA düzeyi normal olan hasta oranı %55.4 olarak saptanmıştır. Diyete uymayan hastalarda yaş ortalamasının daha yüksek (13.8±3.4 yıl; p<0.05) olduğu bulunmuştur. Takip süresi iki yıldan az olan hastaların (%34.8) diyete uyum oranının en yüksek (%68) olduğu bulunmuştur. Kardeş sayısının fazla olması ve kalabalık ev ortamı diyet uyumunu olumsuz etkileyen faktörler olarak tespit edilmiştir. Cinsiyet, tanı yaşı, başvuru semptomları, komorbidite varlığı ve annenin eğitim düzeyi ile diyete uyum arasında ilişki saptanmamıştır. Ebeveynlerin %55.4’ünün çapraz bulaşma konusunda bilgi sahibi olmadıkları tespit edilmiştir. Sonuç: Çalışmanın sonuçlarına göre çocukluk döneminde çölyak hastalarında diyete uyumsuzluk oranı oldukça yüksektir. Çalışmada, tanıdan sonra geçen süre ile diyet uyumu arasında ters ilişki saptanmıştır. Diyetin yaşam şekli olarak benimsenmesi ve istikrarlı bir şekilde uygulanması ile hastalığa ait morbidite ile mortalitenin önlenmesi mümkündür.