Person: TUTAR, ENGİN
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TUTAR
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ENGİN
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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 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 Metadata only Low Titer Tissue Transglutaminase Antibodies: A Link to Helicobacter pylori Infection?(KARGER) ÇELİKEL, ÇİĞDEM; Akkelle, Bilge S.; Sengul, Ozlem K.; Tutar, Engin; Volkan, Burcu; Celikel, Cigdem; Ertem, DenizIntroduction: Low serum titer of anti-tissue transglutaminase (tTG) has been described in various conditions without any evidence of celiac disease (CD). Infectious agents have been suggested to trigger autoimmunity and promote the production of anti-tTG. The aim of this study was to investigate if there is a link between a positive celiac serology and concomitant Helicobacter pylori infection in children. Methods: The data of 178 pediatric patients who underwent upper gastrointestinal endoscopy due to positive celiac serology were compiled. The patients whose histopathologic findings were not consistent with CD were followed on gluten-containing diet. The changes in the serum level of anti-tTG IgA on the follow-up were compared between H. pylori-infected and noninfected patients after the eradication of H. pylori. Results: Of 155 patients who met the inclusion criteria, 119 (group 1) were diagnosed as CD, and duodenal histopathology of the remaining 36 children (group 2) was not compatible with CD. In group 2, 11 out of 36 (30.5%) patients were infected with H. pylori. After the eradication of H. pylori, anti-tTG IgA level either decreased or dropped below cutoff value in 9/11 (81%) patients while it was 20% in those who were not infected with H. pylori in the 6th month of the follow-up (p = 0.001). Conclusion: Our results suggest that H. pylori infection may be the cause of false or transient positive celiac serology. Thus, a positive celiac serology should be carefully interpreted in the presence of H. pylori infection before confirming the diagnosis of this life-long disease.Publication Metadata only Acute Liver Failure and Hepatic Encephalopathy After Cleft Palate Repair(ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS, 2015) TUTAR, ENGİN; Kocaaslan, Nihal Durmus; Tuncer, Fatma Betul; Tutar, Engin; Celebiler, OzhanParacetamol is the most commonly used analgesic after cleft palate repair. It has rarely caused acute hepatic failure at therapeutic or supratherapeutic doses. Only one case of therapeutic paracetamol toxicity after cleft palate repair had been reported previously. Here, we present a similar patient who developed acute liver failure and hepatic encephalopathy after an uncomplicated cleft palate surgery. Lack of large prospective trials in young children due to ethical concerns increases the value of the case reports of acetaminophen toxicity at therapeutic doses. The dosing recommendations of paracetamol may need to be reconsidered after cleft palate surgery.Publication Metadata only Severe gastric outlet obstruction in a child with ectopic pancreas: Is there a role for Helicobacter pylori?(2006) ERTEM ŞAHİNOĞLU, DENİZ; Ertem D., Tutar E., Cam S., Ugras M., Pehlivanoglu E.[No abstract available]Publication Metadata only Outcomes of Pediatric Fistulising Perianal Crohn's Disease(AVES, 2021) ERTEM ŞAHİNOĞLU, DENİZ; Akkelle, Bilge S.; Sengul, Ozlem K.; Volkan, Burcu; Tutar, Engin; Ergelen, Rabia; Yardimci, Samet; Ertem, DenizBackground: Perianal disease is reported more widely in pediatric Crohn patients than in the past, and hos been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn's disease (fpCD) in the pediatric age group. Methods: A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled. Results: Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients hod a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infiiximab. Conclusion: Fistulising perianal Crohn's disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.Publication Metadata only Endoscopic and Histopathologic Findings Associated with H-pylori Infection in Very Young Children(SPRINGER, 2009) ERTEM ŞAHİNOĞLU, DENİZ; Tutar, Engin; Ertem, Deniz; Karaa, Esin Kotiloglu; Pehlivanoglu, EnderMost of the individuals infected with H. pylori acquire the infection early in life. However, there is limited data regarding endoscopic and histopathologic findings of H. pylori infection when it is acquired during infancy. The aim of this study was to investigate the H. pylori-related endoscopic and histopathological findings in children younger than 2 years of age. One hundred and fifty-two infants who underwent upper gastrointestinal endoscopy were included in the study. The diagnosis of H. pylori infection was based on histopathology and a positive rapid urease test. Forty of 152 (26.3%) infants were infected with H. pylori, and 65% of the infected infants had histopathologic gastritis. There were no clinical or endoscopic findings suggestive of H. pylori infection. No correlation could be found between the density of H. pylori and the severity of gastritis. H. pylori infection is associated with various degrees of gastritis in more than half of the infected infants. Since the likelihood of normal histopathology is rare in H. pylori-infected infants, its long-term complications should be cautiously followed up in endemic areas.Publication Metadata only Helicobacter pylori infection in children with celiac disease: Multi-center, cross-sectional study(WILEY, 2020) ERTEM ŞAHİNOĞLU, DENİZ; Bayrak, Nevzat Aykut; Tutar, Engin; Volkan, Burcu; Akkelle, Bilge; Polat, Esra; Kutluk, Gunsel; Ertem, DenizBackground An inverse association has been suggested between celiac disease (CD) and Helicobacter pylori (Hp) infection in children; however, there are inconsistent data. The purpose of this multi-center study is to evaluate the association between Hp and CD in childhood. Methods Children who underwent endoscopy between July 2016 and November 2017 in four pediatric gastroenterology centers were included in the study. Patients with a history of previous Hp eradication, antibiotic or acid-suppressive drug therapy in the last 4 weeks, and any underlying chronic disease were excluded. The presence of Hp infection was confirmed by both histopathology and the rapid urease test. The ones who had the diagnosis of CD were compared with the children who underwent endoscopy during the same period and had another diagnosis. Duodenal histopathology of children with CD was categorized according to the modified Marsh classification. Results Of 3056 endoscopies performed in the study period, 2484 cases were eligible for the study. A total of 482 CD patients (mean age: 9.71 +/- 4.63 years, 58.5% girls) and 2060 controls (mean age: 9.92 +/- 4.66 years, 54.6% girls) were included in the study. The rate of Hp infection was significantly lower in CD group (26.3% vs 50.1%, P < .01). The difference was prominent even in children younger than 6 years old (P < .01). There was no correlation between Hp infection and the modified Marsh scores in CD (P > .05). Conclusion In this cross-sectional study, where Hp infection is common even in the pediatric population, the frequency of Hp infection was significantly lower in children with CD compared with the controls. Systematic cohort studies are necessary to clarify causal association between Hp infection and the development of celiac disease.Publication Metadata only Gastrointestinal sistem kanaması(İnönü Üniversitesi Yayınevi, 2021-01-01) TUTAR, ENGİN; TUTAR E.