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Öğe A rare cause of childhood hypercalcemia: Parathyroid adenoma(Karger, 2021) Kendirci, Havva Nur Peltek; Comba, Atakan; Dogan, Gul; Coskun, Nurcan[Abstract Not Available]Öğe Assessment of endothelial dysfunction with adhesion molecules in patients with celiac disease(Lippincott Williams and Wilkins, 2016) Comba, Atakan; Çaltepe, Gönül; Yanık, Keramettin; Gör, Ufuk; Yüce, Özlem; Kalaycı, Ayhan G.Objectives: Celiac disease (CD) is a systemic immune disorder. We assessed serum levels of adhesion molecules as a marker of endothelial dysfunction in patients with CD at first diagnosis and in those on a glutenfree diet. Methods: Sixty-five patients with CD (mean age 6.74±4.6 years) and 51 age- and sex-matched control patients participated in the present casecontrolled, prospective clinical study. Serum levels of vascular adhesion molecule-1, intercellular adhesion molecule-1, endothelial selectin, vascular endothelial cadherin, high-sensitivity C-reactive protein, and homocysteine levels were measured. Results: Average soluble vascular adhesion molecule-1 (CD vs control group: 1320±308 vs 1120±406 ng/mL, P=0.006), soluble intercellular adhesion molecule-1 (336±99 vs 263±67 ng/mL, P=0.025), and soluble endothelial selectin (113.9±70 vs 76.9±32 ng/mL, P=0.007) levels were significantly higher in cases of newly diagnosed CD than in the control group. Soluble vascular adhesion molecule-1 (1050±190 ng/mL) and soluble endothelial selectin (68.7±45 ng/mL) levels in patients with CD, who were fully compliant with a gluten-free diet, were significantly lower than that in those newly diagnosed as having CD (P=0.003 and P=0.0012, respectively). Conclusions: These results show that serum adhesion molecule levels are higher in patients with CD. Some of the risks associated with endothelial dysfunction may be related to CD and these risks can be reduced with an appropriate and fully controlled diet. Copyright © 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.Öğe Celiac disease does not influence markers of ovarian reserve in adolescent girls(Springer Heidelberg, 2020) Comba, Cihan; Comba, Atakan; Yilmaz, Hakan; Erdogan, Sakir V.; Demir, OmerPurpose The aim of the study was to determine whether celiac disease affects ovarian reserve assessed by antral follicle counting, ovarian volume, and anti-mullerian hormone in adolescent patients. Methods This case-control multicenter trial was performed from January 1, 2017 to May 31, 2018 and included 45 girls. On days 2-5 of the menstrual cycle, measurements of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, and anti-mullerian hormone were performed. Antral follicle counts and ovarian volumes were determined on the same day. Results Evaluation was made of 21 (47.7%) celiac patients with a mean age of 15.8 +/- 1.3 years, and 24 (52.3%) healthy control subjects with a mean age of 16.2 +/- 1.2. There was no difference between the groups in respect of right and left ovarian volumes (p = 0.790 andp = 0.670, respectively). Serum levels of anti-mullerian hormone of the celiac patients and controls were found comparable [(3.7 +/- 2.9 (0.5-12) and 3.6 +/- 1.8 (1.2-8.1)] ng/mL, respectively,p = 0.915). Conclusions Celiac disease may not affect the ovarian reserve determined with established ovarian reserve markers including antral follicle counting, ovarian volume, and anti-mullerian hormone in adolescent patients.Öğe Çölyak hastalarında serum homosistein düzeylerinin değerlendirilmesi(2018) Comba, Atakan; Demirbaş, Fatma; Eren, Esra; Çaltepe, Gönül; Kayadibi, Hüseyin; Kalaycı, Ayhan GaziAmaç:Çölyak hastalığı, genetik yatkın bireylerde diyetle gluten içeren tahılların tüketilmesi sonucu oluşan otoimmün, kronik inflamatuar bir hastalıktır. Çölyak hastalığında, malabsorbsiyona bağlı folat ve vitamin B12 eksikliği sık gelişir. Bu vitaminlerin eksiklikleri hiperhomosisteinemiye neden olabilir. Hiperhomosisteineminin venöz tromboemboli, ateroskleroz, inme gibi vasküler hastalıklarla ilişkisi iyi bilinmektedir. Çalışmanın amacı çölyak hastalığı olan çocuklarda serum homosistein düzeylerini incelemek ve glutensiz diyetin bunun üzerindeki etkisini araştırmaktır. Gereç ve yöntem:Çalışma, Temmuz 2013-Kasım 2016 tarihleri arasında yapıldı. Çölyak hastaları yeni tanılı ve takipli çölyak hastaları olarak iki gruba ayrıldı. Takipli çölyak hastaları en az bir yıldır izlemde olan hastalardan seçildi ve glutensiz diyet uyumuna göre iki gruba ayrıldı. Hastaların sosyodemografik, antropometrik özellikleri ve laboratuvar değerleri kaydedildi. Serum homosistein düzeyi ELISA yöntemi ile çalışıldı. Bulgular:Çalışmaya 106’sı (%63.9) kız olmak üzere toplam 166 çocuk alındı. Yaş ortalamaları 9.6±4.9 yıldı Çocukların 50’si (%30.1) yeni tanı çölyak, 57’si (%34.3) takipli çölyak ve 59’u (%35.5) sağlıklı kontroldü. Çölyak hastalarının 69’u (%64.5) diyetine tam uyuyordu. Çölyak hastalarının folat düzeyi (8.9±4.1 mg/dL) sağlıklı çocuklara göre (10.3±3.2 mg/dL) anlamlı olarak düşük (p=0.042), homosistein düzeyi de 8.9 (2.8-49.5) nmol/mL; sağlıklı gruba göre 8.2 (4.7-25.8) nmol/mL anlamlı olarak yüksekti (p=0.032). Sonuç:Çalışmamızda, çölyak hastalarında serum folat düzeyi daha düşük homosistein düzeyi de daha yüksek saptandı. Bu durum yeni tanı çölyak hastalarında en belirgindi. Çölyak hastalarında folat eksikliğine bağlı görülen hiperhomosisteinemi ciddi komplikasyonlara neden olabilir. Bu nedenle hastalar glutensiz diyete ilaveten folat, B12 gibi mikrobesin öğelerinin eksikliği yönünden de düzenli olarak taranmalı ve eksiklik durumunda mutlaka hiperhomosisteinemi varlığı araştırılmalıdırÖğe Çölyak hastalığı tanısı alan çocuklarda kemik mineral yoğunluğu ve kemik metabolizması belirteçlerinin değerlendirilmesi(2020) Peltek Kendirci, Havva Nur; Kaba, İlknur; Comba, Atakan; Demir, EmreAmaç: Çölyak hastalığında kalsiyum ve D vitamini eksikliğine bağlı metabolik kemik hastalığı en sık ekstraintestinal semptomlardan biridir. Bu çalışmada, çölyak hastalığı olan çocuklarda tanı esnasında kemik mineral yoğunluğunun değerlendirilmesi ve kemik mineral metabolizmasıyla ilişkili faktörlerin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Çalışmaya hastanemiz çocuk gastroenteroloji bölümünde Aralık 2015-Aralık 2019 tarihleri arasında çölyak hastalığı tanısı alan 43 çocuk hasta alındı. Retrospektif olarak hastaların klinik, antropometrik, patolojik ve laboratuar özellikleri [kalsiyum, fosfor, alkalenfosfataz (ALP), parathormon (PTH), 25-OH vitamin D düzeyleri] incelendi. Tanıda Dual Energy X-Ray Absorptiometry (DEXA) yöntemi ile ölçülmüş olan lumbal (L1-L4) kemik mineral yoğunluğu düzeyleri değerlendirilerek kronolojik yaşa ve boy yaşına göre Z-skorları hesaplandı. Bulgular: Ortalama yaşları 9,9±4,8 (2,5-17,7) yıl olan 43 hastanın (34 kız/9 erkek) verileri değerlendirildi. %30,2’si (n=13) 0-6 yaş, %30,2’si (n=13) 7-11 yaş aralığında ve % 39,5’i (n=17) 11 yaş üzerindeydi. Yaşa göre KMY Z-skoru -0,83±1,1 (-3,6- 1,6), boy yaşına göre KMY Z-skoru -0,18±1,1 (-3,6-1,8) saptandı. Hastaların %51,2’sinde (n=22) yaşa göre KMY Z-skoru>-1, %34,9’unda (n=15) -1 ve -2 arasında ve %14’ünde (n=6) <-2 saptandı. Yaşa göre KMY Z-skorunun<-2 olma oranı 11 yaştan büyük çocuklarda anlamı olarak yüksekti (p<0,001). Hastaların KMY Z-skorları ile serum D vitamini, kalsiyum, fosfor, ALP ve PTH düzeyleri arasında ilişki saptanmadı (p>0,050). Sonuç: Çölyak hastalarında tanı yaşının gecikmesi kemik mineral yoğunluğunu olumsuz etkilemektedir. Erken yaşta tanı konulması kemik mineral kaybını engeller ve osteopeni/osteoporoz gelişmiş olan hastalarda tedavi olanağı sağlayarak morbiditeyi azaltır.Öğe Ergenlerde zayıflığın yaşam kalitesi üzerine olan etkisi(Çocuk Sağlığı ve Hastalıkları Dergisi, 2018) Comba, AtakanThinness is commonly seen in adolescents. Our study examined the effect of thinness on quality of life in adolescents. The study was conducted on children aged 13 to 18 years who were healthy school children. The children’s body mass index (BMI) and BMI z scores were calculated. A BMI z score of less than -2 was regarded as thinness. The children and their parents were asked to complete the pediatric quality of life inventory (PedsQL) adolescent form with responses which applied to them. The three categories of the PedsQL score were the total score of inventory, physical health total score, and psychosocial health total score which assesses emotional, social and school attributes. A total of 161 children, 100 (62.1%) girls and 61 (37.9%) boys participated in the study. The average age of the children was 15.4±1.1 years. Twenty-nine (18%) children had BMI z scores less than -2. Physical health total score scores of thin children and parents (73±18, 69±21, respectively) were significantly lower than those of normal children and parents (82±12, 81±15, respectively) (p= 0.014, 0.006), while the total score of inventory of thin children and parents (76±12, 76±14, respectively) were lower than those of normal children and parents (81±10, 81±11, respectively), but no statistically significant difference was found (p=0.052, 0.054, respectively). No difference was found between psychosocial health total score of the two groups. Our study showed that quality of life associated with physical health is lower in thin adolescents, and, parents thought that the physical health of thin children was more deficient. © 2018 Cocuk Sagligi ve Hastaliklan Dergisi. All rights reserved.Öğe Evaluation of Bone Mineral Density and Bone Metabolism Markers in Hicldren Diagnosed as Celiac Disease(Karger, 2018) Peltek Kendirci, Havva Nur; Comba, Atakan; Demir, Emre[Abstract Not Available]Öğe Evaluation of nasal mucociliary clearance time in children with celiac disease(Elsevier Ireland Ltd, 2020) Comba, Atakan; Atan, DoğanObjectives: Celiac disease is an autoimmune disorder that develops because of sensitivity to gluten-containing grains in genetically disposed individuals. Nasal mucociliary clearance is the most important protective factor that protects the upper and lower airways from foreign particulates. This study aimed to investigate the effect of celiac disease on nasal mucociliary clearance. Methods: The study included patients with celiac disease and healthy children. Nasal mucociliary clearance time was measured using the saccharin test. The children's saccharin taste time was recorded in seconds. Results: Overall, 65 children were included: 43 patients with celiac disease (66.2%) and 22 healthy children (33.8%). Of all the children, 42 (64.6%) were female, and the average age was 11.8 +/- 4 years. Nasal mucociliary clearance time of patients with celiac disease (531 +/- 155 s) was significantly prolonged in comparison to that of healthy children (448 +/- 80 s) (p = 0.006). No relationships were found between the diagnosis age, celiac type, and histopathological phase and compliance with the gluten-free diet and nasal mucociliary clearance time of patients with celiac disease. Conclusions: This study showed that nasal mucociliary clearance was prolonged in patients with celiac disease. A defect in nasal mucociliary clearance increases the risk of infection and inflammation in small airways. Studies reported a high prevalence of respiratory tract infection in patients with celiac disease, which was associated with malnutrition, vitamin deficiency, and hyposplenism. The findings of the present study indicated that impairment of nasal mucociliary clearance could play a role in the development of frequent lung infections in patients with celiac disease.Öğe Nutritional status and related factors of schoolchildren in Çorum, Turkey(Cambridge University Press, 2019) Comba, Atakan; Demir, Emre; Barış Eren, NadiyeObjective We aimed to determine nutritional status and related factors among schoolchildren in Çorum, Central Anatolia, Turkey.Design Schoolchildren's height and weight were measured to calculate BMI and BMI Z-scores. Height, weight and BMI Z-scores were analysed and nutritional status classified according to the WHO.Setting Central Anatolia, Turkey.Participants Schoolchildren aged 5-17 years (n 1684) participated in study.Results Of children, 4·2% were stunted, 6·9% thin, 13·8% overweight and 6·6% were obese. Proportions of stunting, thinness and overweight/obesity were significantly higher in children aged >10 years (78·6, 75·0 and 64·9%, respectively) than in those aged ?10 years (21·4, 25·0 and 35·1%, respectively; all P <0·001). Median (range) birth weight and breast-feeding duration in children with stunting (2750 (1400-3600)g; 10 (0-36) months) were significantly lower and shorter, respectively, than those of normal height (3200 (750-5500)g; 15 (0-72) months) and tall children (3500 (2500-4900)g; 18 (0-36) months; P <0·001, <0·001, 0·011 and 0·016, respectively). The same relationship was observed in thin children (3000 (1000-4500)g; 12 (0-36) months) compared with normal-weight (3200 (750-5500)g; 15 (0-72) months) and overweight/obese children (3300 (1200-5500)g; 16 (0-48) months; P=0·026, <0·001, 0·045 and 0·011, respectively).Conclusions Overweight and obesity are health problems that must be addressed in schoolchildren. Adolescents also have a risk of double malnutrition. Promoting normal birth weight and encouraging long duration of breast-feeding are important to support normal growth in children. © The Authors 2018.Öğe Prevalence of celiac disease among school-age children in Çorum, Turkey(AVES, 2018) Comba, Atakan; Barış Eren, Nadiye; Demir, EmreBackground/Aims: Celiac disease (CD) is an autoimmune enteropathy that develops in individuals with genetic susceptibility as a result of o per inonent sensitivity to gluten found in grains. The prevalence of CD in Turkey is between 0.3% and 1%. However, the prevalence of CD in corum, a city in middle Anatolia in Turkey, is unknown. The purpose of this study was to identify the prevalence of childhood CD in corum and to detect patients with silent and atypical CD. Materials and Methods: The sample size was calculated using a stratified sampling method, to provide the sample number that would best represent this population. Screenings were conducted using rapid tissue transglutaminase IgA test kits. Results: A total of 1730 students were included in the study; 877 (50.6%) were female. Of students in the city center, 301 (34%) were in primary school, 299 (34%) were in secondary school, and 283 (32%) were in high school. As for towns, 847 (49%) students from 92 schools were included in the study. Eight children had positive screening results; 4 (50%) were female, and the average age was 11.6 +/- 3.4 (9-17) years. According to the celiac serologyresults and endoscopic duodenum biopsies, all children with positive screening results were diagnosed with CD. The prevalence of CD was found to be 0.46% in schoolchildren. Conclusion: Various studies in Turkey have reported a prevalence of CD between 0.6% and 0.9%, with 0.47% reported in a multicenter study. The present study identified CD prevalence as 0.46% (1 in 216) among children in Corum, Turkey.Öğe Retrospective analysis of children with-1 antitrypsin deficiency(Lippincott Williams & Wilkins, 2018) Comba, Atakan; Demirbas, Fatma; Caltepe, Gonul; Eren, Esra; Kalayci, Ayhan G.Background-1 Antitrypsin (AAT) deficiency is the most frequently occurring genetic liver disorder. The association among classical -1 antitrypsin deficiency (AATD), chronic liver disease, and cirrhosis is common in adult patients but rare in children.AimTo assess the clinical characteristics of children with AATD and to compare symptoms between homozygous and heterozygous children.Materials and methodsThe study included 20 children who were found to have mutant Pi alleles. AAT phenotyping was conducted on patients with a low serum AAT level. The exclusion criteria included infectious, anatomic, and metabolic conditions. Symptoms on presentation, physical examination findings, laboratory values, liver biopsy results, and follow-up periods were recorded for each patient.ResultsThe patients included six (30%) girls and 14 (70%) boys, with a mean age of 6.35.1 (1-16) years. The PiZZ phenotype was present in eight (40%) and PiMZ in 12 (60%) patients. The most frequent symptom was elevated liver function test results. Three patients were referred with neonatal cholestasis and one with compensated cirrhosis. Eight patients underwent liver biopsy; all patients except one had periodic acid-Schiff-positive diastase-resistant globules in the hepatocytes. The mean follow-up period was 34 +/- 33 (12-101) months. At the end of follow-up, all patients with PiZZ were found to have chronic hepatitis, and one with cirrhosis. On the contrary, two patients with PiMZ were found to have chronic hepatitis.ConclusionChildren with classical AATD commonly have chronic liver disease. In heterozygous (PiMZ) children with AATD, enzyme levels can normalize with occasional fluctuations, sometimes causing delayed diagnosis.Öğe The evolution of celiac disease publications: a holistic approach with bibliometric analysis(Springer London Ltd, 2020) Demir, Emre; Comba, AtakanBackgroundDespite the increasing number of publications on celiac disease, there is a lack of studies that made a holistic bibliometric evaluation of the studies on this topic.AimsThe purpose of this study is to analyze the publications about celiac disease by using bibliometric methods and this way to demonstrate the celiac disease-related trends, top effective articles, journals, and international collaborations between the countries and institutions.MethodsAll articles published between 1980 and 2018 on celiac disease were downloaded from Web of Science and analyzed with bibliometric methods. The correlations between economic development and publication productivity of the countries were investigated with Spearman's rank correlation coefficient. Linear regression analysis was used to estimate the number of publications and citations.ResultsThe literature review showed that there were 6545 articles about celiac disease published between the years 1980 and 2018. The top productive country that produced most publications about celiac disease was the Italy. The most prolific journals were the Journal of Pediatric Gastroenterology and Nutrition and Scandinavian Journal of Gastroenterology. There was a moderate positive significant correlation between the number of publications and gross domestic product (r=0.639, p<0.001).ConclusionsDespite the advanced research on the diagnosis, pathophysiology, and treatment of celiac disease, the global research level about the disease is low. Therefore, the international collaboration about the disease should not remain at only regional contexts; the exchange of knowledge and common studies especially in developing or underdeveloped countries should be supported in terms of prevalence and clinic studies.Öğe Thiol-disulfide homeostasis in children with celiac disease(Wiley, 2020) Comba, Atakan; Güreser, Ayşe Semra; Karasartova, Djursun; Senat, Almila; Erel, Özcan; Taylan Özkan, Hikmet AyşegülBackground Toxic gliadin peptide damages enterocytes in celiac disease by causing oxidative stress. Thiols are organic compounds that defend against oxidative stress. This study aimed to investigate the changes in thiol-disulfide homeostasis in children with celiac disease. Methods The study included patients with celiac disease, children diagnosed with functional gastrointestinal disorders, and healthy children. Patients' serum native and total thiol-disulfide amounts, disulfide/total thiol percentage ratios, disulfide / native thiol percentage ratios, and native thiol/total thiol percentage ratios were measured. Results The study involved 172 children, of whom 90 (52.3%) were girls. The mean participant age was 8.6 +/- 4.2 years. A total of 59 (34.3%) children had celiac disease, 56 (32.6%) had functional gastrointestinal disorders, and 57 (33.1%) were healthy. The total thiol and disulfide levels of patients with celiac disease (305 +/- 87 mu mol/L and 25 +/- 15 mu mol/L, respectively) were significantly lower than those of healthy children (349 +/- 82 mu mol/L and 40 +/- 15 mu mol/L, respectively) (P= 0.006 andP <0.001, respectively). Native and total thiol levels (226 +/- 85 mu mol/L and 279 +/- 99 mu mol/L, respectively) in patients with celiac disease who consumed a gluten-containing diet were significantly lower than those of patients who consumed a gluten-free diet (278 +/- 64 mu mol/L and 327 +/- 69 mu mol/L, respectively) (P= 0.017 andP= 0.041, respectively). Conclusions Thiol-disulfide homeostasis, an important antioxidant defense component of the gastrointestinal system, is disrupted in children with celiac disease. A gluten-free diet helped partially ameliorate this decline.
