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Çömlek FÖ, Toprak A, Birbilen AZ, Dilek SÖ, Coşkun F. Evaluation of vitamin D levels in children and adolescents after the first year of the COVID-19 pandemic: 1-year results of a secondary-level state hospital. Arch Pediatr 2024; 31:179-182. [PMID: 38538466 DOI: 10.1016/j.arcped.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic caused a global public health problem with high morbidity and mortality rates. In this study, we aimed to evaluate the 25-hydroxyvitamin D (25(OH)D) status of patients presenting to the Pediatrics Department of Gaziantep Maternity and Children's Hospital in the 1-year period after the onset of the COVID-19 pandemic according to ethnicity, age, and gender. METHOD This cross-sectional study included the data of 7640 patients whose 25(OH)D levels were assessed at our hospital between March 2021 and March 2022. Vitamin D levels, age, gender, and the ethnic origin of the patients were retrospectively scanned and recorded from the laboratory results system. Based on the World Health Organization (WHO) classification of vitamin D levels, patients were divided into three groups: <10 ng/mL = vitamin D deficiency; 10-19 ng/mL = vitamin D insufficiency, and 20 ng/mL and over = normal vitamin D status. RESULTS The mean age of the 7640 patients who presented to the pediatrics department was 7.47 (±5.3) years. Of these patients, 48 % (3665) were male and 52 % (3975) were female. The mean vitamin D level of girls was 18.1 (±15.2) ng/mL, and of boys it was 20.2 (±15.4) ng/mL, with a statistically significant difference (p < 0.001). In total, 21.2 % (1650) of patients had deficient, 43.3 % (3310) of patients had insufficient, and 35.5 % (2710) of patients had normal 25(OH)D levels. Overall, 21.8 % of the patients (1667) were immigrants, and in this group the deficiency was found to be statistically significantly higher at 27.4 % (n = 456; p < 0.001). There was a low negative correlation between the age of the patients and their 25(OH)D levels (r=-0.35; p < 0.001). CONCLUSIONS Vitamin D deficiency remains a serious public health problem. Since the most important production source is exposure to the sun, it must be kept in mind that vitamin D should be supported during lockdown pandemic processes.
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Affiliation(s)
| | - Ali Toprak
- Biostatistics, Bezmialem Vakıf University, İstanbul, Turkey
| | | | | | - Fatma Coşkun
- Anesthesia and Reanimation, Gaziantep Children Hospital, Gaziantep, Turkey
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Çömlek FÖ, Sönmez G. Management Difficulties in the Coexistence of Covid-19 Infection and Diabetic Ketoacidosis (Case Report; Two Children with Newly Diagnosed Diabetes). Ann Afr Med 2023; 22:388-391. [PMID: 37417031 PMCID: PMC10445706 DOI: 10.4103/aam.aam_250_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 07/08/2023] Open
Abstract
Two 8-year-old girls were admitted to the emergency department with diabetic ketoacidosis (DKA) approximately 10 days apart. The patients with resistant severe acidosis and high infection parameters were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction test. Accompanying pneumonia was observed in one of the patients. Here, we aimed to discuss the difficulties in the management of patients with a new diagnosis of DKA with COVID-19 infection. In addition, we wanted to emphasize that COVID-19 infection may be effective in the development of diabetes in patients with a genetic predisposition.
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Affiliation(s)
- Fatma Özgüç Çömlek
- Division of Pediatric Endocrinology, Gaziantep Children's Hospital, Gaziantep, Turkey
| | - Gülsüm Sönmez
- Division of Pediatric Infection Diasese, Gaziantep Children's Hospital, Gaziantep, Turkey
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Yaşar Köstek H, Özgüç Çömlek F, Gürkan H, Özkayın EN, Tütüncüler Kökenli F. A Case of Diabetes Mellitus Type MODY5 as a feature of 17q12 Deletion Syndrome. J Clin Res Pediatr Endocrinol 2022. [PMID: 36511482 DOI: 10.4274/jcrpe.galenos.2022.2022-3-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Maturity onset diabetes of the young (MODY) is characterized by noninsulin-dependent diabetes diagnosed at a young age (<25 years) with an autosomal dominant inheritence. Rare mutations in the hepatocyte nuclear factor-1-beta (HNF1B) gene produce a syndrome that resemble MODY and about half of patients diagnosed with MODY5 (HNF1B mutation) have a a whole gene deletion, called as 17q12 deletion syndrome, is a rare chromosomal anomaly and is typified by deletion of the more than 15 genes including HNF1B resulting in kidney abnormalities and renal cysts and diabetes syndrome and neurodevelepmental or neuropsychiatric disorders. A 12-year-old girl was referred to our clinic, after high blood sugar was detected in the hospital where she suffered with the complaints of poliuria and polydipsia for the last 1 month. Her serum magnessium level was low (1.5 mg/dl) (normal value 1.6-2.6) and HbA1c level was 14% (normal value 3.6-5.8) and c-peptide level was 1.54 ng/ml (normal value 0.8-4). MODY5 was suspected and followed NGS gene panel (ABCC8, BLK, CEL, GCK, HNF1A, HNF1B, HNF4A, INS, KCNJ11, KLF11, NEURODD1, PAX4, PDX1, RFX6, ZFP57, GLIS3, FOXP3, NEUROG3, G6PC2) analysis revealed that there was no any mutation. On follow-up period, her serum magnessium level was low (1.2 mg/dl) and her urinary magnessium excretion was high at 172.5 mg/day. HNF1B gene mutation was considered in the patient with chronic hypomagnesemia with increased basal C peptide level. Abdominal CT and MR imagings revealed that there was a 43 mm diameter cystic lesion in the head of the pancreas, and agenesis of the pancreatic neck, trunk and tail as well. Because of there is no mutation in HBF1B gene in NGS panel, microarray analysis was performed, heterozygous deletion at 17q12 including HNF1B was detected. The HNF1B mutation is difficult to diagnose and has a large phenotypic variation . In case of clinical suspicion,further genetic examination (MLPA, array CGH) may be required since deletions and duplications can not be detected even if mutations in the HNF1B gene are not detected with NGS.
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Affiliation(s)
| | | | - Hakan Gürkan
- Trakya University, Department of Medical Genetics
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Özgüç Çömlek F, Karal Y, Tütüncüler F. A 17-year-old boy who presented with acute mononeuropathy was found to have Type 1 diabetes. Paediatr Int Child Health 2022; 42:105-107. [PMID: 35389821 DOI: 10.1080/20469047.2022.2059879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diabetic neuropathy in children and adolescents with Type 1 diabetes mellitus is rare and is usually subclinical and a complication of the late diabetes period. A 17-year-old boy admitted with a right foot drop of sudden onset was diagnosed with peroneal nerve palsy. He had had osmotic polyuria, polydipsia and weight loss for the past 2 months; his blood glucose was 25 mmol/L (<7.8), HbA1c 15.2% (4.0-5.6) and vitamin B12 125 pg/ml (180-914). The peroneal nerve palsy resolved within 3 months with blood glucose regulation and B12 supplementation. Diabetes should be borne in mind in the differential diagnosis of unusual cases of mononeuropathy.Abbreviations: DCCTS: Diabetes Control and Complications Trial Study; DM: diabetes mellitus; DN: diabetic neuropathy; GAD: glutamic acid decarboxylase; PN: peripheral neuropathy; T1DM: Type 1 diabetes mellitus.
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Affiliation(s)
- Fatma Özgüç Çömlek
- Departments of Pediatric Endocrinology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Yasemin Karal
- Departments of Pediatric Neurology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Filiz Tütüncüler
- Departments of Pediatric Endocrinology, Trakya University Faculty of Medicine, Edirne, Turkey
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Demir S, Yaşar Köstek H, Sanrı A, Yıldırım R, Özgüç Çömlek F, Yalçıntepe S, Deveci M, Atlı Eİ, Atlı E, Eker D, Gürkan H, Tütüncüler Kökenli F. Comprehensive Genetic Analysis of RASopathy in the Era of Next-Generation Sequencing and Definition of a Novel Likely Pathogenic KRAS Variation. Mol Syndromol 2022; 13:88-98. [DOI: 10.1159/000520722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/04/2021] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Germline pathogenic variations of the genes encoding the components of the Ras-MAPK pathway are found to be responsible for RASopathies, a clinically and genetically heterogeneous group of diseases. In this study, we aimed to present the results of patients genetically investigated for RASopathy-related mutations in our Genetic Diagnosis Center. <b><i>Methods:</i></b> The results of 51 unrelated probands with RASopathy and 4 affected relatives (31 male, 24 female; mean age: 9.327 ± 8.214) were included in this study. Mutation screening was performed on DNA samples from peripheral blood of the patients either by Sanger sequencing of <i>PTPN11</i> hotspot regions (10/51 probands), or by a targeted amplicon next-generation sequencing panel (41/51 probands) covering the exonic regions of <i>BRAF</i>, <i>CBL</i>, <i>HRAS</i>, <i>KRAS</i>, <i>LZTR1</i>, <i>MAP2K1</i>, <i>MAP2K2</i>, <i>NF1</i>, <i>NRAS</i>, <i>PTPN11</i>, <i>RAF1</i>, <i>RASA2</i>, <i>RIT1</i>, <i>SHOC2</i>, <i>SOS1</i>, <i>SOS2</i>, <i>SPRED1</i>, and <i>KAT6B</i> genes. <b><i>Results:</i></b> Pathogenic/likely pathogenic variations found in 22 out of 51 probands (43.13%) and their 4 affected family members were located in <i>PTPN11</i>, <i>BRAF</i>, <i>KRAS</i>, <i>NF1</i>, <i>RAF1</i>, <i>SOS1</i>, and <i>SHOC2</i> genes. The c.148A>C (p.Thr50Pro) variation in the <i>KRAS</i> gene was a novel variant detected in a sibling in our patient cohort. We found supportive evidence for the pathogenicity of the <i>NF1</i> gene c.5606G>T (p.Gly1869Val) variation which we defined in an affected boy who inherited the mutation from his affected father. <b><i>Conclusion:</i></b> Although <i>PTPN11</i> is the most frequently mutated gene in our patient cohort, as in most previous reports, different mutation distribution among the other genes studied motivates the use of a next-generation sequencing gene panel including the possible responsible genes.
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Çömlek FÖ, Demir S, Gürkan H, İnan M, Sezer A, Dilek E, Kökenli FT. The efficiency of cinacalcet treatment in delaying parathyroidectomy in a case with neonatal severe hyperparathyroidism caused by homozygous mutation in the CASR gene. Pediatr Endocrinol Diabetes Metab 2022; 28:168-174. [PMID: 35399047 PMCID: PMC10214968 DOI: 10.5114/pedm.2022.115070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/19/2022] [Indexed: 06/07/2023]
Abstract
Neonatal severe hyperparathyroidism (NSHPT) causes severe hypercalcaemia, metabolic bone disease, and potential neurodevelopmental deficits, all of which can be life-threatening. The use of calcimimetic agents can prevent or delay technically difficult parathyroidectomy in the newborn period. We present a 6-day-old male infant who presented with poor feeding, weight loss, and severe hypotonia. His total serum calcium and parathyroid hormone levels were very high (23.6 mg/dl and 1120 ng/dl, respectively). Based on these findings, the patient was diagnosed with NSHPT and was started on cinacalcet therapy until the genetic analysis results were available. Genetic analysis revealed a previously reported homozygous mutation in the CASR gene that was unresponsive to cinacalcet therapy in the literature. However, a normocalcaemic state unexpectantly occurred, which could be maintained with low calcium formula and cinacalcet therapy up to 13 months of age in the patient. Nevertheless, hypercalcaemia developed 2 months after he started a normal calcium-containing diet. Therefore, the patient underwent total parathyroidectomy at 17 months of age. We would like to emphasize, in light of this case, that cinacalcet treatment may be considered as first-line therapy for delaying parathyroidectomy in all cases with NSHPT, even in those who have an unresponsive cinacalcet CASR gene mutation.
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Affiliation(s)
- Fatma Özgüç Çömlek
- Department of Pediatric Endocrinology, Faculty of Medicine, Trakya University, Turkey
| | - Selma Demir
- Department of Medical Genetic, Faculty of Medicine, Trakya University, Turkey
| | - Hakan Gürkan
- Department of Medical Genetic, Faculty of Medicine, Trakya University, Turkey
| | - Mustafa İnan
- Department of Pediatric Surgery, Faculty of Medicine, Trakya University, Turkey
| | - Atakan Sezer
- Department of General Surgery, Faculty of Medicine, Trakya University, Turkey
| | - Emine Dilek
- Department of Pediatric Endocrinology, Faculty of Medicine, Trakya University, Turkey
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Yalçıntepe S, Özgüç Çömlek F, Gürkan H, Demir S, Atlı Eİ, Atlı E, Eker D, Tütüncüler Kökenli F. The Application of Next Generation Sequencing Maturity Onset Diabetes of the Young Gene Panel in Turkish Patients from Trakya Region. J Clin Res Pediatr Endocrinol 2021; 13:320-331. [PMID: 33565752 PMCID: PMC8388052 DOI: 10.4274/jcrpe.galenos.2021.2020.0285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the molecular basis of maturity-onset diabetes of the young (MODY) by targeted-gene sequencing of 20 genes related to monogenic diabetes, estimate the frequency and describe the clinical characteristics of monogenic diabetes and MODY in the Trakya Region of Turkey. METHODS A panel of 20 monogenic diabetes related genes were screened in 61 cases. Illumina NextSeq550 system was used for sequencing. Pathogenicity of the variants were assessed by bioinformatics prediction software programs and segregation analyses. RESULTS In 29 (47.5%) cases, 31 pathogenic/likely pathogenic variants in the GCK, ABCC8, KCNJ11, HNF1A, HNF4A genes and in 11 (18%) cases, 14 variants of uncertain significance (VUS) in the GCK, RFX6, CEL, PDX1, KCNJ11, HNF1A, G6PC2, GLIS3 and KLF11 genes were identified. There were six different pathogenic/likely pathogenic variants and six different VUS which were novel. CONCLUSION This is the first study including molecular studies of twenty monogenic diabetes genes in Turkish cases in the Trakya Region. The results showed that pathogenic variants in the GCK gene are the leading cause of MODY in our population. A high frequency of novel variants (32.4%-12/37) in the current study, suggests that multiple gene analysis provides accurate genetic diagnosis in MODY.
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Affiliation(s)
- Sinem Yalçıntepe
- Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey,* Address for Correspondence: Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey Phone: +90 537 716 86 91 E-mail:
| | - Fatma Özgüç Çömlek
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, Edirne, Turkey
| | - Hakan Gürkan
- Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey
| | - Selma Demir
- Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey
| | - Emine İkbal Atlı
- Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey
| | - Engin Atlı
- Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey
| | - Damla Eker
- Trakya University Faculty of Medicine, Department of Medical Genetics, Edirne, Turkey
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Çömlek FÖ, Yıldız R, Seyrek F, Tütüncüler F. Leydig cell hypoplasia type 1 diagnosed in early childhood with inactivating mutation in LHCGR gene. Oxf Med Case Reports 2021; 2021:omab015. [PMID: 33948188 PMCID: PMC8081017 DOI: 10.1093/omcr/omab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 02/09/2021] [Indexed: 12/05/2022] Open
Abstract
Leydig cell aplasia/hypoplasia is an autosomal recessive condition. In its complete form, these patients are 46XY but are cryptorchid and phenotypically female. Most cases reported in literature presented with in adolescence with pubertal delay. We reported a case with a predefined mutation in the LHCGR gene, presenting with swelling in the inguinal region and therefore diagnosed in early childhood. We wanted to emphasize the necessity of keeping Leydig cell hypoplasia in mind in the differential diagnosis of sexual development disorders in early childhood.
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Affiliation(s)
- Fatma Özgüç Çömlek
- Fellow in Pediatric Endocrinology, Department Trakya, University Faculty of Medicine, Edirne, Turkey
| | - Raif Yıldız
- Assistant in Pediatric Department, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Fatma Seyrek
- Assistant in Pediatric Department, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Filiz Tütüncüler
- Professor in Pediatric Endocrinology, Department Trakya University Faculty of Medicine, Edirne, Turkey
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Abstract
We report an infant with exogenous Cushing syndrome after being treated for 2 months with a potent topical corticosteroid via the mother's application of topical clobetasol for diaper rash without a prescription. We emphasize that potent topical steroids should be used with great caution, especially when used under occlusion (e.g., diaper area) and that parents should be warned about potential side effects of these medications, particularly when used in infants.
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Affiliation(s)
- Fatma Özgüç Çömlek
- Division of Pediatric Endocrinology, School of Medicine, Trakya University, Edirne, Turkey
| | - Sevim Örüm
- Department of Pediatrics, School of Medicine, Trakya University, Edirne, Turkey
| | - Salih Aydın
- Department of Pediatrics, School of Medicine, Trakya University, Edirne, Turkey
| | - Filiz Tütüncüler
- Division of Pediatric Endocrinology, School of Medicine, Trakya University, Edirne, Turkey
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