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Öğe Clinical course of Hashimoto's thyroiditis and effects of levothyroxine therapy on the clinical course of the disease in children and adolescents(2011) Özen S.; Berk Ö.; Şimşek D.G.; Darcan Ş.Objective: The aim of this study was to evaluate the clinical course of Hashimoto's thyroiditis (HT) in children and adolescents and the effects of levothyroxine therapy on the clinical course and laboratory findings. Methods: The clinical and laboratory data of 101 patients with HT at presentation and during a three-year follow-up period were retrospectively evaluated using patient records. Results: The mean age of the patients at the time of diagnosis was 12.3±2.90 years and female/male ratio was 5.7/1. The complaint at the time of hospital presentation was goiter in 57.8% of the patients. At baseline, 36.7% of the patients were euthyroid, whereas 32.7% had subclinical hypothyroidism, 16.6% of subjects were evaluated as hypothyroid. Twelve of the 28 patients who were initially euthyroid and not receiving therapy developed subclinical or overt hypothyroidism during the first 18 months of the follow-up period and were started on thyroid medication. At presentation, the mean anti-thyroglobulin (anti-Tg) and anti-thyroperoxidase antibody levels were 450±725 IU/mL and 392±428 IU/mL, respectively and at the end of the follow-up period, a significant decrease was observed in the anti-Tg levels of patients receiving levothyroxine from the beginning. Conclusions: Thyroid functions of the patients with HT should be monitored periodically for hypothyroidism. Levothyroxine therapy may positively affect the clinical course of the disease and the antibody titers. © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.Öğe The frequency and associated factors of diabetic ketoacidosis at diagnosis in children with type 1 diabetes [Tip 1 diyabetli çocuklarda tani{dotless}da diyabetik ketoasidoz si{dotless}kli{dotless}gi{dotless} ve i·liflkili faktörler](2010) Demir K.; Büyükinan M.; Dizdarer C.; Şimşek D.G.; Özen S.; Asar G.; Can Ş.; Altincik A.; Özhan B.; Ersoy B.; Böber E.; Darcan Ş.Introduction: In this study, it was aimed to assess the frequency and associated factors of diabetic ketoacidosis (DKA) at diagnosis in patients with newly diagnosed type 1 diabetes who were admitted to pediatric endocrinology clinics in tertiary referral hospitals in Izmir and Manisa provinces. Materials and Method: The files of the patients were evaluated retrospectively. Data regarding sex, date of birth, family history for diabetes, and health insurances of the patients were recorded and compared with respect to the form of clinical presentation. Results: It was noted that 139 patients (M/F:74/65, mean age 8.7±3.9 years) were diagnosed in 2008. At the time of diagnosis, the clinical picture of the majority of the patients were ketosis (n=58, 41.7%) or DKA (n=57, 41%). Mortality or severe morbidity developed in none of the patients. It was detected that lack of family history for type 1 diabetes and being less than 5 years of age were associated with DKA at the time of diagnosis. When logistic regression analysis was used to perform risk analysis, only being less than 5 years of age was found to be a risk factor for DKA (p=0.008, Odds Ratio 3.3, 95% confidential interval 1.4-8.1). Conclusion: These results led us consider that large-scale campaigns/studies are needed to be performed to reduce the ratio of DKA at the time of diagnosis by making the society conscious of diabetes in childhood. © The Journal of Current Pediatrics, published by Galenos Publishing.Öğe Molecular analysis in a Turkish patient with severe form of hurler syndrome: Identification of a novel c.826-828del3 mutation(2010) Ucar S.K.; Çoker M.; Bertola F.; Casati G.; Şimşek D.G.; Darcan Ş.Mucopolysaccharidosis type I (MPS I) is a lysosomal disease due to mutations in the gene encoding alpha-L-iduronidase (IDUA) leading to variable clinical phenotypes with progressive severe organomegaly, bone and neurological involvement in the most severe forms. A two-year-old Turkish patient born from consanguineous marriage had an enzymatic and urinary diagnostics suggested a MPS I phenotype. The genetic evaluation revealed c.826-828del3 mutation in the homozygous state, whereas her parents were heterozygous for this mutation. Because of the high frequency of consanguineous marriages in Turkey, identification of the novel mutations permits reliable genetic counseling of at-risk relatives and molecular prenatal diagnosis.Öğe A randomized clinical trial comparing breakfast and bedtime administration of insulin glargine in children and adolescents with type 1 diabetes.(2008) Şimşek D.G.; Yildiz B.; Asar G.; Darcan S.Insulin glargine provides effective glycemic control when administered at bedtime in adults. This study aims to investigate whether insulin glargine is equally effective if administered in the morning or at bedtime in combination with preprandial anologue insulin. Twenty-eight patients that have been treated with an intensified insulin regimen for at least one year were randomized to insulin glargine injection at breakfast (06:00-09:00) (12 patients) or bedtime (21:00-24:00) (16 patients), plus meal-time anologue insulin in the two groups. Glucose data from each day were analyzed at four different times: between 9:00 and 21:00 (t1), between 21:00 and 24:00 (t2), between 24:00 and 04:00 (t3),04:00 and 09:00 (t4) by the Minimed continuous glucose monitoring system. Baseline characteristics were similar in the two groups. The sensor values were lower before breakfast in the bedtime group (180.5 ± 49.0 vs 223.8 ± 47.3 mg/dl, p=0.03). There were 13.7 events.patient (-1).day(-1) in the bedtime group and 6.9 events.patient (-1).day(-1) in the breakfast group in which glucose levels fell below 60 mg/dl (p=0.3). There were 121.6 events.patient (-1).day(-1) in the bedtime group and 162.4 events.patient (-1).day(-1) in the breakfast group in which glucose levels exceeded 180 mg/dl (p=0.05). Nighttime hypoglycemia only reached to a statistical significance between the two groups between 24:00 and 04:00. There were no significant correlations between the duration of nocturnal hypoglycemia, age, duration of diabetes, gender and HbA1c levels. Breakfast group is hyperglycemic during the day and hyperglycemia starts in the morning at 04:00. There is no significant difference in the frequency or duration of hypo/hyper glycemia during the day and night irrespective of the timing of glargine injection except pre-breakfast levels are significantly better in the bedtime group and hypoglycemia occurs between midnight and 04:00 in the bedtime group.
