Acquired factor VII deficiency in pediatric inflammatory bowel disease: Report of three cases.

Bleeding disorders can exacerbate gastrointestinal bleeding in inflammatory bowel disease (IBD) at the time of diagnosis or flares. Factor VII (FVII) deficiency is a life-threatening rare congenital bleeding disorder in childhood. This study describes three adolescent patients with IBD accompanied by acquired FVII deficiency. This is the first case series of patients with IBD accompanied by FVII deficiency. We hypothesized that inflammation, accelerated consumption, disease severity, and weight loss can cause decreased FVII activity in patients diagnosed with IBD. To control intestinal bleeding, we must keep in mind factor deficiencies in IBD.

Internet Addiction in Constipated Adolescents.

BACKGROUND: This study aims to assess internet addiction among adolescents with functional constipation and its relationship with sociodemographic and family factors. METHODS: In this case-control study, 57 and 35 adolescents with and without functional constipation, respectively, were recruited. Functional constipation was diagnosed by applying the Rome IV criteria. Previously validated Young's Internet Addiction Test-Short Form and Parent-Child Internet Addiction Test were completed, and sociodemographic data forms were filled out by all participants. RESULTS: According to the Parent-Child Internet Addiction Test questionnaire, 8.8% (n = 5) of the adolescents with FC suffered from internet addiction, whereas none of the healthy adolescents had internet addiction. The Young's Internet Addiction Test-Short Form survey reported internet addiction among 19.3% (n = 11) of the constipated adolescents and 17.1% (n = 6) of the healthy peers. The ratio of adolescents with limited symptoms and internet addiction in the functional constipation group was as high as 40.4%, according to Young's Internet Addiction Test-Short Form, and adolescents with functional constipation accompanied by pathological and problematic internet use was 24.6%, according to Parent-Child Internet Addiction Test. Although there was no significant difference in the internet addiction ratio between functional constipation and controls, our findings indicated that adolescents with functional constipation were suffering from high internet addiction rates. CONCLUSION: The evaluation of Young's Internet Addiction Test-Short Form and Parent-Child Internet Addiction Test surveys showed high internet usage problems, 40.4% and 24.6% in adolescents with functional constipation. According to adolescents' self-assessment, the internet addiction rate is higher but not significantly higher than their healthy peers. Therefore, internet addiction should be considered while treating adolescents with functional constipation, and clinicians should consider the opinions of adolescents besides their parents.

Iron deficiency is not always innocent in childhood: a rare diagnosis of collagenous gastritis.

BACKGROUND: Collagenous gastritis (CG) is a very rare disease with still lots of unknowns, characterized by the subepithelial collagenous band in the gastric mucosa associated with a mixed inflammatory infiltrate in the lamina propria. CASE: Iron deficiency anemia is the most common and usually single laboratory finding without any complaint at the time of diagnosis. This entity should be well-known so that we can examine and refer the patient to a pediatric gastroenterologist for differential diagnosis. CONCLUSIONS: The histopathological evaluation, albeit invasive, is essential to exclude this diagnosis. We present a 13-year-old girl with intractable iron deficiency anemia due to CG.

Comparison of atherogenic risk factors among poorly controlled and well-controlled adolescent phenylketonuria patients.

BACKGROUND: Previous studies investigating the known risk factors of atherosclerosis in phenylketonuria patients have shown conflicting results. The primary aim of our study was to investigate the serum atherogenic markers in adolescent classical phenylketonuria patients and compare these parameters with healthy peers. The secondary aim was to compare these atherogenic markers in well-controlled and poorly controlled patients. METHODS: A total of 59 patients (median age: 12.6 years, range: 11-17 years) and 44 healthy controls (median age: 12.0 years, range: 11-15 years) were enrolled in our study. Phenylketonuria patients were divided into two groups: well-controlled (serum phenylalanine levels below 360 µmol/L; 24 patients) and poorly controlled patients (serum phenylalanine levels higher than 360 µmol/L). RESULTS: The mean high-density lipoprotein cholesterol levels of well-controlled patients (1.0±0.2 mmol/L) were significantly lower compared with poorly controlled patients and controls (1.1±0.2 mmol/L, p=0.011 and 1.4±0.2 mmol/L, p<0.001, respectively). Poorly controlled patients had lower high-density lipoprotein cholesterol levels than healthy controls (p=0.003). Homocysteine levels of both well-controlled (9.8±6.4 µmol/L) and poorly controlled (9.2±5.6 µmol/L) patients were higher compared with controls (5.8±1.8 µmol/L, p<0.01). The mean platelet volume of well-controlled patients (9.5±1.1 fL) was higher than that of poorly controlled patients and controls (8.9±0.8 fL, p=0.024 and 7.7±0.6 fL, p<0.001, respectively). CONCLUSION: Lower high-density lipoprotein cholesterol and higher homocysteine and mean platelet volume levels were detected in phenylketonuria patients. In particular, these changes were more prominent in well-controlled patients. We conclude that phenylketonuria patients might be at risk for atherosclerosis, and therefore screening for atherosclerotic risk factors should be included in the phenylketonuria therapy and follow-up in addition to other parameters.

Depression and anxiety among parents of phenylketonuria children.

OBJECTIVE: To investigate the existence of depression and/or anxiety with underlying risk factors among parents of children with classical phenylketonuria (PKU). METHODS: This cross-sectional study was conducted in the Division of Pediatric Metabolism, Ankara Children`s Hospital, Dokuz Eylul University, Kirikkale University, and Erzurum Local Research Hospital, Turkey, between January and July 2014. Parents of 61 patients and 36 healthy controls completed the self-report questionnaires. We used Beck Depression Inventory (BDI) to assess the parental depression and State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety. RESULTS: Depression and anxiety scores were significantly higher in the case group (BDI: 12.3 ± 9.1; STAI-S: 38.2 ± 9.6; STAI-T: 43.2 ± 6.9) than controls (BDI: 5.4 ± 4.1 p=0.000; STAI-S: 31.8 ± 7.6 p=0.001; STAI-T: 37.0 ± 7.2 p=0.000). Mothers of the patients had higher scores than the other parental groups (BDI: p=0.000, STAI-S: p=0.001 and STAI-T: p=0.000). Logistic regression analysis showed that low educational level of the parent was the only independent factor for depression (OR: 9.96, 95% CI: 1.89-52.35, p=0.007) and state anxiety (OR: 6.99, 95% CI: 1.22-40.48, p=0.030) in the case group. CONCLUSION: A subset of parents with PKU patients have an anxiety or depressive disorder. Supportive services dealing with the parents of chronically ill children such as PKU are needed in order to reduce the level of anxiety.