Browsing by Author "Kansu Tanca, Aydan"
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Item A Clinical Approach to a Child with Hypoalbuminemia and Lymphopenia.(2016-05) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZItem A point-of-care test for facing the burden of undiagnosed celiac disease in the Mediterranean area: a pragmatic design study.(2014-12) Kansu Tanca, Aydan; Tıp FakültesiBackground: We aimed at assessing the factors that can influence results of the dissemination of an already validated, new generation commercial Point-of-Care Test (POCT) for detecting celiac disease (CD), in the Mediterranean area, when used in settings where it was designed to be administered, especially in countries with poor resources. Methods: Pragmatic study design. Family pediatricians at their offices in Italy, nurses and pediatricians in Slovenia and Turkey at pediatricians’, schools and university primary care centers looked for CD in 3,559 (1-14 yrs), 1,480 (14-23 yrs) and 771 (1-18 yrs) asymptomatic subjects, respectively. A new generation POCT detecting IgA-tissue antitransglutaminase antibodies and IgA deficiency in a finger-tip blood drop was used. Subjects who tested positive and those suspected of having CD were referred to a Celiac Centre to undergo further investigations in order to confirm CD diagnosis. POCT Positive Predictive Value (PPV) at tertiary care (with Negative Predictive Value) and in primary care settings, and POCT and CD rates per thousand in primary care were estimated. Results: At tertiary care setting, PPV of the POCT and 95% CI were 89.5 (81.3-94.3) and 90 (56-98.5) with Negative Predictive Value 98.5 (94.2-99.6) and 98.7% (92-99.8) in children and adults, respectively. In primary care settings of different countries where POCT was performed by a different number of personnel, PPV ranged from 16 to 33% and the CD and POCT rates per thousand ranged from 4.77 to 1.3 and from 31.18 to 2.59, respectively. Conclusions: Interpretation of POCT results by different personnel may influence the performance of POC but dissemination of POCT is an urgent priorityItem A rapid lateral flow stool antigen immunoassay and (14)C-urea breath test for the diagnosis and eradication of Helicobacter pylori infection in children.(2008-12) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZOur aim was to evaluate diagnostic accuracy of rapid immunochromatographic stool antigen test (Rapid HpSA; LİNEAR Chemical,Barcelona, Spain) and a practical low-dose14C urea breath test (UBT) (Heliprobe™) test before and after eradication therapy. One hundrednine children with abdominal symptoms (age range, 5–17 years; mean, 12.1) underwent endoscopy,14C-UBT, and Rapid HpSA. Patientswere defined asHpinfected when histology was positive forHp. Forty children (36.6%) wereHpinfected. The sensitivity of Rapid HpSAand14C-UBT was 65% and 92.5% (P= 0.0003), respectively; the specificity of Rapid HpSA and14C-UBT was 92.3% and 85.5% (P=0.180), respectively. After eradication therapy endoscopy,14C-UBT and Rapid HpSA were repeated. The eradication rate was 70.5%. Aftereradication, the sensitivity of Rapid HpSA and14C-UBT was 60% and 100%, respectively; the specificity of Rapid HpSA and14C-UBT was100%.14C-UBT was more reliable than the Rapid HpSA test for the diagnosis and for confirming eradication ofHpinfectionItem A rare cause of hepatomegaly in the childhood: Lysosomal acid lipase deficiency(2018-07) Kansu Tanca, Aydan; Tıp FakültesiItem A Successful HSCT in a Girl with Novel LRBA Mutation with Refractory Celiac Disease.(2016-01) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZItem An infant with severe refractory Crohn's disease and homozygous MEFV mutation who dramatically responded to colchicine.(2012-03) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZPrevious studies have suggested that inflammatory bowel disease is particulary frequent and severe in familial Mediterranean fever (FMF) families. An 8-monthold boy was admitted to our hospital with chronic bloody diarrhea, failure to thrive and high-grade fever. He was diagnosed as Crohn’s disease (CD) based on clinical, laboratory and histological findings and, corticosteroid therapy was started. The patient did not respond to intensive medical therapy including intravenous corticosteroid, mesalazine, azathioprine, intravenous cyclosporine and enteral feeding. MEFV gene mutation analysis revealed homozygous M694V mutation. In addition to azathioprine and cyclosporine therapy, with the diagnosis of FMF, colchicine therapy was started and partial remission was observed within 2 weeks. To the best of our knowledge, this is the first report of association of CD and FMF in an infant. In cases of CD resistant to medical therapy, possibility of underlying FMF should be considered, especially in countries where FMF is prevalent.Item Angiodysplasia as a cause of severe hematochezia in a child with end-stage renal failure.(2011) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZAngiodysplasia is a frequent cause of gastrointestinal bleeding in adults with chronic renal failure (CRF); however, there is no data about this association in children. The mechanism of this association is not known. We report a 4.5- year-old boy with CRF presenting with hematochezia due to colonic angiodysplasia. He was on hemodialysis for the previous 9 months. Treatment with argon plasma coagulation (APC) was commenced following a short course of octreotide therapy. During the 3 years of follow-up, no occult or gross bleeding occurred. This case illustrates that octreotide and APC therapy seems to be useful for arresting bleeding from angiodysplasia and prevention of recurrent bleeding in children with CRFItem Burden of celiac disease in the Mediterranean area(2011-12) Kansu Tanca, Aydan; Tıp FakültesiAIM: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost. METHODS: For statistics regarding the population of each country in the Mediterranean area, we accessed authoritative international sources (World Bank, World Health Organization and United Nations). The prevalence of CD was obtained for most countries from published reports. An overall prevalence rate of 1% cases/total population was finally estimated to represent the frequency of the disease in the area, since none of the available confidence intervals of the reported rates significantly excluded this rate. The distribution of symptoms and complications was obtained from reliable reports in the same cohort. A standardized mortality rate of 1.8 was obtained from recent reports. Crude health cost was estimated for the years between symptoms and diagnosis for adults and children, and was standardized for purchasing power parity to account for the different economic profiles amongst Mediterranean countries. RESULTS: In the next 10 years, the Mediterranean area will have about half a billion inhabitants, of which 120 million will be children. The projected number of CD diagnoses in 2020 is 5 million cases (1 million celiac children), with a relative increase of 11% compared to 2010. Based on the 2010 rate, there will be about 550,000 symptomatic adults and about 240,000 sick children: 85% of the symptomatic patients will suffer from gastrointestinal complaints, 40% are likely to have anemia, 30% will likely have osteopenia, 20% of children will have short stature, and 10% will have abnormal liver enzymes. The estimated standardized medical costs for symptomatic celiac patients during the delay between symptom onset and diagnosis (mean 6 years for adults, 2 years for children) will be about €4 billion (€387 million for children) over the next 10 years. A delay in diagnosis is expected to increase mortality: about 600,000 celiac patients will die in the next 10 years, with an excess of 44.4% vs age- and sex-matched controls. CONCLUSION: In the near future, the burden of CD will increase tremendously. Few Mediterranean countries are able to face this expanding epidemic alone.Item Carotid intima-media thickness and arterial stiffness as early markers of atherosclerosis in pediatric celiac disease.(2016) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZTurkish National Pediatric Society The Turkish Journal of Pediatrics2016 , Vol 58 , Num 2 Carotid intima-media thickness and arterial stiffness as early markers of atherosclerosis in pediatric celiac disease Arzu Meltem Demir 1 ,Zarife Kuloğlu 1 ,Aytaç Yaman 1 ,Suat Fitöz 2 ,Gökhan Nergizoğlu 3 ,Aydan Kansu 1 1 Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey 2 Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey 3 Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey DOI : 10.24953/turkjped.2016.02.008 The association between pediatric celiac disease (CD) and atherosclerosis is unknown. Our aim was to investigate whether pediatric CD patients have an increased risk of atherosclerosis. We evaluated the premature atherosclerosis by pulse wave velocity (PWV) and carotid intima-media thickness (cIMT). A total of 37 CD patients (20 girls, mean age 13±3.3 years) and 36 healthy age and sex matched controls were enrolled. Mean duration of CD was 47.1±32.3 months and 40.5% of patients had positive tissue transglutaminase antibody (tTg) IgA. Total cholesterol level was lower in CD (p=0.026) and cIMT was lower in tTg IgA antibody negative CD (p=0.030). cIMT was significantly correlated with tTg IgA antibody positivity (r=0.336; p=0.042). Adherence to strict gluten-free diet is associated with decreased cIMT, suggesting that gluten withdrawal seems to have a beneficial effect on premature atherosclerosis.Item Celiac disease in the Mediterranean area.(2014-02) Kansu Tanca, Aydan; Tıp FakültesiBackground: The World Gastroenterology Organization recommends developing national guidelines for the diagnosis of Celiac Disease (CD): hence a profile of the diagnosis of CD in each country is required. We aim to describe a cross-sectional picture of the clinical features and diagnostic facilities in 16 countries of the Mediterranean basin. Since a new ESPGHAN diagnostic protocol was recently published, our secondary aim is to estimate how many cases in the same area could be identified without a small intestinal biopsy. Methods: By a stratified cross-sectional retrospective study design, we examined clinical, histological and laboratory data from 749 consecutive unselected CD children diagnosed by national referral centers. Results: The vast majority of cases were diagnosed before the age of 10 (median: 5 years), affected by diarrhea, weight loss and food refusal, as expected. Only 59 cases (7.8%) did not suffer of major complaints. Tissue transglutaminase (tTG) assay was available, but one-third of centers reported financial constraints in the regular purchase of the assay kits. 252 cases (33.6%) showed tTG values over 10 times the local normal limit. Endomysial antibodies and HLA typing were routinely available in only half of the centers. CD was mainly diagnosed from small intestinal biopsy, available in all centers. Based on these data, only 154/749 cases (20.5%) would have qualified for a diagnosis of CD without a small intestinal biopsy, according to the new ESPGHAN protocol. Conclusions: This cross-sectional study of CD in the Mediterranean referral centers offers a puzzling picture of the capacities to deal with the emerging epidemic of CD in the area, giving a substantive support to the World Gastroenterology Organization guidelines.Item Change of Helicobacter pylori prevalence in a decade among children undergoing endoscopy.(2016) Kansu Tanca, Aydan; ; Tıp Fakültesi; Kuloğlu, ZOur aim was to investigate the trend of H. pylori infection among children during the last decade by a retrospective analysis. Reports of children in whom esophago-gastroduodenoscopy was performed at our institution during two periods 2002-2003 and 2012-2013 were seperated into Group I and Group II, respectively. Pathology reports were investigated for gastritis, atrophy and H. pylori presence. A total of 380 children, 131 in Group I and 249 in Goup II were recruited in the study. H. pylori postivity was found to be higher in Group I (% 48.1 and % 23.1, respectively, p < 0.001). Gastritis and atrophy were associated with H. pylori and both were more prevalent in Group I (p < 0.001). Our study demonstrates that H. pylori prevalence is decreasing in a pediatric population undergoing EGD in Ankara. This is the most recent study regarding pediatric H. pylori prevalence change in Turkey that we know of.Item Classification chaos in coeliac disease: Does it really matter?(2016-12) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZThe spectrum of mucosal pathology in coeliac disease (CD), initially defined by Marsh in 1992 has been subjected to several modifications in the following years by Oberhuber, then by Corazza and Villanaci, and finally by Ensari. The present study, aimed to end the ongoing confusion regarding the classification of mucosal pathology in CD by applying all the classifications proposed so far on a large series of cases. A total of 270 duodenal biopsies taken from the distal duodenum of patients with a diagnosis of CD were included in the study. All biopsies were classified according to Marsh, Oberhuber, Corazza Villanaci, and Ensari classification schemes. For statistical analyses cases were divided into three groups: Group 1 included type 1 lesions in Marsh, Ensari, and Oberhuber and grade A in Corazza Villanaci classifications. Group 2 comprised of type 2 lesions in Marsh and Ensari classifications together with type2, type 3a and 3b lesions in Oberhuber classification and grade B1 lesions in Corazza Villanaci classification. Group 3 included type 3 lesions in Marsh and Ensari classifications, and type 3c lesions in Oberhuber, and grade B2 lesions in Corazza Villanaci classifications. The kappa value was 1.00 (excellent) for group 1, 0.53 (fair) for group 2 and 0.78 (excellent) for group 3 (p < 0.0001). These results suggest that any of the above classification system would serve similar purposes in the diagnosis of CD. Therefore, it is advisable that the pathologist should use the simplest reliable scheme.Item Consensus statement on diagnosis, treatment and follow-up of cow's milk protein allergy among infants and children in Turkey.(2016) Kansu Tanca, Aydan; Tıp FakültesiThe present paper aims to provide experts’ consensus on diagnosis and management of cow’s milk protein allergy (CMPA) among infants and children in Turkey, based on review of available evidence-based guidelines, publications and experts’ clinical experience. The experts agreed that CMPA diagnosis should be based on symptomatic evaluation and diagnostic elimination diet as followed by implementation of an open challenge test after disappearance of symptoms and confirmation of CMPA diagnosis in re-appearance of symptoms. For breastfed infants, differential diagnosis involves withdrawal of cow’s milk-containing products from the mother’s diet, while calcium supplements and appropriate dietary advice are given to mothers to prevent nutritional deficiency. For infants not breastfed exclusively, cow’s milk-based formula and any complementary food containing cow’s milk protein (CMP) should be avoided. The first line treatment should be extensively hydrolyzed formula (eHF) with use of amino acid–based formula (AAF) in severe cases such as anaphylaxis, enteropathy, eosinophilic esophagitis and food protein induced enterocolitis along with cases of multiple system involvement, multiple food allergies and intolerance to eHF. Introduction of supplementary foods should not be delayed in CMPA, while should be made one by one in small amounts and only after the infant is at least 17 weeks of age. Infants who are at-risk can be identified by family history of atopic disease. Exclusive breastfeeding for 4-6 months (17-27 weeks) is recommended as the best method of infant allergy prevention. There is no evidence that modifying the mother’s diet during pregnancy and/or breast-feeding and delaying solid or even potentially allergic foods beyond 4-6 months in infants may be protective against allergy among at-risk infants. When exclusive breastfeeding is not possible, at-risk infants should get a partially or extensively hydrolyzed formula (pHF or eHF) to prevent allergy until risk evaluation by a health professional. In conclusion, the present consensus statement provides recommendations regarding diagnosis, prevention and management of CMPA in infants and children in Turkey, and thus expected to guide physicians to optimize their approach to CMPA and decrease burden of the disease on infants and their caregiversItem Cow`s milk protein allergy awareness and practice among Turkish pediatricians: A questionnaire-survey.(2017) Kansu Tanca, Aydan; Tıp FakültesiRegion-specific recommendations for the prevention, diagnosis, and treatment of cow`s milk protein allergy (CMPA) are not available in Turkey. This cross-sectional questionnaire-survey was designed to evaluate CMPA awareness and practice among Turkish pediatricians. A total of 410 pediatricians were included based on their voluntary participation. Questionnaires elicited demographic data and pediatricians` awareness and practice of CMPA in infants and children. Atopic dermatitis (91.5%), diarrhea (88.0%) and significant blood in stool (85.9%) were the most common symptoms considered suggestive of CMPA. Continuation of breast feeding via elimination of CMP containing products from maternal diet was the most commonly selected (79.0%) therapeutic option in exclusively breast-fed infants diagnosed with CMPA. Amino acid–based formula was the most commonly selected formula in a non-exclusively breast-fed infant with CMPA, for infants presenting with anaphylaxis (58.8%), enterocolitis (40.7%) or multiple food allergies (52.0%), and also for at-risk infants (40.2%). Earliest time to re-challenge was identified to be 6 months by 52.0% of pediatricians. In conclusion, our findings revealed high awareness of CMPA among Turkish pediatricians in terms of clinical presentation and first priority diagnostic tests. However, CMPA practice among Turkish pediatricians needs to be improved in terms of avoidance of other mammalian milks, selection of therapeutic formulas among non-exclusively breast-fed infants and at-risk infants consistent with guideline-based indications and cost-effectivity.Item Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies.(2019-09) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZThis review addresses the current strategies of inducing tolerance development in infant and childhood cow’s milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant’s diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow’s milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.Item Diagnosis of celiac disease and applicability of ESPGHAN guidelines in Mediterranean countries: a real life prospective study.(2017-01) Kansu Tanca, Aydan; Tıp FakültesiBackground: We assessed how the diagnosis of Celiac Disease (CD) is made and how the new ESPGHAN guidelines can be applied in children from countries with different resources. Methods: A real life prospective study was performed in 14 centres of 13 different Mediterranean countries. Participants were asked to apply the usual diagnostic work-up for CD according to their diagnostic facilities. Results: There were 1974 patients enrolled in the study, mean age 4 years, 10 months; 865 male, 1109 female. CD was confirmed in 511 (25.9%) and was unconfirmed in 1391 (70.5%) patients; 14 patients were diagnosed as having CD according to the new ESPGHAN guidelines, 43 patients were classified as having potential CD. In all participating countries the diagnosis of CD relied on histology of duodenal biopsy; in 5 countries, HLA, and in one country endomysial antibodies (EMA) were not available. Symptoms did not add a significant increase to the pre-test probability of serological tests. The positive predictive value of tissue transglutaminase type 2 (tTG) antibodies performed with different kits but all corresponding to those recommended by ESPGHAN was 96.1% (95% CI 94–97.9%) in presence of tTG > 10xULN. In 135 patients with tTG >10xULN, HLA genotyping was performed and in all it was compatible with CD. Conclusions: The results of our study show that CD diagnosis still relies on intestinal biopsy in the Mediterranean area. New ESPGHAN criteria are not applicable in 5 countries due to lack of resources needed to perform HLA genotyping and, in one country, EMA assay. Further simplification of the new ESPGHAN guidelines might be made according to what preliminarily the present results suggest if confirmed by new prospective studiesItem Diagnostic workup and micronutrient deficiencies in children with failure to thrive without underlying diseases.(2019-08) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZObjectives and study: Failure to thrive (FTT) is an interruption in the normal pattern of growth. We aimed to evaluate the clinicalcharacteristics, underlying etiologies, diagnostic workup, and frequency of micronutrient deciencies (MDs) in children with FTT.Methods: This retrospective study was done with 729 children (319 male, mean age 6.8 ± 5.5 years) with FTT (weight for age <3rdpercentile) who had visited the Pediatric Gastroenterology outpatient clinic between 2011 and 2016. Children who had previouslyknown chronic diseases, inadequate intake, or inadequate absorption were excluded. Acute malnutrition was considered if weight-for-age z-scores were below −2 and height-for-age z-scores were above −2, and chronic malnutrition was dened if height-for-agez-scores were below −2. Results: The malnutrition rate was 57.1% (acute: 37.8%, chronic: 19.3%). Of children, 98.7% had laboratoryevaluation. We found that 1.1% of laboratory tests, 0.4% of imaging studies, 27% of endoscopic ndings, and biopsy results led to aspecic diagnosis, equating to a total of 1.3% of diagnostic workup leading to a diagnosis related to FTT. The causes of FTT wereinadequate nutrition (61.4%), psychiatric and behavioral disorders (17.2%), endocrinologic disorders (9%), recurrent infections(6.4%), gastrointestinal diseases (1.9%), and cardiac disorders (0.1%). Vitamin A and D deciencies were the most common MD.Conclusion: We showed that the most common cause of FTT is “purely nutrition” FFT because of inadequate caloric intake, andextensive diagnostic workup is rarely helpful to reveal the etiology. These results implicate the importance of clinical evaluationand anthropometry to evaluate a child with FTT.Item Early-onset inflammatory bowel disease and common variable immunodeficiency-like disease caused by IL-21 deficiency.(2014-06) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZBACKGROUND: Alterations of immune homeostasis in the gut can result in development of inflammatory bowel disease (IBD). Recently, Mendelian forms of IBD have been discovered, as exemplified by deficiency of IL-10 or its receptor subunits. In addition, other types of primary immunodeficiency disorders might be associated with intestinal inflammation as one of their leading clinical presentations. OBJECTIVE: We investigated a large consanguineous family with 3 children who presented with early-onset IBD within the first year of life, leading to death in infancy in 2 of them. METHODS: Homozygosity mapping combined with exome sequencing was performed to identify the molecular cause of the disorder. Functional experiments were performed to assess the effect of IL-21 on the immune system. RESULTS: A homozygous mutation in IL21 was discovered that showed perfect segregation with the disease. Deficiency of IL-21 resulted in reduced numbers of circulating CD19(+) B cells, including IgM(+) naive and class-switched IgG memory B cells, with a concomitant increase in transitional B-cell numbers. In vitro assays demonstrated that mutant IL-21(Leu49Pro) did not induce signal transducer and activator of transcription 3 phosphorylation and immunoglobulin class-switch recombination. CONCLUSION: Our study uncovers IL-21 deficiency as a novel cause of early-onset IBD in human subjects accompanied by defects in B-cell development similar to those found in patients with common variable immunodeficiency. IBD might mask an underlying primary immunodeficiency, as illustrated here with IL-21 deficiency.Item Evaluation of malnutrition development risk in hospitalized children.(2018-04) Kansu Tanca, Aydan; Tıp FakültesiObjectives:Many screening methods, such as the Screening Tool Risk on Nutritional Status and Growth(STRONGkids) and the Pediatric Yorkhill Malnutrition Score (PYMS), have been developed to detect mal-nutrition in pediatric patients. We aimed to explore the prevalence of malnutrition risk in hospitalizedchildren via symptoms and identification of contributing factors, and to examine the efficacy of malnu-trition screening tools for hospitalized children.Methods:STRONGkids and PYMS were applied to 1513 inpatients at 37 hospitals in 26 cities from dif-ferent regions of Turkey. Physical measurements were collected at hospital admission and at discharge.z-Scores of height-for-age, weight-for-age, weight-for-height, and body mass index–for–age were calculated.Results:Overall, 1513 patients were included in the study. A body mass index standard deviation scoreof less than−2 was present in 9.5% of the study population at hospital admission, whereas 11.2% of theparticipants had a weight-for-length/height score of less than−2 at hospital admission. According toSTRONGkids results, the proportion of the patients with an underlying chronic disease was higher forthe patients at high risk of malnutrition than for the patients at medium or low risk (91% compared with47% or 45%, respectively). PYMS results indicated that patients at high risk of malnutrition have morechronic diseases (75%) than the patients at medium or low risk of malnutrition (55% and 44%, respectively).Conclusions:Use of anthropometric measurements in addition to screening tools to identify hospital mal-nutrition (such as PYMS, STRONGkids) will prevent some nutritional risk patients from being overlookedItem Gastric carcinoid tumor in a 14-year old girl.(2014-11) Kansu Tanca, Aydan; Tıp Fakültesi; Kuloğlu, ZGastric carcinoid tumors (GCT) are rare lesions that constitute 2.6-8.7% of all gastrointestinal carcinoids, mostly affect middle-aged females but the incidence in children is unknown. We present a 14-year-old girl, with GCT. She was treated with recombinant human growth hormone (GH) for complete GH deficiency, and endoscopy was performed to identify iron-deficiency anemia. Upper gastrointestinal endoscopy revealed a gastric polyp, and biopsies were compatible with GCT.