Body image disorder is the core symptom of Anorexia Nervosa (AN). Our research focuses on a group... more Body image disorder is the core symptom of Anorexia Nervosa (AN). Our research focuses on a group of adolescent patients diagnosed with AN to investigate neurobiological aspects of body image distortion, comparing the results with healthy control (HC) and major depression (MD) groups. We planned a block-design task in fMRI by using participants' original and distorted overweight and underweight images. We applied General Linear Models (GLM) for whole-brain analyses and examined correlations of the findings with behavioral data. As a result, AN patients differentiated when evaluating their underweight images. However, all adolescents had similar activations for overweight conditions.
Body image disturbance is closely linked to eating disorders including anorexia nervosa (AN). Dis... more Body image disturbance is closely linked to eating disorders including anorexia nervosa (AN). Distorted body image perception, dissatisfaction and preoccupation with weight and shape are often key factors in the development and maintenance of these disorders. Although the pathophysiological mechanism of body image disorder is not yet fully understood, aberrant biological processes may interfere with perceptive, cognitive and emotional aspects of body image. This study focuses on the neurobiological aspects of body image disturbance. The sample consisted of 12 adolescent girls diagnosed with AN, nine girls with major depressive disorder (MDD) and 10 without psychiatric diagnoses (HC, the healthy control group). We applied a block‐design task in functional magnetic resonance imaging using participants' original and distorted overweight and underweight images. After imaging, the participants scored the images for resemblance, satisfaction and anxiety levels. The findings of this study demonstrate that overweight images elicited dissatisfaction and increased occipitotemporal activations across all participants. However, no difference was found between the groups. Furthermore, the MDD and HC groups showed increased activations in the prefrontal cortex and insula in response to underweight images compared to their original counterparts, whereas the AN group exhibited increased activations in the parietal cortex, cingulate gyrus and parahippocampal cortex in response to the same stimuli.
International journal of adolescent medicine and health, Apr 1, 2004
This study was undertaken to assess the frequency of coagulation disorders as a cause of menorrha... more This study was undertaken to assess the frequency of coagulation disorders as a cause of menorrhagia in adolescents. A retrospective chart review was conducted of all adolescents with menorrhagia admitted to the Adolescent Unit of Ihsan Dogramaci Childrens Hospital of Hacettepe University Faculty of Medicine in Ankara, Turkey from May 1999 to April 2002. 47 admissions for menorrhagia were identified, 44 were dysfunctional uterine bleeding due to anovulation, while a primary coagulation disorder was found in three patients. Two had Von Willebrand disease and one factor 11 deficiency. We suggest that pediatricians, gynecologists and other adolescent health care providers should be aware of the primary coagulopathy as a cause of menorrhagia in adolescence.
International Journal of Eating Disorders, Apr 6, 2011
Objective: The aim of this study was to determine the prevalence and potential causes of secondar... more Objective: The aim of this study was to determine the prevalence and potential causes of secondary nocturnal enuresis (NE) in adolescents with anorexia nervosa (AN). Method: Adolescents with AN completed the Incontinence Symptom Index-Pediatric (ISI-P), a self-report urinary incontinence survey. Those who had NE associated with the onset of AN on the ISI-P completed a comprehensive clinical and laboratory evaluation, including urinary flow measurements. The prevalence of NE in adolescents with AN was 17.0% (10 of 59). The overall frequency of day-and nighttime urinary incontinence symptoms in adolescents with AN was 62.7%; urgency incontinence, 57.6%; stress incontinence, 32.2%; and insensate incontinence, 17.0%. Nine of the 10 adolescents with NE had secondary NE and confirmed that bedwetting ceased after weight restoration. Discussion: Decreased functional bladder capacity and detrusor instability may contribute to the NE observed in this population. The high prevalence of NE in adolescents with AN warrants further study to determine the potential causative pathways. Clinicians who work with adolescents with AN should assess for this problem. V
Complementary and alternative medicine are treatments administered alone or in combination with c... more Complementary and alternative medicine are treatments administered alone or in combination with conventional medical treatments. Data on complementary and alternative medicine use in children with kidney and urinary tract diseases are limited. In this cross-sectional study, the frequency and preferred methods of complementary and alternative medicine use and factors associated with their use were evaluated in 201 patients (48% female; median age, 11 years; median disease duration, 5.1 years) with kidney and urinary tract diseases and 260 healthy (without chronic disease) controls. Data were collected through a questionnaire-based interview and patients' medical records. Herbal and dietary supplements, including fish oil, were the most commonly used complementary and alternative medicine agents in both groups. There was no difference in herbal and dietary supplement use between the groups when fish oil was excluded (29% vs. 28%; p = 0.88). Herbal and dietary supplements were mainly used to improve/ mitigate renal disease (52%). Logistic regression analysis revealed that disease duration > 7 years (odds ratio (OR), 3.70; 95% confidence interval (CI), 1.48-9.20), current use of six or more drugs (OR, 5.6; 95% CI, 1.28-24.41), and recurrent urinary tract infection or nephrolithiasis (OR, 3.92; 95% CI, 1.02-15.09) were the independent risk factors for herbal and dietary supplement use, except fish oil. Middle socioeconomic status was associated with decreased herbal and dietary supplement use, except fish oil, compared with low socioeconomic status (OR, 0.30; 95% CI, 0.11-0.81). Herbal and dietary supplements were used by 78% patients, despite knowing that these products could have side effects; only 42% of the patients shared the information about herbal and dietary supplement use with their doctors. Conclusion: Herbal and dietary supplement use is frequent in children with kidney and urinary tract diseases. Educating health professionals regarding such use is mandatory for developing strategies to prevent critical consequences.
The authors describe a case of accidental ethylene glycol poisoning in an 18-month-old boy who de... more The authors describe a case of accidental ethylene glycol poisoning in an 18-month-old boy who developed hemophagocytic syndrome (HPS). Ethylene glycol is a common substance in various antifreeze preparations. Acute ethylene glycol intoxication is a medical emergency that, if not diagnosed correctly and treated aggressively, will lead to serious neurological, cardiopulmonary, and renal dysfunction, and may result in death. The taking of a detailed history, physical examination, and laboratory testing are essential for diagnosis. To the best of the authors' knowledge this is the first case in the literature of a subject who developed HPS after ethylene glycol intoxication.
In this review article, the co-occurrence of substance use and eating disorders will be discussed... more In this review article, the co-occurrence of substance use and eating disorders will be discussed with a specific emphasis on the approach to the adolescent patient in the context of family centered care. The evidence to date suggests that the associations between eating and substance use disorders are multifactorial. Balancing between confidential health care for substance use and family centered health care for eating disorders is a real challenge in the management of adolescent patients with co-occurring eating and substance use disorders. Reconciling confidential health care with parental involvement should be considered with individually determined limits of confidentiality.
Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, Dec 7, 2019
Purpose: Serum amylase has been noted to be elevated in some patients with eating disorders, part... more Purpose: Serum amylase has been noted to be elevated in some patients with eating disorders, particularly those engaging in purging behaviors. This is presumed by most to be due to salivary enzyme activation, although pancreatic lipase levels have not been included in most reports. This report aims to describe pancreatic enzyme levels in adolescents and children with eating disorders and their relationship to diagnosis, percentage median BMI (%mBMI), percentage weight loss, and purging behaviors. Methods: Medical records of 215 patients ages 7-23 years with a DSM-5 ED diagnosis who presented for inpatient treatment from October 2012 to September 2014 were retrospectively reviewed. Inpatient clinical care protocols at this institution had historically suggested baseline amylase and lipase on admission; 157 patients had amylase and/or lipase levels measured within 48 hours of admission and these patients were included. Statistical analyses included standard descriptive testing, chi-squared tests, t-tests, and Spearman correlations. Results: Patients averaged 15.5 years old (SD 2.6, range 7.3 -23.2); 66% had AN, 17% had atypical anorexia (AtAN), 5% bulimia nervosa (BN), 5% purging disorder (PD), 3% avoidant-restrictive food intake disorder (ARFID), and 4% had an unspecified food and eating disorder (UFED). The mean amylase level was 70.5 (n = 151, SD 27.0, range 29 -190); low amylase levels were noted in 3% of patients, while 10% of patients presented with high amylase levels. The mean lipase level was 110.5 (n = 150, SD 96.0, range 25-1073). Patients with high levels were not symptomatic and continued to be refed per inpatient protocols. No patient had a low lipase level at admission, while 34% of patients presented with a high lipase level. Amylase and lipase values were significantly correlated with each other (r = .494, p < .01). Patients with purging behaviors were less likely to have a high lipase levels compared with nonpurgers (22 vs 41%, p = .035) and more likely to have high amylase levels (23 vs 9%, p = .048). Neither pancreatic enzyme was associated with binge eating. Lower %mBMI at presentation correlated with increased lipase levels (r = -.162, p < .05). Patients with high lipase levels had a higher mean percentage weight loss prior to admission (21 vs 18%, p = .048). Conclusions: Elevate amylase and lipase levels were not uncommon in this sample of adolescents with eating disorders, with onethird of patients displaying an elevated lipase level on admission. Levels did not seem to indicate clinical pancreatitis. Purgers were less likely to have high lipase levels and more likely to have high amylase levels. High lipase levels were associated with lower %mBMI and a higher percentage weight loss. Future studies should examine the clinical significance of pancreatic enzyme elevations and changes in these values with refeeding over time in patients with eating disorders.
The aim of the study was to assess potential changes in structural integrity of the brain in adol... more The aim of the study was to assess potential changes in structural integrity of the brain in adolescent patients with Anorexia Nervosa (AN) using the magnetization transfer imaging technique and re-evaluating after nutritional rehabilitation was accomplished. Magnetization transfer ratio (MTR) was used for the detection and quantification of histological changes to the white matter of 9 adolescents diagnosed with AN at diagnosis and after weight gain. Using the MTR technique 6 regions were measured: the pons, left cerebellar hemisphere, amygdala, thalamus, corona radiata and white matter adjacent to the left dorsolateral prefrontal cortex. Scans from the patients with AN were also compared with scans from an age-matched subset of 9 healthy controls. Compared with control subjects, the MTR of participants with AN was no different either at the early stages of diagnosis (p=0.62) or after weight recovery (p=0.81). Similarly, comparison of MTR between patients with AN at diagnoses compared with MTR after weight recovery yielded no statistically significant difference (P=0.33). We conclude that MTR was not able to detect any neuropathological alterations in adolescent patients with AN at either diagnosis or after nutritional recovery and the achievement of weight gain.
Journal of Pediatric Endocrinology and Metabolism, 2008
Ten pubertal boys treated with tamoxifen for gynecomastia for more than 3 months were evaluated a... more Ten pubertal boys treated with tamoxifen for gynecomastia for more than 3 months were evaluated after 2.5-7 years (mean 4.6 years) to determine the side effects of this therapy. We assessed the safety of long duration in adolescents with pubertal gynecomastia treated with tamoxifen. We did not find any serious side effects of tamoxifen in these patients.
Journal of Pediatric Endocrinology and Metabolism, Jun 6, 2018
Background: Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating d... more Background: Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating disturbances. The aim of this study was to evaluate whether the risk of a disordered eating behavior (DEB) also applies to the well sibling sharing the same environment. Methods: Well siblings were included if they were 10-18 years old, had a sibling with a T1DM diagnosis for at least 6 months and lived with the sibling during the illness. The control group was comprised of healthy participants recruited from the outpatient clinic with no family history of T1DM. Participants completed a four-part questionnaire concerning their eating behaviors that was developed by the study team. This survey aimed to evaluate the dietary habits and eating patterns. All participants completed the Eating Attitudes Test-26 (EAT-26) and a 24-h food dietary recall. Any participant with a high EAT-26 score or that seemed to be at risk according to the questionnaire was re-evaluated. Results: Eight cases (33.3%) in the well sibling group had either a total and/or subgroup pathological score. Three of them were found to have DEB and one case was diagnosed with anorexia nervosa (AN). In the control group, five cases (17.2%) had either a total and/or subgroup patholo gical score. Three of these cases were found to have DEB, no cases were diagnosed with an eating disorder. There were no statistically significant differences in the EAT-26 scores between the groups. Conclusions: Although a direct relationship was not observed, the probability of having a pathologic EAT-26 score was higher in the group with a sibling with T1DM.
International journal of adolescent medicine and health, 2004
Anorexia Nervosa (AN) is an eating disorder of puberty or adolescence. It is characterized by sel... more Anorexia Nervosa (AN) is an eating disorder of puberty or adolescence. It is characterized by self-induced weight loss; various psychological disturbances including distorted body image, fear of obesity, active pursuit of thinness and loss of recognition of a number of body enteroreceptive sensations; and secondary physiological abnormalities. The treatment of AN includes individual psychotherapy, family therapy, and nutritional rehabilitation. Hospital treatment is required when the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s medical condition is in danger due to hypovolemia or hypotension. If cardiac arrhythmias occur without electrolyte disturbances or if oral therapy fails, nutrition should be repleted by the safest method available. This can be done by nasogastric tube or intravenous hyperalimentation. The management of AN is challenging, because the treatment process and anticipated outcome is in direct conflict with the sufferer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own wishes. A comprehensive treatment plan including both psychiatric and medical approaches is necessary. We report a severe AN case, who has refeeding problems after a three months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; hospitalisation period. She was admitted to the child intensive care unit due to deterioration of her vital signs. We tried to solve her problems as a team, and believe that AN has a number of crucial problems thus requiring a multi-faceted treatment approach.
Journal of Bone and Mineral Metabolism, Mar 12, 2021
We aimed to evaluate the bone mineral density (BMD) z scores of adolescents with atypical anorexi... more We aimed to evaluate the bone mineral density (BMD) z scores of adolescents with atypical anorexia nervosa (AAN) and investigate the potential predictors of low BMD risk. Potential factors that might have an effect on the femoral neck and lumbar spine dual energy X-ray absorptiometry data of adolescents (11–18 years) with AAN were retrospectively evaluated. Among adolescents with AAN, 13 (34.2%) had a z score lower than − 1 and 25 (65.8%) had a z score equal or greater than − 1. When adolescents with a BMD score lower and higher than − 1 were compared, normal BMD group had a significantly higher mean lifetime maximum BMI (p = 0.0035). Similarly previous overweight history was significantly higher in the normal BMD group (p = 0.005). A positive correlation was found between femoral neck (p = 0.002, r: 0.546) and lumbar spine (p: 0.002, r: 0.505) z scores and lifetime maximum BMI. There was also a positive correlation between lumbar spine BMD scores and BMI at admission (p = 0.001, r: 0.540). Lumbar spine z scores and amenorrhea duration were negatively correlated (p: 0.002, r: − 10.867). In the adolescent period similar to AN, AAN cases are also at risk for disordered bone health. In adolescents with AAN, BMI prior to the illness was estimated to be the significant parameter for the risk of low BMD. Special attention should be paid to the bone health of adolescents with AAN, especially for those who do not have a previous overweight history.
Knee osteoarthritis is one of the leading causes of disability in the United States (Lawrence, 19... more Knee osteoarthritis is one of the leading causes of disability in the United States (Lawrence, 1998). Knee osteoarthritis affects the ability to perform activities of daily living such as walking and climbing stairs (Guccione, 1994). Importantly, preliminary studies indicate that health related quality of life indices tend to be much lower in females awaiting total joint arthroplasty as compared to male counterparts (Kiebzak, et al, 2002). Moreover, the psychological and emotional effects of knee osteoarthritis are understudied in female total knee arthroplasty candidates. PURPOSe: The purpose of this investigation was to examine the association between physical function and emotional health in female total knee arthroplasty candidates. MeTHOdS: Participants were 26 female total knee arthroplasty candidates with a mean age of 63.68 ± 8.46 years. The mean BMI of the study sample was 32.93 ± 5.74. The Physical Function Performance-10 test (PFP-10; Cress et al., 2005) is an objective measure of physical function that assesses physical function based on performance of activities of daily living (i.e. sweeping, climbing stairs, carrying groceries). The Short Form 36 (SF-36) measures health-related quality of life and it includes both physical and emotional health components. ReSUlTS: Pearson product moment correlations revealed significant associations between physical function domains (PFP total, upper body strength, lower body strength, upper body flexibility, balance/coordination, and endurance) and emotional health (SF-36 Role Emotional). The r values for these associations ranged between .486 and .531, with a p < .014. CONClUSiON: In conclusion, emotional health (SF-36 Role Emotional) has a positive correlation with physical function (PFP-10) total scores, as well as all sub-scores (upper body strength, lower body strength, upper body flexibility, balance/coordination, and endurance) in female total knee arthroplasty candidates. The nature of this association may provide practitioners with a better understanding of the emotional impact associated with functional limitation in female knee osteoarthritis patients.
Body image disorder is the core symptom of Anorexia Nervosa (AN). Our research focuses on a group... more Body image disorder is the core symptom of Anorexia Nervosa (AN). Our research focuses on a group of adolescent patients diagnosed with AN to investigate neurobiological aspects of body image distortion, comparing the results with healthy control (HC) and major depression (MD) groups. We planned a block-design task in fMRI by using participants' original and distorted overweight and underweight images. We applied General Linear Models (GLM) for whole-brain analyses and examined correlations of the findings with behavioral data. As a result, AN patients differentiated when evaluating their underweight images. However, all adolescents had similar activations for overweight conditions.
Body image disturbance is closely linked to eating disorders including anorexia nervosa (AN). Dis... more Body image disturbance is closely linked to eating disorders including anorexia nervosa (AN). Distorted body image perception, dissatisfaction and preoccupation with weight and shape are often key factors in the development and maintenance of these disorders. Although the pathophysiological mechanism of body image disorder is not yet fully understood, aberrant biological processes may interfere with perceptive, cognitive and emotional aspects of body image. This study focuses on the neurobiological aspects of body image disturbance. The sample consisted of 12 adolescent girls diagnosed with AN, nine girls with major depressive disorder (MDD) and 10 without psychiatric diagnoses (HC, the healthy control group). We applied a block‐design task in functional magnetic resonance imaging using participants' original and distorted overweight and underweight images. After imaging, the participants scored the images for resemblance, satisfaction and anxiety levels. The findings of this study demonstrate that overweight images elicited dissatisfaction and increased occipitotemporal activations across all participants. However, no difference was found between the groups. Furthermore, the MDD and HC groups showed increased activations in the prefrontal cortex and insula in response to underweight images compared to their original counterparts, whereas the AN group exhibited increased activations in the parietal cortex, cingulate gyrus and parahippocampal cortex in response to the same stimuli.
International journal of adolescent medicine and health, Apr 1, 2004
This study was undertaken to assess the frequency of coagulation disorders as a cause of menorrha... more This study was undertaken to assess the frequency of coagulation disorders as a cause of menorrhagia in adolescents. A retrospective chart review was conducted of all adolescents with menorrhagia admitted to the Adolescent Unit of Ihsan Dogramaci Childrens Hospital of Hacettepe University Faculty of Medicine in Ankara, Turkey from May 1999 to April 2002. 47 admissions for menorrhagia were identified, 44 were dysfunctional uterine bleeding due to anovulation, while a primary coagulation disorder was found in three patients. Two had Von Willebrand disease and one factor 11 deficiency. We suggest that pediatricians, gynecologists and other adolescent health care providers should be aware of the primary coagulopathy as a cause of menorrhagia in adolescence.
International Journal of Eating Disorders, Apr 6, 2011
Objective: The aim of this study was to determine the prevalence and potential causes of secondar... more Objective: The aim of this study was to determine the prevalence and potential causes of secondary nocturnal enuresis (NE) in adolescents with anorexia nervosa (AN). Method: Adolescents with AN completed the Incontinence Symptom Index-Pediatric (ISI-P), a self-report urinary incontinence survey. Those who had NE associated with the onset of AN on the ISI-P completed a comprehensive clinical and laboratory evaluation, including urinary flow measurements. The prevalence of NE in adolescents with AN was 17.0% (10 of 59). The overall frequency of day-and nighttime urinary incontinence symptoms in adolescents with AN was 62.7%; urgency incontinence, 57.6%; stress incontinence, 32.2%; and insensate incontinence, 17.0%. Nine of the 10 adolescents with NE had secondary NE and confirmed that bedwetting ceased after weight restoration. Discussion: Decreased functional bladder capacity and detrusor instability may contribute to the NE observed in this population. The high prevalence of NE in adolescents with AN warrants further study to determine the potential causative pathways. Clinicians who work with adolescents with AN should assess for this problem. V
Complementary and alternative medicine are treatments administered alone or in combination with c... more Complementary and alternative medicine are treatments administered alone or in combination with conventional medical treatments. Data on complementary and alternative medicine use in children with kidney and urinary tract diseases are limited. In this cross-sectional study, the frequency and preferred methods of complementary and alternative medicine use and factors associated with their use were evaluated in 201 patients (48% female; median age, 11 years; median disease duration, 5.1 years) with kidney and urinary tract diseases and 260 healthy (without chronic disease) controls. Data were collected through a questionnaire-based interview and patients' medical records. Herbal and dietary supplements, including fish oil, were the most commonly used complementary and alternative medicine agents in both groups. There was no difference in herbal and dietary supplement use between the groups when fish oil was excluded (29% vs. 28%; p = 0.88). Herbal and dietary supplements were mainly used to improve/ mitigate renal disease (52%). Logistic regression analysis revealed that disease duration > 7 years (odds ratio (OR), 3.70; 95% confidence interval (CI), 1.48-9.20), current use of six or more drugs (OR, 5.6; 95% CI, 1.28-24.41), and recurrent urinary tract infection or nephrolithiasis (OR, 3.92; 95% CI, 1.02-15.09) were the independent risk factors for herbal and dietary supplement use, except fish oil. Middle socioeconomic status was associated with decreased herbal and dietary supplement use, except fish oil, compared with low socioeconomic status (OR, 0.30; 95% CI, 0.11-0.81). Herbal and dietary supplements were used by 78% patients, despite knowing that these products could have side effects; only 42% of the patients shared the information about herbal and dietary supplement use with their doctors. Conclusion: Herbal and dietary supplement use is frequent in children with kidney and urinary tract diseases. Educating health professionals regarding such use is mandatory for developing strategies to prevent critical consequences.
The authors describe a case of accidental ethylene glycol poisoning in an 18-month-old boy who de... more The authors describe a case of accidental ethylene glycol poisoning in an 18-month-old boy who developed hemophagocytic syndrome (HPS). Ethylene glycol is a common substance in various antifreeze preparations. Acute ethylene glycol intoxication is a medical emergency that, if not diagnosed correctly and treated aggressively, will lead to serious neurological, cardiopulmonary, and renal dysfunction, and may result in death. The taking of a detailed history, physical examination, and laboratory testing are essential for diagnosis. To the best of the authors' knowledge this is the first case in the literature of a subject who developed HPS after ethylene glycol intoxication.
In this review article, the co-occurrence of substance use and eating disorders will be discussed... more In this review article, the co-occurrence of substance use and eating disorders will be discussed with a specific emphasis on the approach to the adolescent patient in the context of family centered care. The evidence to date suggests that the associations between eating and substance use disorders are multifactorial. Balancing between confidential health care for substance use and family centered health care for eating disorders is a real challenge in the management of adolescent patients with co-occurring eating and substance use disorders. Reconciling confidential health care with parental involvement should be considered with individually determined limits of confidentiality.
Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, Dec 7, 2019
Purpose: Serum amylase has been noted to be elevated in some patients with eating disorders, part... more Purpose: Serum amylase has been noted to be elevated in some patients with eating disorders, particularly those engaging in purging behaviors. This is presumed by most to be due to salivary enzyme activation, although pancreatic lipase levels have not been included in most reports. This report aims to describe pancreatic enzyme levels in adolescents and children with eating disorders and their relationship to diagnosis, percentage median BMI (%mBMI), percentage weight loss, and purging behaviors. Methods: Medical records of 215 patients ages 7-23 years with a DSM-5 ED diagnosis who presented for inpatient treatment from October 2012 to September 2014 were retrospectively reviewed. Inpatient clinical care protocols at this institution had historically suggested baseline amylase and lipase on admission; 157 patients had amylase and/or lipase levels measured within 48 hours of admission and these patients were included. Statistical analyses included standard descriptive testing, chi-squared tests, t-tests, and Spearman correlations. Results: Patients averaged 15.5 years old (SD 2.6, range 7.3 -23.2); 66% had AN, 17% had atypical anorexia (AtAN), 5% bulimia nervosa (BN), 5% purging disorder (PD), 3% avoidant-restrictive food intake disorder (ARFID), and 4% had an unspecified food and eating disorder (UFED). The mean amylase level was 70.5 (n = 151, SD 27.0, range 29 -190); low amylase levels were noted in 3% of patients, while 10% of patients presented with high amylase levels. The mean lipase level was 110.5 (n = 150, SD 96.0, range 25-1073). Patients with high levels were not symptomatic and continued to be refed per inpatient protocols. No patient had a low lipase level at admission, while 34% of patients presented with a high lipase level. Amylase and lipase values were significantly correlated with each other (r = .494, p < .01). Patients with purging behaviors were less likely to have a high lipase levels compared with nonpurgers (22 vs 41%, p = .035) and more likely to have high amylase levels (23 vs 9%, p = .048). Neither pancreatic enzyme was associated with binge eating. Lower %mBMI at presentation correlated with increased lipase levels (r = -.162, p < .05). Patients with high lipase levels had a higher mean percentage weight loss prior to admission (21 vs 18%, p = .048). Conclusions: Elevate amylase and lipase levels were not uncommon in this sample of adolescents with eating disorders, with onethird of patients displaying an elevated lipase level on admission. Levels did not seem to indicate clinical pancreatitis. Purgers were less likely to have high lipase levels and more likely to have high amylase levels. High lipase levels were associated with lower %mBMI and a higher percentage weight loss. Future studies should examine the clinical significance of pancreatic enzyme elevations and changes in these values with refeeding over time in patients with eating disorders.
The aim of the study was to assess potential changes in structural integrity of the brain in adol... more The aim of the study was to assess potential changes in structural integrity of the brain in adolescent patients with Anorexia Nervosa (AN) using the magnetization transfer imaging technique and re-evaluating after nutritional rehabilitation was accomplished. Magnetization transfer ratio (MTR) was used for the detection and quantification of histological changes to the white matter of 9 adolescents diagnosed with AN at diagnosis and after weight gain. Using the MTR technique 6 regions were measured: the pons, left cerebellar hemisphere, amygdala, thalamus, corona radiata and white matter adjacent to the left dorsolateral prefrontal cortex. Scans from the patients with AN were also compared with scans from an age-matched subset of 9 healthy controls. Compared with control subjects, the MTR of participants with AN was no different either at the early stages of diagnosis (p=0.62) or after weight recovery (p=0.81). Similarly, comparison of MTR between patients with AN at diagnoses compared with MTR after weight recovery yielded no statistically significant difference (P=0.33). We conclude that MTR was not able to detect any neuropathological alterations in adolescent patients with AN at either diagnosis or after nutritional recovery and the achievement of weight gain.
Journal of Pediatric Endocrinology and Metabolism, 2008
Ten pubertal boys treated with tamoxifen for gynecomastia for more than 3 months were evaluated a... more Ten pubertal boys treated with tamoxifen for gynecomastia for more than 3 months were evaluated after 2.5-7 years (mean 4.6 years) to determine the side effects of this therapy. We assessed the safety of long duration in adolescents with pubertal gynecomastia treated with tamoxifen. We did not find any serious side effects of tamoxifen in these patients.
Journal of Pediatric Endocrinology and Metabolism, Jun 6, 2018
Background: Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating d... more Background: Adolescents with type 1 diabetes mellitus (T1DM) are at an increased risk of eating disturbances. The aim of this study was to evaluate whether the risk of a disordered eating behavior (DEB) also applies to the well sibling sharing the same environment. Methods: Well siblings were included if they were 10-18 years old, had a sibling with a T1DM diagnosis for at least 6 months and lived with the sibling during the illness. The control group was comprised of healthy participants recruited from the outpatient clinic with no family history of T1DM. Participants completed a four-part questionnaire concerning their eating behaviors that was developed by the study team. This survey aimed to evaluate the dietary habits and eating patterns. All participants completed the Eating Attitudes Test-26 (EAT-26) and a 24-h food dietary recall. Any participant with a high EAT-26 score or that seemed to be at risk according to the questionnaire was re-evaluated. Results: Eight cases (33.3%) in the well sibling group had either a total and/or subgroup pathological score. Three of them were found to have DEB and one case was diagnosed with anorexia nervosa (AN). In the control group, five cases (17.2%) had either a total and/or subgroup patholo gical score. Three of these cases were found to have DEB, no cases were diagnosed with an eating disorder. There were no statistically significant differences in the EAT-26 scores between the groups. Conclusions: Although a direct relationship was not observed, the probability of having a pathologic EAT-26 score was higher in the group with a sibling with T1DM.
International journal of adolescent medicine and health, 2004
Anorexia Nervosa (AN) is an eating disorder of puberty or adolescence. It is characterized by sel... more Anorexia Nervosa (AN) is an eating disorder of puberty or adolescence. It is characterized by self-induced weight loss; various psychological disturbances including distorted body image, fear of obesity, active pursuit of thinness and loss of recognition of a number of body enteroreceptive sensations; and secondary physiological abnormalities. The treatment of AN includes individual psychotherapy, family therapy, and nutritional rehabilitation. Hospital treatment is required when the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s medical condition is in danger due to hypovolemia or hypotension. If cardiac arrhythmias occur without electrolyte disturbances or if oral therapy fails, nutrition should be repleted by the safest method available. This can be done by nasogastric tube or intravenous hyperalimentation. The management of AN is challenging, because the treatment process and anticipated outcome is in direct conflict with the sufferer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own wishes. A comprehensive treatment plan including both psychiatric and medical approaches is necessary. We report a severe AN case, who has refeeding problems after a three months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; hospitalisation period. She was admitted to the child intensive care unit due to deterioration of her vital signs. We tried to solve her problems as a team, and believe that AN has a number of crucial problems thus requiring a multi-faceted treatment approach.
Journal of Bone and Mineral Metabolism, Mar 12, 2021
We aimed to evaluate the bone mineral density (BMD) z scores of adolescents with atypical anorexi... more We aimed to evaluate the bone mineral density (BMD) z scores of adolescents with atypical anorexia nervosa (AAN) and investigate the potential predictors of low BMD risk. Potential factors that might have an effect on the femoral neck and lumbar spine dual energy X-ray absorptiometry data of adolescents (11–18 years) with AAN were retrospectively evaluated. Among adolescents with AAN, 13 (34.2%) had a z score lower than − 1 and 25 (65.8%) had a z score equal or greater than − 1. When adolescents with a BMD score lower and higher than − 1 were compared, normal BMD group had a significantly higher mean lifetime maximum BMI (p = 0.0035). Similarly previous overweight history was significantly higher in the normal BMD group (p = 0.005). A positive correlation was found between femoral neck (p = 0.002, r: 0.546) and lumbar spine (p: 0.002, r: 0.505) z scores and lifetime maximum BMI. There was also a positive correlation between lumbar spine BMD scores and BMI at admission (p = 0.001, r: 0.540). Lumbar spine z scores and amenorrhea duration were negatively correlated (p: 0.002, r: − 10.867). In the adolescent period similar to AN, AAN cases are also at risk for disordered bone health. In adolescents with AAN, BMI prior to the illness was estimated to be the significant parameter for the risk of low BMD. Special attention should be paid to the bone health of adolescents with AAN, especially for those who do not have a previous overweight history.
Knee osteoarthritis is one of the leading causes of disability in the United States (Lawrence, 19... more Knee osteoarthritis is one of the leading causes of disability in the United States (Lawrence, 1998). Knee osteoarthritis affects the ability to perform activities of daily living such as walking and climbing stairs (Guccione, 1994). Importantly, preliminary studies indicate that health related quality of life indices tend to be much lower in females awaiting total joint arthroplasty as compared to male counterparts (Kiebzak, et al, 2002). Moreover, the psychological and emotional effects of knee osteoarthritis are understudied in female total knee arthroplasty candidates. PURPOSe: The purpose of this investigation was to examine the association between physical function and emotional health in female total knee arthroplasty candidates. MeTHOdS: Participants were 26 female total knee arthroplasty candidates with a mean age of 63.68 ± 8.46 years. The mean BMI of the study sample was 32.93 ± 5.74. The Physical Function Performance-10 test (PFP-10; Cress et al., 2005) is an objective measure of physical function that assesses physical function based on performance of activities of daily living (i.e. sweeping, climbing stairs, carrying groceries). The Short Form 36 (SF-36) measures health-related quality of life and it includes both physical and emotional health components. ReSUlTS: Pearson product moment correlations revealed significant associations between physical function domains (PFP total, upper body strength, lower body strength, upper body flexibility, balance/coordination, and endurance) and emotional health (SF-36 Role Emotional). The r values for these associations ranged between .486 and .531, with a p < .014. CONClUSiON: In conclusion, emotional health (SF-36 Role Emotional) has a positive correlation with physical function (PFP-10) total scores, as well as all sub-scores (upper body strength, lower body strength, upper body flexibility, balance/coordination, and endurance) in female total knee arthroplasty candidates. The nature of this association may provide practitioners with a better understanding of the emotional impact associated with functional limitation in female knee osteoarthritis patients.
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Papers by Nuray Kanbur