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Misirlioglu M, Alakaya M, Arslankoylu AE, Bozlu G, Durak F, Delibas A, Surmeli Doven S, Tezol O, Yesil E, Karahan F, Killi I, Akca M. Evaluation of pediatric trauma score and pediatric age-adjusted shock index in pediatric patients admitted to the hospital after an earthquake. ULUS TRAVMA ACIL CER 2024; 30:254-262. [PMID: 38634847 DOI: 10.14744/tjtes.2024.47835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND In our earthquake-prone country, it is crucial to gather data from regional hospitals following earthquakes. This information is essential for preparing for future disasters and enhancing healthcare services for those affected by earthquakes. This study aimed to evaluate the Pediatric Trauma Score (PTS) and the Shock Index, Pediatric Age-Adjusted (SIPA), in children affected by earthquakes, to provide clinicians with insights into the severity of trauma and hemodynamic stability. METHODS The study included patients admitted to our hospital's pediatric emergency service within the three weeks following the earthquake. We evaluated their age, sex, admission vital signs, mechanical ventilation requirements, development of crush syndrome, length of hospital stay, PTS, and SIPA. RESULTS Our study included 176 children (89 females and 87 males) with trauma. Fifty-eight (32.95%) children had crush syndrome, and 87 (49.43%) were hospitalized. The median PTS was 10 (ranging from -3 to 12), and the median SIPA was 1.00 (ranging from 0.57 to 2.10). We observed a negative correlation between the time spent under debris and PTS (r=-0.228, p=0.002) and a positive correlation with the SIPA score (r=0.268, p<0.001). The time spent under debris (p<0.001) and SIPA score (p<0.001) were significantly higher in hospitalized children. PTS was significantly lower in hospitalized children than in others. A PTS cutoff point of 7.5, and a SIPA cutoff point of 1.05, predicted hospitalization in all children. Time spent under debris and SIPA were significantly higher in children with crush syndrome than in others (p<0.001). PTS at a cutoff point of 8.5 and SIPA at a cutoff point of 1.05 predicted crush syndrome in all children. CONCLUSION PTS and SIPA are important practical scoring systems that can be used to predict the severity of trauma, hospitalization, crush syndrome, and the clinical course in pediatric patients admitted to the hospital due to earthquake trauma.
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Affiliation(s)
- Merve Misirlioglu
- Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Ali Ertug Arslankoylu
- Department of Pediatric Intensive Care, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Gulcin Bozlu
- Department of Pediatric Emergency, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Fatma Durak
- Department of Pediatric Emergency, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Ali Delibas
- Department of Pediatric Nephrology, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Serra Surmeli Doven
- Department of Pediatric Nephrology, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Ozlem Tezol
- Department of Pediatrics, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Edanur Yesil
- Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Feryal Karahan
- Department of Pediatric Hematology and Oncology, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Isa Killi
- Department of Pediatric Surgery, Mersin University Faculty of Medicine, Mersin-Türkiye
| | - Mehtap Akca
- Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine, Mersin-Türkiye
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Döven SS, Tezol Ö, Yeşil E, Durak F, Mısırlıoğlu M, Alakaya M, Karahan F, Kıllı İ, Akça M, Erdoğan S, Can M, Delibaş A. The 2023 Türkiye-Syria earthquakes: analysis of pediatric victims with crush syndrome and acute kidney Injury. Pediatr Nephrol 2024:10.1007/s00467-024-06307-7. [PMID: 38358551 DOI: 10.1007/s00467-024-06307-7] [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] [Received: 10/11/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND On February 6th, 2023, two consecutive earthquakes struck southeastern Türkiye with magnitudes of 7.7 and 7.6, respectively. This study aimed to analyze the clinical and laboratory findings, as well as management of pediatric victims with Crush Syndrome (CS) and Acute Kidney Injury (AKI). METHODS The study included pediatric earthquake victims who were presented to Mersin University Hospital. Clinical and laboratory characteristics of the patients were collected retrospectively. RESULTS Among 649 patients, Crush injury (CI), CS and AKI was observed in 157, 59, and 17 patients, respectively. White blood cell count (12,870 [IQR: 9910-18700] vs. 10,545 [IQR: 8355-14057] /µL, P < 0.001), C-reactive protein (51.27 [IQR: 14.80-88.78] vs. 4.59 [1.04-18.25] mg/L, P < 0.001) and myoglobin levels (443.00 [IQR: 198.5-1759.35] vs. 17 [11.8-30.43] ng/ml) were higher in patients with CS, while their sodium (IQR: 134 [131-137] vs. 136 [134-138] mEq/L, P < 0.001) levels were lower compared to non-CS patients. An increase in myoglobin levels was identified as an independent risk factor for developing CS (OR = 1.017 [1.006-1.027]). Intravenous fluid replacement was administered to the patients with CS at a dose of 4000 cc/m2/day. Hypokalemia was observed in 51.9% of the CS patients on the third day. All patients with AKI showed improvement and no deaths were reported. CONCLUSIONS Hyponatremia and increase in inflammation markers associated with CS may be observed. An increase in myoglobin levels was identified as a risk factor for CS. Hypokalemia may be seen as a complication of vigorous fluid therapy during hospitalization.
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Affiliation(s)
- Serra Sürmeli Döven
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Türkiye.
| | - Özlem Tezol
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Türkiye
| | - Edanur Yeşil
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Türkiye
| | - Fatma Durak
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Türkiye
| | - Merve Mısırlıoğlu
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Türkiye
| | - Mehmet Alakaya
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Türkiye
| | - Feryal Karahan
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Türkiye
| | - İsa Kıllı
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Türkiye
| | - Mehtap Akça
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Türkiye
| | - Semra Erdoğan
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Mersin University, Mersin, Türkiye
| | - Mevlüt Can
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Türkiye
| | - Ali Delibaş
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Türkiye
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Özhan AK, Demirhan A, Arikoglu T, Karahan F, Satıcı FEG, Tokmeci N, Gündoğan BD, Yalaki Aİ, Akbey V, Karabulut YY, Ünal S, Kuyucu S. Toxic Skin Reactions Should Be Differentiated from Allergic Reactions to Chemotherapeutic Drugs in Children: A Case Series and Review of the Literature. Dermatitis 2024. [PMID: 38165639 DOI: 10.1089/derm.2023.0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Background: Chemotherapeutic drugs can lead to a wide spectrum of cutaneous findings, ranging from nonimmune toxic reactions to severe immune-mediated hypersensitivity reactions. The aim of this study was to evaluate the clinical, histopathological features, and prognosis of toxic skin reactions to chemotherapeutic drugs and to compare them with characteristics of immune-mediated reactions in children with malignancies. Methods: The medical records of all children with cancer who experienced skin reactions after chemotherapy administration and diagnosed as a toxic skin reaction between 2010 and 2022 were retrospectively analyzed. The diagnosis was re-evaluated and differentiated from other similar disorders by using clinical manifestations, photodocumentation, and histopathological findings. Results: A total of 17 children aged 2-17 years were involved: toxic erythema of chemotherapy (TEC) in 14 children, methotrexate-induced epidermal necrosis in 2 children, and toxic epidermal necrolysis (TEN)-like TEC in 1 child. The most commonly implicated drug was methotrexate. Most patients recovered rapidly after drug cessation and supportive measures. In 10 of the 17 patients, reintroduction of the culprit chemotherapeutic drug at reduced doses or increased dosage intervals was possible without any recurrence. Six patients could not receive further doses since they deceased due to sepsis and other complications. Conclusions: Cutaneous toxic eruptions to chemotherapeutic drugs may present with a severe phenotype resembling Stevens-Johnson syndrome/TEN. An accurate diagnosis prevents potentially harmful therapeutic interventions, withholding of chemotherapy, and erroneous assignment of drug allergies.
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Affiliation(s)
- Aylin Kont Özhan
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ali Demirhan
- Department of Pediatric Allergy and Immunology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Tuğba Arikoglu
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Feryal Karahan
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | | | - Nazan Tokmeci
- Department of Pediatric Allergy and Immunology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Begümhan Demir Gündoğan
- Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Aysu İlhan Yalaki
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Veysi Akbey
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | | | - Selma Ünal
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Semanur Kuyucu
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Karahan F, Yilmaz SS, Bayrakdar F, Tezol Ö, Kuyucu N, Kiliç S, Türkegün M, Ünal S. Evaluation of Intestinal Microbiota in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2023; 45:e904-e909. [PMID: 37526399 DOI: 10.1097/mph.0000000000002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND AND AIMS Sickle cell disease (SCD) is a chronic hemolytic anemia that may be life-threatening due to multisystemic effects. Identification of the factors which affect the pathophysiology of the disease is important in reducing mortality and morbidity. This study aimed to determine gut microbial diversity in children and adolescents with SCA compared with healthy volunteers and to evaluate the clinical impact of microbiota. MATERIALS AND METHODS The study included 34 children and young adolescents with SCD and 41 healthy volunteer participants. The microbiome was assessed by 16S rRNA sequencing in stool samples. Laboratory parameters of all participants, such as complete blood count and C-reactive protein values and clinical characteristics of SCD patients, were determined and compared, as well as clinical conditions of the patients, such as vascular occlusive crisis and/or acute chest syndrome, frequency of transfusions, intake of penicillin, hydroxyurea, and chelation therapy were recorded. RESULTS White blood cell count, hemoglobin, immature granulocyte and C-reactive protein levels were significantly higher in the patient group ( P <0.05). Microbiota analysis revealed 3 different clusters among subjects; controls and 2 clusters in the SCD patients (patient G1 and G2 groups). Bacteroides spp. were more prevalent, while Dialester spp. and Prevotella spp. were less prevalent in SCD compared with controls ( t =2.142, P <0.05). Patient G2 (n=9) had a higher prevalence of Bacteroides and a lower prevalence of Prevotella than patient G1 (n=25). CONCLUSION In our study, there was a difference between SCD patients and the control group, while 2 different microbiota profiles were encountered in SCD patients. This difference between the microbiota of the patients was not found to affect the clinical picture (such as vascular occlusive crisis, acute chest syndrome).
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Affiliation(s)
- Feryal Karahan
- Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine
| | - Serap Süzük Yilmaz
- National Molecular Microbiology Reference Laboratory, Public Health General Directorate, Ministry of Health, Ankara, Turkey
| | - Fatma Bayrakdar
- National Molecular Microbiology Reference Laboratory, Public Health General Directorate, Ministry of Health, Ankara, Turkey
| | - Özlem Tezol
- National Molecular Microbiology Reference Laboratory, Public Health General Directorate, Ministry of Health, Ankara, Turkey
| | - Necdet Kuyucu
- Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine
| | - Selçuk Kiliç
- National Molecular Microbiology Reference Laboratory, Public Health General Directorate, Ministry of Health, Ankara, Turkey
| | - Merve Türkegün
- Mersin University, Department of Biostatistics and Medical Informatics, Mersin
| | - Selma Ünal
- Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine
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Karahan F, Ünal S, Tezol Ö, Sürmeli Döven S, Durak F, Alakaya M, Mısırlıoğlu M, Yeşil E, Kıllı İ, Kurt H, Altunköprü G. Thromboprophylaxis in pediatric patients with earthquake-related crush syndrome: a single centre experience. Pediatr Surg Int 2023; 39:248. [PMID: 37584864 DOI: 10.1007/s00383-023-05540-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Injuries increase the risk of venous thromboembolism (VTE). However, the literature on the management of anticoagulant therapy in pediatric patients with crush injury is limited. In this study, we aimed to share our experience about anticoagulant thromboprophylaxis in pediatric patients with earthquake-related crush syndrome. METHODS This study included patients who were evaluated for VTE risk after the Turkey-Syria earthquake in 2023. Since there is no specific pediatric guideline for the prevention of VTE in trauma patients, risk assessment for VTE and decision for thromboprophylaxis was made by adapting the guideline for the prevention of perioperative VTE in adolescent patients. RESULTS Forty-nine patients [25 males and 24 females] with earthquake-related crush syndrome had participated in the study. The median age of the patients was 13.5 (8.8-15.5) years. Seven patients (14.6%) who had no risk factors for thrombosis were considered to be at low risk and did not receive thromboprophylaxis. Thirteen patients (27.1%) with one risk factor for thrombosis were considered to be at moderate risk and 28 patients (58.3%) with two or more risk factors for thrombosis were considered to be at high risk. Moderate-risk patients (n = 8) and high-risk patients aged < 13 years (n = 11) received prophylactic enoxaparin if they could not be mobilized early, while all high-risk patients aged ≥ 13 years (n = 13) received prophylactic enoxaparin. CONCLUSION With the decision-making algorithm for thyromboprophylaxis we used, we observed a VTE rate of 2.1% in pediatric patients with earthquake-related crush syndrome.
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Affiliation(s)
- Feryal Karahan
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey
| | - Selma Ünal
- Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey
| | - Özlem Tezol
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey.
| | - Serra Sürmeli Döven
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Turkey
| | - Fatma Durak
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
| | - Mehmet Alakaya
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Merve Mısırlıoğlu
- Faculty of Medicine, Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Edanur Yeşil
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - İsa Kıllı
- Faculty of Medicine, Department of Pediatric Surgery, Mersin University, Mersin, Turkey
| | - Hakan Kurt
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
| | - Gül Altunköprü
- Faculty of Medicine, Department of Pediatrics, Mersin University, Mersin, Turkey
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Atay A, Karahan F, Gunes O, Gunay S, Dilek ON. From dyspepsia to complicated peptic ulcer: new markers in diagnosis and prognosis. Eur Rev Med Pharmacol Sci 2023; 27:1352-1359. [PMID: 36876674 DOI: 10.26355/eurrev_202302_31370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Peptic ulcer disease (PUD) may present with different clinical findings, ranging from mild dyspeptic complaints to mortal complications, such as gastrointestinal system perforation. The aim of this study was to investigate the potential blood parameters that can be used in the diagnosis of PUD and prediction of complications. PATIENTS AND METHODS A total of 80 patients with dyspeptic complaints, 83 patients with PUD, and 108 patients with peptic ulcer perforation (PUP) who were treated in our hospital between January 2017 and December 2020 were included in the study. Clinical findings, laboratory data, and imaging methods were reviewed retrospectively. RESULTS The mean age of 271 (154 men, 117 women) patients included in the study was 56.04 ± 17.98 (mean ± standard deviation) years. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume, white blood cell, C-reactive protein, and neutrophil values were higher in patients with PUP compared to other groups (p < 0.001 for all). In the PUD group, only red blood cell distribution width was significantly higher compared to the patient group with dyspeptic complaints. In the postoperative period, NLR and PLR were significantly higher in patients who developed severe complications according to the Clavien-Dindo classification compared to patients who developed mild complications. CONCLUSIONS This study showed that simple blood parameters can be used as diagnostic markers at different stages of PUD. NLR and PLR can be helpful in the diagnosis of PUP and red blood cell distribution width can be used to differentiate patients with peptic ulcer from dyspeptic patients. Additionally, NLR and PLR can be used to predict serious postoperative complications after PUP surgery.
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Affiliation(s)
- A Atay
- Department of General Surgery, Department of Gastroenterology, Izmir Katip Celebi University Atatürk Training and Research Hospital, Izmir, Turkey.
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Tezol O, Karahan F, Unal S. Sickle Cell Disease and Psychosocial Well-Being: Comparison of Patients With Preclinical and Clinical Avascular Necrosis of the Femoral Head. Turk Arch Pediatr 2022; 56:308-315. [PMID: 35005723 PMCID: PMC8655956 DOI: 10.5152/turkarchpediatr.2021.20270] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
Aim: Sickle cell disease (SCD) has significant adverse psychosocial impacts in childhood. Patients with SCD may be affected by avascular necrosis (AVN) and the most commonly involved site is the femoral head. We aimed to conduct a comparative investigation of the psychosocial well-being of pediatric SCD patients with preclinical and clinical femoral head AVN. Materials and Methods: Patients with homozygous SCD and healthy peers aged 7-17 years were included in this cross-sectional study. Psychosocial well-being was assessed by the Strengths and Difficulties Questionnaire (SDQ), parent version. SDQ scores were compared between the groups. Results: A total of 74 mother–child couples were enrolled in this study. The SCD with clinical AVN (stages I-IV) group consisted of 17 patients, SCD with preclinical AVN (stage 0) group consisted of 20 patients, and the control group consisted of 37 individuals. The sociodemographic characteristics and medians of total difficulties, emotional problems, conduct problems, hyperactivity, and peer problems scores were not different between the 3 groups (P > .05). There was a significant difference between the 3 groups in the prosocial score that indicates more positive social behaviors. Both groups, SCD with clinical AVN and with preclinical AVN, had lower prosocial scores than the control group (P < .001). The 2 patient groups did not differ in any SDQ scores or disease-related characteristics of vaso-occlusive crises and blood/exchange transfusions in the recent year (P > .05). Conclusions: Pediatric patients with SCD, whether or not complicated with clinical AVN, had lower prosocial scores than healthy peers. This study has presented the first comparison of the psychosocial well-being of pediatric SCD patients with preclinical and clinical femoral head AVN.
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Affiliation(s)
- Ozlem Tezol
- Department of Pediatrics Mersin University School of Medicine, Mersin, Turkey
| | - Feryal Karahan
- Department of Pediatric Hematology, Mersin University School of Medicine, Mersin, Turkey
| | - Selma Unal
- Department of Pediatric Hematology, Mersin University School of Medicine, Mersin, Turkey
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Karahan F, Ünal S, Topçu DB, Öztaş Y, Bozlu G. The role of immature granulocyte percentage in predicting acute chest syndrome and the severity of the vaso-occlusive crisis in sickle cell disease. Turk J Pediatr 2022; 64:92-97. [DOI: 10.24953/turkjped.2021.1385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yildirim N, Unal S, Yalcinkaya A, Karahan F, Oztas Y. Evaluation of the relationship between intravascular hemolysis and clinical manifestations in sickle cell disease: decreased hemopexin during vaso-occlusive crises and increased inflammation in acute chest syndrome. Ann Hematol 2021; 101:35-41. [PMID: 34564750 DOI: 10.1007/s00277-021-04667-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/28/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
The aims of this study were to determine the possible relationships between the levels of hemin, hemopexin, acid sphingomyelinase, nitrite/nitrate (NOx), and other parameters in patients with SCD and to assess whether they were associated with vaso-occlusive crises (VOCs) or acute chest syndrome (ACS). Patients with SCD (homozygous or sickle beta-thalassemia) who were confirmed to have VOC or ACS were included. Blood samples were obtained at admission, on the third day of hospitalization, and at steady state. Demographic characteristics, pain (visual analog scale), complication history, complete blood count, lactate dehydrogenase, and C-reactive protein levels were recorded. Hemin, hemopexin, acid sphingomyelinase, and NOx were measured via ELISA. A total of 31 patients (22 VOC, 9 ACS) were included. Mean age was 16.4 ± 4.7 years. Admission white blood cell count and C-reactive protein levels were significantly higher in the ACS group. Patients with ACS also demonstrated a significant decreasing trend of LDH and an increasing trend of NOx values from admission to steady state. Notably, hemopexin levels were significantly lower on the third day of hospitalization compared to steady-state levels. Despite limited patient count in the ACS group, these patients appear to have strikingly greater inflammatory activation at admission, and the progression of ACS may be associated with LDH and NOx levels. Lower hemopexin levels during hospitalization versus steady state appear to support a role for the administration of hemopexin therapy during crises.
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Affiliation(s)
- Nazim Yildirim
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Selma Unal
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sıhhiye, Ankara, Turkey.
| | - Feryal Karahan
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Yesim Oztas
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sıhhiye, Ankara, Turkey
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Abstract
Objective: Transcobalamin II deficiency is a rare autosomal recessive disease characterized by decreased cobalamin availability, which in turn causes accumulation of homocysteine and methylmalonic acid. The presenting clinical features are failure to thrive, diarrhea, megaloblastic anemia, pancytopenia, neurologic abnormalities, and also recurrent infections due to immune abnormalities in early infancy. Materials and Methods: Here, we report the clinical and laboratory features of six children with transcobalamin II deficiency who were all molecularly confirmed. Results: The patients were admitted between 1 and 7 months of age with anemia or pancytopenia. Unexpectedly, one patient had a serum vitamin B12 level lower than the normal range and another one had nonsignificantly elevated serum homocysteine levels. Four patients had lymphopenia, four had neutropenia and three also had hypogammaglobulinemia. Suggesting the consideration of transcobalamin II deficiency in the differential diagnosis of immune deficiency. Hemophagocytic lymphohistiocytosis was also detected in one patient. Furthermore, two patients had vacuolization in the myeloid lineage in bone marrow aspiration, which may be an additional finding of transcobalamin II deficiency. The hematological abnormalities in all patients resolved after parenteral cobalamin treatment. In follow-up, two patients showed neurological impairments such as impaired speech and walking. Among our six patients who were all molecularly confirmed, two had the mutation that was reported in transcobalamin II-deficient patients of Turkish ancestry. Also, a novel TCN2 gene mutation was detected in one of the remaining patients. Conclusion: Transcobalamin II deficiency should be considered in the differential diagnosis of infants with immunological abnormalities as well as cytopenia and neurological dysfunction. Early recognition of this rare condition and initiation of adequate treatment is critical for control of the disease and better prognosis.
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Affiliation(s)
- Selma Ünal
- Mersin University Faculty of Medicine, Department of Pediatric Hematology, Mersin, Turkey
| | - Feryal Karahan
- Mersin University Faculty of Medicine, Department of Pediatric Hematology, Mersin, Turkey
| | - Tuğba Arıkoğlu
- Mersin University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Mersin, Turkey
| | - Asuman Akar
- Mersin University Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin, Turkey
| | - Semanur Kuyucu
- Mersin University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Mersin, Turkey
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Ünal S, Karahan F, Arıkoğlu T, Akar A, Kuyucu S. Different presentations of patients with transcobalamin II deficiency: A single center experience from Turkey. Turk J Haematol 2018. [DOI: 10.4274/tjh.2018.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Coşar E, Arıkoğlu T, Akar A, Karahan F, Kuyucu S, Kuyucu N. The Relation of Serum Vitamin D and Cathelicidin Levels in Recurrent Lower Respiratory Tract Infections in Preschool Children. J Pediatr Inf 2018. [DOI: 10.5578/ced.67243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Coşar E, Arıkoğlu T, Akar A, Karahan F, Kuyucu S, Kuyucu N. Tekrarlayan Alt Solunum Yolu Enfeksiyonu Olan Okul Öncesi Çocuklarda Serum Vitamin D ve Katelisidin İlişkisi. J Pediatr Inf 2018. [DOI: 10.5578/ced.201815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Citak EC, Ozeren M, Karaca MK, Karpuz D, Karahan F, Yilmaz EB, Balci Y, Kara PO, Arpaci RB. A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma. Braz J Cardiovasc Surg 2018; 33:104-106. [PMID: 29617509 PMCID: PMC5873788 DOI: 10.21470/1678-9741-2017-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022] Open
Abstract
Cardiac angiosarcomas are extremely rare in childhood, they are rapidly
progressive tumours that often present themselves as diagnostic dilemmas,
resulting in delayed diagnosis. Also, extracardiac manifestations, including
abdominal pain, are extremely rare in patients with intracardiac tumors. We
herein present the case of a 15-year-old girl who presented with abdominal pain.
Echocardiography and thoracic computed tomography showed right atrial mass. The
patient underwent surgery, chemotherapy, and radiotherapy. Eight months after
treatment, abdominal recurrence was detected. The abdominal mass was resected,
and radiotherapy and new chemotherapy protocol were given. The present case
illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic
dilemma in an adolescent girl.
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Affiliation(s)
- Elvan Caglar Citak
- Department of Pediatric Oncology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Murat Ozeren
- Department of Cardiovascular Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - M Kerem Karaca
- Department of Cardiovascular Surgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Derya Karpuz
- Department of Pediatric Oncology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Feryal Karahan
- Department of Pediatric Oncology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Eda Bengi Yilmaz
- Department of Radiation Oncology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yuksel Balci
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Pelin Ozcan Kara
- Department of Nuclear Medicine, Mersin University Faculty of Medicine, Mersin, Turkey
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Karahan F, Çıtak EÇ, Yaman E, Alakaya M, Sağcan F, Yılmaz EB, Kuş F, Gürses İ, Balcı Y. Metachronous Synovial Sarcoma After Treatment of Mixed Germ Cell Tumor in a Child with Complete Gonadal Dysgenesis. J Clin Res Pediatr Endocrinol 2018; 10:87-90. [PMID: 28836496 PMCID: PMC5838380 DOI: 10.4274/jcrpe.4905] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Patients with complete XY gonadal dysgenesis (GD) show a high predisposition to germ cell tumors (GCT). Patients with coexistence of GCT and GD have been reported previously. Here we present a 15-year-old girl with mixed GCT and GD who also developed an intra-abdominal synovial sarcoma one year after the treatment. This is the first report, to our knowledge, of synovial sarcoma associated with XY GD.
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Affiliation(s)
- Feryal Karahan
- Mersin University Faculty of Medicine, Department of Pediatric Oncology, Mersin, Turkey
| | - Elvan Çağlar Çıtak
- Mersin University Faculty of Medicine, Department of Pediatric Oncology, Mersin, Turkey,* Address for Correspondence: Mersin University Faculty of Medicine, Department of Pediatric Oncology, Mersin, Turkey E-mail:
| | - Emel Yaman
- Mersin University Faculty of Medicine, Department of Medical Oncology, Mersin, Turkey
| | - Mehmet Alakaya
- Mersin University Faculty of Medicine, Department of Pediatrics, Mersin, Turkey
| | - Fatih Sağcan
- Mersin University Faculty of Medicine, Department of Pediatrics, Mersin, Turkey
| | - Eda Bengi Yılmaz
- Mersin University Faculty of Medicine, Department of Radiation Oncology, Mersin, Turkey
| | - Funda Kuş
- Mersin University Faculty of Medicine, Department of Pathology, Mersin, Turkey
| | - İclal Gürses
- Mersin University Faculty of Medicine, Department of Pathology, Mersin, Turkey
| | - Yüksel Balcı
- Mersin University Faculty of Medicine, Department of Radiology, Mersin, Turkey
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Ozkutlu U, Alican I, Karahan F, Onat F, Yegen BC, Ulusoy NB, Oktay S. Are m-cholinoceptors of guinea pig gallbladder smooth muscle of m4 subtype? Pharmacology 1993; 46:308-14. [PMID: 8516380 DOI: 10.1159/000139061] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The antagonism of carbachol-induced contractions of guinea pig gallbladder smooth muscle strips via selective antagonists, methoctramine, HHSiD, pf-HHSiD and DABDMA has been investigated in order to find out the m-cholinoceptor subtype(s) of gallbladder smooth muscle. All m-cholinoceptor antagonists examined, displaced the concentration-response curves to the right parallel in a concentration-dependent manner without affecting the maximum response. Schild analysis of data was consistent with competitive antagonism. -log KB values of the antagonists were 7.37 for HHSiD, 7.53 for pf-HHSiD, 6.58 for DABDMA and 7.60 for methoctramine. These results, together with the high affinity of pirenzepine and low affinities of 4-DAMP and AF-DX 116, indicate that the m-cholinoceptors of the guinea pig gallbladder which mediate cholinergic contractions are not of m1-, m2- and m3- subtypes but seem likely to be of m4-subtype.
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Affiliation(s)
- U Ozkutlu
- Department of Physiology, Marmara University, School of Medicine, Istanbul, Turkey
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Abstract
Methylene blue (MB) is a soluble guanylate cyclase inhibitor, and known as an endothelium-derived relaxing factor (EDRF) inhibitor in vitro. In the present study, it was demonstrated that intravenous administration of MB caused a dose-dependent hypertensive effect in rats. The hypertensive responses to the higher doses (10 and 20 mg/kg) of MB was followed by a reflex hypotension which did not appear in pithed rats. Noradrenaline depletion by reserpine pretreatment did not inhibit MB-induced hypertension, but abolished the hypotensive response. Both hypertensive and hypotensive phases were not altered by indometacin. These results may suggest that in vivo guanylate cyclase inhibition leads to an increase in blood pressure; prostaglandins and noradrenaline release from sympathetic nerve endings do not contribute to MB-induced hypertension and it may be due in part to the inhibition of EDRF.
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Affiliation(s)
- S Oktay
- Department of Pharmacology, Marmara University, School of Medicine, Istanbul, Turkey
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Karahan F, Alican I, Ozkutlu U, Onat F, Yegen BC, Ulusoy NB, Oktay S. Muscarinic receptor subtypes of guinea-pig common bile duct. Arch Int Pharmacodyn Ther 1991; 312:140-5. [PMID: 1772334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The antagonism of carbachol-induced contractions of guinea-pig common bile duct smooth muscle strips by various antagonists has been investigated in order to find out the muscarinic receptor subtype(s) of common bile duct smooth muscle. Atropine, pirenzepine, 4-DAMP and AF-DX 116 were used as nonselective, M1-selective, M1- and M3-selective and M2-selective muscarinic antagonists, respectively. All muscarinic antagonists examined displaced the concentration-response curves to the right, parallelly and in a concentration-dependent manner, without affecting maximum response. Schild analysis of data was consistent with competitive antagonism. pA2 values of the antagonists were as follows: atropine, 9.59; pirenzepine, 7.32; 4-DAMP, 8.99; AF-DX 116, 6.85. When these pA2 values are compared with those obtained in the ileum, it may be concluded that the muscarinic receptors of the guinea-pig common bile duct mediating cholinomimetic-induced contractions, are of the M3 subtype, but not of the M1 and M2 subtypes.
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Affiliation(s)
- F Karahan
- Department of Pharmacology, Marmara University School of Medicine, Turkey
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