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Çağlayan Ş, Koç BŞ, Baba Ö, Bağlan E, Kurucu B, Yıldırım DG, Ayhan AC, Çakan M, Yener GO, Öztürk K, Çakmak F, Sönmez HE, Ayaz NA, Kısaarslan AP, Bakkaloğlu S, Kalyoncu M, Kılıç SÇ, Sözeri B. Evaluation of childhood malignancies presenting with musculoskeletal manifestations from two different divisions: a multicenter study. Turk J Pediatr 2024; 66:81-89. [PMID: 38523382 DOI: 10.24953/turkjped.2023.446] [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] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND The aim of the study was to evaluate the approaches of pediatric rheumatologists and pediatric hematologists to patients with similar musculoskeletal (MSK) complaints and to highlight the differences that general pediatricians should consider when referring patients to these specialties. METHODS This is a cross-sectional study involving the patients who applied to pediatric rheumatology centers with MSK complaints and were diagnosed with malignancy, as well as patients who were followed up in pediatric hematology centers with a malignancy diagnosis, and had MSK complaints at the time of admission. RESULTS A total of 142 patients were enrolled in the study. Of these patients, 83 (58.4%) applied to pediatric rheumatology centers, and 59 (41.6%) applied to pediatric hematology centers. Acute lymphoblastic leukemia (ALL) was the most common diagnosis among the patients who applied to both centers, with 80 cases (56.3%). The median age of diagnosis was 87 (interquartile range, IQR: 48-140) months. The most common preliminary diagnosis in pediatric rheumatology centers was juvenile idiopathic arthritis (JIA), with 37 cases (44.5%). MSK involvement was mainly seen as arthralgia, and bone pain. While arthralgia (92.7%) was the most common complaint in rheumatology centers, bone pain (88.1%) was more common in hematology centers. The most frequently involved joints were the knee (62.9%), ankle (25.9%), hip (25%), and wrist (14%). The most common laboratory abnormalities were high lactate dehydrogenase (LDH), high C-reactive protein (CRP), anemia, and high erythrocyte sedimentation rate (ESR). Thrombocytopenia, neutropenia, and high LDH were statistically significantly more frequent in patients admitted to hematology centers than in patients admitted to rheumatology centers (p < 0.001, p=0.014, p=0.028, respectively). Patients who applied to rheumatology clinics were found to have statistically significantly higher CRP levels (p=0.032). CONCLUSIONS Malignancies may present with only MSK system complaints in childhood. Therefore, malignancies should be included in the differential diagnosis of patients presenting with MSK complaints.
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Affiliation(s)
- Şengül Çağlayan
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul
| | - Begüm Şirin Koç
- Department of Pediatric Hematology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul
| | - Özge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Sami Ulus Research and Training Hospital, Ankara
| | - Burçak Kurucu
- Department of Pediatric Hematology, Sami Ulus Research and Training Hospital, Ankara
| | | | - Aylin Canbolat Ayhan
- Department of Pediatric Hematology, Istanbul Medeniyet University, Göztepe Research and Training Hospital, İstanbul
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, İstanbul
| | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Research and Training Hospital, İstanbul
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, İstanbul
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, İstanbul
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Sevcan Bakkaloğlu
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Suar Çakı Kılıç
- Department of Pediatric Hematology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul
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Koç BŞ, Tekkeşin F, Haccaloğlu EE, Beyter B, Aydoğdu S, Çakı Kılıç S, Caki Kilic S. Any Concern About Delays in the Diagnosis of Childhood Cancers During the COVID-19 Pandemic? Turk Arch Pediatr 2023; 58:75-79. [PMID: 36598215 PMCID: PMC9885817 DOI: 10.5152/turkarchpediatr.2022.22224] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The lockdown precautions during the COVID-19 pandemic led to concerns about the delayed diagnosis of malignancies. This study aimed to compare the duration of complaints at home and the presence of metastasis at diagnosis during the pre-pandemic and pandemic period in children with cancer. MATERIALS AND METHODS All children diagnosed with cancer and followed up in our clinic between 2017 and 2022 were included. Patients with a diagnosis of acute/chronic leukemia were excluded. Age, gender, cancer type, duration of complaints, and presence of metastasis at diagnosis of the children were recorded. The duration of complaints and presence of metastasis at diagnosis were compared statistically before and after March 11, 2020, the start point of the COVID-19 pandemic in our country. RESULTS A total of 161 patients diagnosed with cancer were analyzed retrospectively; 61% of patients were males and 39% were females. These patients were diagnosed with brain tumors (23.6%), lymphomas (23%), neuroblastoma (13.7%), rhabdomyosarcomas (10.6%), Ewing's sarcoma (4.3%), osteosarcoma (3.7%), Wilm's tumor (3.7%), and germ cell tumors (3.1%). The duration of complaint was longer during the pandemic than before the pandemic (median: 45 days vs. 30 days) (P < .05). The presence of metastases at diagnosis was 45.3% in the prepandemic period, while it was 40% during the pandemic with no statistical difference (P > .5). CONCLUSION We concluded that the duration of complaint before diagnosis was longer during the pandemic, while this delay did not affect the metastasis rate at diagnosis in children with cancer. The high rates of distant metastases in newly diagnosed patients both before and during the pandemic suggest that more studies are needed to diagnose these patients earlier.
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Affiliation(s)
- Begüm Şirin Koç
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Ümraniye Research and Training Hospital, İstanbul, Turkey,Corresponding author:Begüm Şirin Koç ✉
| | - Funda Tekkeşin
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Elif Ezgi Haccaloğlu
- Department of Pediatrics, University of Health Sciences, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Büşra Beyter
- Department of Pediatrics, University of Health Sciences, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Selime Aydoğdu
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Suar Çakı Kılıç
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Ümraniye Research and Training Hospital, İstanbul, Turkey
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Kızılocak H, Özdemir N, Varol F, Koç BŞ, Dikme G, Çam H, Celkan T. Five-year-old girl with tongue bleeding. Turk Pediatri Ars 2016; 51:117-119. [PMID: 27489471 PMCID: PMC4959741 DOI: 10.5152/turkpediatriars.2016.3458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/21/2015] [Indexed: 06/06/2023]
Affiliation(s)
- Hande Kızılocak
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Nihal Özdemir
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Fatih Varol
- Division of Pediatric Emergency, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Begüm Şirin Koç
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Gürcan Dikme
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Halit Çam
- Division of Pediatric Emergency, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tiraje Celkan
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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Abstract
Neutrophils have an important role in host defense and acute inflammation. It is well known that susceptibility to infection increases when the neutrophil count is low. Neutropenia were classified as mild, moderate and severe according to the neutrophil counts, or acute and chronic depending on the duration of neutropenia, or congenital and acquired according to the mechanism. The patients with neutropenia are clinically different due to underlying mechanism, they have life- threatening infections or no infection may be observed. The most common cause of acquired neutropenia is viral infection, followed by drugs and autoimmune neutropenia. Congenital neutropenia are usually diagnosed by acute and life- threatening invasive bacterial and fungal infections. Immune system disorders and other systemic abnormalities may be accompanied or not. Recent years, novel single gen defects causing congenital neutropenia were defined through advanced genetic techniques. Molecular diagnosis is useful for risk stratification, choice of therapy and prognosis on follow- up. This review was prepared for pediatricians as a guide focused on approach neutropenia, which tests should be performed and when should be referred to a specialist.
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Affiliation(s)
- Tiraje Celkan
- Division of Pediatric Hematology-Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Begüm Şirin Koç
- Division of Pediatric Hematology-Oncology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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Koç BŞ, Karaman S, Unüvar A, Uysalol E, Karakaş Z, Devecioğlu O, Anak S. Bone marrow involvement of rhabdomyosarcoma from unknown origin. Turk J Haematol 2014; 31:211-2. [PMID: 25035689 PMCID: PMC4102059 DOI: 10.4274/tjh.2013.0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/13/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Begüm Şirin Koç
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
| | - Serap Karaman
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
| | - Ayşegül Unüvar
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
| | - Ezgi Uysalol
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
| | - Zeynep Karakaş
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
| | - Omer Devecioğlu
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
| | - Sema Anak
- İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Hematology&Oncology, İstanbul, Turkey
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Abstract
BACKGROUND Arterial blood pressure (BP) is one of the four vital signs that reflect cardiovascular status in neonates. The present study aimed to obtain BP percentiles among healthy, singleton, liveborn neonates between 34 and 43 weeks of gestation who were less than 1 h old. METHODS BP measurements were taken after birth in supine-positioned neonates in the delivery room using an oscillometric device. A total of 982 well-nourished neonates who did not require resuscitation, were not fetally malnourished, were not admitted to the neonatal intensive care unit and were without obvious congenital abnormalities were included in the study. RESULTS Sex- and type-of-delivery-specific 5th and 95th percentiles BP measurements were obtained for gestation. Mean BP values for systolic, diastolic and mean of term neonates were 63.98 ± 12.29 mmHg, 38.34 ± 11.06 mmHg and 49.32 ± 11.33 mmHg, and late preterm neonates were 61.80 ± 12.46 mmHg, 33.17 ± 9.97 mmHg and 46.52 ± 10.8 mmHg, respectively. There were weak but significant correlations between birthweight, birth length and head circumference and systolic, diastolic and mean arterial BP values (r = 0.20, r = 0.15 and r = 0.20, respectively, P < 0.001). Neonates who were delivered vaginally had higher mean BP values for systolic, diastolic and mean than neonates delivered by cesarean section (P < 0.05). Female neonates had higher systolic BP values than male neonates (P < 0.05). CONCLUSION Data presented in this study include sex- and delivery-mode-specific BP percentile curves using an oscillometric method and serve as a valuable reference for physicians in dealing with the management of singleton, liveborn late preterm and term newborns in the delivery room intensive care.
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Affiliation(s)
- Ozgül Salihoğlu
- Neonatal Intensive Care Unit, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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