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Bozkurt C, Hazar V, Malbora B, Küpesiz A, Aygüneş U, Fışgın T, Karakükçü M, Kuşkonmaz B, Kılıç SÇ, Bayırlı D, Arman Bilir Ö, Yalçın K, Gözmen S, Uygun V, Elli M, Sarbay H, Küpesiz FT, Şaşmaz Hİ, Aksoy BA, Yılmaz E, Okur FV, Tekkeşin F, Yenigürbüz FD, Özek G, Atay AA, Bozkaya İO, Çelen S, Öztürkmen S, Güneş AM, Gürsel O, Güler E, Özcan A, Çetinkaya DU, Aydoğdu S, Özbek NY, Karasu G, Sezgin G, Doğru Ö, Albayrak D, Öztürk G, Aksoylar S, Daloğlu H, Odaman Al I, Evim MS, Akbayram S, Öncül Y, Zengin E, Albayrak C, Timur Ç, Kar YD, Çakmaklı HF, Tüfekçi Ö, Töret E, Antmen B. COVID-19 disease in children and adolescents following allogeneic hematopoietic stem cell transplantation: A report from the Turkish pediatric bone marrow transplantation study group. Pediatr Transplant 2024; 28:e14758. [PMID: 38659218 DOI: 10.1111/petr.14758] [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] [Received: 05/03/2023] [Revised: 02/27/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Data on the risk factors and outcomes for pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. OBJECTIVES The study aimed to analyze the clinical signs, risk factors, and outcomes for ICU admission and mortality in a large pediatric cohort who underwent allogeneic HSCT prior to COVID-19 infection. METHOD In this nationwide study, we retrospectively reviewed the data of 184 pediatric HSCT recipients who had COVID-19 between March 2020 and August 2022. RESULTS The median time from HSCT to COVID-19 infection was 209.0 days (IQR, 111.7-340.8; range, 0-3845 days). The most common clinical manifestation was fever (58.7%). While most patients (78.8%) had asymptomatic/mild disease, the disease severity was moderate in 9.2% and severe and critical in 4.4% and 7.6%, respectively. The overall mortality was 10.9% (n: 20). Deaths were attributable to COVID-19 in nine (4.9%) patients. Multivariate analysis revealed that lower respiratory tract disease (LRTD) (OR, 23.20, p: .001) and lymphopenia at diagnosis (OR, 5.21, p: .006) were risk factors for ICU admission and that HSCT from a mismatched donor (OR, 54.04, p: .028), multisystem inflammatory syndrome in children (MIS-C) (OR, 31.07, p: .003), and LRTD (OR, 10.11, p: .035) were associated with a higher risk for COVID-19-related mortality. CONCLUSION While COVID-19 is mostly asymptomatic or mild in pediatric transplant recipients, it can cause ICU admission in those with LRTD or lymphopenia at diagnosis and may be more fatal in those who are transplanted from a mismatched donor and those who develop MIS-C or LRTD.
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Affiliation(s)
- Ceyhun Bozkurt
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Istinye University School of Medicine, Bahçelievler Medicalpark Hospital, Istanbul, Turkey
| | - Volkan Hazar
- Department of Pediatric Hematology-Oncology, Memorial Health Group, Medstar Yıldız Hospital, Antalya, Turkey
| | - Barış Malbora
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Utku Aygüneş
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
| | - Tunç Fışgın
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Bahçelievler Medicalpark Hospital, Altınbaş University School of Medicine, Istanbul, Turkey
| | - Musa Karakükçü
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Barış Kuşkonmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Suar Çakı Kılıç
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Derya Bayırlı
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Özlem Arman Bilir
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Koray Yalçın
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Salih Gözmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Behçet Uz Training and Research Hospital, Izmir, Turkey
| | - Vedat Uygun
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Murat Elli
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medipol University School of Medicine, Istanbul, Turkey
| | - Hakan Sarbay
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Funda Tayfun Küpesiz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Hatice İlgen Şaşmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
| | - Başak Adaklı Aksoy
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Bahçelievler Medicalpark Hospital, Altınbaş University School of Medicine, Istanbul, Turkey
| | - Ebru Yılmaz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Fatma Visal Okur
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Funda Tekkeşin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Demir Yenigürbüz
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Gülcihan Özek
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ege University School of Medicine, İzmir, Turkey
| | - Abdullah Avni Atay
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Suna Çelen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Seda Öztürkmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Adalet Meral Güneş
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Uludağ University School of Medicine, Bursa, Turkey
| | - Orhan Gürsel
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Elif Güler
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Alper Özcan
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Erciyes University School of Medicine, Kayseri, Turkey
| | - Duygu Uçkan Çetinkaya
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Selime Aydoğdu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Gülsün Karasu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Gülay Sezgin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Çukurova University School of Medicine, Adana, Turkey
| | - Ömer Doğru
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Marmara University School of Medicine, Istanbul, Turkey
| | - Davut Albayrak
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Samsun Hospital, Samsun, Turkey
| | - Gülyüz Öztürk
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Serap Aksoylar
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ege University School of Medicine, İzmir, Turkey
| | - Hayriye Daloğlu
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medical Park Antalya Hospital, Antalya, Turkey
| | - Işık Odaman Al
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Medipol University School of Medicine, Istanbul, Turkey
| | - Melike Sezgin Evim
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Uludağ University School of Medicine, Bursa, Turkey
| | - Sinan Akbayram
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Yurday Öncül
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Inönü University School of Medicine, Malatya, Turkey
| | - Emine Zengin
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Canan Albayrak
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Çetin Timur
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Yeter Düzenli Kar
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Afyon Health Sciences University School of Medicine, Afyonkarahisar, Turkey
| | - Hasan Fatih Çakmaklı
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Tüfekçi
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ersin Töret
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Bülent Antmen
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, Acıbadem Adana Hospital, Adana, Turkey
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Kar YD, Özdemir ZC, Bör Ö. Thiol / disulfide balance and oxidative stress parameters in pediatric patients diagnosed with acute and chronic idiopathic thrombocytopenic purpura. Turk J Pediatr 2022; 63:962-969. [PMID: 35023645 DOI: 10.24953/turkjped.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Changes in oxidative stress and thiol / disulfide balance are thought to play a role in the pathogenesis of idiopathic thrombocytopenic purpura (ITP). Our study investigates total oxidant level (TOS), total antioxidant level (TAS), oxidative stress index (OSI) levels and thiol / disulfide balance in pediatric patients with acute and chronic ITP. METHODS Thirty four patients with acute ITP, eighteen patients with chronic ITP and thirty three healthy children (control) were included. TOS, TAS, OSI, thiol / disulfide balance were analyzed. RESULTS In acute ITP, TAS levels were lower than chronic ITP and control, TOS and OSI levels were higher than control, and native thiol level was lower than chronic ITP (p < 0.05). In acute ITP; disulfide level, disulfide / native thiol and disulfide / total thiol ratios were higher than chronic ITP and control, and native thiol / total thiol ratio was lower than chronic ITP and control group (p = 0.038, p = 0.018, respectively). TOS and OSI levels of the chronic ITP were higher than the control group (p < 0.05). CONCLUSIONS The results of this study have shown that oxidative stress increases in children with acute ITP and chronic ITP, that thiol / disulfide balance is disrupted in favor of disulfide in acute ITP, and that thiol / disulfide balance isn`t disrupted in chronic ITP patients whose platelet count is close to normal and who don`t require treatment.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology, Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar
| | - Zeynep Canan Özdemir
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Kar YD, Özdemir ZC, Çarman KB, Yarar C, Tekin N, Bör Ö. Cerebral sinovenous thrombosis in children: clinical presentation, locations, and acquired and inherited prothrombotic risk factors. Turk J Pediatr 2022; 63:1028-1037. [PMID: 35023653 DOI: 10.24953/turkjped.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cerebral sinovenous thrombosis (CSVT) in children is a rare and life-threatening cerebrovascular disease. Hence, we evaluated its clinical presentations, inherited and acquired prothrombotic risk factors along with the accompanying diseases, the thrombosis locations as well as the outcomes of anticoagulant therapy in children with CSVT. METHODS The medical records of pediatric CSVT patients treated between January 2011 and September 2018 were analyzed retrospectively. RESULTS The study included 29 children, 15 boys (51.7%) and 14 girls (48.3%), with the median age being 11 years (range:3 days-17 years). The most commonly presented complaint in neonates was seizures and in the non-neonatal age groups was a headache. Also, at least one acquired and/or inherited thrombophilic risk factor was identified in 89.7% of the patients. The most commonly acquired prothrombotic risk factors along with the accompanying diseases included infections, central venous catheter, and dehydration, while the most commonly inherited thrombophilic risk factors included heterozygous factor-V Leiden mutation and elevated lipoprotein (a). The most common thrombosis location was found to be the transverse sinus. Also, none of the patients died due to the thrombotic episode. Complications included epilepsy in five patients, hydrocephalus in one patient, and intracranial hypertension in another patient. CONCLUSIONS Clinicians need to be well aware of the inherited and acquired prothrombotic risk factors in CSVT. It should also be kept in mind that at-risk patients may also present with nonspecific signs and symptoms with no apparent neurological manifestation. The risk of acute complications and long-term sequelae can be substantially reduced if diagnosed early and initiated with appropriate treatment at the early stages.
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Affiliation(s)
| | - Zeynep Canan Özdemir
- Divisions of Pediatric Hematology and Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Kürşat Bora Çarman
- Divisions of Pediatric Neurology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Coşkun Yarar
- Divisions of Pediatric Neurology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Neslihan Tekin
- Divisions of Neonatology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Divisions of Pediatric Hematology and Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Özdemir ZC, Çolak E, Kar YD, Özen H, Bör Ö. Relationship between oxidant-antioxidant status and hypercoagulobility indices in children with iron deficiency anaemia. Blood Coagul Fibrinolysis 2021; 32:451-457. [PMID: 34148983 DOI: 10.1097/mbc.0000000000001060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/26/2022]
Abstract
Oxidative stress is a potential mechanism involved in the pathogenesis of iron deficiency anaemia (IDA). Although a tendency for hypercoagulability has been reported in IDA, its underlying mechanism is yet to be elucidated. This study investigated the probable relationship between oxidative stress and hypercoagulability in children with IDA. This study included 57 children diagnosed with IDA (IDA group) between October 2016 and October 2017 in addition to 48 healthy children (control group). The maximum clot firmness (MCF) index, and clot formation time (CFT) index, which are indicators of hypercoagulability in rotational thromboelastometry assays [intrinsic TEM (INTEM) and extrinsic TEM (EXTEM)] derived from our previous study, were recorded. Total oxidant status (TOS), total antioxidant capacity (TAC) and oxidative stress index (OSI) were analysed from serum samples of the individuals. In IDA group, OSI and TOS levels were higher and TAC level was lower compared to the control group (P < 0.001, for all). The EXTEM and INTEM MCF in the IDA group was higher than in the control group, while the INTEM CFT was lower than in the control group (P < 0.001, P < 0.001, P < 0.05, published data).TOS and OSI had a negative correlation with INTEM CFT (r:-0.361, P < 0.001 and r:-0.333, P = 0.001) and a positive correlation with INTEM MCF (r:+0.420, P < 0.001 and r:+0.367, P < 0.001) and EXTEM MCF (r:+0.476, P < 0.001 and r:+0.403, P < 0.001). However, TAC demonstrated no correlation with CFT and MCF index. The oxidant-antioxidant balance is disrupted in favour of oxidative stress in children with IDA. In addition, TOS and OSI, which are parameters of oxidative stress, are correlated with CFT and MCF indices. Oxidative stress appears to be an important factor for the development of tendency to hypercoagulability in IDA.
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Affiliation(s)
| | | | | | - Hülya Özen
- Department of Biostatistics, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology, Department of Pediatrics
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Özdemir ZC, Düzenli Kar Y, Bör Ö. Whole Blood miR-210, miR-122, miR-223 Expression Levels and Their Relationship With Iron Status Parameters and Hypercoagulability Indices in Children With Iron Deficiency Anemia. J Pediatr Hematol Oncol 2021; 43:e328-e335. [PMID: 33710119 DOI: 10.1097/mph.0000000000002127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/24/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022]
Abstract
MicroRNAs have the potential to regulate systemic and cellular iron homeostasis at multiple points. In iron deficiency anemia (IDA), hypoxia, platelet reactivity, and potentially microRNAs play a role in the development of hypercoagulability. A total of 57 children diagnosed with IDA between October 2016 and October 2017 and 48 healthy children were included in this cross-sectional study. Blood count parameters, serum iron, transferrin saturation, ferritin level, maximum clot firmness (MCF), and clot formation time index, which are indicators of hypercoagulability in rotational thromboelastometry test, of the IDA and control groups obtained in our previous study were recorded. miR-210, miR-122, and miR-223 levels were analyzed. There was no difference in the miR-210, miR-122, and miR-223 levels between the IDA and control groups. Patients with hemoglobin (Hb) <8 g/dL had higher miR-210 levels than patients with Hb>8 g/dL (P<0.05). There was a negative correlation between miR-210 and Hb and ferritin levels, a positive correlation between miR-122 and ferritin levels, and a negative correlation between miR-223 and MCF index. In IDA, there is a close relationship between the severity of anemia and miR-210, and miR-210 expression is slightly increased in those with severe anemia. miR-210 and miR-122 collectively play a role in maintaining the iron balance. The correlation between miR-223, a platelet function regulator, and the MCF index, suggested that miR-223 has a role in the development of hypercoagulability in IDA.
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Affiliation(s)
- Zeynep C Özdemir
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Özdemir ZC, Çakıl Sağlık A, Düzenli Kar Y, Köşger P, Arık D, Tekin AN, Bör Ö. A Case of Congenital Hepatoblastoma Coexisting with Pulmonary Hypertension. Arch Iran Med 2020; 23:621-623. [PMID: 32979909 DOI: 10.34172/aim.2020.73] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/16/2019] [Indexed: 11/09/2022]
Abstract
Hepatoblastoma (HBL) is the most frequently detected malignant tumor of the liver in childhood. HBLs detected antenatally or up to 3 months after birth are considered congenital HBLs. We report a five-day-old female infant in whom a hepatic mass was detected at 20 weeks' gestation. At birth (36 weeks), the hepatic mass measured 12x6 cm, and she had respiratory distress. Pulmonary hypertension (PHT) was detected on echocardiographic evaluation. Despite dual medical therapy, her PHT did not improve. Histologically, the biopsy demonstrated a mixed epithelial-mesenchymal HBL with predominance of fetal morphology in the epithelial component. Chemotherapy was initiated on postnatal day 15; however, the baby died of respiratory failure on postnatal day 23. Conclusion: HBL is an embryonal tumor which can develop early in the intrauterine period. Although the mechanism is not known, it may cause PHT which would affect the prognosis negatively.
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Affiliation(s)
- Zeynep Canan Özdemir
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Adviye Çakıl Sağlık
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Yeter Düzenli Kar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Pelin Köşger
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Deniz Arık
- Department of Pathology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Ayşe Neslihan Tekin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Düzenli Kar Y, Akın F, Sert A, Arslan Ş. Pulmonary Hypertension in Children with Lower Respiratory Tract Infections in the Konya Province of Turkey. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0039-3401984] [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: 10/25/2022]
Abstract
Abstract
Objective Lower respiratory tract infections (LRTI) are one of the most important causes of morbidity and mortality in childhood. Hypoxemia, pulmonary hypertension (PH) due to pulmonary vasoconstriction, and heart failure due to various causes are the most important risk factors for mortality in LRTI. The aim of this study was to investigate characteristics of the patients with LRTI and the frequency of PH that developed secondary to LRTI.
Materials and Methods The study included 70 patients who were diagnosed as having LRTI clinically and radiologically between January 2012 and March 2013 at Department of Pediatrics, Konya Training and Research Hospital. Age, sex, risk factors for LRTI, symptoms and physical examination findings, laboratory tests, and Doppler echocardiography findings of the patients were retrospectively reviewed.
Results Of the patients, 44 (62.9%) were male and 26 (37.1%) were female. Thirty-seven (52.9%) patients were younger than 1 year, and the mean age was 2.5 ± 3.11 years. The most common symptoms of the patients were cough and fever. Rhonchus, retraction, and crackles were found to be the most common findings in physical examinations. Heart failure was found in 10% of patients and PH was detected in 8.6% through Doppler echocardiography. Development of heart failure and the presence of bilateral patch infiltration on posteroanterior chest X-rays were significantly more frequent in patients with PH. Some 42.9% of patients had at least one viral agent in their nasopharyngeal swabs. The most common viral agents were respiratory syncytial virus and rhinoviruses.
Conclusion PH may develop during the course of LRTI in children. Given that the development of PH can cause life-threatening complications such as heart failure, affected patients should be kept under close follow-up. It should be remembered that PH is more likely to develop in patients with bilateral patch infiltration on chest X-ray.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
- Department of Pediatrics, Konya Training and Research Hospital, Konya, Turkey
| | - Fatih Akın
- Department of Pediatrics, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Sert
- Division of Pediatric Cardiology, Department of Pediatrics, Selçuk University Medical School, Konya, Turkey
| | - Şükrü Arslan
- Division of Pediatric Rheumatology, Department of Pediatrics, Selçuk University Medical School, Konya, Turkey
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Düzenli Kar Y, Özdemir ZC, Acu B, Bör Ö. Infantile hemangioma: Efficacy of low-dose propranolol and of intralesional bleomycin injection for propranolol non-response. Pediatr Int 2019; 61:459-464. [PMID: 30861274 DOI: 10.1111/ped.13830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/16/2018] [Revised: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile hemangioma (IH) is the most common form of benign childhood vascular tumor. Most resolve spontaneously, but treatment is recommended in patients who develop complication. Propranolol is recommended as the first-line therapy, while the treatment in the case of non-response to first-line therapy depends on the clinical experiences of each center. The aim of this study was to investigate the efficacy of low-dose propranolol in the treatment of IH, and the outcomes of percutaneous intralesional bleomycin injection (IBI) in patients unresponsive to propranolol. METHODS Medical records of 104 children diagnosed with IH between June 2014 and June 2017 were reviewed retrospectively. RESULTS Median patient age was 6 months (range, 3-12 months). Forty-five patients (43.3%) received therapy: 18 (40%) for cosmetic problems and 27 (60%) for lesion-related complications. The most common complications were hemorrhage (15.6%) and impairment in visual function (15.6%). All of the patients received propranolol 1 mg/kg/day as the first-line therapy. Response to treatment was excellent in 35 patients, good in four and poor in one, while five patients did not respond to therapy. The five unresponsive patients received percutaneous IBI at 0.3-0.5 mg/kg/dose as second-line therapy. The response to treatment was excellent in four patients, good in one. CONCLUSIONS The majority of IH resolved spontaneously. In the patients who required treatment, low-dose propranolol was successful in most, and IBI was effective and safe in the remaining five patients who did not respond to propranolol.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Berat Acu
- Division of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Düzenli Kar Y, Özdemir ZC, Kiral E, Kiliç Yildirim G, Dinleyici EÇ, Bör Ö. Hemophagocytic Lymphohystiocytosis Associated With Type Ia Glycogen Storage Disease. J Pediatr Hematol Oncol 2019; 41:e260-e262. [PMID: 29750741 DOI: 10.1097/mph.0000000000001208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemophagocytic lymphohystiocytosis (HLH) is characterized by fever, splenomegaly, pancytopenia, and elevated levels of triglycerides and ferritin. These signs and symptoms are common to other metabolic diseases. OBSERVATION A 5-month-old female infant, who presented with fever, respiratory distress, massive hepatomegaly, and bicytopenia, was diagnosed as having HLH and chemotherapy was initiated. The patient was negative for familial HLH gene mutations. Respiratory distress and laboratory findings improved rapidly after starting chemotherapy. However, there was no improvement in the massive hepatomegaly and she experienced hypoglycemic episodes. In addition, her family history included a cousin with glycogen storage disease (GSD). On the basis of the findings, the patient was diagnosed as having type Ia GSD. There are no previous reports of HLH secondary to GSD type Ia in the literature. CONCLUSIONS Congenital metabolic diseases should be considered in the differential diagnosis of children with HLH.
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Affiliation(s)
| | | | - Eylem Kiral
- Department of Pediatric Intensive Care Unit, Eskişehir Osmangazi University Faculty of Medicine
| | | | - Ener Ç Dinleyici
- Department of Pediatric Intensive Care Unit, Eskişehir Osmangazi University Faculty of Medicine
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology
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10
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Özdemir ZC, Düzenli Kar Y, Gündüz E, Turhan AB, Bör Ö. Evaluation of hypercoagulability with rotational thromboelastometry in children with iron deficiency anemia. Hematology 2018; 23:664-668. [DOI: 10.1080/10245332.2018.1452456] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Zeynep Canan Özdemir
- Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| | - Yeter Düzenli Kar
- Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| | - Eren Gündüz
- Department of Hematology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
| | - Ayşe Bozkurt Turhan
- Department of Pediatric Hematology/Oncology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Özcan Bör
- Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Ekişehir, Turkey
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11
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Özdemir ZC, Düzenli Kar Y, Demiral M, Sırmagül B, Bör Ö, Kırel B. The Frequency of Metabolic Syndrome and Serum Osteopontin Levels in Survivors of Childhood Acute Lymphoblastic Leukemia. J Adolesc Young Adult Oncol 2018; 7:480-487. [PMID: 29641359 DOI: 10.1089/jayao.2017.0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Metabolic syndrome (MetS) and obesity have increasingly been reported in survivors of childhood cancer. Osteopontin (OPN) is primarily synthesized in adipose tissue and is thought to have a role in obesity and the development of insulin resistance (IR). The aim of this study was to investigate the frequency of MetS in survivors of acute lymphoblastic leukemia (ALL) and to establish the relationship between serum OPN levels and anthropometric measurements and glucose metabolism. METHODS A total 50 survivors of ALL (median age: 10.5 years; post-treatment interval 4.54 ± 2.48 years), and 20 healthy children (median age: 11 years) were included in the study. Anthropometric measurements were taken, and serum glucose, insulin, homeostasis model assessment and IR index (HOMA-IR index), lipoprotein, thyroid hormone levels, and OPN levels were measured. RESULTS Twenty-one (42%) survivors were overweight/obese, 2 (5.1%) survivors had MetS, 7 (14%) survivors had IR, and 19 (38%) survivors had dyslipidemia. Fasting insulin levels and HOMA-IR of the overweight/obese survivors were significantly higher than those of the normal-weight survivors (p < 0.05 and p < 0.01) and control group (p < 0.01 and p < 0.01). The serum OPN level was significantly lower in the overweight/obese survivor than in the normal-weight survivor and control group (37.42 ng/mL [range, 27.32-62.07], 69.02 ng/mL [range, 40.29-88.21], and 85.7 ng/mL [range 67.7-102.3]; p < 0.01, p < 0.001, respectively). Serum OPN levels were inversely correlated with anthropometric measurements and HOMA-IR index in all the subjects. CONCLUSION Our results showed that obesity and IR are associated with decreased serum OPN levels in childhood survivors of ALL.
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Affiliation(s)
- Zeynep Canan Özdemir
- 1 Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University , Ekişehir, Turkey
| | - Yeter Düzenli Kar
- 1 Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University , Ekişehir, Turkey
| | - Meliha Demiral
- 2 Department of Pediatric Endocrinology, Eskişehir Osmangazi University , Ekişehir, Turkey
| | - Başar Sırmagül
- 3 Department of Pharmacology, Faculty of Medicine, Eskişehir Osmangazi University , Ekişehir, Turkey
| | - Özcan Bör
- 1 Department of Pediatric Hematology/Oncology, Eskişehir Osmangazi University , Ekişehir, Turkey
| | - Birgül Kırel
- 2 Department of Pediatric Endocrinology, Eskişehir Osmangazi University , Ekişehir, Turkey
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12
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Kar YD, Özdemir ZC, Bör Ö. Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients. Turk Arch Pediatr 2017; 52:213-220. [PMID: 29483801 DOI: 10.5152/turkpediatriars.2017.5312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/23/2017] [Indexed: 12/23/2022]
Abstract
Aim Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The objective of this study was to evaluate febrile neutropenic episodes in children with malignancy. Material and Methods Sixty-eight children who received chemotherapy for malignancy between 2010 and 2015 were retrospectively reviewed. The demographic characteristics, laboratory data, infection foci, and frequency of microorganisms grown in culture were examined. Also, the frequency of febrile neutropenic attacks was investigated according to the chemotherapy periods. Results Of the total 200 episodes, 81 (40.5%) were clinically documented, and 73 (36.5%) were microbiologically documented infections. Fever of unknown origin was observed in 46 (23%) episodes. The most frequently clinically documented focus were mucositis (33.4%) and pneumonia (24.7%). Blood culture was positive in 55 (75.3%) episodes of microbiologically documented infections. The most commonly isolated microorganisms in blood culture were Gram-negative bacteria (47.2%). C-reactive protein levels in microbiologically documented infections were higher than in clinically documented infections, and fever of unknown origin (p<0.05, for both). The most common underlying malignancy was acute lymphoblastic leukemia (73.5%). The highest proportions (34.6%) of febrile neutropenic episodes were observed during the reinduction period for these children. Nine (13.2%) children died of neutropenic sepsis. Conclusions Febrile neutropenia continues to be an important cause of mortality in pediatric patients with malignancy. C-reactive protein levels may be an indicator for predicting bacterial infection in children with febrile neutropenia without apparent focus. The most frequently isolated agents in our center were Gram-negative microorganisms. Determining the microbial flora of each center may be beneficial to improving survival rates.
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Affiliation(s)
- Yeter Düzenli Kar
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Eskişehir, Turkey
| | - Özcan Bör
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Eskişehir, Turkey
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Özdemir ZC, Bozkurt Turhan A, Düzenli Kar Y, Dinleyici ÇE, Bör Ö. Fatal course of Saprochaete capitata fungemia in children with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2017; 34:66-72. [PMID: 28574735 DOI: 10.1080/08880018.2017.1316808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Saprochaete capitata (S. capitata) is a very rare fungal pathogen that causes disseminated opportunistic infections in patients with hematologic malignancies. Fever resistant to broad-spectrum antibiotic and antifungal treatment is common in the presence of fungemia during the period of profound neutropenia. We describe three cases of leukemic children who died from S. capitata fungemia following a first febrile neutropenic episode after the induction of chemotherapy. S. capitata fungemia is an emergent infection associated with high mortality and low susceptibility to fluconazole and echinocandins. Awareness of this emergent infection is needed to ensure that it can be properly treated.
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Affiliation(s)
- Zeynep Canan Özdemir
- a Division of Pediatric Hematology/Oncology, Faculty of Medicine , Eskişehir Osmangazi University , Eskişehir , Turkey
| | - Ayşe Bozkurt Turhan
- b Divison of Pediatric Hematology/Oncology , İstanbul Medeniyet University Göztepe Traininig and Research Hospital , İstanbul , Turkey
| | - Yeter Düzenli Kar
- a Division of Pediatric Hematology/Oncology, Faculty of Medicine , Eskişehir Osmangazi University , Eskişehir , Turkey
| | - Çağrı Ener Dinleyici
- c Division of Pediatric Intensive Care Unit, Faculty of Medicine , Eskişehir Osmangazi University , Eskişehir , Turkey
| | - Özcan Bör
- d Department of Pediatrics, Faculty of Medicine , Eskişehir Osmangazi University , Eskişehir , Turkey
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Özdemir ZC, Düzenli Kar Y, Şöhret NC, Kebapçı M, Bör Ö. Beta blocker and steroid therapy in the treatment of infantile hepatic hemangioendothelioma. Drug Discov Ther 2017; 11:161-164. [DOI: 10.5582/ddt.2017.01025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Zeynep Canan Özdemir
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine
| | - Yeter Düzenli Kar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine
| | | | - Mahmut Kebapçı
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University Faculty of Medicine
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Özdemir ZC, Bozkurt Turhan A, Düzenli Kar Y, Bör Ö. The frequency of hepatotoxicity and myelotoxicity in leukemic children with different high doses of methotrexate. Int J Pediatr Adolesc Med 2016; 3:162-168. [PMID: 30805487 PMCID: PMC6372565 DOI: 10.1016/j.ijpam.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/02/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 11/16/2022]
Abstract
Background and objectives Methotrexate (MTX) is a chemotherapeutic agent that functions as a folic acid antagonist. The frequency of high dose methotrexate (HDMTX)-associated toxicity is variable. In this study, we investigated the frequency of myelotoxicity and hepatotoxicity 7 days after HDMTX infusion. Patients and methods This study included children diagnosed with acute lymphoblastic leukemia (ALL) between January 2010 and April 2015. The patient blood counts and biochemical parameters measured before and after 7 days of HDMTX infusion were retrospectively recorded. We assessed HDMTX infusions for 48 children. The number of patients and drug doses included the following: 17 children receiving 1 g/m2 (68 infusions), 14 children receiving 2 g/m2 (56 infusions), and 17 children receiving 5 g/m2 (68 infusions). The classification of toxicity was made based on the Common Terminology Criteria for Adverse Events (CTCAE) 2010 criteria. Myelotoxicity was defined as a hemoglobin level <10 g/L and absolute neutrophil count <1 × 109/L or platelet count <75 × 109/L. The presence of transaminase levels ≥5 times the upper limit was considered to be hepatotoxicity grade ≥3. The MTX levels at 42 h in patients with and without toxicity were compared to evaluate the correlation between MTX levels, hematologic parameters, and transaminase levels. Results Myelotoxicity was observed in 35.2%, 37.5%, and 33.8% of the infusions, and hepatotoxicity grade ≥3 was detected in 13.2%, 12.5%, and 11.7% of the infusions in patients receiving 1, 2 and 5 g/m2 HDMTX after 7 days, respectively. There was no statistically significant difference between MTX levels at 42 h in patients with and without toxicity (P > .05, for all). There was no correlation between hematologic parameters and transaminase levels and MTX levels at 42 h. Conclusion Hematologic toxicity was the most common toxicity observed. The data indicate the hematologic toxicity increased after repeated cycles in patients receiving 5 g/m2. However, the hepatic toxicity decreased with additional cycles. Our results show the level of MTX at 42 h is not effective to identify toxicity.
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Affiliation(s)
- Zeynep Canan Özdemir
- Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Meşelik Kampüsü, 26480, Eskişehir, Turkey
| | - Ayşe Bozkurt Turhan
- Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Meşelik Kampüsü, 26480, Eskişehir, Turkey
| | - Yeter Düzenli Kar
- Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Meşelik Kampüsü, 26480, Eskişehir, Turkey
| | - Özcan Bör
- Pediatric Hematology/Oncology, Eskişehir Osmangazi University Faculty of Medicine, Meşelik Kampüsü, 26480, Eskişehir, Turkey
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Akin F, Aygun S, Gormus N, Kar YD, Susam HT, Ozel A. A case of May-Thurner syndrome with inconsistent radiological and surgical findings: case report. Cardiovasc J Afr 2015; 26:e3-5. [DOI: 10.5830/cvja-2015-013] [Citation(s) in RCA: 2] [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] [Received: 06/18/2013] [Accepted: 01/27/2015] [Indexed: 11/06/2022] Open
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