Browsing by Author "Sarper, Nazan"

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Hepatosplenic fungal infections in children with leukemia-risk factors and outcome: A multicentric study
(Lippincott Williams & Wilkins, 2019-05-01) Celkan, Tiraje; Kızılocak, Hande; Evim, Melike; Güneş, Adalet Meral; Özbek, Namık Y.; Yaralı, Neşe; Ünal, Ekrem; Patıroğlu, Türkan; Karapınar, Deniz Yılmaz; Sarper, Nazan; Zengin, Emine; Karaman, Serap; Koçak, Ülker; Kürekçi, Emin; Özdemir, Canan; Tuğcu, Deniz; Uysalol, Ezgi; Dikme, Gürcan; Adaletli, İbrahim; Kuruoğlu, Sebuh; Kebudi, Rejin; SEZGİN EVİM, MELİKE; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hematoloji-Onkoloji Bilim Dalı; AAH-1452-2021; JGX-6145-2023
Background: Invasive fungal infections, including hepatosplenic fungal infections (HSFI), cause significant morbidity and mortality in children with leukemia. There are not enough data to support for the best approach to diagnosis of HSFI in children, nor for the best treatment. Procedure: In this multicentric study, we assessed the demographic data, clinical and radiologic features, treatment, and outcome of 40 children with leukemia and HSFI from 12 centers. Results: All cases were radiologically diagnosed with abdominal ultrasound, which was performed at a median of 7 days, of the febrile neutropenic episode. Mucor was identified by histopathology in 1, and Candida was identified in blood cultures in 8 patients. Twenty-two had fungal infection in additional sites, mostly lungs. Nine patients died. Four received a single agent, and 36 a combination of antifungals. Conclusions: Early diagnosis of HSFI is challenging because signs and symptoms are usually nonspecific. In neutropenic children, persistent fever, back pain extending to the shoulder, widespread muscle pain, and increased serum galactomannan levels should alert clinicians. Abdominal imaging, particularly an abdominal ultrasound, which is easy to perform and available even in most resource-limited countries, should be recommended in children with prolonged neutropenic fever, even in the absence of localizing signs and symptoms.
The outcome of children treated with MRC-AML protocols in six referral centres, Turkey
(Wiley, 2008-04) Turkiz, Gürsel; Hazar, V; Sarper, Nazan; Özgen, U; Anak, Sema; Güneş, Adalet Meral; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları; EXD-8400-2022
Thrombolysis with systemic recombinant tissue plasminogen activator in children: A multicenter retrospective study
(Galenos Yayıncılık, 2021-08-18) Zengin, Emine; Sarper, Nazan; Erdem, Arzu Yazal; Al, Işık Odaman; Evim, Melike Sezgin; Yaralı, Neşe; Belen, Burcu; Akçay, Arzu; Yıldırım, Aysen Türedi; Karapınar, Tuba Hilkay; Güneş, Adalet Meral; Gelen, Sema Aylan; Oren, Hale; Olcay, Lale; Baytan, Birol; Gülen, Hüseyin; Öztürk, Gülyüz; Orhan, Mehmet Fatih; Oymak, Yeşim; Akpınar, Sibel; Tüfekci, Özlem; Albayrak, Meryem; Günen, Burçak Tatlı; Canpolat, Aylin; Özbek, Namık; SEZGİN EVİM, MELİKE; MERAL GÜNEŞ, ADALET; Baytan, Birol; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Hematoloji Bilim Dalı.; 0000-0002-4792-269X; 0000-0002-0686-7129; 0000-0002-9375-2855; JGX-6145-2023 ; AAH-1452-2021 ; DVW-8108-2022
Objective: This study aimed to evaluate systemic thrombolysis experiences with recombinant tissue plasminogen activator (rtPA). Materials and Methods: Retrospective data were collected from 13 Turkish pediatric hematology centers. The dose and duration of rtPA treatment, concomitant anticoagulant treatment, complete clot resolution (CCR), partial clot resolution (PCR), and bleeding complications were evaluated. Low-dose (LD) rtPA treatment was defined as 0.01-0.06 mg/kg/h and high-dose (HD) rtPA as 0.1-0.5 mg/kg/h. Results: Between 2005 and 2019, 55 thrombotic episodes of 54 pediatric patients with a median age of 5 years (range: 1 day to 17.75 years) were evaluated. These patients had intracardiac thrombosis (n=16), deep vein thrombosis (DVT) (n=15), non-stroke arterial thrombosis (n=14), pulmonary thromboembolism (PE) (n=6), and stroke (n=4). The duration from thrombus detection to rtPA initiation was a median of 12 h (range: 2-504 h) and it was significantly longer in cases of DVT and PE compared to stroke, non-stroke arterial thrombosis, and intracardiac thrombosis (p=0.024). In 63.6% of the episodes, heparin was initiated before rtPA treatment. LD and HD rtPA were administered in 22 and 33 of the episodes, respectively. Concomitant anticoagulation was used in 90% and 36% of the episodes with LD and HD rtPA, respectively (p=0.0001). Median total duration of LD and HD rtPA infusions was 30 h (range: 2-120 h) and 18 h (2-120 h), respectively (p=0.044). Non-fatal major and minor bleeding rates were 12.5% and 16.7% for LD and 3.2% and 25.8% for HD rtPA, respectively. At the end of the rtPA infusions, CCR and PCR were achieved in 32.7% and 49.0% of the episodes, respectively. The most successful site for thrombolysis was intracardiac thrombosis. HD versus LD rtPA administration was not correlated with CCR/PCR or bleeding (p>0.05). Conclusion: Systemic thrombolytic therapy may save lives and organs effectively if it is used at the right indications and the right times in children with high-risk thrombosis by experienced hematologists with close monitoring of recanalization and bleeding.