Person: MERAL GÜNEŞ, ADALET
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MERAL GÜNEŞ
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ADALET
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Publication Characteristics, treatment and outcome of 15 to 18 years-old adolescents with Chronic Myeloid Leukemia (CML): The experience of the International Registry of Childhood CML (I-CML-Ped Study)(American Society of Hematology, 2021-11-23) Froment, Morgane; Suttorp, Meinolf; Ragot, Stephanie; Deutsch, Helene; Goyeau, Violaine; De Moerloose, Barbara; Brandalise, Silvia Regina; Borisevich, Marina; Sedlacek, Petr; Gunes, Adalet Meral; Lausen, Birgitte; Molines Honrubia, Antonio; Jakovljevic, Gordana; Versluys, Birgitta; Kalwak, Krzysztof; Hraskova, Andrea; Millot, Frederic; MERAL GÜNEŞ, ADALET; Uludağ Üniversitesi/Tıp Fakültesi; EXD-8400-2022Publication Hepatitis-associated aplastic anemia: Etiology, clinical characteristics and outcome(Lippincott Williams & Wilkins, 2022-01-01) Tüfekçi, Özlem; Özdemir, Hamiyet H.; Malbora, Barış; Özbek, Namık Y.; Yaralı, Neşe; Erdem, Arzu; Evim, Melike; Baytan, Birol; Güneş, Adalet M.; Karapınar, Tuba; Oymak, Yeşim; Toret, Ersin; Bor, Özcan; Yılmaz, Sebnem; Oren, Hale; Özdemir, Gül N.; Karapınar, Deniz Y.; SEZGİN EVİM, MELİKE; Baytan, Birol; MERAL GÜNEŞ, ADALET; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Hematoloji Bölümü; AAH-1452-2021; DVW-8108-2022; JGX-6145-2023Hepatitis-associated aplastic anemia (HAA) is a form of acquired aplastic anemia (AA) in which bone marrow failure develops after an acute attack of hepatitis. Bone marrow failure leading to AA is generally severe in cases of HAA and fatal if left untreated. This retrospective multicenter study investigated clinical and laboratory characteristics, possible causes, treatment, and outcome of HAA in children. Twenty patients from 8 centers were included in the study. Aspartate aminotransferase and alanine aminotransferase were <3 to 5xupper limit of normal (ULN) in 2 patients, <5 to 10xULN in 2 patients, and >10xULN in 16 patients. Acute liver failure developed in 5 (29%) patients. Pancytopenia was simultaneously present in 6 of 20 (30%) patients. Eleven of the 20 patients (55%) were alive, in remission and transfusion free. Those who were alive either had undergone hematopoietic stem cell transplantation and/or immunosuppressive treatment, except 1 patient who had received no treatment. Patients with the diagnosis of acute hepatitis should be evaluated and followed up carefully for presence of cytopenia, so that definitive treatment of AA can be initiated in a timely and appropriate manner when needed.Publication Treatment of severe bleeding and prophylaxis with rFVIIA in a child with FVIII inhibitor(Wiley, 2015-06-01) Güneş, Adalet Meral; Evim, Melike Sezgin; Baytan, Birol; MERAL GÜNEŞ, ADALET; SEZGİN EVİM, MELİKE; Baytan, Birol; Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Hematoloji Bölümü; 0000-0002-9375-2855; AAH-1452-2021; EXD-8400-2022; DVW-8108-2022Publication Evaluation of micafungin use in children(Ankara Microbiology, 2020-01-01) Hacimustafaoglu, Mustafa; Yeşil, Edanur; YEŞİL, EDANUR; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Sezgin Evim, Melike; SEZGİN EVİM, MELİKE; Özer, Arife; Turan, Cansu; TURAN, CANSU; Timur, Demet; TİMUR, DEMET; Çakır, Salih Cağrı; ÇAKIR, SALİH ÇAĞRI; Bülbül, Beyhan; BÜLBÜL, BEYHAN; Ener, Beyza; ENER, BEYZA; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Koksal, Nilgun; Özkan, Hilal; ÖZKAN, HİLAL; Sevinir, Betul; SEVİNİR, BETÜL BERRİN; Düzcan Kilimci, Duygu; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Onkoloji Anabilim Dalı.; 0000-0002-8926-9959; 0000-0003-3146-6391; 0000-0001-5761-4757; 0000-0002-5720-1212; 0000-0002-3232-7652; 0000-0003-4646-660X; AAG-8523-2021; AEZ-2469-2022; GSO-3630-2022; AAH-1570-2021; HJZ-4508-2023; AAE-6201-2021; AAG-8393-2021; JCD-9679-2023Micafungin is recommended especially in patients with liver and kidney failure and in the presence of other side effects due to antifungals apart from its known priority indications such as invasive candidiasis. The aim of this study was to evaluate the children who have received micafungin treatment. In the study, 125 children who were hospitalized in the pediatric wards and intensive care units of our hospital and had used micafungin between November 2016 and January 2019 were analyzed retrospectively. Clinical data, micafungin indication, blood values on the first and fourth days of the treatment, side effects of the drug and efficacy were evaluated. Sixty percent (75/125) of the patients were male and the mean age of all the patients were 58 +/- 67 (0-215, 30) months. Approximately half of the cases (48%) had malignancy and 13% of them were premature. Sixty-two percent (n= 37) of the malignencies were hematological (27 acute lymphocytic leukemia, nine acute myeloid leukemia, one myelodysplastic syndrome) and 38% (n= 23) were oncological (six neuroblastoma, four Hodgkin lymphoma, two Non-Hodgkin's lymphoma, five sarcomas, one hepatoblastoma, five others) malignencies. The major cause of hospitalization was sepsis (53%). The patients had several risk factors like immunosuppressive therapy (n= 68, 54%), neutropenia (n= 61, 49%), central venous catheter (n= 102, 82%), nasogastric tube (n= 63, 50%), endotracheal intubation tube (n= 49, 39%), urinary catheter (n= 14, 11%) and total parenteral nutrition (n= 81, 65%). Thirteen percent (n= 16) of the cases were post-operative patients. Candida species were cultivated in 97 clinical specimens (blood, endotracheal aspirate, sputum, urine, etc.) among 23 (18%) of the patients. Thirteen (10%) of the patients had candidemia and 62% of them were non-albicans strains. In all candidemias, strains were echinocandin susceptible, and blood cultures were negative within four days. When all the patients (n= 125) were evaluated, a significant decrease in C-reactive protein, an increase in sodium, and a decrease in alanine aminotransferase were observed on the fourth day of micafungin treatment (p< 0.05). A total of 39 (31%) patients underwent various antifungal treatments for median seven (1-60) days prior to micafungin treatment. Fourteen (36%) of these 39 patients, had elevated liver function tests (LFT), 10 (26%) of them had hypokalemia, and five (13%) of them had elevated renal function tests. Ten (26%) patients had antifungal-induced hypokalemia previously; and potassium levels were normalized after micafungin treatment (p= 0.0001). The patients for which micafungin treatment was chosen due to elevated liver function tests (n= 47, 38%), whether the antifungalinduced or not; alanine aminotransferase and aspartate aminotransferase levels were decreased after micafungin treatment (p= 0.0001 and p= 0.0001, respectively). Nineteen (15%) of the patients have died within the first 30 days of micafungin treatment and one of them had candidemia. No micafungin treatment related significant side effects were observed in any of the patients. Our study showed that micafungin could be a safe and effective option in pediatric cases including newborns with high liver and kidney function tests.Publication Incidence and management of thromboembolism in patients with acute leukemia(Springer India, 2023-03-29) Temuroğlu, Aytuel; Güler, Salih; GÜLER, SALİH; Evim, Melike Sezgin; SEZGİN EVİM, MELİKE; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Hemotoloji Anabilim Dalı.Thromboembolic events (TE) in childhood are relatively rare but, serious complications of acute leukemia. The aim was to define the incidence and risk factors of thrombosis in children with leukemias. The electronic files of pediatric denovo/relapsed acute leukemia patients aged below 18 years, treated between 2011 and 2021 were retrospectively evaluated for thrombotic attacks. Thirty out of 469 patients developed 35 thrombotic events. The median age at the time of the TE was 11.8 (2-17.6) years, and the median time from diagnosis to TE was 9 (0-58) months. The frequency of TE was found at 7.4% ( n = 35/469). When catheter related (n = 13) events, superficial venous events (n = 10), and arterial central nervous system thrombosis (n = 1) were excluded, the frequency of TE was decreased to 2.3% (n = 11/469). Children older than 10 years old (13.8%; n = 21/152) had significantly higher thromboembolic events than the others (4.4%; n = 14/317) (p = 0.03). The majority of attacks were symptomatic 66% (n = 23/35). The most common complaints were local pain, swelling, and redness 52% (n = 12/23). The majority of attacks in patients with relapsed (75%; 6/8) and newly diagnosed acute lymphoblastic leukemia (40%; 10/25%) developed during the induction phase. Thrombosis recurred in 13.3% (n = 4/30) of cases more than once. Thrombotic attacks were successfully treated with low molecular weight heparin 60% (n = 21/35), and recombinant tissue plasminogen activator 17% (n = 6/35). None of the children were lost due to thrombosis. Thrombosis is an important complication during acute leukemia treatment.Successful results are obtained with early diagnosis and treatment attempts by creating awareness.Publication Treatment of infective endocarditis with recombinant tissue plasminogen activator(Wiley-liss, 2008-01-01) Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Baytan, Birol; Semizel, Evren; Bostan, Özlem Mehtap; BOSTAN, ÖZLEM MEHTAP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/ Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0001-7707-2174; 0000-0002-9375-2855; AAG-8558-2021Infective endocarditis (IE) caused by microbial infection is virtually always fatal if untreated. High-dose and long-term antibiotic treatment is required to eradicate microorganisms. If increased risk of embolic events, persistent infection, and progressive cardiac failure are present, surgery is indicated. However, surgery can carry an increased risk of mortality and morbidity in critically ill children of whom other treatment options Such as administering, a thromholytic agent; recombinant tissue plasminogen activator (r-tPA) could be an alternative choice. Here, we report a 14-year-old male with Down syndrome and acute myeloblastic leukemia, diagnosed with IE characterized by two large vegetations on aortic and mitral valves, who was successfully treated with r-tPA.Publication The effectiveness of exercise programme and radioisotope synovectomy: In hemophilic patients(Wiley, 2015-06-01) Evim, Melike Sezgin; Şekir, Ufuk; Baytan, Birol; Güneş, Adalet Meral; SEZGİN EVİM, MELİKE; ŞEKİR, UFUK; Baytan, Birol; MERAL GÜNEŞ, ADALET; Uludağ Üniversitesi/Tıp Fakültesi; 0000-0003-2735-8697; 0000-0002-9375-2855; AAM-4348-2020; AAH-1452-2021; R-5044-2018; DVW-8108-2022; JGX-6145-2023Publication Healthcare-associated infections in the department of pediatric hematology-oncology; a single center evaluation(Galenos Publishing House, 2024-04) Özdel, Zeynep Gizem Ergün; Çelebi, Solmaz; Güneş, Adalet Meral; Evim, Melike Sezgin; Sevinir, Betül Berrin; Baytan, Birol; Demirkaya, Metin; Köse, Serdal Kenan; Çetin, Benhur; Çelik, Taylan; Salı, Enes; Hacımustafaoğlu, Mustafa; ERGÜN ÖZDEL, ZEYNEP GİZEM; ÇELEBİ, SOLMAZ; MERAL GÜNEŞ, ADALET; SEZGİN EVİM, MELİKE; SEVİNİR, BETÜL BERRİN; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Bursa Uludağ Üniversitesi/Tıp Fakültesi; H-2691-2017Introduction: With advances in the treatment of Pediatric Hematology -Oncology (PHO) patients, the survival of patients are increasing day by day. However, Healthcare -Associated Infections (HAI) is still a significant cause of mortality and morbidity in this group of patients. This study aimed to evaluate the rates of HAI in patients who were hospitalized in Uludag University Medical Faculty PHO Clinic during the 4 -year study period. Materials and Methods: HAI was diagnosed according to the CDC (Center for Disease Control and Prevention) 2008 criteria. We recorded the number of patients admitted, the number of patients with HAI, the total number of HAI episodes, and the length of stay in hospital. We calculated HAI rate and HAI density (per 1000 patient -days). Results: During the four years, 3069 hospitalizations were recorded in 607 PHO patients (5.05 admissions per patient). 38.6% of the patients were female, and 61.4% male. The mean age was 100.8 +/- 63.6 months. The mean duration of hospitalization was 14 +/- 17.16 days. A total of 232 HAI episodes were recorded in 141 hospitalizations. HAI rate was 7.5%, and HAI density was 5.36/1000 patient -days. Conclusion: The HAI rates in our PHO unit were comparable to those of developed countries and lower than those of developing countries and prior results from our country.Publication Single center experience: Intracranial hemorrhage in children with hemophilia(Wiley, 2019-02-01) SEZGİN EVİM, MELİKE; Evim, Melike; Guneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Baytan, Birol; Ertekin, M.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Hematoloji Anabilim Dalı.; 0000-0002-9375-2855; 0000-0002-5492-7982; AAH-1452-2021Publication 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-6145-2023Background: 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.