Person: SEZGİN EVİM, MELİKE
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SEZGİN EVİM
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MELİKE
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Publication 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 A rare case of recurrence presenting with bilateral exudative retinal detachment in a child with acute lymphoblastic leukemia(Wiley, 2021-08-16) Yalçınbayır, Özgür; Sezgin Evim, Melike; Uçan Gündüz, Gamze; Güler, Salih; Meral Güneş, Adalet; YALÇINBAYIR, ÖZGÜR; SEZGİN EVİM, MELİKE; UÇAN GÜNDÜZ, GAMZE; GÜLER, SALİH; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göz Hastalıkları Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hematoloji Anabilim Dalı; 0000-0002-7311-5277; 0000-0002-1219-8304; 0000-0002-5458-1686; 0000-0002-4792-269X; 0000-0002-0686-7129; IYJ-9408-2023; AAH-1452-2021; AAH-6661-2021; DWH-8632-2022; EXD-8400-2022Publication 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-8108-2022Objective: 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.Publication 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 Congenital malformation in children with acute leukemia: Single center report(Bursa Uludağ Üniversitesi, 2021-04-01) Güler, Salih; Temuroglu, Aytul; Evim, Melike Sezgin; Baytan, Birol; Güneş, Adalet Meral; GÜLER, SALİH; TEMUROĞLU, AYTÜL; SEZGİN EVİM, MELİKE; Baytan, Birol; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hematoloji Anabilim Dalı; 0000-0002-8943-6585; 0000-0002-2398-0959; 0000-0002-4792-269X; 0000-0002-0686-7129; JHO-2788-2023; GES-3112-2022; AAH-1452-2021; DVW-8108-2022; JGX-6145-2023Introduction:Leukemia is a multifactorial disease. Some genetic syndromes is well known related to leukemia. We evaluated non-syndromic malformation and leukemia relation.Materials and Methods: 288 patients diagnosed with acute leukemia are included the study. 201 patients with non-malign hematologic disease are accepted as a control. Syndromic children were excluded both group. All children were examined according to ICD-10th, Chapter XVII for congenital malformation. The type and number of malformations were compared both group.Results: There were no differences between leukemia and control group in terms of age at diagnosis, gender, consanguinity between parents, parents age at birth, family history of cancer and pregnancies of mother. Congenital malformations were more observed in leukemic population (p<0.001). The most common malformation in the control group was on the skin. Whereas the most common malformation in leukemic children was seen in the circulatory system, second region was skin. Having circulatory system malformation explained 12.53 high of the leukemia risk.Conclusions: Malformations were more common in leukemic children. We found that having a circulatory system malformation significantly increased the risk of leukemia. But the risk was very high previous study. This related to we evaluated echocardiography result which is common use for basal test.Publication Assessment of patients with von willebrand disease with STH/BAT and PBQ scores(Galenos Yayıncılık, 2020-01-01) Apak, Fatma Burcu Belen; Ümit, Elif Gülsüm; Zengin, Yağmur; Evim, Melike Sezgin; Ünal, Ekrem; Özbas, Hasan Mücahit; Acıpayam, Can; SEZGİN EVİM, MELİKE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatrik Hematoloji Onkoloji Anabilim Dalı.; 0000-0002-4792-269X; AAH-1452-2021Publication Acute endocrine and metabolic complications during treatment in childhood acute lymphoblastic leukemia patients: Retrospective study(Güncel Pediatri, 2023-04-01) Evim, Melike Sezgin; Tobçu, Zeynep; Güler, Salih; Öngen, Yasemin Denkboy; Güneş, Adalet Meral; SEZGİN EVİM, MELİKE; TOBCU, ZEYNEP; GÜLER, SALİH; DENKBOY ÖNGEN, YASEMİN; MERAL GÜNEŞ, ADALET; Uludağ Üniversitesi Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Hematoloji Bilim Dalı; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dal; Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Endokrinoloji Bilim Dal; IRI-7023-2023; JJX-6307-2023; JHO-2788-2023; JJP-0399-2023; JGX-6145-2023Introduction: Acute leukemias are the most common malignancy of childhood, and acute lymphoblastic leukemia (ALL) is the most common subtype. In this study; we aimed to asses to acute endocrine and metabolic complications which occurs during treatment. Newly diagnosed ALL patients were included in the study.Materials and Methods: The endocrine and metabolic complication of 293 patients aged 1-18 years old who were newly diagnosed ALL between January 2007 and December 2017 in Uludag University Faculty, Department of Pediatric Hematology were analyzed. Patients' age, gender, risk groups, leukemia subtypes, and chemotherapy phases at the time of endocrine complications were noted.Results: In total, 250 patients were follow-up with B-ALL and 43 patients with T-ALL. 64% (n=188) of patients were male and 36% (n=105) were female. In our study, 36.4% of patients were in the high risk group but ten of the patients died before the risk group could be determined. During the two-year treatment, We found that 83% of the patients developed at least one endocrine complication. Hyperglycemia, osteoporosis and avascular necrosis were observed more frequently in patients older than 10 years at the time of diagnosis. The difference between the sexes was found only in vitamin D and was lower in girls. In regression analysis, only to be high risk group were found to be effective for the development of endocrine complications.Conclusion: Although the chemotherapeutics used today have prolonged the survival time, they have caused an increase in the incidence of complications. We think that these complications can be reduced by determining the risk factors in advance.Publication Different kinetics and risk factors for isolated extramedullary relapse after allogeneic hematopoietic stem cell transplantation in children with acute leukemia(Elsevier, 2021-08-20) Hazar, Volkan; Öztürk, Gülyüz; Yalçın, Koray; Uygun, Vedat; Aksoylar, Serap; Küpesiz, A.; Bozkaya, İkbal Ok; Karagün, Barbaros Şahin; Bozkurt, Ceyhun; İleri, Talia; Atay, Didem; Koçak, Ülker; Karasu, Gülsün Tezcan; Yeşilipek, Akif; Gökçe, Müge; Kansoy, Savas; Kintrup, Gulen Tüysüz; Karakukcu, Musa; Okur, Fatma Visal; Ertem, Mehmet; Kaya, Zühre; Gürsel, Orhan; Yaman, Yöntem; Özbek, Namık; Antmen, Bülent; Tüfekci, Özlem; Albayrak, Canan; Aksoy, Başak Adakli; Sezgin, Gülay; Albayrak, Davut; Evim, Melike Sezgin; Zengin, Emine; Pekpak, Esra; SEZGİN EVİM, MELİKE; Bursa Uludağ Üniversitesi/Tıp Fakültesi.; 0000-0002-4792-269X; AAH-1452-2021Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the most frequent cause of post-transplantation mortality. Isolated extramedullary (EM) relapse (iEMR) after HSCT is relatively rare and not well characterized, particularly in pediatric patients. We retrospectively analyzed 1527 consecutive pediatric patients with acute leukemia after allo-HSCT to study the incidence, risk factors, and outcome of iEMR compared with systemic relapse. The 5 -year cumulative incidence of systemic relapse (either bone marrow [BM] only or BM combined with EMR) was 24.8%, and that of iEMR was 5.5%. The onset of relapse after allo-HSCT was significantly longer in EM sites than in BM sites (7.19 and 5.58 months, respectively; P =.013). Complete response (CR) 2 +/active disease at transplantation (hazard ratio [HR], 3.1; P <.001) and prior EM disease (HR, 2.3; P =.007) were independent risk factors for iEMR. Chronic graft-versus-host disease reduced the risk of systemic relapse (HR, 0.5; P=.043) but did not protect against iEMR. The prognosis of patients who developed iEMR remained poor but was slightly better than that of patients who developed systemic relapse (3 -year overall survival, 16.5% versus 15.3%; P =.089). Patients experiencing their first systemic relapse continued to have further systemic relapse, but only a minority progressed to iEMR, whereas those experiencing their iEMR at first relapse developed further systemic relapse and iEMR at approximately similar frequencies. A second iEMR was more common after a first iEMR than after a first systemic relapse (58.8% versus 13.0%; P =.001) and was associated with poor outcome. iEMR has a poor prognosis, particularly after a second relapse, and effective strategies are needed to improve outcomes. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.Publication Retrospective evaluation of hemophagocytic lymphohistiocytosis cases treated(Galenos Yayıncılık, 2020-04-01) Temuroğlu, Aytül; Evim, Melike Sezgin; Sevinir, Betül; Baytan, Birol; Güler, Salih; Güneş, Adalet Meral; TEMUROĞLU, AYTÜL; SEZGİN EVİM, MELİKE; SEVİNİR, BETÜL BERRİN; Baytan, Birol; GÜLER, SALİH; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hematoloji ve Onkoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Hematoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Onkoloji Anabilim Dalı.; 0000-0002-8943-6585; 0000-0002-3232-7652; 0000-0002-9375-2855; AAH-1570-2021; AAH-1452-2021; GES-3112-2022; DVW-8108-2022; JHO-2788-2023; JGX-6145-2023INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a rare inflammatory syndrome resulting from uncontrolled proliferation in the monocyte / macrophage system. It is divided into two classes as familial (primary) and secondary. Since the rate of consanguineous marriage in our country is high with 29.2%, the frequency of HLH is also increasing. Secondary HLH can be seen at any age, but its true incidence is unknown. It can accompany malignancies, infections and inflammatory processes. Major clinical findings are persistent high fever, cytopenia, splenomegaly and / or hepatomegaly. The first finding is usually fever. The goal of treatment is to stop abnormal inflammation and treat the underlying cause.MATERIALS and METHODS: We retrospectively reviewed 15 patients diagnosed and treated in our clinic between 2010 and 2019. Statistical analysis was performed with kruskal-wallis test.RESULTS: The median age of diagnosis of 15 patients diagnosed and treated in our clinic was 18 months (1 month-17 years). The female to male ratio was 6/9. Fever was seen in all patients, hepatosplenomegaly was 80%. The mean ferritin value was 33.927 +/- 51.461 mu / 1 (964-201.074). In our patient group, consanguineous marriage rate was 53% (n = 8) and it was high and the factor was EBV in all patients who developed secondary to infection. 33% (n 5) of the cases were primary and 67% (n = 10) were secondary. 40% (n = 4) of secondary cases had malignancy in etiology, 50% (n = 5) infection and 10% (n = 1) metabolic disease.CONCLUSIONS: HLH is important for early diagnosis in cases with persistent high fever, hepatosplenomegaly and high ferritin conditions in our country. In cases presenting with HLH, malignancy should not be forgotten in etiology besides primary causes.