Can Acipayam

The protective effect of hesperidin on methotrexate-induced intestinal epithelial damage in rats: an experimental study.

Objective: The purpose of this experimental study was to evaluate the efficacy of hesperidin (HES) in protecting against methotrexate (MTX)-induced intestinal damage using histopathological and immunohistochemical techniques. Materials and Methods: Seventy-eight male Wistar albino rats were divided into 4 groups that received (a) saline only (control group), n = 19; (b) HES only, n = 19; (c) MTX only, n = 19, and (d) MTX plus HES, n = 21. On the first day of the study, a single dose of MTX (20 mg/kg) was administered intraperitoneally to group 3 and 4 rats. The HES (200 mg/kg) was administered by gavage for 5 days. For the MTX plus HES group, HES (200 mg/kg) was administered by gavage for 5 days after MTX treatment. Rats were sacrificed on the 2nd, 4th and 6th day of the study. Tissue samples from the jejunum were taken for histopathological and immunohistochemical analysis. Results: On the 4th day, crypt injury in the MTX plus HES group (1.00 ± 0.00) was less than that in the MTX group (2.00 ± 0.89; p < 0.05). The small intestinal damage score was lower in the MTX plus HES group (6.33 ± 0.82) as compared to the MTX group (8.00 ± 2.37). Inducible nitric oxide synthase and interleukin-8 levels were lower in the MTX plus HES group (65 and 25%, respectively) as compared to the corresponding values of the MTX group (80 and 52.5%, respectively). On the 6th day, the Ki-67 proliferation index in the MTX group (45%) was lower than that in the MTX plus HES group (76.67%) and the control group (p < 0.05). The small intestinal damage score was high in the HES group on the 4th day due to increased cellular infiltration. On the 6th day, the Ki-67 proliferation index rose in parallel with the decrease in cellular infiltration and therefore histopathological scoring. The proliferation-enhancing effect of HES also appeared in healthy rats. Conclusion: HES seemed to have a protective effect against MTX-induced intestinal injury.

Meropenem Versus Piperacillin-Tazobactam as Empiric Therapy for Febrile Neutropenia in Pediatric Oncology Patients

BACKGROUND Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/ TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. MATERIALS AND METHODS Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. RESULTS Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/ TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups. CONCLUSIONS Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.

Treatment of Wilms Tumor Using Carboplatin Compared to Therapy Without Carboplatin

Wilms tumor (WT) is the most common pediatric malignant primary renal tumor. One of the main drugs used in treatment is actinomycin‐D. This was not readily available in Turkey at one time. Carboplatin was used in the primary treatment of WT in order to prevent delays in treatment. The aim of this study is to present the results of patients with WT receiving carboplatin or actinomycin‐D therapy.

Çocukluk Çağında Dev Disgerminomlu Üç Olgu

Disgerminom, dev boyutlara ulasabilen overin en sik gorulen malign tumorudur. Genelde hormon salgilamamakla beraber beta-HCG salgilayabilirler. Bizde karinda kitle ve karin agrisi sikâyetleri olan radyolojik goruntuleme ile tespit edilen beta-HCG salgilayan dev boyutlara ulasmis disgerminom tanili 3 olguyu inceledik. Uc olguya da salpingo -ooferektomi ameliyati yapildi. Bir olguda komsu lenf nodlarindan, peritondan ve karsi overden ornekleme yapildi. Bir olgu da uc haftada bir dort kur BEP ( Bleomisin, Etoposid, Sisplatin ) kemoterapi protokolu ile fertilite de korunarak tedavi saglanmis oldu. Bir olguda da 3 kur BEP kemoterpi protokulu verilmesi planlandi ve 2 kur BEP kemoterapi protokolu verildi.

CERRAHİ UYGULANAN ORAK HÜCRELİ ANEMİLİ ÇOCUKLARDA PREOPERATİF VE POSTOPERATİF YÖNETİM: TEK MERKEZ DENEYİMİ

OZ AMAC: Orak hucre anemisinde (OHA) cerrahi islemler sikca gereklidir. OHA’li hastalarin postoperatif komplikasyonlar icin nispeten daha yuksek riske sahip oldugu kabul edilmektedir. Bu calismanin amaci, ameliyat olan OHA’li hastalarin ameliyat oncesi ve sonrasi yonetimini degerlendirmektir. GEREC VE YONTEM: Hastanemizde ameliyat olan tum OHA’li cocuklarin yas, cinsiyet, preoperatif incelemeler ve postoperatif komplikasyon bilgilerine geriye donuk olarak tibbi kayitlari incelenerek ulasildi. BULGULAR: 2012-2014 yillari arasinda, OHA’li 12 cocuk hasta hastanemizde ameliyat oldu. Hastalarin ortalama yasi 12.1 yil (aralik, 6–17) idi. Besi kiz cocuktu. Cerrahi islemler kolesistektomi (n=6), tonsillektomi/adenoidektomi (n=3), splenektomi (n=2) ve over kist eksizyonu (n=1) idi. Splenektomi olan bir hastaya es zamanli olarak kolesistektomi uygulandi. Hastalar ameliyattan once basit eritrosit transfuzyonu (n=1) veya total kan degisimi (n=10) tedavisi aldi. Bir hasta kronik transfuzyon programina kayitli oldugu icin transfuzyon almadi. Tum hastalar ameliyat oncesi geceden baslayarak ve ameliyat sonrasida devam eden intravenoz hidrasyon aldi. Ameliyat sonrasi ortalama hastanede kalis suresi 5,3 gun (dagilim, 3–10) idi. Hic vazookluziv kriz ya da olum saptanmadi. SONUC: OHA’li hastalara elektif cerrahi oncesi, postoperatif komplikasyonlari azaltmak amaci ile Hemoglobin S oranini %40’in altina dusurmek icin transfuzyon yapilmalidir. Iyi preoperatif ve postoperatif yonetim ile cerrahi OHA’li cocuklarda etkili ve guvenlidir.

A Case of Familial Hemophagocytic Lymphohistiocytosis Type 4 With Involvement of the Central Nervous System Complicated With Infarct

Background: Familial hemophagocytic lymphohistiocytosis (HLH) is a fatal disease affecting infants and very young children. Central nervous system involvement of HLH can cause catastrophic results. Method: We present a case with cranial involvement of familial HLH type 4 who showed diffuse infiltration of white matter complicated with intracranial thrombosis. A 5-year-old girl from a consanguineous couple presented with fever and pancytopenia, and was referred to our hematology unit. Examination revealed fever, lymphadenopathy, and hepatosplenomegaly. Ultrasound examination revealed hepatosplenomegaly and free intra-abdominal fluid. HLH was revealed on bone marrow aspiration biopsy. Defective natural killer and T lymphocyte cytotoxicity using degranulation tests was determined. In the genetic analysis, syntaxin gene mutation was found. On T2-weighted and T2-fluid-attenuated inversion recovery magnetic resonance imaging (MRI), diffuse hyperintense signal changes of cerebral white matter, indicating white matter demyelination, were observed. A second brain MRI showed an acute infarct involving the left temporooccipital region. Immunosuppressive therapy according to the HLH 2004 protocol was started. The infarct resolved but white matter lesions were stable on the brain MRI that was performed 1 month later. Brain MRI taken 4 months after the first examination showed stable cerebral white matter lesions, but hyperintense signal changes appeared in the cerebellar white matter and were regarded as progression. The patient died because of infection despite immunosuppressive therapy. Conclusions: Physicians managing patients with HLH must be vigilant about the possibility of central nervous system involvement including stroke.

The Effectiveness of Enteral Nutrition Support in the Growth of Children Patients with Cancer

DOI: 10.4328/JCAM.2637 Received: 23.06.2014 Accepted: 25.07.2014 Published Online: 25.07.2014 Corresponding Author: Can Acıpayam, Mustafa Kemal University,Tayfur Ata Sokmen Medical School, Department of Pediatric Hematology and Oncology, 31000, Serinyol, Hatay, Turkey. T.: +90 3262291000 F.: +90 3262455654 E-Mail: cacipayam@hotmail.com Özet Amaç: Bu çalışmanın amacı, kemoterapi alan kanserli çocuklarda antropometrik ve biyokimyasal parametreler aracılığla, enteral beslenme desteğinin büyümede olumlu etkisini araştırmaktır. Gereç ve Yöntem: Yeni tanı almış ve yoğun kemoterapi alan ardışık 43 pediatrik kanserli hasta çalışmaya dahil edildi. Yirmi altı hasta enteral beslenme formülası aldı. Onyedi kontrol hastası enteral beslenme formülası almadı. Antropometrik parametreleri (boy, kilo, vücut kitle indeksi, triseps, subskapular ve suprailiak deri kıvrım kalınlığı), serum albümin, prealbumin, transferrin düzeyleri ve lipid profilleri tanı anında ve 3. ayda ölçüldü. Bulgular: 3 ayın sonunda enteral beslenme alan grupta subskapular ve suprailiak deri kıvrım kalınlıklarında tanı anındaki ölçülerle karşılaştırıldığımızda belirgin bir artış saptadık (p=0.01 ve p=0.014 sırasıyla). Prealbümin ve albümin değerlerinde enteral beslenme desteğinin 3. ayında artış saptandı (p=0.005 ve p=0.006, sırasıyla). Enteral beslenme alan grubunun % 69.2’inde tedavi sonunda ağırlık persentil artışı görüldü. Üçüncü ayda, albümin ve suprailiak deri kıvrım kalınlıkları değerleri enteral beslenme grubunda, kontrol grubuna göre yüksek idi (p=0.012 ve p=0.017, sırasıyla). Üçüncü ayda kontrol grubunun antropometrik ve biyokimyasal parametrelerinde tanı anı ile karşılaştırıldığında anlamlı bir değişiklik görülmedi. Tartışma: Bu çalışma enteral beslenme formülası alan kanserli çocuklarda antropometrik ve biyokimyasal parametrelerde iyileşme göstermektedir.

The Results of Hemoglobinopathy Screening in Hatay, the Southern Part of Turkey

Aim: β-Thalassemia and hemoglobinopathies are common genetic disorders in Turkey. Because of this reason, either anemic people or couples before marriage are investigated for hemoglobinopathies routinly. In this retrospective study, our aim was to determine the frequency of β-thalassemia and hemoglobinopathies in Hatay, which is located in the southern part of Turkey. Material and Method: In this study, data from 70226 individuals, admitted to Antakya State Hospital Hemoglobinopathy Center in Hatay, both for the reason of anemia and before marriage investigations, were evaluated between January 2006 and October 2012. The blood samples were collected into EDTA-containing tubes and hematological parameters were analyzed using a Sysmex XT-2000i Hematology Analyzer. High performance liquid chromatography technique was used to determine the type of hemoglobin. Results: The frequency of hemoglobinopaties were 6% β-Thalassemia trait, 6.3% sickle cell trait, 12.9% α-thalassaemia trait? and 4.2 % other abnormal hemoglobinopaties variants. We detected 49 cases with homozygot β-thalassaemia, 60 cases with homozygot haemoglobin S, 33 cases with HbH disease (thalassaemia intermedia) among all. Discussion: The frequency of β-thalassemia trait and other haemoglobinopathies in Hatay is found to be quite high as compared with other provinces in Turkey.

Screening of Glucose-6-Phosphate Dehydrogenase Deficiency in Cord Blood

Aim: Glucose-6-phosphate dehydrogenase deficiency is an important factor in etiology of pathologic neonatal jaundice. The aim of this study was to indicate the significance of screening glucose-6-phosphate dehydrogenase de ficiency in the cord blood of neonates and the frequency of this deficiency in the etiology of neonatal hyperbilirubinemia. Material and Method: The study was performed consecutive 1015 neonates were included. Five hundred fifty six (54.8%) of them were male and 459 (45.2%) were female. The following parameters were recorded: Gender, birth weight, birth height, head circumference and gestational age. The glucose-6-phosphate dehydrogenase level of neonates were measured with quantitative method in cord blood. Also, hemoglobine, hematocrite, red blood cell count and blood group were measured. The following parameters were recorded in cases with jaundice: exchange transfusion, phototherapy, physiologic and pathologic jaundice, peak bilirubin day, maximum bilirubin level, total bilirubin level at the first day of jaundice, beginning time of jaundice. Results: Enzyme deficiency was detect ed in 133 (13.1%) of neonates and 76 (57%) of them were male, 57 (43%) were female. Significant difference was detected in low glucose-6-phosphate dehydrogenase enzyme level with jaundice group for total bilirubin level at the first day of jaundice, maximum total bilirubin level and pathologic jaun dice (p<0.05). Discussion: The ratio of glucose-6-phosphate dehydrogenase deficiency was found in Edirne in this study and this ratio was higher than other studies conducted in our country. For this reason, glucose-6-phosphate dehydrogenase enzyme level in cord blood of neonates should be measured routinely and high risk neonates should be followed up for hyperbilirubinemia and parents should be informed in our region.

Very High Levels of C - Reactive Protein Should Alert the Clinician to the Development of Acute Chest Syndrome in Sickle Cell Patients

Purpose: Acute chest syndrome (ACS) is associated with both inflammation and tissue ischemia. C-reactive protein (CRP) is a marker of systemic inflammation. The aim of this study was to determine if a relationship exists between CRP and severe ACS. Methods: Forty-three patients with painful crises (range: 4-18 years, mean: 11.4 years) hospitalized between 2012 and 2014, consisting of 23 patients with ACS and 20 patients without ACS (uncomplicated vaso-occlusive crisis) were recruited into this study. Retrospective data were obtained directly from inpatient medical records. ACS was defined as a new pulmonary infiltrate on chest radiograph after admission and before discharge. CRP was measured using a BN II Nephelometer. Results: Mean length of hospital stay of ACS patients was 9.9 days (range 7-18 days) while that of patients without ACS was 5.2 days (range 2-10 days), (p=0.001). In 91% of the ACS cases, ACS developed within the first 72 hours, while the remaining 9% cases were admitted for vaso-occlusive crises but subsequently developed ACS during their hospital stay on the 5th to 7th days. CRP levels on admission were significantly higher in patients with ACS than those without ACS (p=0.001). Conclusion: We investigated CRP in relation to ACS in children with sickle cell disease (SCD). Elevated CRP was determined in all ACS patients with SCD. CRP may be a superior diagnostic marker and herald severe ACS in individuals with SCD.