Person: GÜLER, SALİH
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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 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.Publication 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 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 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 The evaluation of central venous catheter-related complications in pediatric acute leukemia patients: Single center experience(Lippincott Williams & Wilkins, 2023-01-01) Evim, Melike Sezgin; SEZGİN EVİM, MELİKE; Yörük, Gülce; Parlak, Ayse; YÖRÜK, GÜLCE; PARLAK, AYŞE; GÜLER, SALİH; Çelik, Fatih; ÇELİK, FATİH; Çelebi, Solmaz; ÇELEBİ, SOLMAZ; Hacımustafaoğlu, Mustafa; HACIMUSTAFAOĞLU, MUSTAFA KEMAL; Baytan, Birol; Güneş, Adalet Meral; MERAL GÜNEŞ, ADALET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; 0000-0002-1266-4897; 0000-0001-7686-2561; 0000-0002-9375-2855; 0000-0003-4646-660X; AAI-3665-2021; AAH-6766-2021Central venous catheters (CVCs) are important for maintenance of childhood leukemia treatment but CVCs may develop complications. The aim of this study was to retrospectively evaluate the CVC-related complication rate, complication types, and outcome in children with acute leukemia. Complications developing in 310 CVCs (ports n=250, Hickman catheters n=60) inserted in 262 patients were evaluated. A total of 225,296 catheter days were screened. Median (range) CVC in-dwelling time was 661.5 (1 to 2636) days. In total, 157 complications developed of which 91 (58%) were infectious complications, 35 (22.3%) were vascular, 19 (12.1%) were surgical, and 12 (7.6%) were mechanical. Hickman catheters had a higher complication rate and were more prone to mechanical complications (P<0.01) but there was no difference for other complications. A lower absolute neutrophil count at insertion was observed in children with infectious complications (P<0.01). Seventy-eight of 136 catheters (57.3%) had to be removed prematurely. The overall complication rate was 0.65 per 1000 catheter days. In multivariate analysis, relapse leukemia, Hickman catheter and low absolute neutrophil count increased complication risk by 4.00, 1.97, and 1.92 times, respectively. Five (1.9%) deaths occurred because of catheter complications. Safe use of CVCs can be improved by early detection of complications and an experienced catheter care team.