Başkent Üniversitesi Yayınları
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Item Thrombotic Microangiopathy in Allogeneic Stem Cell Transplantation in Childhood(Başkent Üniversitesi, 2010-09) Erbey, Fatih; Tanyeli, Atila; Uckan, Duygu; Cetin, Mualla; Yilmaz, Sema; Kuskonmaz, Baris; Bayram, IbrahimObjectives: We define the incidence, risk factors, and mortality rates for the occurrence of thrombotic microangiopathy in 50 children who underwent transplants between January 2006 and June 2008 at 2 Turkish pediatric centers. Materials and Methods: The diagnosis of thrombotic microangiopathy was done according to the reports of International Working Group in 2007. Results: Fifty patients (27 male and 23 female; age range, 3 months to 18 years) were included. Patients with malignant and nonmalignant diseases were 13 (26%) and 37 (74%). Myeloablative and nonmyeloablative conditioning regimens were used in 29 (58%) and 21 patients (42%). Bone morrow was used as the source of stem cells in 32 patients (62%) and peripheral blood was used in 18 patients (36%). Thrombotic microangiopathy was seen in 3 of 50 cases (6%). Thrombotic microangiopathy developed in 3 of 18 patients in whom peripheral blood was used as the source of stem cells while none of 32 patients who had bone marrow as the source developed thrombotic microangiopathy (P < .05). Conclusions: Using peripheral blood as a source of stem cells is a risk factor for development of thrombotic microangiopathy.Item De Novo Inflammatory Bowel Disease After Pediatric Orthotopic Liver Transplant: A Case Report(Başkent Üniversitesi, 2009-09) Dehghani, Seyed Mohsen; Malek-Hosseini, Seyed Ali; Geramizadeh, Bita; Kakaei, Farzad; Bahador, Ali; Eshraghian, AhadObjectives: The improvement of pre-existing inflammatory bowel disease after orthotopic liver transplant might be anticipated. However, both the exacerbation of inflammatory bowel disease and de novo inflammatory bowel disease after orthotopic liver transplant (despite sufficient allograft immunosuppressive therapy) have been described. Materials and Methods: We present a case of ulcerative colitis in a pediatric liver transplant recipient. Results: A 13-year-old boy with cryptogenic liver cirrhosis received an orthotopic liver transplant from a deceased donor. Five months later, he presented with watery diarrhea and abdominal distention. He was treated with the immunosuppressive agents tacrolimus (0.15 mg/kg/d) and mycophenolate mofetil (20 mg/kg/d). A general physical examination revealed a boy with stable vital signs and without fever. The only positive finding was enlargement of the abdomen without tenderness. Many pus cells and a few red blood cells were detected in the patient’s stool, but the results of a stool culture for bacteria were negative. Because of his chronic diarrhea, this patient underwent colonoscopy, which revealed diffuse erythematous mucosa, multiple ulcers, exudate, and pseudo¬polyps with a diffuse loss of vascularity. Those findings are indicators of colitis. The results of histopathologic examination of the colonic mucosa suggested ulcerative colitis. The patient was treated with mesalamine and prednisolone, and a repeat colonoscopy revealed an improvement in his bowel disease. Conclusions: De novo inflammatory bowel disease should be considered in patients in whom chronic diarrhea develops after an orthotopic liver transplant. We suggest that colonoscopy and biopsy should always be performed if other causes of diarrhea have been excluded.Item Pediatric Liver Transplant: Results of a Single Center(Başkent Üniversitesi, 2008-03) Haberal, Mehmet; Arslan, Gulnaz; Demirhan, Beyhan; Torgay, Adnan; Yilmaz, Ugur; Moray, Gokhan; Ozcay, Figen; Karakayali, Hamdi; Sevmis, SinasiObjectives: Liver transplant in the pediatric population has become an accepted treatment modality for children with end-stage liver disease. In this study, we analyze our experiences with pediatric liver transplant at our center. Materials and Methods: Since September 2001, 8 deceased-donor and 96 living-donor liver transplants have been done in 101 children (mean age, 6.7 ± 5.5 years; range, 2 months to 17 years). The children’s charts were reviewed retrospectively. Results: Indications for liver transplant were cholestatic liver disease (n=17), biliary atresia (n=24), Wilson’s disease (n=16), fulminant liver failure (n=18), hepatic tumor (n=13), and other (n=13). The median pediatric end-stage liver disease score was 23.1 ± 11.1 (range, –8 to 48). The median follow-up was 24.2 ± 19.4 months (range, 1-77 months). Three children underwent retransplant. The main complications were infections (25.9%) and surgical complications (39.5%) (including biliary complications and vascular problems). The incidence of acute cellular rejection was 42.3%. Sixteen children died during follow-up, and, at the time of this writing, the remaining 85 children (85%) were alive with good graft functioning, showing patient survival rates of 90%, 85%, and 83% at 6, 12, and 36 months, respectively. Conclusions: In conclusion, the overall outcomes of pediatric liver transplantation at our center are quite promising.Item Outpatient Management of Pediatric Burns in Chile(Başkent Üniversitesi, 2023-02) María Dora Espinosa González; Orlando FloresABSTRACT Most burn injuries can be treated on an outpatient basis. However, data on burn injuries treated at outpatient centers are largely omitted from the burn literature. Patients suitable for pediatric outpatient burn care are mostly children younger than 5 years old at the time of the injury, with the hand as the prevalent burn location and total body surface area of <1%. The main causal agent in this population are scalds and hot objects, and patients have an average healing time of 13 days. The hospitalization rate varies from 1% to 6%. The success of ambulatory care depends on careful patient selection. The criteria for outpatient management can vary based on the center’s experience and resources and mainly involve partial thickness burns affecting <5% of the total body surface area and burns with minimal involvement of special areas. A careful review of the patient’s social and economic situation is an essential component of the assessment for successful outpatient burn care, as the child’s family should be able to support the wound care, attend to follow-up consultation, and have access to transportation for timely access to a specialized burn center. The treatment goal should be to close the burn wounds as soon as possible. The outpatient care strategy should include adequate pain management, local wound care, home instructions, and follow-up until the burn wounds are well reepithelialized. The most important potential complication is wound infection. It is relevant to know the symptoms and signs of local and systemic infection, so that infections can be treated in a timely and adequate manner. At our outpatient burn center in Chile, we can successfully manage 85% to 90% of patients with burns by making adequate patient selection, having an outpatient management strategy that includes family education, and knowing the possible complications.Item Did COVID-19 Pandemic Conditions Change the Features of Pediatric Minor Burn Injuries? A Single-Center Experience(Başkent Üniversitesi, 2021) Ayse Ebru Abali; Mehmet Haberal; Nigar Turkmen; Semra Kamilova; Cem AydoganABSTRACT OBJECTIVES: Social life changes during the COVID-19 pandemic may have influenced burn injury characteristics among children. Here, we compared features among pediatric burn outpatients who were treated at our burn center before and during the COVID-19 pandemic. MATERIALS AND METHODS: We compared medical records of 217 patients treated between March 2018 and May 2019 (pre-pandemic; group I) and 212 patients treated between March 2020 and May 2021 (during the pandemic; group II). P < .05 was significant. RESULTS: In group I versus group II, mean age was 4.19 ± 0.4 versus 4.25 ± 0.3 years, male-to-female ratio was 0.9:1 versus 1.1:1, and mean total surface area burned was 1.87 ± 0.2% versus 1.93 ± 0.3%, respectively (P > .05). Most patients in both groups lived in urban settings, had mostly day-time injuries, and were under the umbrella of the social security system, with cause of burns being mostly scalds (P > .05). Injuries occurred mostly at home in both groups, but more patients in group II had outdoor burns (P < .05). Hands, head, and neck regions were more commonly involved in group I than in group II (P < .05). Group II patients were more frequently admitted on the same day as injury (P < .05), but rates of direct burn center admission were similar with resembling numbers of other medical center admissions before reaching to our burn-center (P > .05). CONCLUSIONS: The COVID-19 pandemic did not change primary burn injury features among our pediatric outpatients. Decreases in burns to hands, head, and neck and increases in admissions on the same day as injury during the pandemic may be a clue for enhanced caregiver precaution against injuries to children during lockdowns. Increased admissions on the same day as injury may reflect our uninterrupted burn care service, because many other medical centers had to serve COVID-19 patients rather than burn victims.Item Review of Pediatric Burn Injuries in Egypt(Başkent Üniversitesi, 2021-12) Amr Mabrouk; Mohamed Samir Badawy; Amira Hussein Sabry; Salah NaserOBJECTIVES: Most childhood burns can be avoided if proper preventive measures, public education, and continuing medical education are applied. These actions are especially important in general hospitals, which are the first lines of management to provide good burn care facilities as near to the place of injury as possible. Here, we described the first aid and initial management of patients at our center, which are still far from ideal and which could explain the high mortality rate. MATERIALS AND METHODS: This study included 507 acutely burned pediatric patients admitted to the Burn Unit of Ain Shams University (Cairo, Egypt) from January 1, 2008, to December 31, 2020. Our objective was to analyze risk factors and demographic and epidemiological features of patients in our area, which could be used to define preventive measures that can be implemented to minimize burns in children and provide better quality of patient care. RESULTS: Of 7450 patients with burns patients who presented to our unit during the study period, 2831 were children between 2 months and 14 years (representing 38.0% of the total number). There were 1678 total admissions for all age groups during this period, and 507 were children, representing 30.2% of total admissions. Male-to-female ratio was 1.38:1. Four age groups were distinguished, according to children’s main activities and behavior, with 130 children (25.5%) <1 year of age, 242 children (47.8%) from 2 to 3 years of age, 109 children (21.5%) from 4 to 7 years of age, and 26 children (5.3%) from 8 to 14 years of age. Average age was 4.09 years. The burns occurred predominantly during the winter. CONCLUSIONS: Our analysis showed that most pediatric burns were avoidable.Item Pediatric Burns During the COVID-19 Pandemic: A Single-Center Experience(Başkent Üniversitesi, 2021-06) Ayse Ebru Abali; Cem Aydogan; Nigar Turkmen; Mehmet HaberalOBJECTIVES: We documented children treated at our burn center during the COVID-19 pandemic period to investigate the features of pediatric burns and burn care modalities within the influence of pandemic conditions. MATERIALS AND METHODS: Medical records of 248 new admissions and 54 telemedicine visits were collected (March 2020-May 2021). Data collected included age, sex, burn cause, burn extent, affected body site, environment, time of day when injury occurred, time interval between injury and arrival at the burn center, and direct or indirect admissions from other centers. Collected data were also compared according to 2 different subgroups (age and treatment modality [outpatient/inpatient]). P ˂ .05 was considered significant. RESULTS: Male-to-female ratio was 1.07:1. Scalds were the most common burn cause (83.8%), most burns occurred at home (87.1%), and burn injuries mostly occurred between 1200 and 2400 hours (72.2%). Most children were brought to our burn center in the initial 3 days postburn (82.7%). The rate of direct admissions was 60.5%. Most patients were in the 0- to 2-year-old age group (53.6%). The number of admissions on the same day as injury was significantly greater for this age group compared with older groups. Outdoor burns were increased in older children (7- to 11-year-old group and 12- to 18-year-old group) (P ˂ .05). Outpatients and inpatients comprised 87.5% and 12.5%, respectively. The mean total body surface area burned (minimum, maximum) was 2.0 ± 0.3 (0.1%, 50%) for outpatients and 10.4 ± 2.3% (1%, 72%) for inpatients; mean length of hospital stay for inpatients was 9 ± 2.6 days (1, 77 days). CONCLUSIONS: During the pandemic, burn injuries in children continued at the same rate. Meticulous COVID-19 protection is essential for continuity of expected quality in pediatric burn care. Telemedicine is advantageous, and progress on basic burn care guidelines, including telemedicine facilities, should be supported.