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Öğe A child with a severe headache: Answers(Springer Science and Business Media Deutschland GmbH, 2021) Telhan, Leyla; Beğenik, Murat; Yaman, Yöntem; Yavaşcan, Önder1) What is your suspected diagnosis of acute severe headache in this patient? We report here an adolescent girl who presented with severe headache while receiving acute sinusitis treatment and was found to have bilateral papilledema, anemia, hepatosplenomegaly, and hypertension. In addition, our patient also manifested the symptoms and signs suggesting increased intracranial pressure as intractable headache, nausea, vomiting, and bilateral papilledema.Öğe A child with a severe headache: Questions(Springer, 2021) Telhan, Leyla; Beğenik, Murat; Yaman, Yöntem; Yavaşcan, ÖnderA 12-year-old girl presented with complaint of severe headache lasting 10 days, nausea and vomiting for 1 day. The headache was localized in the right fronto-occipital region with spread to the neck and shoulders. In her medical history, tympanostomy tubes were inserted in her ears due to frequent otitis media with effusion before 2 years. She had recurrent reactive airway, asthma attacks, and allergic rhinitis. Before the definitive diagnosis could be established, she had received systemic antihistamine, nasal steroid, leukotriene antagonist, inhaler steroid, and salbutamol. She was treated with sefaclor per orally due to acute sinusitis for 5 days. The patient was admitted to our hospital with symptoms of severe headache. Physical examination showed that she was alert with an axillary temperature of 36.3 °C, weight of 60 (95th percentile) kg, height of 155 (65th percentile) cm, blood pressure of 150/100 mmHg (> 95th/> 95th percentile), and heart rate of 98 beats/min.Öğe Assessment of the clinical course of human rhinovirus/enterovirus infections in pediatric intensive care(Lippincott Williams and Wilkins, 2023) Koçoğlu Barlas, Ülkem; Akçay, Nihal; Menentoğlu, Mehmet Emin; Şevketoğlu, Esra; Duyu, Muhterem; Telhan, Leyla; Kanğın, Murat; Tuğrul, Hazal Ceren; Erdoğan, Seher; Durak, Cansu; Güney Şahin, Ebru; Umur, Özge; Şık, Sare GüntülüBackground: This study aims to evaluate the clinical course of human rhinovirus/enterovirus (HRV/EV) infections in the pediatric intensive care unit. Methods: The study was conducted as a multicenter, prospective observational study from September 2022 to December 2022. Cases with positive polymerase chain reaction testing for HRV/EV of nasopharyngeal swab samples within the first 24 hours of pediatric intensive care unit admission were recorded. There were 2 groups: 1-24 months and >24 months. Results: A total of 75 cases (39 male) were included in the study. The median age for all cases was 21 months. The highest polymerase chain reaction positivity rates were observed in October (37.33%). Among the cases, 32 (42.67%) presented with bronchopneumonia/pneumonia, 24 (32%) presented with acute bronchiolitis/bronchitis and 7 (9.33%) presented with sepsis/septic shock. The frequency of pediatric acute respiratory distress syndrome was found to be 6.67%. In the age group of 1-24 months, mean lymphocyte and liver enzyme levels were higher, while in the age group of >24 months, mean hemoglobin and mean kidney function test levels were higher (P ? 0.05). Continuous oxygen therapy was provided to 65.3% of the cases, noninvasive ventilation to 33.3%, high-flow nasal cannula-oxygen therapy to 32% and invasive mechanical ventilation to 16%. Conclusions: HRV/EV infections primarily affect the respiratory system and generally exhibit a clinical course with low mortality rates (1, 1.3%). In cases with underlying chronic diseases, more severe clinical conditions such as pediatric acute respiratory distress syndrome and septic shock may occur.Öğe Brain magnetic resonance imaging findings of pediatric hemophagocytic lymphohistiocytosis could be diagnostic and life-saving(Elsevier Inc., 2022) Aydın, Kürşad; Kılıç, Betül; Topçu, Yasemin; Telhan, Leyla; Dolu, Merve Hilal; Kartal, AyşeBackground: Hemophagocytic lymphohistiocytosis (HLH) is a rare and fatal disease and may also present with central nervous system findings at the beginning without specific diagnostic criteria. Brain magnetic resonance imaging (MRI) findings are diverse and can also be diagnostic. We aimed to emphasize the importance of brain MRI findings in the early diagnosis of this fatal disease. Methods: MRI findings, clinical presentations, treatment response, and prognosis of seven patients with HLH were described. Results: There were seven pediatric patients who were initially diagnosed with HLH with neurological findings without systemic signs of HLH: four as primary, two as secondary, and one as possible primary HLH. All patients had contrast-enhancing diffuse cerebellar and brainstem lesions; patchy periventricular and callosal cerebral lesions were observed. Thalamus involvement was found in three (42.8%), corpus callosum involvement in six (85.7%), and cervical spinal involvement in one (14.2%). Patients were followed up with these MRI findings, with prediagnoses of toxic, metabolic, infectious, vascular, and demyelinating diseases. Not all patients met the HLH diagnostic criteria due to incomplete systemic/laboratory findings; therefore, only two were immediately directed for hematopoietic stem cell therapy. Four died shortly after admission, one patient could not be followed up after HLH treatment, and two patients who fulfilled the HLH diagnostic criteria underwent hematopoietic stem cell transplantation and survived. Conclusions: Brain MRI findings, especially in the presence of neurological findings, allow for early diagnosis, which can be life-saving. These common features in brain MRI findings should be evaluated with this suspicion and included in HLH diagnostic criteria.Öğe Clinical efficacy of ruxolitinib monotherapy and haploidentical hematopoeitic stem cell transplantation in a child with philadelphia chromosome-like relapsed/refractory acute lymphoblastic leukemia(Wiley, 2021) Bayram, Nihan; Yaman, Yöntem; Özdilli, Kürşat; Telhan, Leyla; Nepesov, Serdar; Bilgen, Hülya; Elli, Murat; Behar, Sude Sema; Anak, SemaIntroduction (Ph-like) ALL is a subset of leukemia which has a gene expression profile similar to Ph+disease, but without the presence of BCR-ABL1 translocation. Case description We reported an exceptional case of a child with relapsed Ph-like ALL with IKZF1 gene deletion treated with high-dose ruxolitinib as monotherapy, after multi-agent chemotherapy. He remains in continued MRD-negative leukemia remission with full donor chimerism at 12 months post-HSCT. Discussion The circumstance that makes our case featured is the usage of ruxolitinib as monotherapy. This report, we believe, is a pioneering report for a frequent disease with a high risk of failure for the outcome.Öğe Clinical, genetic, and outcome characteristics of pediatric patients with primary hemophagocytic lymphohistiocytosis(AVES, 2022) Nepesov, Serdar; Yaman, Yöntem; Elli, Murat; Bayram, Nihan; Özdilli, Kürşat; Kıykım, Ayça; Çakır, Deniz; Kılıç, Betül; Aydın, Kürşad; Ayaz, Akif; Telhan, Leyla; Anak, SemaObjectİive: In this study, we sought to describe the clinical, laboratory, and genetic characteristics of patients diagnosed with primary hemophagocytic lymphohistiocytosis. Thus, we aimed to evaluate the early diagnosis and appropriate treatment options for pediatric hemophagocytic lymphohistiocytosis patients. Materials and Methods: Medical records of 9 patients diagnosed with primary hemophagocytic lymphohistiocytosis between November 2013 and December 2019 were analyzed retrospectively. Clinical, genetic, and laboratory characteristics, family histories, initial complaints, physical examination findings, age at diagnosis, treatment choices, and clinical follow-up of all patients were investigated. Results: The mean age at diagnosis was 11 months (range: 1.5 months to 17 years). Genetic analysis was performed in all patients, and a disease-related mutation was detected in 8 (89%) of them. Among clinical features, 6 (66%) patients had fever, 5 (56%) had splenomegaly, 4 (44%) had lymphadenopathy, 4 (44%) had skin rash, and 4 (44%) had neurological findings. Hemophagocytosis was observed in the bone marrow samples of 6 (66%) patients. Disease remission was achieved in 7 (78%) patients. Hematopoietic stem cell transplantation was performed in 7 (78%) patients. Conclusion: Hemophagocytic lymphohistiocytosis may present with different clinical symptoms that can cause a significant diagnostic delay. The only curative treatment option in primary hemophagocytic lymphohistiocytosis patients is hematopoietic stem cell transplantation. The chemotherapy should be started as early as possible, in order to achieve a disease remission. Patients should be referred to the appropriate bone marrow transplant center for hematopoietic stem cell transplantation as soon as they reach the disease remission.Öğe Examination of patients with acute kidney injury in the pediatric intensive care unit(Springer, 2021) Teber, Burcu Gizem; Telhan, Leyla; Kezer, Seçil; Akgün, Cihangir; Yavaşcan, ÖnderIntroduction: Acute kidney injury (AKI), has negatively impacting the mortality and morbidity of patients in pediaric intensive care units. We aimed to investigate AKI causes, risk factors and factors affecting survival in children while being monitored in the pediatric intensive care unit (PICU). Material and methods: 328 patients, who were followed up in the PICU between January 2018 and March 2021 for various reasons, were examined retrospectively. 43 (13,1%) patients who diagnosed with AKI without prior chronic kidney injury were included in the study. Results of demographic data, primary diagnosis, AKI causes, risk factors and Pediatric Risk of Mortality (PRISM III) scores of surviving and deceased were compared. Results: 15 of AKI patients (34,9%) were girls. The mean age was 6.18 ± 5.61 (median: 5) years. On the first day of hospitalization in PICU, PRISM III scores were 19.48 ± 9.65 (median: 19). Acute lymphoblastic leukemia was the most common primary disease with 7 patients (16,2%). Median PICU length of stay was 10 days. We found that 30 (89,7%) patients developed AKI while being followed up with a mechanical ventilator and 28 (65,1%) of these patients used nephrotoxic drugs before AKI developed. It was found that 17 (39,5%) cases developed oliguria and/or anuria, and 36 (83,7%) patients developed multiple organ failure. Dialysis treatment was applied to 8 (18,6%) patients and continuous dialysis treatment methods were preferred in all of them. Median duration of dialysis time was 3,5 days. 28 (65,1%) patients died. PRISM scores, sepsis and dialysis requirement were found to be statistically significantly higher in deceased than surviving patients (respectively p= 0.001, p=0.001, p=0.001). Conclusions: Despite technological advances, AKI is an important cause of mortality and morbidity in critically ill patients. PRISM scoring and the presence of sepsis can be considered as an important determinant in predicting mortality and acting early for the dialysis decision.Öğe Hodgkin lenfoma nüks ve/veya kemoterapi dirençli olgularda hematopoetik kök hücre nakli ve yüksek doz kemoterapi: Tek merkez deneyimi(İstanbul Üniversitesi, 2021) Yaman, Yöntem; Elli, Murat; Özdilli, Kürşat; Telhan, Leyla; Bayram, Nihan; Hazar, Volkan; Tuprul Sarıbeyoğlu, Ebru; Şahin, Şifa; Anak, SemaGiriş: Standart tedavi alan Hodgkin Lymphoma (HL) hastalarının yaklaşık %20’sinde hastalık dirençli seyredebilir veya tekrar edebilir. Tekrar eden/ dirençli HL’da standart tedavi yüksek doz kemoterapi ve takip eden otolog kök hücre naklidir (OKHN). Otolog KHN sonrası tekrar eden hastalarda ise allojeneik kök hücre nakli (AKHN) önemli bir kurtarma tedavisi olarak görülmektedir. Amaç: Medipol Üniversitesi Tıp Fakültesi çocuk kemik iliği nakil ünitesinde OKHN ve AKHN yapılan hastalarda sonuçları değerlendirmek. Yöntem: Tekrar eden/dirençli HL nedeniyle 2014 Kasım ile Temmuz 2019 tarihleri arasında merkezimizde OKHN yapılan 18 olgu retrospektif olarak değerlendirilmiştir. Otolog KHN sonrası hastalığı tekrar eden ve AKHN yapılan hastalarda ayrıca değerlendirilmiştir. Bulgular: Onaltı hasta halen hayattadır. Onbir hastada OKHN sonrası has talık tekrar etmiştir. Relaps eden hastalardan 10’una AKHN yapılmıştır. Bu hastalardan üçünde tekrar görülmüş olup, sekizi nakil sonrası hayattadır lar.Öğe Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study(Wiley, 2021) Atağ, Emine; Ünal, Füsun; Yazan, Hakan; Girit, Saniye; Uyan, Zeynep Seda; Ergenekon, Almala Pınar; Yayla, Esra; Merttürk, Edanur; Telhan, Leyla; Meral, Özge; Küçük, Hanife Büşra; Gündüz, Mehmet; Gökdemir, Yasemin; Eralp, Ela Erdem; Kıyan, Gürsu; Çakır, Erkan; Ersu, Refika; Karakoç, Fazilet; Öktem, SedatIntroduction Flexible bronchoscopy (FB) is frequently used for assessment and treatment of patients with respiratory diseases. Our aim was to investigate the contribution of FB to diagnosis and therapy in children admitted to the intensive care units (ICU) and to evaluate the safety of FB in this vulnerable population. Methods Children less than 18 years of age who underwent FB in the five neonatal and pediatric ICUs in Istanbul between July 1st, 2015 and July 1st, 2020 were included to the study. Demographic and clinical data including bronchoscopy indications, findings, complications, and the contribution of bronchoscopy to the management were retrospectively reviewed. Results One hundred and ninety-six patients were included to the study. The median age was 5 months (range 0.3-205 months). The most common indication of FB was extubation failure (38.3%), followed by suspected airway disease. Bronchoscopic assessments revealed at least one abnormality in 90.8% patients. The most common findings were airway malacia and the presence of excessive airway secretions (47.4% and 35.7%, respectively). Positive contribution of FB was identified in 87.2% of the patients. FB had greater than 1 positive contribution in 138 patients and 80.6% of the patients received a new diagnosis. Medical therapy was modified after the procedure in 39.8% and surgical interventions were pursued in 40% of the patients. Therapeutic lavage was achieved in 18.9%. There were no major complications. Conclusion Flexible bronchoscopy is a valuable diagnostic and therapeutic tool in neonatal and pediatric ICUs and is not associated with major complications.Öğe Quality of life assessment after pediatric hematopoietic stem cell transplantation(Springer Nature, 2020) Kacır, Aybüke; Elli, Murat; Anak, Sema; Yaman, Yöntem; Baysoy, Gökhan; Özdilli, Kürşat; Bilgen, Hülya; Hazar, Volkan; Telhan, Leyla; Öktem, Sedat[Abstract Not Available]Öğe Respiratory syncytial virus infections in pediatric intensive care: association of sociodemographic data and clinical outcomes with viral and bacterial co-infections(2024) Koçoğlu Barlas, Ülkem; Akçay, Nihal; Telhan, Leyla; Kanğın, Murat; Umur, Özge; Çıtak, Agop; Boydağ Güvenç, KübraObjective: The aim of the study was to evaluate respiratory syncytial virus (RSV) infections in cases followed in the pediatric intensive care unit (PICU). Materials and Methods: The study was designed as a prospective cohort in 6 PICUs. There were 3 groups: only RSV (+), RSV (v+) who were positive for another viral agent(s) in addition to RSV, and RSV (b+) who were positive for a bacterial agent(s) in addition to RSV. Results: A total of 119 cases were included in the study, 67 (56.3%) of whom were male. The RSV (+) group had a lower pH compared to the other groups and a higher rate of acute bronc hiolitis/bronchitis diagnoses compared to the RSV (v+) group. The RSV (v+) group had higher bicarbonate levels, higher creatinine levels, longer hospital stays, and higher Pediatric Risk of Mortality-3 scores (PRISM-3) compared to the RSV (+) group. Cases with RSV (b+) were younger and also had lower body weight compared to the other groups. Furthermore, the RSV (b+) group had higher C-reactive protein and Procalcitonin (PCT) levels and higher rates of High Flow Nasal Cannula-Oxygen Therapy (HFNC-OT) use. Multiple linear regression analysis revealed that PRISM-3 score, PCT levels, Pediatric Acute Respiratory Distress Syndrome diagnoses, inhaled steroid use, chronic illness status, and heart rate on admission were associated with the length of stay in the PICU. Conclusion:High flow nasal cannula-oxygen therapy continues to be the most frequently preferred respiratory support method in RSV infections. Viral infections accompanying RSV can increase the severity of the disease.Öğe Severe pertussis infections in pediatric intensive care units: a multicenter study(2025) Akçay, Nihal; Tosun, Demet; Bingöl, İlyas; Bingöl, İbrahim; Çıtak, Agop; Telhan, Leyla; Baydemir, CananThis study aims to evaluate the clinical course of critical pertussis illness to the pediatric intensive care unit in Istanbul. The study was conducted as a multicenter, retrospective study between January 1, 2023, and December 31, 2023. Cases with positive polymerase chain reaction testing for Bordetella pertussis of nasopharyngeal swab samples within the first 24 h of pediatric intensive care unit admission were recorded. We divided the patients into exchange blood transfusion group and non-exchange blood transfusion group, comparing related factors and clinical characteristics among each group. A total of 50 children with severe pertussis were enrolled in the study, including 29 males (58%), with a median age of 9.14 weeks (range, 7.29–15.3 weeks). The mortality rate for severe pertussis was 8%. Exchange blood transfusion was performed in eight patients (16%). There were no significant differences between patients who received exchange blood transfusion and those who did not in terms of age, male gender, gestational age, birth weight, comorbidities, presenting symptoms, duration of cough, prior antibiotic use, vaccination status, coinfections, PICU length of stay, or mortality (p > 0.05). Children who underwent exchange blood transfusion had significantly higher white blood cell (WBC) counts, lymphocyte counts, neutrophil counts, and C-reactive protein (CRP) levels compared to those who did not receive the procedure (p < 0.05). Pulmonary hypertension was observed in 50% of the children who received exchange blood transfusion, while it was present in only 11.8% of those who did not undergo the procedure (p < 0.05). Additionally, patients who received exchange blood transfusion had higher incidences of respiratory failure, cardiac failure or arrest, inotrope requirement, and mechanical ventilation compared to those who did not receive the transfusion (p < 0.05). Conclusions: Pertussis can lead to severe complications and mortality in critically ill infants. Most severe pertussis occurred in young, unimmunized infants. Children admitted with pertussis with high CRP level, high WBC and lymphocyte, and cardiac and respiratory failure can need exchange blood transfusion. (Table presented.)Öğe The effect of early warning scoring system in pediatric intensive care unit on mortality after pediatric hematopoietic stem cell transplantation(Nature Publishing Group, 2018) Anak, Sema; Telhan, Leyla; Yaman, Yöntem; Şahin, Şifa; Elli, Murat[Abstract Not Available]Öğe The effect of nebulized antibiotics in children with tracheostomy(Elsevier Ireland Ltd, 2021) Atağ, Emine; Ünal, Füsun; Arslan, Hüseyin; Teber, Burcu Gizem; Telhan, Leyla; Hamutçu Ersu, Refika; Karakoç, Fazilet; Öktem, SedatIntroduction: Children with tracheostomy have an increased risk of bacterial colonization and infection of the lower respiratory tracts. This study aimed to investigate the effects of nebulized antibiotics on the bacterial load, the need for oral antibiotics, the number of hospitalizations, and the length of stay in the intensive care unit in tracheotomised children with persistent colonization. Methods: Children with tracheostomy and persistent bacterial colonization who were started on nebulized antibiotic therapy after a lower respiratory tract infection were included in the study. Nebulized gentamicin or colistin were used according to the results of the tracheal aspirate cultures. Demographic and clinic characteristics were recorded from one year prior until one year after initiation of nebulized antibiotic treatment. Results: Nebulized antibiotic treatment was initiated in 22 patients. Nebulized gentamicin was administered to 14 patients (63.6%) and colistin to 8 patients (36.4%). The median duration of treatment was 3 months (range 2–5 months). Following nebulized antibiotic treatment, median number of hospitalizations decreased from 2 (range 1.0–3.5) to 1 (range 0.0–1.5) (p = 0.04). The median length of stay in the intensive care unit reduced significantly from 89.5 days (range 43.0–82.5) to 25 days (range 7.75–62.75) after starting nebulized antibiotics (p = 0.028). Following nebulized antibiotic treatment median bacterial colony count also decreased (from 105 CFU/ml (range 105-106) to 6 × 104 CFU/ml (range 104-105); p = 0.003). There were no significant side effects during nebulized antibiotic therapy. Conclusions: The use of nebulized antibiotics reduced the number of hospitalizations, length of stay in the intensive care unit, and bacterial load in tracheotomised children with persistent airway colonization without significant side effects. The use of nebulized antibiotics showed a statistically significant decrease in the measures studied. Use of nebulized antibiotics may help to decrease the health care burden of these children, families and health care system. Further studies are needed to determine the indications and optimal duration of long-term nebulized antibiotic treatment in children with tracheostomy.Öğe Unusual clinical presentation of hodgkin lymphoma in a child: Both spinal cord compression and hydronephrosis(Lippincott Williams & Wilkins, 2021) Bayram, Nihan; Yaman, Yöntem; Elli, Murat; Doğan, Mehmet S.; Ayyıldız, Suat; Telhan, Leyla; Çakır, Aslı; Ünal, Dilek; Sebirli, Fatih; Anak, SemaBackground: Hodgkin lymphoma (HL) is predominantly a nodal disease with extranodal presentation being uncommon. Presentation with neurological symptoms is not uncommon in adult patients with HL. Subdiaphragmatic involvements are less common especially in childhood. In the literature, there has been no case which presented with both spinal cord compression and bilateral hydronephrosis in pediatric patients with HL. Observation: We report a 9-year-old boy diagnosed with HL who presented with bilateral hydronephrosis and epidural involvement. Conclusion: Differential diagnosis of abdominal mass in patients presenting with spinal cord compression and/or hydronephrosis should include HL. Retrograde J ureteral stenting is the treatment of choice for malignant ureteral obstruction.
