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Öğe Anormal Uterin Kanamalı Adölesanların Multidisipliner Yaklaşım ile Yönetiminin Değerlendirilmesi(2024) Ertekin, Mehtap; Evin, Ferda; Ayrancı, İlkayAnormal uterin kanama (AUK), uterus korpusundan süre, miktar, sıklık ve/veya düzen açısından anormal olan kanama olarak tanımlanır. Adölesan dönemde en sık karşılaşılan jinekoendokrinolojik problemdir. Çalışmamızda AUK olan 40 adölesanın verileri retrospektif olarak incelendi. Hemoglobin 10-12 gr/dL hafif AUK; hemoglobin 8-9,9 gr/dL orta AUK; hemoglobin <8 gr/dL ağır AUK olarak sınıflandırıldı. Olguların yaş ortalaması 14,38±2,1 (11-17,8) yıldı. Olguların ortanca menstrual siklus aralığı 25 (10-45) gün, ortanca kanama süresi 10 (4-35) gün, ortalama ped sayısı 6,2 ped/gün idi. Olguların %17.5’inde (n=7) ağır AUK, %20’sinde (n=8) orta AUK, %62,5’inde (n=25) hafif AUK mevcuttu. 2 (%5) olguda hafif Von Willebrand Hastalığı saptandı. Kanama etiyolojisinde saptanan en sık etken anovulasyondu (n=34). Hafif AUK olan olgularda kanamaya yönelik tedavide ilk seçenek olarak non-steroid antiinflamatuar ilaçlar (NSAİİ) başlandı. Orta AUK olan adölesanlara (n=8) ve hafif AUK olup NSAİİ ile kanamaları kontrol altın alınamayan olgulara (n=6) 3mg drospirenon ve 30 mcg etinilöstradiol içeren kombine oral kontraseptif (KOK) başlandı. Bu olguların kanamaları KOK ile kontrol altına alındı. Ağır AUK olan olgulara, 3mg drospirenon ve 30 mcg etinilöstradiol içeren KOK günde 2-3 tablet olacak şekilde başlandı. Bu olguların kanamalarının kontrol altına alınamaması nedeniyle tedavilerine traneksamik asit oral olarak eklendi. Ağır AUK olan tüm olgularda kombine tedavi ile kanamalar kontrol altına alındı. Sonuç olarak; adölesan dönemde aşırı ve uzun süreli kanama sadece jinekolojik bir sorun değil, aynı zamanda sosyal bir sorundur. Bu nedenle hastalar çocuk endokrinoloji ve çocuk hematoloji tarafından kapsamlı olarak değerlendirilmeli ve tedavileri multidisipliner olarak planlanmalıdır.Öğe Evaluation of the Lag Time Between Onset of Symptoms and Diagnosis in Childhood Cancers(Galenos Publishing House, 2023) Kalay, Gülşah; Sevinir, Betül Berrin; Demirkaya, Metin; Aygüneş, Utku; Ertekin, MehtapIntroduction: Our aim was to evaluate the lag time between the first onset of symptoms and the final diag-nosis in children with lymphoma and solid tumors. Materials and Methods: This study was carried out by retrospectively scanning the records of 759 patients admitted to the Pediatric Oncology Department of Uludağ University between January 2005 and December 2014. Demographic data of the patients, first complaints, the time to apply to a physician after the first complaint, the first application center were determined, lag time to the center that established the oncologic diagnosis, the final diagnosis, time to diagnosis at the last center, total time elapsed from the first onset of complaints to the establishment of diagnosis and the last health state of the patient were obtained from the hospital records. Results: The patients diagnosed with cancer firstly applied to a physician median 15 days. The physicianwho saw the patient for the first time referred to him/her to the center that established the final diagnosis after a median of 8 days. The median time to final diagnosis was 10 days minimum 1 days and totaly 55 days at the last center. In patients whose first symptom is fever, abdominal pain and seizures and In patients with a definitive diagnosis of germ cell tumor, neuroblastoma, kidney tumor and liver tumor, the time to the first admission was shorter than 15 days. In patients whose first symptom was a headache, and abdominal mass; in patients and central nervous system (CNS), and eyes, and in patients with the final diagnosis of CNS tumor germ cell tumor and retinoblastoma, the lag times for referrals were significantly shorter than 8 days. In patients whose first symptom was headache, nausea and vomiting, fatigue-weight loss, and visual disturbances and in patients with the final diagnosis of CNS tumors and neuroendocrine tumors, the time to diagnosis was significantly shorter than 10 days. Conclusion: Delays in diagnosis are common in children with cancer. A sustained effort should be made to raise the level of awareness of childhood cancer among parents and to sensitize all physicians, especially those who treat pediatric patients infrequently, about the warning signs of the disease. © 2023 by Bursa Uludağ University, Department of Pediatrics.Öğe Hemophilia Caregiver Burden in a Low Socioeconomic Region of Turkey(Aves, 2023) Ersoy, Gizem Zengin; Ertekin, Mehtap; Dikme, GuercanObjective: This study aims to evaluate the caregiver burden of parents of hemophilia patients and related factors in the southeast region of Turkey, where access to a regular healthcare facility is more complicated than in other areas.Materials and Methods: Twenty-six caregivers of patients with hemophilia were consecutively enrolled in this non-interventional study. Caregiver burden is measured using the Hemophilia -Associated Caregiver Burden Scale (HEMOCAB).Results: Hemophilia affects 65.4% of caregivers emotionally, and 92.3% feel the burden caused by financial problems related to hemophilia. The perception of the patients by caregivers was negative in the groups of low educational degree and unstable employment status (P = .037 and P = .017, respectively). The employment status and job changes influence the caregiver burden because of hemophilia (P = .034 and P = .001, respectively). The groups of those who spent greater than 5 hours for transportation to the hemophilia treatment center (HTC) had a higher burden (P = .001). Multiple linear regression analysis analyzed variables affecting HEMOCAB, frequency, and burden total scores. The model created with the burden total score was statistically significant (P = .047).Conclusion: The main factors affecting caregiver burden were educational status, working conditions, and economic difficulties, as well as the length of infusion times and transfer to HTCs. There is a need to develop socioeconomic policies related to these problems.Öğe Restrictive effects of thalassemia on respiratory functions: One center experience(Kare Publ, 2023) Ersoy, Gizem Zengin; Nain, Ercan; Ertekin, Mehtap; Terzi, Ozlem; Sasihuseyinoglu, Ayse Senay; Dikme, GurcanOBJECTIVE: Respiratory functions in thalassemia major (TM) patients concerning poor chelation are a frequently researched issue. Our study aims to evaluate the lung functions of our patients with TM in the chronic transfusion program and to correlate them with their age, ferritin levels, and pre-transfusion hemoglobin values.METHODS: Height, weight, pulmonary function test (PFT) results, pre-transfusion hemoglobin levels, and ferritin levels of 97 patients (55 boys and 42 girls) without any underlying cardiac or chronic respiratory disease were recorded. PFT is consisted of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), the ratio of FEV1/FVC to peak expiratory flow (PEF), and forced mid-exhaled flow between 25% and 75% of mid-expiratory flow (MEF25-75). Data were analyzed with IBM SPSS V25.RESULTS: Low FVC was observed in 58 patients (60%), and low FEV1 was observed in 26 patients (27.6%). Low PEF was ob-served in 62 patients (64.5%), and low MEF25-75 was observed in 8 (8.3%). PFT was affected in 75 patients (78.1%). The pattern of involvement was restrictive. Age, height, and ferritin values significantly affected the MEF25-75 (p<0.05). Age and pre -trans-fusion hemoglobin values had a significant effect on the FVC test (p<0.05). There was a weak negative correlation between ferritin values and MEF25-75 (r=-0.221) and a weak positive correlation between pre-transfusion hemoglobin and FVC (r=0.222).CONCLUSION: Age and height are the main risk factors affecting FEV1, MEF25-75, and PEF. Serum ferritin has only an effect on MEF25-75 in our study. The respiratory functions of TM patients were affected in a restrictive pattern.Öğe The Relationship Between Premature Adrenarche and Markers of Inflammation in Complete Blood Count(Galenos Publ House, 2024) Evin, Ferda; Ayranci, Ilkay; Ertekin, MehtapAim: Premature adrenarche (PA) has been associated with metabolic and polycystic ovary syndrome (PCOS) and, thus, with an increased risk for type 2 diabetes and cardiovascular diseases in later life. Mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), and platelet/ lymphocyte ratio (PLR) are parameters used to show inflammation. This study planned to evaluate systemic inflammation in children with PA using MPV, NLR, and PLR. Materials and Methods: The study included 40 female patients diagnosed with PA and 40 healthy female individuals as a control group. The patient and control groups' MPV, NLR, and PLR values were compared. Results: The mean age of the PA group was 7.18 +/- 0.66 years, and the mean age of the control group was 7.09 +/- 1.08 years. The mean MPV and platelet distribution width (PDW) values in the PA group were significantly higher than those in the control group (10.25 +/- 0.87 vs 9.52 +/- 0.79, p<0.001 and 15.43 +/- 1.31 vs 14.35 +/- 1.84, p=0.04, respectively). However, in the PA group, NLR and PLR were not significantly different from the values in the control group (p>0.05). The results of multivariate logistic regression analysis revealed that the MPV [odds ratio (OR); 95% confidence interval (CI): 0.331 (0.174-0.630); p=0.001], and PDW [OR; 95%: CI: 0.612 (0.425-0.884); p=0.008] were associated with PA in the patient group. Conclusion: Our results demonstrated that PA patients had significantly higher MPV levels and PDW than the healthy controls. Hence, recognition of early markers in adolescence might reveal primary pathogenetic alterations predictive of the later development of PCOS and/or metabolic syndrome.
