Papers by Yurdanur Kılınc
Çukurova Üniversitesi Tıp Fakültesi dergisi, 2015
DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2015
Thalassemias are a heterogeneous group of autosomal recessive diseases characterized by hypochrom... more Thalassemias are a heterogeneous group of autosomal recessive diseases characterized by hypochromic microcytic anemia and occur as a result of defective synthesis of one or more hemoglobin chains. In patients, life-threatening clinical manifestations may occur because of severe iron overload due to frequent blood transfusions. Ocular changes in patients with thalassemia are to be encountered depending on the disease itself or chelator used in the treatment, but not very often. These changes are usually cataracts, optic neuropathy, retinal pigment epithelium (RPE) degeneration, RPE mottling, retinal venous tortuosity, vitreoretinal hemorrhages and obliteration of the iris pattern. Desferrioxamine that is used as the first iron-binding chelating has well-known complications such as optic neuropathy and retinal toxicity. However, Deferiprone that used more common recently has replaced the Desferrioxamine but, there is very little information in the literature about the ocular toxicity of deferiprone. In this case report, we have reported a patient with deferiprone-induced cataract formation in order to draw attention to a little-known complication of the drug. [Cukurova Med J 2015; 40(Suppl 1): 112-116]
Nephrology Dialysis Transplantation, Jun 1, 2023
1/3 and 2/3 of the area, and 3: damage over 2/3 of the area. Subsequently, the mean scores of the... more 1/3 and 2/3 of the area, and 3: damage over 2/3 of the area. Subsequently, the mean scores of the kidneys from the same experimental group were calculated, as well as the standard error of the mean. Data was analyzed with the statistical software SPSS R . Results: Our results showed tubular renal damage associated with cisplatin treatment. It was more pronounced in the external cortical area. However, no structural alterations associated with ICI treatment were found. Co-treatment with both drugs potenciated renal structural damage from cisplatin. Conclusion: This potentiation was more evident in the corticomedullary region, so it seems that the drugs combination causes a deeper lesion in the kidney than cisplatin monotherapy. Our study suggests that the combined therapy of anti-CTLA-4 and cisplatin could induce generalized tubular lesions.
Journal of Pediatric Hematology Oncology, Jan 27, 2021
Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can... more Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.
JAMA, 2021
Importance Although effective agents are available to prevent painful vaso-occlusive episodes of ... more Importance Although effective agents are available to prevent painful vaso-occlusive episodes of sickle cell disease (SCD), there are no disease-modifying therapies for ongoing painful vaso-occlusive episodes; treatment remains supportive. A previous phase 3 trial of poloxamer 188 reported shortened duration of painful vaso-occlusive episodes in SCD, particularly in children and participants treated with hydroxyurea. Objective To reassess the efficacy of poloxamer 188 for vaso-occlusive episodes. Design, Setting, and Participants Phase 3, randomized, double-blind, placebo-controlled, multicenter, international trial conducted from May 2013 to February 2016 that included 66 hospitals in 12 countries and 60 cities; 388 individuals with SCD (hemoglobin SS, SC, S-β0 thalassemia, or S-β+ thalassemia disease) aged 4 to 65 years with acute moderate to severe pain typical of painful vaso-occlusive episodes requiring hospitalization were included. Interventions A 1-hour 100-mg/kg loading dose of poloxamer 188 intravenously followed by a 12-hour to 48-hour 30-mg/kg/h continuous infusion (n = 194) or placebo (n = 194). Main Outcomes and Measures Time in hours from randomization to the last dose of parenteral opioids among all participants and among those younger than 16 years as a separate subgroup. Results Of 437 participants assessed for eligibility, 388 were randomized (mean age, 15.2 years; 176 [45.4%] female), the primary outcome was available for 384 (99.0%), 15-day follow-up contacts were available for 357 (92.0%), and 30-day follow-up contacts were available for 368 (94.8%). There was no significant difference between the groups for the mean time to last dose of parenteral opioids (81.8 h for the poloxamer 188 group vs 77.8 h for the placebo group; difference, 4.0 h [95% CI, -7.8 to 15.7]; geometric mean ratio, 1.2 [95% CI, 1.0-1.5]; P = .09). Based on a significant interaction of age and treatment (P = .01), there was a treatment difference in time from randomization to last administration of parenteral opioids for participants younger than 16 years (88.7 h in the poloxamer 188 group vs 71.9 h in the placebo group; difference, 16.8 h [95% CI, 1.7-32.0]; geometric mean ratio, 1.4 [95% CI, 1.1-1.8]; P = .008). Adverse events that were more common in the poloxamer 188 group than the placebo group included hyperbilirubinemia (12.7% vs 5.2%); those more common in the placebo group included hypoxia (12.0% vs 5.3%). Conclusions and Relevance Among children and adults with SCD, poloxamer 188 did not significantly shorten time to last dose of parenteral opioids during vaso-occlusive episodes. These findings do not support the use of poloxamer 188 for vaso-occlusive episodes. Trial Registration ClinicalTrials.gov Identifier: NCT01737814.
Blood, 2005
Objective: Platelet transfusion is used for the treatment of acute hemorrhages in diseases other ... more Objective: Platelet transfusion is used for the treatment of acute hemorrhages in diseases other than immunological events, which lead to severe thrombocytopenia. Besides the diseases in which production of platelets is completely terminated in the bone marrow and the platelet requirement is increased, immune thrombocytopenia and alloimmunization may also result in not being able to achieve the desired platelet levels with platelet transfusion, and life threatening hemorrhages. rFVIIa which is used for the management of life threatening hemorrhages in hemophiliac patients with inhibitors and in cases of acquired coagulopathies has also been used successfully in patients with thrombocytopenia. Here we present a case with a diagnosis of kala-azar, where nasal hemorrhage couldn’t be managed with conventional methods and required continuous replacement, and finally treated successfully by using rFVIIa. Case: At admittance to hospital, hepatosplenomegaly and pancytopenia were detected in...
Blood, 2018
Objective: Immune thrombocytopenia is a bleeding disorder related to deficiency of the main eleme... more Objective: Immune thrombocytopenia is a bleeding disorder related to deficiency of the main element in primary hemostasis, platelets. But it rarely results in an opposite clinical complication as thrombosis. The mechanism of this unexpected complication is not fully understood still and the treatment of the patients in this thrombocytopenic and thrombotic condition is critical and hard to manage. Here we present a case of immune thrombocytopenia with cerebral infarct with his clinical management details. Case: A seven-year old boy diagnosed with Immune thrombocytopenia at the age of 1 in another clinic and treated with IVIG when the platelet levels fell and bleeding symptoms appeared. The patient refered to our clinic with severe refractory thrombocytopenia. After being diagnosed with ITP, IVIG treatment and HDDXM treatment (20 mg/m2/day for 4 days) was given 2 cure in a month then the patient follow up in the clinic. It is learned that the family continued with HDDXM and sometimes ...
Blood, 2018
Background: Sickle cell anemia (SCA) is a hemoglobinopathy as a result of substitution of glutami... more Background: Sickle cell anemia (SCA) is a hemoglobinopathy as a result of substitution of glutamic acid with valine in the 6th position of the β globin chain. The vaso-occlusive crises of patients are often caused by pain that requires in-patient treatment. The attack rate is reported to changed between 0.5-1.0 attacks per year per patient. It could be reach up to 10% in 5% of patients. Identification of the SCA painful crisis and the determination of appropriate treatment is very important for the pain relief. Recently studies support that ketamine treatment is beneficial in patients who do not respond to traditional methods. Ketamine is a non-competitive antagonist at the NMDA receptor. We used retrospective visual analogue scale (VAS) scoring system in acute painful crisis patients and then applied ketamine and tramadol to investigate the effect of treatment and side effects and the maximum change in pain score within the first hour after drug administration retrospectively. The ...
Blood, 2006
Introduction: A large proportion of pts enrolled in the deferasirox clinical trials were children... more Introduction: A large proportion of pts enrolled in the deferasirox clinical trials were children aged 2–<16 years. Data from the core, 1-year trials demonstrated that deferasirox was effective in these pts, with a similar safety profile to adults. After the core trials, pts entered 4-year extension phases. This post-hoc analysis presents long-term deferasirox safety and efficacy data in pediatric pts. Methods: Pediatric pts with various underlying anemias (β-thalassemia, sickle cell disease, other congenital anemias) either received deferasirox in the core trials (deferasirox cohort) or crossed over from deferoxamine to deferasirox during the extension phases (crossover cohort). Safety and efficacy were assessed monthly, primarily by evaluating the incidence and type of adverse events (AEs) and by measuring serum ferritin (SF) levels. Liver iron concentration (LIC) was measured at baseline and the end of the core trials. Results: The deferasirox (n=289) and crossover (n=144) coh...
Blood, 2016
Introduction: Severe congenital nötropenia (SCN) is a very rare disease. Genetic mutation in neut... more Introduction: Severe congenital nötropenia (SCN) is a very rare disease. Genetic mutation in neutrophil elastase gene (ELANE) is the most frequent mutation in European and North American registries. However, differences could be expected in the countries where consanguineous marriages are common. It is important to find out whether the approach for genetic typing shall be the same in western Europe, eastern Europe and middle East. We aimed to establish a national neutropenia registry in Turkey, a country with an extraordinary mixed population of Caucasian and Asian decent and the proportion of consanguineous families being higher than in most other parts of Europe. Patients and Methods: In this study, establishment of a national registry for severe congenital neutropenia (SCNR) and national bone marrow failure (BMFR) was aimed. Clinical and laboratory findings of 699 patients with BMF including 223 patients (31.9%) with SCN were entered into Turkish National BMFR. Results: The media...
Blood, 2012
996 The incidence of agranulocytosis during deferiprone (Ferriprox®) use has been reported in cli... more 996 The incidence of agranulocytosis during deferiprone (Ferriprox®) use has been reported in clinical trials where patients' neutrophil counts were generally monitored weekly and deferiprone was discontinued at the first sign of neutropenia (neutrophil count < 1.5 × 10 9/L), but the incidence in a less rigorously monitored environment is unknown. This observational, open label, prospective, multi-centre, non-interventional drug surveillance program was designed to assess how the safety of deferiprone therapy is monitored in clinical practice. All patients in the 15 participating treatment sites (Egypt, Oman, Saudi Arabia and Turkey) who initiated therapy with deferiprone during the observation period, were enrolled in the program. There were no exclusion criteria. The program was approved by local ethics boards and informed consent was obtained. 294 patients (53.4% males) were enrolled and the results of the first year of treatment are reported herein. Mean (SD) age of all p...
Haemophilia : the official journal of the World Federation of Hemophilia, 2015
Recombinant factor VIII (rFVIII) products provide a safe and efficacious replacement therapy for ... more Recombinant factor VIII (rFVIII) products provide a safe and efficacious replacement therapy for prevention and treatment of bleeding episodes in patients with haemophilia A. The present investigations from the multinational, open-label guardian(™) clinical trials assessed the haemostatic response of turoctocog alfa (NovoEight(®)), a rFVIII product, in patients with severe haemophilia A (FVIII ≤ 1%) undergoing surgery. All patients had a minimum of 50 exposure days to any FVIII product prior to surgery and no history of inhibitors. A total of 41 procedures (13 orthopaedic, 19 dental and 9 general) were performed in 33 patients aged 4-59 years. Of the 41 procedures, 15 were major surgeries in 13 patients and 26 were minor surgeries in 21 patients. The success rate for haemostatic response was 100% (success was defined as 'excellent' or 'good' haemostatic outcome). Turoctocog alfa consumption on the day of surgery ranged from 27 to 153 IU kg(-1). The mean daily dose de...
Jornal Brasileiro de Pneumologia, 2007
A hemossiderose pulmonar idiopática (HPI), principal causa de hemossiderose pulmonar em crianças,... more A hemossiderose pulmonar idiopática (HPI), principal causa de hemossiderose pulmonar em crianças, cursa com sangramento alveolar intermitente e presença de hemossiderófagos no escarro ou no lavado gástrico. O tratamento é baseado nos corticoesteróides e citostáticos, em condições especiais. Descreve-se o caso de uma menina de sete anos com HPI, que conseguiu controle parcial da doença mediante altas doses de corticoesteróide. O tratamento, no entanto, necessitou ser suspenso gradualmente visto a paciente ter desenvolvido fácies cushingóide. Foi iniciada a associação da azatioprina ao corticóide até a substituição total por azatioprina isolada, cujo uso foi mantido por quatro anos, com ótimo resultado.
Pediatric Blood & Cancer, 2013
BackgroundA risk associated with the iron chelator deferiprone is the development of neutropenia ... more BackgroundA risk associated with the iron chelator deferiprone is the development of neutropenia or agranulocytosis. Accordingly, the product label recommends weekly blood monitoring and immediate interruption of treatment upon detection of an absolute neutrophil count (ANC) <1.5 × 109/L, out of concern that continued therapy might lead to a more severe drop. However, it is uncertain how these recommendations are followed under real‐life conditions and, if they are not followed, whether continuation of therapy results in increased incidence of agranulocytosis.ProcedureThis non‐interventional surveillance program assessed the monitoring of deferiprone therapy in clinical practice. A total of 294 patients with transfusion‐dependent anemias received deferiprone, as monotherapy or with another chelator, for up to 1 year. The participating physicians were not given any instructions about treatment and monitoring beyond being referred to the information in the package insert.ResultsANC...
Field Crops Research, 1999
Zinc (Zn) de®ciency is a critical nutritional problem for plants and humans in Turkey. About 14 M... more Zinc (Zn) de®ciency is a critical nutritional problem for plants and humans in Turkey. About 14 Mha of cropped land in Turkey are known to be Zn de®cient, particularly cereal growing areas of Anatolia. In 1993, a joint research project was started in Turkey with the ®nancial support of the NATO-Science for Stability Programme to select and characterize cereal genotypes with high yield and/or high Zn accumulation in grain under de®cient supply of Zn. Field, greenhouse and growth chamber experiments were carried to study morphological, physiological and genetic factors determining the bases of genotypical differences in Zn ef®ciency among cereal species and within cultivars of wheat. Among the cereals, rye had particularly high Zn ef®ciency (high yield under Zn de®ciency). There were large genotypical differences among wheat lines. High Zn ef®ciency was closely associated with enhanced capacity of some lines to take up Zn from soils, but not with increased Zn accumulation per unit dry weight of shoot or grain. Measurement of Zn-containing superoxide dismutase activity in leaves revealed that an ef®cient utilization of Zn at the tissue or cellular level is an additional major factor involved in Zn ef®ciency of cereals. Zinc present in grains from Anatolia seems to be not bioavailable. Phytate : Zn molar ratios in grains, a widely accepted predictor of Zn bioavailability, were extremely high and ranged between 95 and 216 for crops grown severely on Zn-de®cient soils of Central Anatolia. In the studies concerning determination of Zn nutritional status of school children in Southeastern Anatolia, most children were found to be of shorter stature and had very low levels of Zn (<100 mg kg À1 ) in hair.
BMC Endocrine Disorders, 2014
Background: To compare the safety and efficacy of saxagliptin 2.5 mg twice daily (BID) versus pla... more Background: To compare the safety and efficacy of saxagliptin 2.5 mg twice daily (BID) versus placebo add-on therapy to metformin immediate release (IR) in patients with type 2 diabetes and inadequate glycemic control with metformin alone. Methods: This multicenter, 12-week, double-blind, parallel-group trial enrolled adult outpatients with type 2 diabetes (glycated hemoglobin [HbA 1c ] 7.0%-10.0%) on stable metformin IR monotherapy (≥1500 mg, BID for ≥8 weeks). Patients were randomized to double-blind saxagliptin 2.5 mg BID or placebo added on to metformin IR following a 2-week, single-blind, placebo add-on therapy lead-in period. The primary end point was the change from baseline to week 12 in HbA 1c . Key secondary end points included change from baseline to week 12 in fasting plasma glucose (FPG) and the proportion of patients achieving HbA 1c <7.0% or HbA 1c ≤ 6.5% at week 12. Efficacy was analyzed in all patients who received randomized study drug with ≥1 postbaseline assessment. Safety was assessed in all treated patients. Results: In total, 74 patients were randomized to double-blind saxagliptin add-on therapy and 86 to placebo add-on therapy. At week 12, least-squares mean changes (95% CI) from baseline HbA 1c (adjusted for baseline HbA 1c ) were significantly greater (P = 0.006) in the saxagliptin + metformin group -0.56% (-0.74% to -0.38%) versus the placebo + metformin group -0.22% (-0.39% to -0.06%). Adjusted mean changes from baseline in FPG were numerically greater with saxagliptin versus placebo; the difference (95% CI) -9.5 mg/dL (-21.7 to 2.7) was not statistically significant (P = 0.12). A numerically greater proportion of patients in the saxagliptin group than the placebo group achieved HbA 1c < 7.0% (37.5% vs 24.2%) or HbA 1c ≤6.5% (24.6% vs 10.7%). There were no unexpected safety findings. Hypoglycemia occurred in 4 patients (5.4%) in the saxagliptin group and 1 patient (1.2%) in the placebo group; confirmed hypoglycemia (symptoms plus fingerstick glucose ≤50 mg/dL) occurred in 1 patient in the placebo group. Conclusions: Addition of saxagliptin 2.5 mg BID to metformin therapy in patients with type 2 diabetes and inadequate glycemic control on metformin monotherapy reduced HbA 1c compared with placebo added to metformin, with an adverse events profile similar to placebo and no unexpected safety findings.
Pediatric practice and research, Aug 31, 2020
Aim: Immune thrombocytopenia (ITP) is the most common cause of acquired thrombocytopenia in child... more Aim: Immune thrombocytopenia (ITP) is the most common cause of acquired thrombocytopenia in childhood. We aimed to investigate the clinical features of the disease and provide insight into how the treatment method is determined accordingly. It is also intended to examine and compare the treatment responses. Between January 2013 and December 2018, a total of 80 patients diagnosed with ITP, at the Pediatric Hematology Outpatient Clinic were enrolled in the study. During the study period, we recorded data of all patients thoroughly. The results were compared with those undergoing appropriate medical therapy statistically after the exclusion of the causes of secondary thrombocytopenia. The mean age of the patients was 5 ± 2.3 years; the ratio of females to males was found to be 1 : 2. Among the most common complaints were ecchymosis (63.7%), followed by petechiae (20%). Four (5%) patients received no treatment. Methylprednisolone, IVIG, and dexamethasone were given in 49 (61.2%), 17 (21.2%), and 8 (10%) patients, respectively. Both of methylprednisolone and IVIG were given to only 2 (2.5%) patients. The ITP patients receiving IVIG have been found to progress to chronicity more than those receiving methylprednisolone. Our study also presents knowledge to be able to predict the development of chronicity in ITP.
Turkiye Klinikleri Medical Genetics - Special Topics, 2017
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Papers by Yurdanur Kılınc