Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients

CONCLUSION: TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TIS used for the evaluation of body balance is valid and reliable for the Turkish population

A Decision Support System For Detecting Stage In Hodgkin Lymphoma Patients Using Artificial Neural Network and Optimization Algorithms

Hodgkin-type lymphoma is a disease with unique histological, immunophenotypic, and clinical features. This disease occurs in nearly 30% of all lymphomas. Its treatable is high. However, the treatment plan is specified after the stage and risk status are determined. For this reason, it is an important process for doctors to decide on the stage of the disease correctly. Some of the data used for this decision are the patient's history, detailed physical examination, laboratory findings, imaging methods and bone marrow biopsy results. Hybrid FDG-PET is the other method used in the medical world. This method is used in diagnosis, evaluation of response given to treatment, staging and restaging process. However, it is radiation-based. Therefore it has the possibility of producing undesirable results in the future. In this study, an artificial intelligence-based computer-assisted decision support system is done to reduce the number of used medical methods and radiation exposure. Data were obtained from the NCBI-GEO dataset. The evaluation of these data, which contains missing values, is handled in two ways. Firstly, samples with missing values in the initial evaluation are deleted from the dataset. Then, these data are trained with “trainlm” function in artificial neural network architecture. However, reducing the error value of the estimates is important. For this, the artificial neural network architecture is retrained with the artificial bee colony algorithm, particle swarm optimization algorithm and invasive weed algorithm, respectively. Secondly, the same operations are performed again on the dataset containing missing values. As a result of the training, the maximum performance was obtained for invasive weed and particle swarm optimization algorithms with 1,45547E+14 and 1,23103E+14 average error rates, respectively

Haemophagocytic Lymphohistiocytosis in a Newborn Infant Presenting with Cholestasis: Case Report

Hemophagocytic lymphohistiocytosis (HLH) is a rare, fatal disease. Neonatal cholestasis exhibits symptoms similar to those seen in several newborn diseases. HLH is rapidly fatal; therefore, an effective and prompt differential diagnosis is vital. A 10-hour-old newborn with icterus was referred to our clinic. Laboratory examination revealed direct bilirubinemia and pancytopenia, and cholestasis developed. HLH findings were observed in the bone marrow aspiration. Induction chemotherapy as described in the HLH-2004 protocol was initiated. Despite notable improvement in clinical signs and laboratory findings, the infant died, probably due to sepsis, one week after start of chemotherapy HLH should be kept in mind in the differential diagnosis of all cholestatic patients with recently developed cytopenia. For definitive diagnosis of HLH, clinical signs and laboratory findings of the patient should be evaluated, hyperferritinemia and hypertriglyceridemia should be searched and bone marrow aspiration materials should be examined carefully

Haemophagocytic Lymphohistiocytosis in a Newborn Infant Presenting with Cholestasis: Case Report ULUSLARARASı HEMATOLOJI-ONKOLOJI DERGISI CASE REPORT International Journal of Hematology and Oncology

ABSTRACT Hemophagocytic lymphohistiocytosis (HLH) is a rare, fatal disease. Neonatal cholestasis exhibits symptoms similar to those seen in several newborn diseases. HLH is rapidly fatal; therefore, an effective and prompt differential diagnosis is vital. A 10-hour-old newborn with icterus was referred to our clinic. Laboratory examination revealed direct bilirubinemia and pancytopenia, and cholestasis developed. HLH findings were observed in the bone marrow aspiration. Induction chemotherapy as described in the HLH-2004 protocol was initiated. Despite notable improvement in clinical signs and laboratory findings, the infant died, probably due to sepsis, one week after start of chemotherapy HLH should be kept in mind in the differential diagnosis of all cholestatic patients with recently developed cytopenia. For definitive diagnosis of HLH, clinical signs and laboratory findings of the patient should be evaluated, hyperferritinemia and hypertriglyceridemia should be searched and bone marrow aspiration materials should be examined carefully. Keywords: Hemophagocytic lymphohistiocytosis, Cholestasis, Infant ÖZET Kolestazla Baflvuran Yenidoan ‹nfantta Hemofagositik Lenfohistiositoz: Olgu Sunumu Hemofagositik lenfohistiositozis (HLH) nadir ve ölümcül bir hastal›kt›r. Neonatal kolestazis birçok ciddi yenido¤an hastal›¤›nda görü-len ortak bir bulgudur. HLH h›zla ölümcül olabilece¤inden etkili ve h›zl› tan› konulmas› hayati öneme sahiptir. Klini¤imize 10 saatlik, sar›l›¤› olan bir yenido¤an sevk edildi. Laboratuar tetkiklerinde direkt bilirubinemi, pansitopeni ve kolestaz varl›¤› saptand›. Yap›lan kemik ili¤i aspirasyonunda HLH bulgular› gözlendi. HLH-2004 protokolünde belirtildi¤i flekilde indüksiyon kemoterapisi baflland›. Klinik ve laboratuar bulgularda görülen iyileflmeye ra¤men hastam›z kemoterapi bafllad›ktan bir hafta sonra olas› sepsis sebebiyle kaybedildi. HLH, sitopeni geliflen tüm kolestatik hastalar›n ay›r›c› tan›s›nda ak›lda tutulmas› gereken bir hastal›kt›r. HLH'nin kesin tan›s›n› koyabilmek için hastan›n klinik ve laboratuar bulgular› de¤erlendirilmeli, hiperferritinemi ve hipertrigliseridemi araflt›r›lmal› ve kemik ili¤i aspirasyon materyali dikkatlice incelenmelidir

Clinical experience with recombinant tissue plasminogen activator in the management of intracardiac and arterial thrombosis in children

Thrombotic events may complicate the clinical course of many pediatric diseases. Drugs for therapeutic thrombolysis include streptokinase, urokinase and tissue plasminogen activator (t-PA). There is less experience with recombinant t-PA (rt-PA) in children. We aimed to present our experiences with rt-PA in children with intracardiac or peripheral arterial thrombus. We retrospectively reviewed the children who received rt-PA for thrombus. Twenty-two children (13 boys, 9 girls; age range: 1 day-17 years) with intracardiac (n = 5), prosthetic heart valve (n = 2) and peripheral arterial (n = 15) thrombus were evaluated. Twelve (54%) had congenital heart disease, two (9%) had rheumatic heart disease, three (14%) had leukemia and five (23%) had documented sepsis, prematurity or meconium aspiration syndrome. Ten of the 15 peripheral arterial thromboses were observed following cardiac catheterization. Three of the five intracardiac thrombi were detected in children with leukemia. All children received low-molecular-weight heparin. rt-PA (alteplase) infusion (at a dose of 0.01-0.5 mg/kg per h) was administered for different time periods (3-66 h). Ten of 11 patients with peripheral arterial occlusion and three of five patients with intracardiac thrombus showed full recovery. However, there was no response in two patients with intracardiac thrombus and in two patients with heart valve thrombus. Nose bleeding, melena and decreased serum fibrinogen concentration were observed in seven patients during the rt-PA infusion. All bleedings stopped after cessation of rt-PA infusion, and no blood transfusion was required in any patient We conclude that rt-PA infusion seems effective and well tolerated in children for the treatment of peripheral arterial and intracardiac thrombus. Blood Coagul Fibrinolysis 25:726-730 2014 (C) Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

A National Registry of Thalassemia in Turkey: Demographic and Disease Characteristics of Patients, Achievements, and Challenges in Prevention

WOS: 000426572200002PubMed ID: 28404539Objective: The Turkish Society of Pediatric Hematology set up a National Hemoglobinopathy Registry to demonstrate the demographic and disease characteristics of patients and assess the efficacy of a hemoglobinopathy control program (HCP) over 10 years in Turkey. Materials and Methods: A total of 2046 patients from 27 thalassemia centers were registered, of which 1988 were eligible for analysis. This cohort mainly comprised patients with beta-thalassemia major (n = 1658, 83.4%) and intermedia (n = 215, 10.8%). Results: The majority of patients were from the coastal areas of Turkey. The high number of patients in Southeastern Anatolia was due to that area having the highest rates of consanguineous marriage and fertility. The most common 11 mutations represented 90% of all beta-thalassemia alleles and 47% of those were IVS1-110(G->A) mutations. The probability of undergoing splenectomy within the first 10 years of life was 20%, a rate unchanged since the 1980s. Iron chelators were administered as monotherapy regimens in 95% of patients and deferasirox was prescribed in 81.3% of those cases. Deferasirox administration was the highest (93.6%) in patients aged <10 years. Of the thalassemia major patients, 5.8% had match-related hemopoietic stem cell transplantation with a success rate of 77%. Cardiac disease was detected as a major cause of death and did not show a decreasing trend in 5-year cohorts since 1999. Conclusion: While the HCP has been implemented since 2003, the affected births have shown a consistent decrease only after 2009, being at lowest 34 cases per year. This program failure resulted from a lack of premarital screening in the majority of cases. Additional problems were unawareness of the risk and misinformation of the at-risk couples. In addition, prenatal diagnosis was either not offered to or was not accepted by the at-risk families. This study indicated that a continuous effort is needed for optimizing the management of thalassemia and the development of strategies is essential for further achievements in the HCP in Turkey.Ege Children's Foundation; Novartis Pharmaceuticals CorporationNovartisThe authors thank Caglar Serdar, Aylin Gokduman, and Tolga Turgay of Plexus Information Technologies for their website support. The current study and the work presented here are from an Investigator Initiated Trial, which was sponsored by the Ege Children's Foundation and funded by Novartis Pharmaceuticals Corporation