Late Effects of Therapy in Childhood Acute Lymphoblastic Leukemia Survivors

Over the last 50 years, the survival rates in children with acute lymphoblastic leukemia (ALL) have increased remarkably. The optimal use of antileukemic agents in cooperative group protocols, central nervous system-directed treatment, improvements in supportive care, and recognition of biological, clinical, and treatment response characteristics that predict patients with a higher or a lower risk of treatment failure have improved 5-year event-free survival rates, reaching more than 85%, and 5-year overall survival rates, reaching more than 90%. Consequently, it has become increasingly important to characterize the occurrence of long-term late effects. ALL treatments have been associated with increased risks for adverse outcomes such as late mortality, secondary malignancies, and neurological, cardiac, endocrine, and social/psychological disorders. In recent decades, cooperative groups in Europe and in the United States have provided essential information about the long-term effects of ALL therapy, giving recommendations for screening as well as facilitating new approaches for reducing late-term morbidity and mortality. Current frontline protocols continue to examine ways to lower the intensity and amount of therapy to reduce late effects, whereas survivorship studies attempt to predict such adverse effects precisely and develop targeted prevention and treatment strategies

Thalassemia intermedia

Beta talasemi hastalığı beta globin zincirlerinin sentezindeki bozukluk, alfa ve beta zincir dengesizliği, etkin olmayan eritropoez ve kronik aneminin sonucu gelişir. Talasemide klinik bulgu oldukça değişkendir, bir uçta hiçbir klinik bulgusu olmayan taşıyıcı bireyler var iken, diğer uçta yaşamının birinci yılından itibaren derin anemi nedeni ile düzenli transfüzyon gereksinimi olan ağır seyirli hastalar olabilir. Beta talasemi intermedia klinikte talasemi minörden ağır, fakat talasemi majörden hafif hastaları tanımlamak için kullanılmaktadır. Yapılan son çalışmalar talasemi intermedianın düşünülenin aksine çok da hafif seyretmediğini, organ işlev bozuklukları ve komplikasyonlarla ilişkili olduğunu göstermiştir. Biz de bu nedenle, bu grup talasemi hastalarına dikkat çekerek, olguların tanı ve izlemini (kan transfüzyon ve demir şelasyon tedavisi, splenektomi, safra taşları, tromboemboliye yatkınlık, pulmoner hipertansiyon, büyüme gelişme geriliği ve diğer endokrin yan etkiler) tartışmayı hedefledik.Beta-thalassemias are a group of hereditary blood disorders characterized by anomalies in the synthesis of the beta chains of hemoglobin, impaired alfa beta globin ratio, ineffective erythropoiesis and chronic anemia resulting in variable phenotypes ranging from severe anemia and transfusion dependency to clinically asymptomatic individuals. The term thalassemia intermedia refers to patients with clinical symptoms which are too mild than thalassemia major and too severe than thalassemia minor. Recent studies show that thalassemia intermedia is not as harmless as we think and is associated with organ dysfunctions, complications and high morbidity rate. For these problems, we want to mention iron chelation therapy, splenectomy, gall stones, hypercoagulability, pulmonary hypertension, growth retardation and other endocrine complications of these patients

Akut lenfoblastik lösemili bir çocuk hastada mukormikoz enfeksiyonunun başarılı tedavisi

Invasive fungal infections may cause morbidity and mortality in pediatric patients with hematologic and oncologic malignancies treated with intensive protocols. We present a case of mucormycosis in an 8-year-old boy with acute lymphoblastic leukemia. In our patient, the suspicion for an oculoorbital and paranasal infection only due to mild pain in the orbital area without any abnormal pathologic findings in the ophthalmologic and otolaryngologic examination, led us to an early diagnosis. Despite the use of antifungal therapy, the lesion persisted and fever subsided after surgical drainage of the periorbital abscess. Antifungal treatment continued during chemotherapy. He has been in remission for four years. Mucormycosis should be in the differential diagnosis in infections in children with cancer, especially leukemia, according to clinical and radiologic findings. A high degree of suspicion and prompt systemic empirical antifungal therapy, as well as surgical debridement, are crucial for the survival of patients. Beside antifungals, early surgery plays an important role in patients with mucormycosis.Invaziv fungal enfeksiyonlar, yoğun tedaviler alan çocukluk çağı kanserlerinde mortalite ve morbiditenin önemli bir nedenidir. Bu yazıda, akut lenfoblastik lösemi tanılı sekiz yaşındaki erkek hastada saptanan mukormikoz enfeksiyonu irdelenmiştir. Ateş ve orbita etrafında hafif ağrı saptanan olgumuzda, kulak burun boğaz ve oftalmolojik değerlendirmede patolojik bulgu olmamasına rağmen, okuloorbital ve paranazal enfeksiyonun düşünülmesi, bizi erken tanıya götürdü. Görüntülemede saptanan periorbital apse, antifungal tedaviye ragmen gerilemedi ve cerrahi drenaj sonrasi ateş düştü. Kemoterapi boyunca antifungal tedavisine devam edilen hasta, tedavi bitiminden sonra dört yıldır hastalıksız izlenmektedir. Çocukluk çağı kanserlerinde, özellikle lösemi tanılı hastaların enfeksiyonlarda, klinik ve radyolojik bulgular dogrultusunda mukormikoz ayırıcı tanıda düşünülmelidir. Bu infeksiyonun ayırıcı tanıda düşünülmesi, hızla sistemik antifungal tedavi başlanması, ve cerrahi debridman hastaların hayatta kalmaları için çok önemlidir. Antifungal tedavi yanında, erken cerrahi drenaj, mukormikoz tedavisinde önemli rol oynar

The Gomphocerinae Tarbinsky, 1932 (Orthoptera: Acrididae) fauna of the Turkish Thrace

WOS: 000406375200003Fifteen taxa belonging to nine genera (Arcyptera, Ramburiellla, Dociostaurus, Notostaurus, Omocestus, Stenobothrus, Euchorthippus, Pseudochorthippus and Chorthippus) of Gomphocerinae (Orthoptera: Acrididae) were sampled during field trips throughout the different ranges of Turkish Thrace between the years of 2010 and 2015. Bioacoustic parameters of these 15 species have been described for the first time from Turkish Thrace with this study. A total of 5 taxa (Arcyptera (Pararcyptera) microptera microptera, Omocestus (Dirshius) petraeus, Stenobothrus eurasius eurasius, Euchorthippus declivus and C. (Glyptobothrus) biguttulus euhedickei) were identified in the Turkish Thrace region as new records. In addition to these, Stenobothrus eurasius eurasius has been given a new record for Turkey.Research Fund of the Namik Kemal University [NKUBAP.00.10.AR.12.01]Our special thanks go to Dr. Dirk BERGER (Naturkundemuseum, Potsdam / GERMANY) for his valuable comments about Stenobothrus eurasius eurasius and Dr. Petru GOLBAN (Namik Kemal University, Tekirdag/TURKEY) for improving the English of the manuscript. This study was conducted by using facilities of Namik Kemal University Entomology Museum, NKUEM (Tekirdag/Turkey). We also thank to three anonymous reviewers for their constructive comments. This work was supported by Research Fund of the Namik Kemal University, (Project numbers: NKUBAP.00.10.AR.12.01)