Two years experience of a multidisciplinary approach for pediatric thrombosis in a tertiary referral center

Pediatric thrombosis has unique characteristics due to its epidemiology, pathophysiology and treatment considerations. Children diagnosed with thrombosis should be evaluated by a multidisciplinary team at the level of diagnosis, treatment, and follow-up. Here we present our 2 years experience of pediatric thrombosis patients with a multidisciplinary thrombosis council management. We retrospectively reviewed case presentations and recommendations of monthly thrombosis council for 61 children (95 admissions) between November 2017 and August 2019. The male/female ratio was 1.54 and children and adolescents were the majority of evaluated 61 patients. Based on patients' clinical and radiological status, treatment and prophylaxis periods were determined. Cerebral arterial and sinovenous thrombosis were more common in our pediatric thrombosis council cases. Acquired risk factors for thrombosis were more common than congenital thrombophilia. Infection and elevated Factor VIII were commonest, respectively. Thirty-nine patients (64%) received primary or secondary prophylaxis with vitamin K antagonists, aspirin or LMVH for different periods. Further studies on treatment and prophylaxis management are needed for the improvement of evidence-based guidelines in pediatric thrombosis. Multidisciplinary councils may improve patient care for pediatric patients with complicated thrombosis. Keywords: Pediatric thrombosis, treatment, prophylaxis, multidisciplinary managemen

Akut Lenfoblastik Lösemide İmmunfenotipleme ve Klinik ile İlişkisi

ÖZ Amaç: Akut lenfoblastik lösemi (ALL) tanılı çocuk hastalarda immunfenotipleme ve klinik özelliklerle ilişkisini değerlendirmek. Yöntem: Merkezimizde 1989-2007 yılları arasında ALL tanısı almış ve tedavi edilmiş olan 18 yaş altındaki 192 hastada akım sitometri ile incelenen immunfenotipleme sonuçlarının klinik özellikler ile ilişkisi değerlendirildi. Bulgular: Vakaların 79’unu (%41,1) kız, 113’ünü (%58,9) ise erkek hastalar olusturmaktaydı. Vakalar prekürsör-B hücreli ve T hücreli ALL olarak 2 gruba ayrıldı. T hücreli ALL erkeklerin %27.6’sında görülürken, bu oran kızlarda %14,2 idi (p=0,038). Yaş grupları immunfenotiplendirmeye göre değerlendirildiğinde, 1 yaş altında tüm hastalar prekürsör-B ALL grubunda iken, 1-10 yaş arasındaki vakaların %82,9’u prekürsör B ALL, %17,1’i T-ALL’li grubunda, ≥10 yaş üzerindeki vakaların %58,6’sı prekürsör B ALL’li, %41,4’ü T-ALL grubunda idi (p: 0.002). Hiperlökositoz, ekstramedüller tutulum, lenfadenopati ve mediastinel kitle T hücreli ALL grubunda anlamlı olarak daha sık görüldü. T hücreli ALL sıklığının yıllar içinde azaldığı görüldü. Sonuç: Akut lenfoblastik lösemi erkeklerde kız cinsiyete göre daha fazla görülmektedir. Erkek çocuklarda ve 10 yaş üstünde T hücreli ALL sıklığı artmaktadır. Lenfadenomegali, mediastinel kitle, ekstramedüller tutulum ve hiperlökositoz sıklığı, T hücreli ALL grubunda prekürsör B hücreli ALL grubuna göre anlamlı olarak artmaktadır. T hücreli ALL sıklığının yıllar içinde azaldığı bunun sosyoekonomik düzeyde iyileşme ile ilişkili olabileceği düşünülmüştür

Differential Effect of Young Adults’ and Students’ MetaCognitive Skills in Mathematics Problem Solving Process

The purpose of this study is to examine how young adults and pupils use their metacognitive abilities such as cognitive strategies and self-checking during the mathematics problem-solving process. The study group consisted of 12 young adults selected from three different faculties in a foundation university and 32 pupils from public and privateK-12 schools, Istanbul, Turkey. Multimodal mixed-methods design was employed, where participants were asked to think out loud while solving ten mathematical problems. The experimental process was recorded with the use of eye-tracking, which was utilized to evaluate the active use of metacognitive sub-skills. The findings from the experimental process revealed that there is a significant difference between the amount of reflection of young adults’ and pupils' cognitive strategy and self-checking skill levels on their responses to mathematics problem solving process in favor of pupils

Ceftriaxone-induced hemolytic anemia in a child successfully managed with intravenous immunoglobulin

Drug-induced hemolytic anemia is an immune-mediated phenomenon that leads to the destruction of red blood cells. Here, we present a case of life-threatening ceftriaxone-induced hemolytic anemia (CIHA) in a previously healthy 3-year-old girl. We also reviewed the literature to summarize the clinical features and treatment of hemolytic anemia. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with high mortality. Our patient had a sudden loss of consciousness with macroscopic hematuria and her hemoglobin dropped from 10.2 to 2.2 g/dl over 4 hours, indicating that the patient had life-threatening hemolysis after an intravascular dose of ceftriaxone who had previously been treated with ceftriaxone in intramuscular form for six days. CIHA is associated with a positive direct antiglobulin test, revealing the presence of IgG in all cases and C3d in most cases. Our patient's direct antiglobulin test was positive for IgG (3+) and for C3d (4+). The case was managed successfully with supportive measures and intravenous immunoglobulin therapy. Ceftriaxone is used very frequently in children; an early diagnosis and proper treatment of hemolytic anemia are essential to improve the patient outcome. The pathophysiological mechanism is the same as for non-drug autoimmune hemolytic anemia. However, there is still no consensus treatment for CIHA. Intravenous immunoglobulin can be used in clinical emergencies, such as our case, or in refractory cases