Çocukluk çağında en sık görülen kanserleri akut lösemiler oluşturmaktadır. Lösemili çocukların en sık başvuru nedenleri arasında ateş, halsizlik, hepatosplenomegali ve lenfadenopati gelmektedir. Akut löseminin geliş bulgularının ilk değerlendiren hekim tarafından bilinmesi erken tanı ve tedavi için hayati önem taşımaktadır. Bu çalışmada hematolog olmayan tüm hekimler için çocukluk çağında akut lösemiden şüphelenilmesi gereken durumların ipuçlarını ortaya çıkarmak amaçlanmıştır. Gereç ve Yöntem: Hastanemizin Çocuk Hematoloji ve Onkoloji kliniğinde Mayıs 2017-Şubat 2021 tarihleri arasında akut lösemi tanısı alan 0-18 yaş arası tüm çocuklar dahil edildi. Akut lösemi tanılı tüm hastaların ilk geliş şikayetleri, fizik muayene bulguları ve laboratuvar sonuçları hastaların dosyalarından retrospektif olarak incelendi. Bulgular: Akut lösemi tanısı konulan toplam 62 çocuk hastanın dosyası incelendi. Erkek/Kız oranı: 1.58, ortalama tanı yaşı: 6±4,93 yıl (min-max 1-17 yaş) idi. Şikayetlerin başlama süresi ortanca 15 gün olarak bulundu. En sık görülen şikayetler: halsizlik (%85,5), ateş (%51,1), bacak ağrısı (%33,8), karın ağrısı (%22,6) ve karın şişliği (%21) idi. Fizik muayene bulgularında en sık solukluk (%74,2), hepatosplenomegali (%43,1) ve lenfadenopati (%37,1) saptandı. Tüm hastaların tam kan sayımında en az bir seride anormallik mevcuttu. Hastaların başvuru anındaki tam kan sayımlarında %79'unda anemi (hb<10g/dl), %69,4'ünde trombositopeni (<100000/ mm 3 ), %67,7'sinde nötropeni (<1500/mm 3 ), %37,1'inde lökositoz (>20000/ mm 3 ), %25,8'inde lökopeni(<4000/mm 3 ) saptandı. Eş zamanlı bakılan biyokimyasal tetkiklerinde en sık görülen anormallik LDH değerlerinde yükseklik (ortanca LDH: 576 IU/L) idi. Sonuç: Çocukluk çağı lösemilerinin en sık başvuru bulgularının hastayı ilk gören hekim tarafından bilinmesi hastanın vakit kaybetmeden tanı ve tedaviye ulaşmasını sağlayacaktır.
Background:Fever without a source (FWS) is caused by various diseases, making differential diagnosis difficult. Clinical similarities between Kawasaki disease (KD) and systemic Juvenile Idiopathic Arthritis (sJIA) are well known. Kawasaki disease (KD), a self-limiting systemic vasculitis, remains of unknown etiology and can cause irreversible coronary artery aneurysms (CAAs). SoJIA is sometimes confused with incomplete KD because both diseases have overlapping clinical features and can be accompanied with CAAs and/or SJIA with macrophage activation syndrome (MAS).Objectives:In this study, the frequency of both KD and SJIA among the patients evaluated with FWS and the clinical features of patients diagnosed with Kawasaki disease.Methods:Medical records of patients who first visited our department between January 2016 and December 2019 were reviewedResults:A total of 107 patients were enrolled in this study, including 43 patients (40.2%, 23 males) who fulfilled the criteria of Kawasaki disease and 64 patients (59.8%, 39 males) who did not fulfill them. In patients who fulfilled the criteria of classical FWS, 36(33.6%, 20 males) patients were diagnosed with systemic juvenile idiopathic arthritis. The mean age of the patients with Kawasaki disease was 30.0±20,4 months (median 25 months), the mean age of other patients was 52,6±40 months (median 39,5 months). The mean age of the patients with sJIA patients was 87,6±49,8 (median 80months). Kawasaki patients were younger than others (p=0.01). There was no difference in gender between groups.In Kawasaki patients, the most common clinical feature at diagnosis was fever (100%) followed by conjunctival congestion and mucosal changes (69%). The last two findings are more significant in kawasaki patients than others (p<0,00). Twenty-six (59%) patients had completed KD while 25% had incomplete KD. 7 (16%) patients had atypical KD. The mean fever duration was longer in sJIA patients than KD and others (median 14,8 and 7 days, p<0.00). All patients with KD received IVIG (2 g/kg, infusion in 12 h) and aspirin (60 mg/kg/day). 13.6% of the patients also received oral corticosteroids because of IVIG resistance. Thirty-one patients (72.1%) responded to IVIG treatment, whereas 12 (6 female, 6 male) were IVIG resistant. CAI was detected in echocardiography at diagnosis in 10 (22.7%) (6 female; 4 male) patients. We also detected 4 patients pericarditis with /without CIA.Conclusion:The clinical presentations of KD and sJIA are quite similar with fever, rash, hepatomegaly, and lymphadenopathy. All 2 entities may provide clues to potentially shared immunopathology.References:[1]Arslanoglu Aydin E et al. The factors affecting the disease course in Kawasaki disease. Rheumatol Int. 2019 Aug;39(8):1343-1349[2]Dong S et al. Diagnosis of systemic-onset juvenile idiopathic arthritis after treatment for presumed Kawasaki disease. J Pediatr. 2015 May;166(5):1283-8.Disclosure of Interests:None declared
The virus, which emerged from Wuhan, China in the last months of 2019, and named by the World Health Organization as COVID-19, caused a pandemic all over the world. According to the studies and experiences, it has been seen that COVID-19 can infect people of all age groups and affect human health for a long time. Since the months of the outbreak of the pan- demic, the majority of studies conducted worldwide have been in symptomatic adults; However, considering the spread rate of COVID-19 all over the world, it is expected that the number of pediatric cases will increase day by day. Therefore, it is of great importance to establish diagnostic criteria for pediatric patients. In this review article, the common results of the studies conducted on pediatric patients in line with the studies worldwide are mentioned.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.