Person: TOKUÇ, AYŞE GÜLNUR
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TOKUÇ
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AYŞE GÜLNUR
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Publication Metadata only Investigation of Vitamin D Receptor Gene Polymorphism in Pediatric Patients with Brain Cancer(THIEME MEDICAL PUBL INC, 2017) KOÇ, AHMET; Yilmaz, Baris; Tokuc, Gulnur Ayse; Koc, Ahmet; Yesil, EdanurAim: In recent years, it is believed that Vitamin D may play a protective role in some cancer types. Certain regions of the Vitamin D receptor (VDR) gene may show a genetic difference in structure. The most frequent polymorphisms in this gene are in Taq-1, Fok-1, and Bsm-1 regions. Some adult cancer types are associated with VDR gene polymorphism such as; colorectal carcinoma, breast carcinoma, and prostate carcinoma. Reviewing the medical literature, no such study had been done on children so far. Materials and Methods: We investigated the association of the three most common gene polymorphisms (Taq-1, Fok-1, and Bsm-1 regions) in VDR gene in 32 children with brain tumors and forty control healthy volunteers. Results: We could not find any relationship between childhood brain tumors and VDR gene polymorphism in these three regions. Conclusion: The present results suggest that the Taq-1, Fok-1, and Bsm-1 polymorphism in the VDR gene and pediatric brain cancers have no association.Publication Open Access Successful treatment of refractory graft-versus-host disease with ruxolitinib in a child after autologous stem cell transplantation(2022-06-01) TRUE, ÖMER; TOKUÇ, AYŞE GÜLNUR; KOÇ, AHMET; EKER, NURŞAH; Eker N., Tas B. T., Doğru Ö., Senay E., Tokuç A. G., Koç A.Autologous hematopoietic stem cell transplantation (AHSCT) is an increasingly used curative treatment for some solid tumors in children. Instead of allogeneic transplantation, the risk of developing graft-versus-host disease (GvHD) is much lower after AHSCT. Although the clinical findings of auto-GVHD are mild and self-limited in most cases, rare cases may be severe and need intensive immunosuppressive treatment. Here, we present a case who underwent autologous HSCT due to relapsed neuroblastoma, developed steroid-refractory GvHD after AHSCT, and achieved remission using ruxolitinib. A 12 years old female patient was diagnosed with relapsed neuroblastoma. After metaiodobenzylguanidine treatment, AHSCT was performed, and the status of the disease was a very good partial response at the time of transplantation. Our patient was diagnosed with severe and steroid-refractory GvHD with skin involvement after AHSCT. We used ruxolitinib with extracorporeal photopheresis because of the essential side effects of the other drugs and got a very good response. Over the following five months, there was no recurrence of GvHD. She was in complete remission of neuroblastoma after two years of AHSCT. It is crucial to keep in mind that GvHD may develop after AHSCT. Ruxolitinib is an effective treatment for GvHD also after AHSCT. Further studies and case reports are needed to understand the disease\"s pathogenesis and regulate appropriate treatment.Publication Metadata only Çocuk onkoloji hastalarında santral venöz kateter ilişkili enfeksiyonlar: tek merkez deneyimi(2022-02-18) EKER, NURŞAH; KOÇ, AHMET; TOKUÇ, AYŞE GÜLNUR; Aras S., Eker N., Koç A., Tokuç A. G.Giriş ve Amaç: Çocuk Hematoloji ve Onkoloji ünitelerinde kemoterapi uygulamak, kan ürünlerinin transfüzyonları, hastalardan sık kan örneği alımları yapabilmek, parenteral beslenmenin de güvenli şekilde verilebilmesi için uzun süreli santral kateterler gereklidir. Santral kateterler, hastalara girişimsel işlemlerle santral venöz kateterler ve port kateterleri olarak yerleştirilirler. Uzun süren tedavi sürecinde yoğun ve çoklu infüzyonlar için uygulama kolaylığı sağlarlar. Ancak yine bu özellikli hasta grubu için kateter varlığı enfeksiyon odağı için ek bir risk faktörü olabilmektedir. Bu çalışmada merkezimizde kanser tanısı ile tedavi edilen hastalarda santral kateter ilişkili enfeksiyonlar, bakteriyemi ve sorumlu mikroorganizmaların epidemiyolojik olarak incelenmesi amaçlanmıştır. Gereç ve Yöntem: Marmara Üniversitesi Çocuk Hematoloji Onkoloji Bölümü’nde Ocak 2016-Mart 2021 yılları arasında kanser tanısı ile tedavi gören,santral kateter olarak santral venöz kateter ya da port kateteri takılan hastalar retrospektif olarak incelenmiştir.Hastaların demografik verileri,tanıları, santral venöz katater ilişkili komplikasyonlar kayıt edilmiş; bunların yönetimi ve tedavi süreci gözden geçirilmiştir. Bulgular: Çalışma dönemi boyunca toplam 71 hastaya toplamda 84 port kateteri ve/veya santral venöz kateter yerleştirilmiştir. Bu süre boyunca toplam kemoterapi alan hasta sayısı 511 idi.Erkek/ Kız oranı 38:33 idi.Hastalarda ortalama kateterin kalış süresi 8.5aydı. Kateter ilişkili enfeksiyonlardan sorumlu olan patojenlerden en sık görüleni metisiline dirençli-koagülaz negatif stafilokoklardı. Otuz hastada (%42) kateterde enfeksiyöz bir ajan üremesi saptandı.Enfeksiyöz ajan tespit edildikten hemen sonra tüm kateterler çıkartıldı.İntraluminal oklüzyonları ve kateter kolonizasyonunu önlemek için de hemen antibiyotik ile kilit tedavileri uygulandı. Hematojen komplikasyon olarak 9 hastada(%12) infektif endokardit,24 hastada(%33) sepsis gelişti. Tüm hastalar başarıyla tedavi edildi. Enfeksiyöz nedenle kaybedilen hastamız olmadı.Santral kateteri olan 41 hastada(%57) hiçbir organizma tanımlanmadı. Sonuç: Çocuk Hematoloji Onkoloji hastalarında santral kateter kullanımı tedavi süreçleri boyunca uzun süreli olmaktadır.Santral katater varlığı nötropenik hastalarda bakteriyemi ve sepsisin en sık kaynağıdır. Bu hastalarda sepsisin önlenmesi için en önemli adım santral kateter ilişkili enfeksiyonların erken tespiti ile başlamalıdır.Antibiyotik kilit tedavisi,uygun antibiyotik ile tedavi başlanması ve kateterin hemen çıkarılması tedavi süreci uygun şekilde yönetilmesinde oldukça önemlidir.Publication Metadata only Malignancy and lymphoid proliferation in primary immune deficiencies; hard to define, hard to treat(WILEY, 2020) KOÇ, AHMET; Kiykim, Ayca; Eker, Nursah; Surekli, Ozlem; Nain, Ercan; Kasap, Nurhan; Akturk, Hacer; Dogru, Omer; Canbolat, Aylin; Somer, Ayper; Koc, Ahmet; Tokuc, Gulnur; Bozkurt, Suheyla; Turkoz, Kemal; Karakoc-Aydiner, Elif; Ozen, Ahmet; Baris, SafaBackground Regarding the difficulties in recognition and management of the malignancies in primary immune deficiencies (PIDs), we aimed to present the types, risk factors, treatment options, and prognosis of the cancers in this specific group. Methods Seventeen patients with PID who developed malignancies or malignant-like diseases were evaluated for demographics, clinical features, treatment, toxicity, and prognosis. Results The median age of malignancy was 12.2 years (range, 2.2-26). Lymphoma was the most frequent malignancy (n = 7), followed by adenocarcinoma (n = 3), squamous cell carcinoma (n = 2), cholangiocarcinoma (n = 1), Wilms tumor (n = 1), and acute myeloid leukemia (n = 1). Nonneoplastic lymphoproliferation mimicking lymphoma was observed in five patients. The total overall survival (OS) was 62.5% +/- 12.1%. The OS for lymphoma was 62.2% +/- 17.1% and found to be inferior to non-PID patients with lymphoma (P = 0.001). Conclusion In patients with PIDs, malignancy may occur and negatively affect the OS. The diagnosis can be challenging in the presence of nonneoplastic lymphoproliferative disease or bone marrow abnormalities. Awareness of susceptibility to malignant transformation and early diagnosis with multidisciplinary approach can save the patients' lives.Publication Metadata only The diagnostic value of soluble urokinase plasminogen activator receptor compared with C-reactive protein and procalcitonin in children with febrile neutropenia(TAYLOR & FRANCIS INC, 2016) KOÇ, AHMET; Sirinoglu, Melis; Soysal, Ahmet; Karaaslan, Ayse; Kadayifci, Eda Kepenekli; Cinel, Ismail; Koc, Ahmet; Tokuc, Gulnur; Yaman, Ali; Haklar, Goncagul; Sirikci, Onder; Turan, Serap; Gelmez, Gulsen Altinkanat; Soyletir, Guner; Bakir, MustafaThe aim of the present study was to determine the diagnostic value of soluble urokinase plasminogen activator receptor (suPAR) in pediatric patients with febrile neutropenia. A prospective case-control study was performed. Patients included 29 children with febrile neutropenia (FN) and 27 control subjects without any infection or immunosuppressive condition. Blood samples were obtained on the day of admission and on the 4th to 7th days of the hospital stay. The median (minimum-maximum) serum levels of suPAR obtained on the first day of the admission were 2.08 (0.93-9.42) and 2.22 (1.08-5.13) ng/mL for the FN group and the control group, respectively. The median serum levels of suPAR in the FN and control groups were not significantly different (P=.053). The mean serum suPAR level was significantly higher in nonsurvivors than in survivors in the FN group (P<.05). In the FN group, the area under the receiver operating characteristics curve (AUCROC) for suPAR was 0.546, but no optimum cutoff value, sensitivity, specificity, negative predictive value (NPV), or positive predictive value (PPV) was obtained. We conclude that suPAR is not useful as a diagnostic biomarker in children with febrile neutropenia; however, persistent high serum suPAR level may predict mortality in FN in children.Publication Open Access Single-center experience in vaccination of children in special risk groups: A multidisciplinary institutional consensus protocol(2023-09-01) BARIŞ, HATİCE EZGİ; KEPENEKLİ KADAYİFCİ, EDA; ÜTÜK, BURAK; ŞAHİN, PINAR; TOKUÇ, AYŞE GÜLNUR; KOÇ, AHMET; AYDINER, ELİF; BORAN, PERRAN; BARIŞ H. E., Kepenekli E., Sakar F. İ. A., ÜTÜK B., ŞAHİN P., Ergenç Z., TOKUÇ A. G., KOÇ A., Karakoç-Aydıner E., BORAN P.Objective: Despite marked improvements in the accessibility of childhood vaccines, knowledge gaps remain about the vaccination of children in special risk groups (SRG). This study aimed to analyze the clinical data of children vaccinated in SRG in a single-center unit to contribute to the clinical evidence for the specific planning of immunization of children in SRG. The secondary aim is to present institutional consensus on the vaccination of children in SRG. Materials and Methods: This retrospective study was conducted at a single-center pediatric vaccination clinic. Patient charts between 2018 and 2021 were retrospectively reviewed, and clinical and laboratory data were extracted. Serial joint meetings with multiple healthcare pro-fessionals were performed to develop an institutional protocol for vaccination. Results: There were 479 children vaccinated between 2018 and 2021 for reasons such as post-chemotherapy, after hematopoietic stem cell transplantation, before/after solid organ trans-plantation, allergies, and chronic diseases. Of these, 298 (62.2%) children vaccinated in the unit due to a history of food or vaccine allergies were excluded. One hundred eighty-one children were vaccinated at a median age of 11 [7-15] years. Most children were vaccinated after treatment for malignancies. Solid tumors were the most frequent malignancy (67%), followed by acute lymphoblastic leukemia (29.0%) and acute myeloid leukemia (4.0%). Institutional vaccination protocols for cancer survivors, hematopoietic stem cells, and solid organ recipient children were developed and presented. Conclusion: There is a need to prepare national guidelines for vaccinating children with altered immunocompetence. Sharing vaccination practices by multidisciplinary vaccination units might increase and provide knowledge to develop national policies.