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    Drug Induced Thrombotic Microangiopathy with Certolizumab Pegol
    (2018) Baysal, Mehmet; Ümit, Elif Gülsüm; Sarıtaş, Fatih; Kodal, Nil Su; Demir, Ahmet Muzaffer
    Background: Certolizumab pegol is used to treat ankylosing spondylitis, Crohn’s disease, psoriatic arthritis, and rheumatoid arthritis. Unlike other monoclonal antibodies such as infliximab and adalimumab, certolizumab does not contain an Fc fraction and hence does not induce complement activation. In this report, we describe the case of a patient with thrombotic microangiopathy caused due to certolizumab pegol, with a brief description about the pathophysiological approach to thrombotic microangiopathy. Case Report: A-39-year-old man suffering from ankylosing spondylitis for the past 10 years presented with fatigue. He had been on certolizumab pegol treatment for 6 months, starting with 400 and 200 mg every 2 weeks. He had significant nonimmune hemolytic anemia and thrombocytopenia without a disseminated intravascular coagulopathy. Schistocytes were observed in more than 10% of the erythrocytes per field. Plasma exchange along with corticosteroid treatment was started. There was a dramatic improvement within a week, and after 10 sessions of plasma exchange, the patient was discharged on corticosteroids with a tapering plan. ADAMTS13 enzyme activity was determined to be normal. Conclusion: The development of drug-induced thrombotic microangiopathy may be either immune-mediated or dose-dependent toxicity-mediated Anti-drug antibodies and their immunological aspects are still unclear and yet to be elucidated.
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    Effectiveness of Pet/Ct in Evaluation of the Lymphoma
    (Trakya Üniversitesi, 2019) Atnallar, Göktuğ; Özdemir, Büşra; Ümit, Elif Gülsüm; Durmuş Altun, Gülay
    Aims: Prognosis and survival of Hodgkin lymphoma have been improved dramatically by the development of treatments as well as the sensitivity of evaluation tools. In this case report, we aimed to emphasize the importance of positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography in the initial staging of Hodgkin’s lymp-homa, evaluating the response to treatment, and to demonstrate residual tissue or recurrence. Case Report: A 25-year-old male patient presented to Trakya University Hospital with swelling in the right groin and was diagnosed with Hodgkin’s lymphoma. Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography scan was used for initial staging and assessment of response to treatment. Conclusion: Positron emission tomography is a feasible imaging modality for the evaluation of lymphomas. It is sensitive to detect minimal recurrence as well as alterations of lesions’ metabolic activity. Keywords: Positron emission tomography, lymphoma, hodgkin disease
  • Küçük Resim Yok
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    Evaluation of Stomach Involvement of Non-Hodgkin's Lymphoma: Single Center Experience
    (2015) Ümit, Elif Gülsüm; Uyanık, Mehmet Şevki; Emel, Gulsum Pamuk; Demir, Ahmet Muzaffer; Maden, Muhammet
    Introduction: Gastrointestinal tract is the most common site of involvement in non-Hodgkin s lymphomas. Appropriate treatment regiments were not defined because of rare involvement. In the present study we aimed to evaluate treatment response of non-Hodgkin s lymphoma patients with stomach involvement. Methodology: 26 patients with stomach involvement were retrospectively analyzed between 01/01/1998 and 01/06/2014. Descriptive statistic was performed to analyze data. Methods: 20 of the patients (76.9%) were composed of primary stomach non-Hodgkin lymphoma, 6 of the patients (23.1%) were composed of patients secondary involvement of the advanced stage disease. All of the patients were subtypes of B cell lymphoma. 3 of the patients (11.5%) was indolent, 22 of the patients (84.6%) was aggressive, and 1 of them (3.8%) was very aggressive. Diffuse large B cell lymphoma was 72.9%; Maltoma was 8.7%, and Mantle cell lymphoma was %3.8. Complete response was achieved at 10 patients, partial response was achieved in 1 patient, and 7 patients were failed to response the treatment. Treatment response and overall survival of low grade and high grade patients, both according to Ann-Arbor and Lugano classification systems were similar. Patients with elevated sedimentation rate had significant lower survival than patients with normal sedimentation rate (p=0.027). Discussion: Together with the data from recent studies, aggressive treatment approach without organ preservation should not be performed on patients without higher inflammatory response and early stage presentation. Sedimentation rate might help to clinicians for the treatment of choice.
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    Letter to the Editor concerning "New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio"
    (2016) Ümit, Elif Gülsüm
    To the Editor, I have read with great interest the article on Bell's palsy and related blood count assessments by Atan et al. (1). The authors found that the neutrophil to lymphocyte ratio and platelet to lymphocyte are increased in patients with Bell's palsy. Though increased compared to healthy controls, these ratios were not associated with increased paralysis severity. The authors state that these changes may be concordant with the pathogenesis because Bell's palsy is an inflammatory disease. However, from a hematological perspective, there are certain points that need to be emphasized to avoid misunderstanding and clinical confusion. The American Academy of Autolaryngology Head and Neck Surgery Foundation Clinical Practice Guideline on Bell's Palsy highly recommend that oral corticosteroids should be started within 72 hours of symptom onset (2). Corticosteroids are well known to show dramatic effects on blood cell counts. Specifically, the administration of glucocorticoids results in neutrophilic leukocytosis, accompanied by marked reductions in circulating eosinophils, monocytes and lymphocytes (3). These changes are so dramatic that a single dose of glucocorticoid leads to lymphopenia within 2 hours of the dose, peaked at 6 hours and resolved by 24 hours (4). The increase in circulating neutrophil is due to impaired neutrophilic migration to sites of inflammation, enhanced release of cells from the bone marrow and inhibition of apoptosis. Regarding lymphocytes, glucocorticoids rapidly deplete circulating T cells by enhanced circulatory emigration, inhibition of interleukin-2, a major T cell growth factor, impaired release of cells to the circulation and apoptosis induction (5). Number of circulating B cells are also reduced but to a lesser extent. Although the major argument of this study is based upon altered blood cell count in Bell's palsy, treatment is highly recommended to commence within 72 hours. The study presents no such treatment to achieve dramatic and rapid changes in white blood cell count. In a hematological perspective, these changes may be attributable to the effects of treatment (glucocorticoids) rather than the disease itself. The authors' not finding any relation between the severity of paralysis with the cell ratios, also support my assessment. Furthermore, in retrospective studies, the countenance and reliability of factors, which may confound the main finding, are not easily managed. As stated as a retrospective study, derivation of the data leaves an obscure sensation in the reader's mind. In conclusion, I believe that this study, as presented to contribute to the literature with new findings should be considered under the information I have mentioned above. Ethics Committee Approval: N/A. Informed Consent: N/A. Peer-review: Externally peer-reviewed. Conflict of Interest: No conflict of interest was declared by the author. Financial Disclosure: The author declares that this study has received no financial support.
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    Risk Factors and Management of Hepatitis B Virus Reactivation in Patients With Hematological Disorders
    (Trakya Üniversitesi, 2018) Akay, Fatih Erkan; Tan, Berfin; Güldağ, Mahmut Alper; Çifcibaşı, Hilal Sena; Elmacı, Kubilay; Ümit, Elif Gülsüm
    Aims: The aim of this study is to evaluate hepatitis B virus serological status and to categorize the risks of our treatmentmodalities in patients with both benign and malignant hematological disorders.Methods: This was a retrospective study of 552 patients who were admitted to the Trakya University Hospital Hematologyunit between 01.01.2017 and 31.12.2017. All data regarding the diagnosis, treatment and HBV serologicalstatus were collected from patient files. Data were analyzed with IBM SPSS V.20 using descriptive statistical analysis.Results: Hepatitis B surface antigen was positive in 45 (8.2%) patients, antibody to the hepatitis B surface antigenwas positive in 279 (50.5%) patients and antibody to the hepatitis B core antigen was positive in 247 (44.7%) patients.According to these results, 32 patients were found to be vaccinated for hepatitis B virus. Reactivation was observed in4 (0.7%) patients who have been hepatitis B surface antigen positive and have received adequate duration of antiviralprophylaxis with tenofovir. These 4 patients have received monoclonal antibody for immunosuppressive treatment.Conclusion: To conclude, although the rate of hepatitis B surface antigen reactivation is quite low, as many patientsas possible should be vaccinated to reduce the costs of antiviral treatments and monitorization. If there is notime to vaccinate, patients should be categorized according to guidelines by their hepatitis B surface antigen serologicalstatus and by the planned immunosuppressive treatments.
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    Sistemik lupus eritematozuslu hastalarda ateroskleroz ve ilişkili faktörlerin değerlendirilmesi
    (Trakya Üniversitesi Tıp Fakültesi, 2010) Ümit, Elif Gülsüm; Pamuk, Ömer Nuri
    Çalışmamızda, öncelikle Sistemik lupus eritematozus tanısı ile izlenen hastaların genel özelliklerini, organ ve sistem tutulumlarını, ilaç kullanımını, kardiyovasküler risk faktörlerini saptamayı amaçladık. Bununla birlikte kronik inflamasyona maruz kalan bu hasta grubunda ateroskleroz ile inflamasyon arasındaki ilişkiyi tespit etmek için önemli inflamasyon ve ateroskleroz parametreleri olan migrasyon inhibe edici faktör, LIGHT, endotelyal lipaz'ın değerlendirilmesi amaçlandı. Subklinik aterosklerozun değerlendirilmesi amacı ile karotis arter intima-media kalınlığının ultrasonografi ile değerlendirilmesi amaçlandı. Trakya Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Romatoloji Bilim Dalı'ında yürütülen çalışmaya, Sistemik lupus eritematozus tanısı ile izlenen 87 hasta ve kontrol grubu olarak 84 sağlıklı birey alındı. Sistemik lupus eritematozuslu hastaların klinik özellikleri, poliklinik kontrolleri sırasında değerlendirilen lipid düzeyleri ve insülin direncine ilişkin veriler kaydedildi. Tüm hastalarda ve kontrol grubunda enzyme-linked immunosorbent assay yöntemi ile migrasyon inhibe edici faktör, LIGHT ve endotelyal lipaz düzeyleri bakıldı. Tüm hastalara ve kontrol grubundan 30 bireye karotis arter intima-media kalınlık değerlendirilmesi yapıldı ve Framingham risk skorları değerlendirildi. Çalışmamızda Sistemik lupus eritematozuslu olgularımızda Framingham 10 yıllık kardiyovasküler risk skoru ortalama %2,67 bulundu. Hastalarımızda subklinik ateroskleroz sıklığını ise %12,6 olarak saptadık. Karotis intima-media kalınlığı ile Framingham risk skoru ve faktörleri arasında anlamlı ilişki bulunmadı. Aynı şekilde subklinik ateroskleroz ile hastalık genel özellikleri arasında ilişki saptanmadı. Antifosfolipid antikor pozitifliği ile subklinik ateroskleroz arasında anlamlı ilişki gözlendi (p<0001). Tedavi parametrelerinde steroid, siklofosfamid ve antimalaryal ilaçlar ile karotis intima-media kalınlığı arasında ilişki gözlenmez iken, azatiopirin ile karotis intima-media kalınlığı arasında ilişki gözlendi (p=0,05). Bunun yanında, hasta ve kontrol grupları arasında migrasyon inhibe edici faktör, LIGHT ve endotelyal lipaz değerlendirilmesi ile karotis intima-media kalınlığı arasında anlamlı farklılık gözlenmedi.