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Öğe Acute Lymphoblastic Leukemia; Prognostic Factors' Perspective(Akad Doktorlar Yayinevi, 2010) Tekgunduz, Emre; Demir, Muzaffer; Akpinar, SevalAcute lymphoblastic leukemia represents a biologically and clinically heterogeneous group of diseases with different outcomes among patients subgroups. Identification of prognostic factors is critical in selecting therapy for subgroups of patients to achieve a high cure rate with minimal toxicity. Another important goal of risk stratification is to define patients with a very high risk of relaps, who may benefit from up-front allogeneic hematopoietic stem cell transplantation following first complete remission. Clinical parameters, immunophenotype, cytogenetics, treatment response, minimal residual disease are among currently used factors in risk stratification of acute lymphoblastic leukemia patients. But there are emerging new parameters like global gene expression profiling, host pharmacodynamics-pharmacogenetics and treatment protocols which may have an impact on risk-adapted treatment in the near future. In the present review we will discuss a variety of prognostic factors and their impact on clinical outcome of children and adults with acute lymphoblastic leukemia.Öğe Carotid intima media thickness is independently associated with urinary sodium excretion in patients with chronic kidney disease(Taylor & Francis Ltd, 2015) Ustundag, Sedat; Yilmaz, Gulay; Sevinc, Can; Akpinar, Seval; Temizoz, Osman; Sut, Necdet; Ustundag, AytenAtherosclerosis-induced premature vascular diseases are the leading cause of mortality among patients with chronic kidney disease (CKD). The pathogenetic mechanism of atherosclerosis in patients with CKD has not been fully explained. Experimental studies have demonstrated that high dietary sodium intake not only increases circulatory volume and blood pressure, but also facilitates development of atherosclerosis by reducing production-bioavailability of nitric oxide due to oxidative stress and accordingly by enhancing endothelial and arterial stiffness. In this study, we investigated the relationship between sodium consumption and carotid artery intima-media thickness, which is the indicator of atherosclerosis, by determining daily urinary sodium excretion, which is a reliable indicator of sodium consumption, in our patient group. Our patient group included 193 patients with stage 2-4 non-diabetic CKD and without a history of atherosclerotic disease. We determined that 77% of our patients have been consuming more than 2 g of sodium per day, which is the upper limit of sodium consumption recommended for patients with CKD. We determined a positive linear correlation between carotid artery intima-media thickness and patient age (p < 0.001), C-reactive protein (p < 0.001), urinary sodium excretion (p < 0.001), body mass index (p = 0.002), systolic blood pressure (p = 0.002), hemoglobin (p = 0.030), triglycerides (p = 0.043), and diastolic blood pressure (p = 0.049). We also found a negative linear correlation between carotid artery intima-media thickness and glomerular filtration rate (p = 0.008). We found that urinary sodium excretion is the determinant of intima-media thickness even if all factors associated with intima-media thickness are adjusted, and that intima-media thickness increases by 0.031 (0.004-0.059) mm per 2 g increase in daily sodium excretion, independent from overall factors (p = 0.025). Our results reveal a relation between urinary sodium excretion and carotid artery intima-media thickness and suggest that excessive sodium consumption predisposes development of atherosclerosis in patients with CKD.Öğe Dorsal sural nerve conduction study in vitamin B12 deficiency with megaloblastic anemia(Blackwell Publishing, 2006) Turgut, Burhan; Turgut, Nilda; Akpinar, Seval; Balci, Kemal; Pamuk, Guelsuem E.; Tekguenduez, Emre; Demir, MuzafferPeripheral neuropathy is frequently observed in B-12 deficiency. In spite of this, there is little knowledge about peripheral neuropathy in B-12 deficiency because the severity of clinical involvement of the central nervous system clearly outweighs signs and symptoms due to peripheral nervous system involvement. We primarily investigated peripheral neuropathy with dorsal sural conduction study, which is a new method for detection of early peripheral neuropathy, in B-12 deficiency with megaloblastic anemia. Conventional nerve conduction studies and tibial sensory-evoked potential (SEP) recording were also performed. Twenty-eight B-12-deficient patients (15 male, 13 female, mean age 65.8 years) with megaloblastic anemia and 18 age- and sex-matched controls were included in the study. Although dorsal sural sensory nerve action potentials (SNAPs) were not recorded in 15 (54%) of 28 patients, only 9 (32%) of them were found to have polyneuropathy by conventional conduction studies. Furthermore, patients with dorsal sural SNAP had mean lower amplitude, mean longer latency, and slower velocity response when compared with controls. Twenty patients (71%) were diagnosed as having myelopathy by the combination of tibial SEP and neurological findings. Two patients whose dorsal sural SNAPs were not recorded had normal tibial SEP responses; therefore, these patients were considered to have isolated peripheral neuropathy. As a result, we conclude that dorsal sural nerve conduction study is a reliable method for detection of early peripheral neuropathy in B-12 deficiency.Öğe Effectiveness of Defibrotide in the Prevention of VOD Among Patients Receiving Allogeneic Hematopoetic Cell Transplantation: A Retrospective Single Center Experience(Amer Soc Hematology, 2012) Tekgunduz, Emre; Akpinar, Seval; Bozdag, Sinem Civriz; Tetik, Aysegul; Kocubaba, Serife; Cinarsoy, Murat; Durgun, Gamze[Abstract Not Available]Öğe Immune Thrombotic Thrombocytopenic Purpura in Elderly Patients: The Roles of PLASMIC and French Scores(Galenos Publ House, 2023) Baysal, Mehmet; Hindilerden, Fehmi; Umit, Elif Gulsum; Demir, Ahmet Muzaffer; Karadag, Fatma Keklik; Saydam, Guray; Akpinar, SevalObjective: In recent years, new developments have been incorporated into daily practice in the management of immune thrombotic thrombocytopenic purpura (iTTP). In particular, clinical scoring systems could help clinicians with clinical decision-making and early recognition. However, older patients frequently present with more organ involvement and in unusual ways. The ways in which age could affect these clinical prediction scoring systems remain unclear. We evaluated the use of PLASMIC and French scores in patients over 60 years of age. Materials and Methods: We performed a retrospective cross-sectional analysis of patients over 60 years of age with a presumptive diagnosis of iTTP between 2014 and 2022 at 10 centers. We calculated PLASMIC and French scores and compared our data with a single-center analysis of younger patients presenting with thrombotic microangiopathy. Results: Our study included 30 patients over 60 years of age and a control group of 28 patients younger than 60 years. The diagnostic sensitivity and specificity of a French score of >= 1 were lower in older patients compared to the control group (78.9% vs. 100% and 18.2% vs. 57.1%, respectively). The diagnostic sensitivity and specificity of a PLASMIC score of >= 5 were 100% vs. 95% and 27.3% vs. 100% for the study group and control group, respectively. Our study showed a higher mortality rate in older patients compared to the control group (30% vs. 7.1%, p=0.043). Conclusion: For a limited number of patients (n=6), our results showed that rituximab can reduce mortality. Given that the reliability of clinical prediction scores for iTTP in older patients may be lower, more caution must be undertaken in interpreting their results.Öğe The significance of KIR gene polymorphisms in chronic lymphocytic leukemia(Taylor & Francis Ltd, 2015) Pamuk, Gulsum Emel; Akpinar, Seval; Tozkir, Hilmi; Gurkan, Hakan; Duymaz, Julide; Demir, Ahmet Muzaffer; Pamuk, Omer Nuri[Abstract Not Available]Öğe Sticky Platelet Syndrome in Patients with Uninduced Venous Thrombosis(Galenos Yayincilik, 2013) Tekgunduz, Emre; Demir, Muzaffer; Erikci, Alev Akyol; Akpinar, Seval; Ozturk, Erman; Kirkizlar, OnurObjective: Sticky platelet syndrome (SPS) is a common autosomal dominant inherited platelet disorder. SPS is characterized by platelet hyperreactivity and is associated with arterial and venous thrombosis. The aim of this study was to determine the role of SPS in patients with uninduced venous thrombosis. Material and Methods: The study included 28 patients (15 male and 13 female) with uninduced venous thrombosis. SPS was defined according to Mammen's aggregation method, which is described in detail elsewhere. Results: According to the defined ranges for platelet hyperreactivity, 3 (50%) patients, 2 (33%), and 1 (17%) (n =6 [21%]) with a confirmed diagnosis were classified as type II, I, and III SPS, respectively. In 1 patient SPS was the only hereditary abnormality noted. The other 5 patients carried other inherited coagulation defects, in addition to SPS. Conclusion: The present findings indicate that the prevalence of SPS was 21% in the patients with uninduced venous thrombosis. We therefore suggest that SPS should be considered in the differential diagnosis of such cases.
