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    Effect of obesity on TAFI in postmenopausal period
    (Elsevier Sci Ltd, 2010) Taskiran, Bengur; Guldiken, Sibel; Demir, Ahmet M.; Okman, Tulay K.; Arikan, Ender; Turgut, Burhan; Tugrul, Ayse A.
    Aim: The aim of the study was to evaluate how obesity effects the coagulation and fibrinolytic system in the postmenopausal period. Method: Forty-eight obese (body mass index (BMI) >= 30 kg/m(2)) and 38 nonobese (BMI < 30 kg/m(2)) postmenopausal women were enrolled in the study. Fat mass and insulin resistance were calculated. Plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), D-dimer, thrombomodulin, and thrombin activatable fibrinolysis inhibitor (TAFI) antigen were determined by ELISA method. TAFI activity was measured using the chromogenic assay. Results: Obese subjects had higher PAI-1 (73.5 +/- 35.7 ng/mL vs. 57.1 +/- 34.2 ng/mL, p < 0.05) levels but lower tPA/PAI-1 ratio (0.59 +/- 0.50 vs. 38 +/- 0.21, p < 0.05) than their nonobese counterparts. Obesity was not statistically significant for other haemostatic variables. BMI and fat mass were positively correlated with PAI-1 (r = 0.312, p = 0.003; r = 0.381, p = 0.005, respectively) and negatively correlated with tPA/PAI-1 ratio (r = -0.273, p = 0.01; r = -0.545, p = 0.01, respectively). HOMA scores were also positively correlated with PAI-1 levels (r = 0.236, p = 0.04). Conclusion: We found that tendency to hypercoagulability in the postmenopausal women was due to increased PAI-1 rather than TAFI levels, which may contribute to adverse cardiovascular outcomes in this cohort. Further studies should be undertaken to evaluate effects of weight loss on the coagulation and fibrinolytic system. (C) 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
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    Late onset left ventricular dysfunction and cardiomyopathy induced with ibrutinib
    (Sage Publications Ltd, 2020) Gulsaran, Sedanur K.; Baysal, Mehmet; Demirci, Ufuk; Bas, Volkan; Kirkizlar, Hakki O.; Umit, Elif; Demir, Ahmet M.
    Introduction Ibrutinib, an oral inhibitor of Bruton's tyrosine kinase, has altered the treatment perspective of chronic lymphocytic leukemia and showed modest activity against several types of non-Hodgkin's lymphomas. According to phase studies and real-world data, reported serious adverse effects included atrial fibrillation, diarrhea, and bleeding diathesis. However, heart failure was not reported to be a probable adverse effect linked with ibrutinib. Case report In this paper, we present a 66-year-old female chronic lymphocytic leukemia patient who developed significant and symptomatic left ventricular dysfunction at the 13th month of ibrutinib treatment. Management and outcome Following cessation of ibrutinib, ejection fraction and clinical findings of the left ventricular dysfunction alleviated. Discussion Although the use of ibrutinib is generally well tolerated, cardiac functions should be monitored occasionally in all patients.
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    Polypharmacy and potentially inappropriate medication use in older patients with multiple myeloma, related to fall risk and autonomous neuropathy
    (Sage Publications Ltd, 2020) Umit, Elif G.; Baysal, Mehmet; Bas, Volkan; Asker, Ismail; Kirkizlar, Onur; Demir, Ahmet M.
    Purpose Multiple myeloma is a chronic, uncurable hematological cancer with the involvement of multiple organ systems. As a disease affecting older patients, the treatment of multiple myeloma should be based on individual patient characteristics. Polypharmacy is an increasing problem in the care of older patients and in patients with multiple myeloma, polypharmacy is almost inevitable. We aimed to evaluate the applicability of polypharmacy definitions and the relation of polypharmacy with disease outcomes in patients with multiple myeloma. Methods Eighty patients older than 65 years and diagnosed with multiple myeloma were retrospectively enrolled. Patient files, prescriptions, evaluations for polypharmacy were determined according to Beers and START/STOPP criteria. Outcomes were recorded from files in terms of fractures, autonomous neuropathy, and renal functions. Results Polypharmacy with >= 4 drugs was observed in 65 patients while polypharmacy with >= 5 drugs was observed in 51 patients. Autonomous neuropathy, polypharmacy with more than four or five medications, and use of multiple medications in the same category were related with poor ECOG performance status in women, while prolonged use of benzodiazepines and central nervous system (CNS) affecting drugs and inappropriate polypharmacy were more frequent in men with poor ECOG performance status. The majority of patients aged 75-84 years were observed to use inappropriate polypharmacy. Autonomous neuropathy and fall risk were observed to be significantly related with inappropriate polypharmacy. Conclusions Drugs affecting balance and perception should be reconsidered in patients with multiple myeloma.