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Akut iskemik inmede serum interlökin-6 düzeylerinin lezyon büyüklüğü ve erken dönem fonksiyonel kötüleşme ile ilişkisi
(2018) Avcı, Aynur Yılmaz; Demir, Ahmet Muzaffer; Turunçoğlu, Ufuk Utku; Vural, Adile Özden; Ekuklu, Galip
Amaç: Bu çalışmada, akut dönemde serum İnterlökin-6 (IL-6) düzeylerinin iskemiklezyon büyüklüğü, lokalizasyonu ve hastalığın erken dönem nörolojik fonksiyonelkötüleşmesi ile ilişkisi araştırıldı.Hastalar ve Yöntem: Çalışmaya akut serebral infarkt tanısı alan 55 olgu alındı. Kontrol grubu, benzer yaş aralığında 25 sağlıklı gönüllüden oluşturuldu. Olgular BBT’deinfarkt yeri ve büyüklüğüne göre dört gruba ayrıldı. Modifiye Rankin Skoru ile erkendönem fonksiyonel kötüleşme değerlendirildi.Bulgular: Serum IL-6 seviyeleri sağlıklı kontrol grubuna göre tüm hasta gruplarındaanlamlı olarak daha yüksek saptandı (p=0.001). Bilgisayarlı beyin tomografisinde(BBT) büyük lezyonu olanların IL-6 düzeyleri, küçük olanlara göre anlamlı olarakdaha yüksek saptandı; ancak lezyon yerleşimi açısından anlamlı farklılık yoktu. Erkendönem fonksiyonel kötüleşmesi daha fazla olan olguların IL-6 değerleri, erken dönemfonksiyonel durumları iyi olan gruba göre anlamlı olarak daha yüksekti. IL-6 düzeyleriile lökosit sayısı ve fibrinojen düzeyleri arasında anlamlı zayıf korelasyon saptandı.Sonuç: Serum IL-6 düzeyi yüksekliğinin lezyon büyüklüğü ve erken dönem fonksiyonel kötüleşme ile ilişkili olması; IL-6’nın intratekal salındığını ve inme patofizyolojisinde önemli rol oynayabileceğini düşündürebilir. Ayrıca akut iskemik inme sonrasıinflamatuvar yanıtın IL-6 ile değerlendirilmesi serebral infarkt boyutu ve erken dönemfonksiyonel kötüleşmesi hakkında fikir verebilir.
Akış Sitometrisi Verilerinin Geriye Dönük Taranması: Tek merkez deneyimi
(2015) Asoğlu, Veysi; Demir, Ahmet Muzaffer; Varım, Ceyhun; Baysal, Mehmet; Pamuk, Gülsüm Emel; Uyanık, Mehmet Şevki; Maden, Muhammet
Amaç: Akış sitometrisi (AS) çeşitli hücrelerin bir süspansiyon halinde bir akış kanalı boyunca tek tek geçmesi vebu esnada hücre büyüklük ve içeriğine göre sınıflandırılması esasına dayanan florokromojenik-lazer tabanlı bir tanıyöntemidir. Hematolojik malignitelerin tanısı AS cihazının en fazla kullanım alanıdır. Mevcut çalışmada hastanemizAS laboratuvarına gönderilen örneklerin yıllara göre dağılımlarını, istek yapan bilim dalının dağılımını, gönderininyapıldığı örnek tipini ve tanı-izlemde ASnin yerini değerlendirmeyi hedefledik. Yöntem ve Gereçler: Trakya Üniversitesi Tıp Fakültesi AS Laboratuvarına 01.01.2002 ile 01.01.2014 tarihleriarasında gönderilerek değerlendirilen AS testleri geriye dönük olarak değerlendirildi. Elde edilen parametreler ta- nımlayıcı istatistik çerçevesinde değerlendirildi.Sonuç: Bu zaman zarfında toplam 4874 adet test değerlendirildi (Ortalama: 406 test/yıl). Örneklerin %18,7si çocukyaştaki hastalardan (n=964) gönderilmişken, % 81,3ü (n=3910) erişkin hastalarından gönderilmişti. Gönderilen ör- neklerin %35,3ü (n=1725) kemik iliği, %58,2si periferik kan (n=2828), %6,5i (n=321) diğer vücut dokularındangönderilmişti. Örneklerin %20,2sinin (n=989) tanısında AS inceleme başrol oynamıştı. Örneklerin %18,5i (n=880)hastalıkların tedaviye yanıtlarının değerlendirilmesinde kullanıldı. Tanısı ASyle konulan hastaların %34,6sı akutmyeloid lösemi, %32si kronik B-lenfoproliferatif hastalıklar, %19,5i akut lenfositer lösemi, %10,2si myelodisp- lastik sendrom, %3,2si kronik myeloid lösemi, %0,3ü Burkitt lösemi/lenfoma, %0,1i T-lenfoproliferatif hastalıkve %0,1i bifenotipik lösemiydi.Tartışma: Tek merkez verilerinin değerlendirildiği bu çalışma tanı konulması istenilen hastalıkların ülkemizdekisıklıklarını göstermesi açısından önemli veriler sunmaktadır. Yıllara göre dağılım ise merkezimizin deneyim artı- şını ve hastaların merkezimize ulaşımının kolaylaşması olarak değerlendirilebilir. Hastane verilerine dayalı geriyedönük çalışmaların yararları arasında hastalık sıklık verilerinin saptanmasında dolaylı bir yöntem olması sayılabilir.
A case of refractory chronic lymphocytic leukaemia with an unusual course
(All India Inst Medical Sciences, 2019) Umit, Elif G.; Baysal, Mehmet; Ozdover, Ali Caner; Kirkizlar, Onur; Demir, Ahmet Muzaffer
Chronic lymphocytic leukaemia (CLL) is a heterogeneous disease with uncertain course. Treatment should be tailored to the patient's disease as well as the prognostic subgroup. With the increased use of rituximab as well as other selective and non-selective immunomodulatory agents, the incidence of infectious complications and second malignancies has also increased. Progressive multifocal leucoencephalopathy (PML) is a complication of rituximab in HIV-negative patients. A 56-year-old male with CLL had been treated and relapsed four times in 6 years. Rituximab was added to the combination after the second relapse and repeated in the third relapse in combination with bendamustine. In the seventh year of diagnosis, relapse of CLL and an ulcerated tumorous lesion was observed in the left index finger, which progressed in 3 months and was later diagnosed as angiosarcoma. The cancer was treated with local radiotherapy and combination chemotherapy. One year after the last rituximab exposure, progressive muscle weakness developed and polyoma JC virus DNA was observed with increased titres in the cerebrospinal fluid, and the patient was diagnosed as having PML. The patient died 2 months later. Our patient had an unusual course of CLL over 8 years, with relapses, complicated with a secondary malignancy and an infectious complication.
CD11B EXPRESSION IN ACUTE MYELOID LEUKEMIA IS ASSOCIATED WITH HEMOSTATIC COMPLICATIONS AND RESPONSE TO TREATMENT
(2020) Baysal, Mehmet Kemal; Ümit, Elif G.; Öztürk, Gökhan; Gülsaran, Sedanur Karaman; Baş, Volkan; Kırkızlar, Hakkı Onur; Demir, Ahmet Muzaffer
Aim: In our study, we aimed to investigate the effects of CD11b expression on myeloblasts on clinical course and prognosis in patients with AML. Materials and Methods: Data of 123 patients diagnosed with AML between 2014-2017 in Trakya University Faculty of Medicine, Department of Hematology, a tertiary referral hospital in the Trakya Region, were evaluated in a retrospective manner. The diagnosis of AML was based on WHO 2016 criteria of Myeloid Neoplasms. Results: Of the 123 patients in our study, 60 were female, and 63 were male. The mean age was 57.93 years. CD11b positivity was observed in 40 patients. Platelet counts were significantly lower in patients with CD11b positivity (p = 0.004). Likewise, D-dimer levels at presentation were higher in the CD11b positive patient group (p = 0.000). Regarding outcomes, patients with CD11b positivity were found to have lower rates of remission with first-line remission induction therapy (p = 0.003). There was no significant relationship between CD11b positivity and overall survival with Kaplan Meier survival analysis (8.5 months in CD 11b positive group, 12.1 months in negative group, p: 0.436). Conclusion: Our study demonstrated that patients with CD11b expression had lower remission rates with remission induction chemotherapy.
Clinical and epidemiologic data on chronic lymphocytic leukemia patients followed up at a tertiary center in Turkey
(Taylor & Francis Ltd, 2015) Pamuk, Gulsum Emel; Uyanik, Mehmet Sevki; Aydogdu, Erkan; Ak, Recep; Demir, Ahmet Muzaffer; Harmandar, Orbay
[Abstract Not Available]
Clonal Hematopoiesis in Multiple Myeloma, Relations with Treatment Toxicity
(Cig Media Group, Lp, 2021) Gulsaran, Sedanur Karaman; Umit, Elif Gulsum; Bas, Volkan; Baysal, Mehmet; Puyan, Fulya Oz; Demir, Ahmet Muzaffer
[Abstract Not Available]
A comment on a prospective, multicenter study of low dose decitabine in adult patients with refractory immune thrombocytopenia by Zhou et al
(Wiley, 2020) Demirci, Ufuk; Umit, Elif G.; Demir, Ahmet Muzaffer
[Abstract Not Available]
Comparison of Clinical Scoring Systems in the Management of Patients with Microangiopathic Hemolytic Anemia and Thrombocytopenia
(Galenos Yayincilik, 2021) Baysal, Mehmet; Umit, Elif; Kirkizlar, Hakki Onur; Demir, Ahmet Muzaffer
Objective: Several clinical scoring systems have been developed for the differential diagnosis of thrombotic microangiopathies (TMAs), all to predict and identify patients with ADAMTS13 deficiency and to start treatment as soon as possible. The first scoring system in this regard was the Bentley score, and the French score and PLASMIC score were developed afterwards. Materials and Methods: We aimed to evaluate the laboratory parameters and clinical features of patients who underwent plasma exchange with a prediagnosis of TTP at our clinic between 2007 and 2019 and whose ADAMTS13 enzyme levels were measured and to compare the findings with the scoring systems. Results: Data of 35 patients were evaluated. Twelve patients were evaluated as high risk according to all three scoring systems. A statistically significant relation was observed between all three scoring systems and ADAMTS13 levels. Conclusion: A moderate correlation was found between all three scoring systems and ADAMTS13 levels. We observed similar potential strength of all three scoring systems to predict TTP among other TMAs and we conclude that they are applicable in daily practice.
Could Antinuclear Antibody Positivity Be a Factor Affecting Treatment Response in Immune Thrombocytopenia Patients on Eltrombopag?
(Galenos Yayincilik, 2022) Baysal, Mehmet; Bas, Volkan; Umit, Elif; Kirkizlar, Hakki Onur; Demir, Ahmet Muzaffer
Objective: Eltrombopag remains a prominent option in the treatment of steroid-dependent or steroid-refractory immune thrombocytopenia (ITP) patients. Unfortunately, not all patients respond to eltrombopag. Antinuclear antibody (ANA) positivity can be seen at rates of up to 30% in ITP patients. Despite being widely used, more markers to predict the response to eltrombopag are still needed. In the present study, we aimed to show the association between ANA positivity and eltrombopag response in ITP patients. Materials and Methods: Patients who were diagnosed with ITP in the Trakya University Faculty of Medicine's Department of Hematology and who underwent eltrombopag treatment due to their resistance to steroids and other treatments were included in our study. ANA measurement was performed by indirect fluorescent antibody method and titers of 1:160 and above were considered positive. ANA measurements were made before starting eltrombopag. Results: Forty-five patients were included in our study, 33 being women and 12 men. The mean age of the patients was 45.73 years. There were 14 patients with ANA positivity and 31 patients were found to be ANA-negative. Response rates were higher in ANA-negative patients compared to ANA-positive patients in the 1st and 6th months of eltrombopag treatment (p<0.05). Conclusion: ANA positivity in ITP may indicate unresponsiveness to eltrombopag treatment, a finding that should be further supported by prospective studies involving more patients.
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.
Economic analysis of oral posaconazole prophylaxis in acute myeloid leukemia during remission induction in Turkey
(Kare Publ, 2020) Umit, Elif Gulsum; Baysal, Mehmet; Kirkizlar, Hakki Onur; Demir, Ahmet Muzaffer
OBJECTIVE: Invasive fungal infections (IFI) are important and trending causes of mortality in patients with acute leukemia, especially during the remission induction. METHODS: In this study, 225 patients who were diagnosed with acute myeloid leukemia (AML) and undergoing intensive treatment for remission induction were enrolled in a retrospective manner. RESULTS: Within the whole group, which consisted of 225 patients, 90 patients received prophylactic antifungal treatment (PAT) (40%), while 135 patients did not (60%) receive. The mean cost of hospitalization was 9.151,6 (2.872,6-20.483,3) US dollars. Gender distribution and mean ages of groups were similar. One hundred fourteen patients not on PAT (84.4%) and five patients on PAT (5.5%) received intravenous antifungal treatment. Thirty-two of the patients who were not on PAT (23.7%) and 11 of the patients on PAT died during remission induction (12.22%). The mean day of the hospitalization was 22.61 days for the patients on PAT and 33.89 days for the patients who were not on PAT. In patients on PAT, the mean number of transfused platelet units was six (0-9), while 12.51 (4-43) units for patients who were not on PAT. CONCLUSION: In our study, the oral suspension form of posaconazole was observed to be cost-effective to prevent IFI with a significant decrease in mortality during remission induction treatment.
Effect of exercise on ADMA level in type 2 diabetes mellitus
(2012) Taşkıran, Bengür; Uğur, Betül Altun; Vardar, Selma Arzu; Demir, Ahmet Muzaffer; Karadağ, Çetin Hakan; Altun, Armağan
Amaç: Simetri (SDMA) ve asimetri dimetil argininde (ADMA)artış endotelyal disfonksiyona işaret eder. Bu projenini amacı tip 2 diabetes mellitusta egzersizden sonraki düzeylerini incelemektir. Hastalar ve Yöntemler: Tip 2 DM bulunan 36 kadın ve 44 sağlıklı kadın dahil edildi. Sırasıyla 14 ve 19'u 4 haftalık orta yoğunlukta egzersize alındı. Başlangıçta, ilk egzersiz seansından sonra ve bir ay sonra plazmada SDMA, ADMA ve L-arginin düzeyleri HPLC yöntemiyle ölçüldü. Bulgular: Her iki grupta da tüm ölçümler normal aralıktaydı ve ne egzersizden sonra ne de bir ayın sonunda belirgin olarak değişmedi. Egzersiz yapan sağlıklı grupta bir ayın sonunda L-arginin/ADMA ve L-arginin/SDMA oranları başlangıç değerlerine göre belirgin olarak yüksek bulundu (sırasıyla, p<0.022 ve 0.017). Bir aylık egzersizin sonunda, ilk egzersiz seansı sonundaki değerlere göre oranlar diyabetiklerde arttı ve sağlıklı kişilerde azaldı. Sonuç: Mutlak değerlerden ziyade L-arginin/ADMA ve L-arginin/SDMA oranlarının kullanılması gerektiğini düşünüyoruz. Sağlıklı kişilerde egzersizin yararlı etkileri açısından bu moleküllerin önemli rolü bulunurken diyabetiklerde bu rol çok azdır.
The effects of fat distribution and some adipokines on insulin resistance in subjects with prediabetes
(Via Medica, 2016) Bilir, Betul Ekiz; Guldiken, Sibel; Tuncbilek, Nermin; Demir, Ahmet Muzaffer; Polat, Ahmet; Bilir, Bulent
Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p < 0.001) and visfatin (p < 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p < 0.01) and fat mass (p < 0.01) and low adiponectin (p < 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance.
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.
Genetic Diagnosis of Hereditary Hemorrhagic Telangiectasia: Four Novel Pathogenic Variations in Turkish Patients
(2020) Baysal, Mehmet; Demir, Selma; Ümit, Elif G.; Gürkan, Hakan; Baş, Volkan; Gülarslan, Sedanur Karaman; Demir, Ahmet Muzaffer
Aims: Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized by telangiectasia, epistaxis, and vascular malformations. Pathogenic mutations were found in ENG, AVCRL1, SMAD4, and GDF genes. In this study, we present our database of patients with hereditary hemorrhagic telangiectasia regarding the phenotype-genotype relations and discuss two novel ENG gene pathogenic variations in two unrelated families. Methods: Next Generation Sequencing analysis was performed on the peripheral blood of nine patients with hereditary hemorrhagic telangiectasia in four unrelated families. All patients were diagnosed with hereditary hemorrhagic telangiectasia according to the Curaçao criteria. Data on treatment and screenings of visceral involvement were recorded from files. Results: We have found a pathogenic variation in either the ENG or ACVRL1 gene in each family. Two novel pathogenic variations in the ENG gene, including NM_000118.3 (ENG): c.416delC (p.P139fs*24) and NM_000118.3(ENG): c.1139dupT (p.Leu380PhefsTer16), were found in the same family. The NM_000020.2(ACVRL1): c.1298C>T (p.Pro433Leu) pathogenic variation in the ACVRL1 gene in our first family and a novel heterozygous likely pathogenic NM_000020.2(ACVRL1): c.95T>C (p.Val32Ala) variation was found in our second family. Seven of the nine patients were treated with thalidomide for controlling bleeding episodes. All patients responded to thalidomide. In one patient, the response to thalidomide was lost and switched to bevacizumab. Conclusion: In hereditary hemorrhagic telangiectasia, certain types of mutations correlate with disease phenotypes and with next generation sequencing methods. New pathogenic variations can be revealed, which might help manage patients with hereditary hemorrhagic telangiectasia
Growth Arrest-Specific 6 (Gas6) and TAM Receptors in Mouse Platelets
(Galenos Yayincilik, 2015) Uras, Fikriye; Kucuk, Burhanettin; Ozakpinar, Ozlem Bingol; Demir, Ahmet Muzaffer
Objective: Growth arrest-specific 6 (Gas6) is a newly discovered vitamin K-dependent protein, which is a ligand for TAM receptors [Tyro3 (Sky), Axl, and Mer] from the tyrosine kinase family. Gas6 knockout mice were resistant to venous and arterial thrombosis. There are contradictory reports on the presence of Gas6 and its receptors in mouse platelets. The objective of this study was to investigate whether Gas6 and its receptors were present in mouse platelets or not. Materials and Methods: Specific pathogen-free BALB/c male and female mice of 8-10 weeks old and 25-30 g in weight were anesthetized under light ether anesthesia and blood samples were taken from their hearts. RNAs were isolated from isolated platelets, and then mRNAs encoding Gas6 and TAM receptors were detected by reverse transcription-polymerase chain reaction (RT-PCR). Protein concentrations of Gas6 and TAM receptors in platelets were measured by ELISA, but not those of Mer, because of the absence of any commercial ELISA kit for mouse specimens. Results: RT-PCR results indicated the presence of mRNAs encoding Gas6 and Mer in mouse platelets. However, although RTPCR reactions were performed at various temperatures and cycles, we could not detect the presence of mRNAs encoding Axl and Tyro3 (Sky). Receptor protein levels of Axl and Tyro3 were below the detection limits of the ELISA method. Conclusion: We found the presence of mRNAs encoding Gas6 and the receptor Mer in mouse platelets, but not Axl and Tyro3. Gas6, Axl, and Tyro3 protein levels were below the detection limits of the ELISA. The presence of mRNA is not obvious evidence of protein expression in platelets that have no nucleus or DNA. Further studies are required to clarify the presence of Gas6/TAM receptors in platelets using real-time PCR and more sensitive immunological methods, and future studies on mechanisms will indicate whether the Gas6/TAM pathway is a strategy for treatment of disorders.
High-intensity interval training acutely alters plasma adipokine levels in young overweight/obese women
(Taylor & Francis Ltd, 2018) Vardar, Selma Arzu; Karaca, Aziz; Guldiken, Sibel; Palabiyik, Orkide; Sut, Necdet; Demir, Ahmet Muzaffer
The aim of this study was to investigate the plasma adipokine responses to high-intensity interval training (HIT) in overweight/obese women. Twelve women (age 21.7 +/- 3.8 years) completed a 19 days of HIT comprising six session of 4-6 repeats of a Wingate test (0.065 kg load/kg). Plasma adipokine levels were measured before exercise, and at 5 and 90 min after exercise on the first and the last training days. Adiponectin was higher at 5 min than 90 min post-exercise (11.7 +/- 7.3 and 10.5 +/- 5.8 ng/ml; p = .01) in the first exercise day. Leptin decreased 5 min after exercise (23.6 +/- 13.2 vs. baseline 27.8 +/- 14.4 ng/ml; p < .01) and remained depressed following 90 min (p < .01). The changes in adiponectin and leptin concentrations were similar on the first and last exercise days. No consistent effect was found on resistin concentration. Future studies are required to disclose the functional consequences of these alterations in plasma adipokine levels.
History Of The Hematology Proficiency Exam And The Turkish Experience
(2023) Bulduk, Tuba; Demir, Ahmet Muzaffer; Andıç, Neslihan; Sayınalp, Nilgün; Aylı, Meltem
Objective: The purpose of the present paper was to provide information about the Turkish Society of Hematology Proficiency Exam and to raise awareness about continuing medical education and proficiency certification. Method: The data of the theoretical proficiency exams organized by the Turkish Society of Hematology since 2010 and the participation of Turkish hematologists in the European Hematology Examinations organized since 2017 were evaluated in the study. The number of hematology assistants and specialists who applied for the exam and the success levels of the participants were investigated. Results: A total of 10 Hematology Proficiency Written Exams have been administered since 2010 and a total of 108 candidates applied for the exam. A total of 53.7% (58 candidates) of the test takers were female and 46.3% (50 candidates) were male. According to the results of the proficiency exam that has been applied since 2010, almost all of the candidates (99%) were successful in the exam. The proficiency oral/practical exam was held for the first time on 29.04.2023. Conclusion: Proficiency exams are essential to provide an ideal level and standardization in hematology education. When compared to the European Hematology Examination, participation in the proficiency exam is lower than expected in our country. Hematologists should be encouraged to participate in the Hematology Proficiency Exam organized by the Hematology Medical Specialization Qualification Commission (HEM-TUYEK). Hematologists must also be supported to have a certificate of competence, which is an indicator of professionalism and continuous medical education.
Hypogammaglobulinemia and Poor Performance Status are Predisposing Factors for Vancomycin-Resistant Enterococcus Colonization in Patients with Hematological Malignancies
(Galenos Yayincilik, 2017) Umit, Elif Gulsum; Kuloglu, Figen; Demir, Ahmet Muzaffer
Objective: Vancomycin-resistant enterococci (VRE) are common pathogens of hospital-acquired infection. Long hospitalization periods, use of broadspectrum antibiotics, and immunosuppression are major risks for VRE colonization. We aimed to evaluate patients' characteristics and factors that may contribute to VRE colonization. Materials and Methods: Data of 66 patients with colonization and 112 patients without colonization who were hospitalized in the hematology clinic were collected. Hematological malignancies, preexisting gastrointestinal complaints, the presence of hypogammaglobulinemia at the time of diagnosis, complications like neutropenic enterocolitis (NEC), and Eastern Cooperative Oncology Group (ECOG) and Karnofsky performance statuses were recorded. Results: Ages of the patients ranged between 19 and 95 years (mean: 55.99). Karnofsky and ECOG scores were statistically related to VRE colonization (p<0.000 and p<0.000), though only the Karnofsky score was significant based on logistic regression analysis. Almost all patients with acute leukemia (45 patients) had been on antibiotics (piperacillin-tazobactam, ceftazidime, and meropenem), while no patients with myelodysplastic syndrome, myeloma, or benign diseases and 2 patients with lymphoma and 1 with chronic myeloid leukemia were on antibiotics. Median time for colonization regardless of antibiotic use and diagnosis was 4.5 days (range: 3-11 days). In the VRE-colonized group, 40.9% of patients had NEC development, while in the non-colonized group, only 1.7% had NEC development. In the VRE-colonized group 46 patients (69.7%) and in the non-colonized group 27 patients (24.1%) had hypogammaglobulinemia at diagnosis; among these patients, 23 patients in the VRE-colonized group (50%) had a B-cell malignancy (lymphoma, myeloma, or chronic lymphocytic leukemia). Conclusion: Besides already anticipated diseases like leukemia, B-cell malignancies are also at high risk for colonization. This proclivity may be attributed to lack of gastrointestinal IgA due to hypogammaglobulinemia. Prolonged hospitalization (>7 days) may also be accepted as a risk factor, independent of diagnosis or antibiotic use. Performance status is also an important factor for colonization, which may be related to poorer hygiene and increased external help.
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, Seval
Objective: 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.

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