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Cushing Hastalığı Remisyon Değerlendirmesinde Nötrofil Lenfosit Oranının Yeri
No full textObjective: In recent years neutrophil-to-lymphocyte ratio is defined as one of the new and early prognostic markers for many carcinomas including some types of intracranial tumors. The aim of the present study is to assess the association between preoperative and postoperative neutrophil-to-lymphocyte ratios and remissions in patients with Cushing’s disease. Method: The present study was carried out using the data of 162 consecutive patients operated for Cushing’s disease by a single surgeon (NG) between 1997 and 2017. Clinical records were analyzed retrospectively. Neutrophil-to-lymphocyte ratios calculated from complete blood counts recorded preoperatively, on postoperative 1st day and at postoperative 3rd month in 24 patients in early, and 3rd month remissions and correlations among them were investigated. Results: A statistically significant difference was observed between preoperative, postoperative 1st day and postoperative 3rd month NLRs in patients who were in early stage emission (p=0.001) or not (p=0.002). Any statistically significant difference was not found between patients who were in remission or not at 3rd months in terms of NLRs measured at different time points. There was a statistically significant difference between preoperative, postoperative first day and postoperative 3rd month NLRs in patients in remission (p=0.001) or not (p=0.005) during longterm follow-up. No statistically significant difference was found between NLRs measured at different times among those who were remission or not during long-term follow-up. Conclusion: Cushing’s disease is a disease directly associated with stress hormones and its effects on NLR is inevitable. New studies with larger patient series will shed light on this issue.Amaç: Son yıllarda nötrofil lenfosit oranı bazı beyin tümörü tiplerini de içeren pek çok kanser için erken prognostik faktörlerden biri olarak tanımlanmıştır. Çalışmanın amacı Cushing hastalarında operasyon öncesi ve sonrası nötrofil lenfosit oranları ile remisyon arası ilişkiyi araştırmaktır. Yöntem: Çalışma Cushing hastalığı tanısıyla 1997 ila 2017 yılları arasında tek bir cerrah (NG) tarafından opere edilmiş ardışık 162 hastanın bilgileri retrospektif olarak araştırılarak gerçekleştirilmiştir. Çalışma kriterlerini karşılayan 24 hastanın operasyon öncesi, postoperatif 1. gün ve postoperatif 3. ay tam kan sayımı değerlerinden hesaplanan nötrofil lenfosit oranları ile erken remisyon ve 3. ay remisyona girmiş olma durumları karşılaştırılarak arasındaki ilişki araştırıldı. Bulgular: Preoperatif, postoperatif 1.gün ve postoperatif 3. ay nötrofil lenfosit oranının erken remisyona giren hasta grubunda (p=0,001) ve erken remisyona girmeyen grup hastalarda da (p=0,002) anlamlı farklı olduğu gözlendi. Ancak 3. ay remisyona giren grupta ve remisyona girmeyen grupta ölçülen nötrofil lenfosit oranları arası fark anlamlı bulunmadı. Uzun dönem takipte olup remisyonda olan ve remisyona girmemiş olguların operasyon öncesi, postoperatif 1. gün ve postoperatif 3. ayda bakılan nötrofil lenfosit oranları arasında anlamlı bir fark bulundu. Ancak uzun dönem takiplerinde remisyonda olan hastalar (p=0,001) ile remisyona girmemiş hastaların (p=0,005) oranları arasında anlamlı bir fark bulunmamıştır. Sonuç: Cushing hastalığı stres hormonları ile direkt bağlantılı bir hastalıktır ve bunun nötrofil lenfosit oranlarına etkisi kaçınılmazdır. Daha geniş serilerle yapılacak çalışmalar bu konuya ışık tutacaktır
Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure
No full textWOS: 000582235000003PubMed: 33008692Introduction and Aims: the prognosis of chronic heart failure with reduced ejection fraction (HFrEF) has been studied extensively, but factors predicting cardiac decompensation are poorly defined. Right ventricular stroke work index (RVSWI), an invasive measure of right ventricular (RV) systolic function, is a well-known prognostic marker of RV failure after left ventricular assist device insertion and after lung transplantation. Thus, the aim of this study was to assess whether there is a relationship between RVSWI, HFrEF hospital readmission due to cardiac decompensation, and prognosis. Methods: We prospectively enrolled 132 consecutive patients with HFrEF. Right heart catheterization was performed and RVSWI values were calculated in all patients. the relationship between RVSWI values and readmission and prognosis was analyzed. Results: During a median follow-up of 20 +/- 7 months, 33 patients were readmitted due to cardiac decompensation in the survivor group, and 18 patients died due to cardiac causes. There was no difference between patients who died and survived in terms of RVSWI values. Among patients with decompensation, mean RVSWI was significantly lower than in patients with stable HFrEF (6.0 +/- 2.2 g/m(2)/ beat vs. 8.8 +/- 3.5 g/m(2)/ beat, p<0.001). on correlation analysis, RVSWI was negatively correlated with NYHA functional class. RVSWI was also identified as an independent risk factor for cardiac decompensation in Cox regression survival analysis. Conclusions: We showed that RVSWI predicts cardiac decompensation and correlates with functional class in advanced stage HFrEF. Our data suggest the value of combining information on right heart hemodynamics with assessment of RV function when defining the risk of patients with advanced HFrEF. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia
Intradialytic hypotension prevalence, influencing factors, and nursing interventions: prospective results of 744 hemodialysis sessions
No full textPubMed: 32447597Introduction: the aim of this study was to evaluate intradialytic hypotension (IDH) prevalence, influencing factors, and nursing interventions in hemodialysis (HD) patients. Methods: This descriptive and cross-sectional study was conducted at a private dialysis center. the patients were followed-up in terms of IDH development based on the European Best Practice Guidelines criteria during six consecutive HD sessions. the study followed the STROBE checklist. Results: A total of 744 hemodialysis sessions of 124 patients were monitored. IDH developed in 51.6% of the patients and the prevalence was 17.60%. the most common nursing interventions were stopping ultrafiltration and isotonic saline solution administration. White blood cell (WBC) (p = 0.017) and creatinine (p = 0.005) values were statistically significantly higher in patients developing IDH. WBC was found to increase IDH development risk 0.796 times (95% CI [0.657–0.996], p = 0.021). Conclusion: Nursing staff awareness regarding the frequency of IDH in hemodialysis patients and the related symptoms needs to be increased. © 2020, Royal Academy of Medicine in Ireland.We would like to thank the patients who participated in the study
Akut lenfoblastik lösemili bir çocuk hastada mukormikoz enfeksiyonunun başarılı tedavisi
No full textInvasive fungal infections may cause morbidity and mortality in pediatric patients with hematologic and oncologic malignancies treated with intensive protocols. We present a case of mucormycosis in an 8-year-old boy with acute lymphoblastic leukemia. In our patient, the suspicion for an oculoorbital and paranasal infection only due to mild pain in the orbital area without any abnormal pathologic findings in the ophthalmologic and otolaryngologic examination, led us to an early diagnosis. Despite the use of antifungal therapy, the lesion persisted and fever subsided after surgical drainage of the periorbital abscess. Antifungal treatment continued during chemotherapy. He has been in remission for four years. Mucormycosis should be in the differential diagnosis in infections in children with cancer, especially leukemia, according to clinical and radiologic findings. A high degree of suspicion and prompt systemic empirical antifungal therapy, as well as surgical debridement, are crucial for the survival of patients. Beside antifungals, early surgery plays an important role in patients with mucormycosis.Invaziv fungal enfeksiyonlar, yoğun tedaviler alan çocukluk çağı kanserlerinde mortalite ve morbiditenin önemli bir nedenidir. Bu yazıda, akut lenfoblastik lösemi tanılı sekiz yaşındaki erkek hastada saptanan mukormikoz enfeksiyonu irdelenmiştir. Ateş ve orbita etrafında hafif ağrı saptanan olgumuzda, kulak burun boğaz ve oftalmolojik değerlendirmede patolojik bulgu olmamasına rağmen, okuloorbital ve paranazal enfeksiyonun düşünülmesi, bizi erken tanıya götürdü. Görüntülemede saptanan periorbital apse, antifungal tedaviye ragmen gerilemedi ve cerrahi drenaj sonrasi ateş düştü. Kemoterapi boyunca antifungal tedavisine devam edilen hasta, tedavi bitiminden sonra dört yıldır hastalıksız izlenmektedir. Çocukluk çağı kanserlerinde, özellikle lösemi tanılı hastaların enfeksiyonlarda, klinik ve radyolojik bulgular dogrultusunda mukormikoz ayırıcı tanıda düşünülmelidir. Bu infeksiyonun ayırıcı tanıda düşünülmesi, hızla sistemik antifungal tedavi başlanması, ve cerrahi debridman hastaların hayatta kalmaları için çok önemlidir. Antifungal tedavi yanında, erken cerrahi drenaj, mukormikoz tedavisinde önemli rol oynar
The Influence of Class III Obesity on Subarachnoid Depth of Turkish Parturient: A Prospective Observational Study
No full textSeyhan, Tulay Ozkan/0000-0002-7070-8827WOS: 000535666500001Introduction: This observational study aimed to investigate the effects of morbid obesity on the subarachnoid depth and spinal anaesthesia technique. Methods: Sixty American Society of Anesthesiologists Classification II women with term pregnancy who were candidates for elective caesarean section under spinal anaesthesia were enrolled in this prospective, observational study. Only patients with a Body Mass index (BMI) of = 40 kg/m(2) (obesity group) were included in the study. Spinal anaesthesia was performed in the sitting position via a midline approach at either L3-4 or L4-5 level by using a 25G 90-mm Quincke spinal needle with an introducer. Demographic data of the parturient, visual characteristics of the lumbosacral region, palpation of landmarks, depth of the spine, technical characteristics of the block, time of block performance and satisfaction of patients were recorded. Results: the spinal depth of the control and obesity groups were 51.7 +/- 4.4 and 69 +/- 10.4 mm, respectively (p<0.001). Although needle change was not necessary for any of the patients in the control group, a 120-mm long needle change was required in six patients in the obesity group (p<0.024). We found that the incidence of patients with landmarks that were difficult to palpate was higher in the obesity group, and significantly increased attempt number, skin puncture and needle pass were also required in this group. Conclusion: Anaesthesiologists should be prepared for a longer attempt in patients with obesity but should not be discouraged as the increase in the number of attempts or prolonged initiation time of spinal anaesthesia was not associated with patient dissatisfaction or discomfort
Anatomical Features of Neural Foramen at T12–L1 Level for Endoscopic Transforaminal Approach of Paramedian and Foraminal Disc Herniations: An Anatomical Study on Fresh Human Cadavers
No full textAIM: To explore the anatomic features of the neural foramen in particularly at the T12-L1 level in order to assess reveal the safety and efficiency of the endoscopic transforaminal approach for paramedian and foraminal disc herniations at this level. MATERIAL and METHODS: The study included 15 fresh human cadavers. The soft tissues were removed at the T12-L1 level and bony tissues, were exposed including the transverse processes. The bilateral facets and pars interarticulares at this level were resected revealing the foraminal anatomy and exiting roots. The anatomical structures constituting the triangular safe working zone (TSWZ) were explored. The nerve root length, nerve root width, nerve root angle, TSWZ height, and base of TSWZ base, nerve root width, nerve root angle and disc height were recorded. RESULTS: The root length is the hypotenuse of the TSWZ between the axilla of the exiting root and the lateral margin of the pedicle, and the mean root length was 14.94 ± 2.45 mm. The dural height is the interval between the axilla of the exiting nerve root axilla and the superior end plate of the caudal vertebra, and the mean of the dural height was 10.95 ± 1.74 mm. The base of TSWZ is the distance between the lateral margin of the dural sac and the medial margin of the exiting root, and the mean measurement for the base measurement was 11.83 ± 2.26 mm. CONCLUSION: According to the results data from our cadaveric study, we believe that Kambin’s triangular working zone is a safe area to consider for the endoscopic transforaminal approach at the T12-L1 level, especially for paramedian and foraminal disc herniations
Malignant Melanoma Metastasis to the Thyroid Gland Causing Severe Central Airway Obstruction
No full textMetastasis of malignant melanoma to the thyroid gland causing airway obstruction is an extremely rare condition. In an 80-year-old woman who presented with painless swelling of the neck, a diagnosis of malignant melanoma metastasis to the thyroid gland with an unknown source was established. She received multiple radiotherapy sessions that resulted in occasional regression but not complete resolution. She was then referred for tracheal stenting owing to progressed dysphagia and dyspnea. Rigid bronchoscopy was performed, and a fully covered metal stent was placed to secure the open airway. Dyspnea improved immediately after stent insertion. The patient died at her residence because of a cerebrovascular event 2 weeks after the procedure. To the best of our knowledge, central airway obstruction due to malignant melanoma metastasis to the thyroid gland has been not reported in the literature. The approach for palliation of obstruction is similar to that of other malignant central airway obstructions
Clinoptilolite induces cell death in THP-1 cells in oxidative stress conditions
No full textWOS: 000518838900032Aim: Zeolites are tectosilicates which appear as minerals in nature and can also be synthesized in the laboratory conditions. Clinoptilolite is a natural zeolite which has ion exchanging and adsorbent characteristics. We have aimed to display the effect of clinoptilolite to apoptotic, autophagic and antioxidant characteristics of cancer cell lines under oxidative stress conditions. Material and Methods: the cytotoxicity of clinoptilolite was evaluated using the MTT assay. the total antioxidant status was measured by the total antioxidant status (TAS) detection kit. the western blotting analysis was performed in order to assess the protein expression levels of the apoptosis and to autophagy markers like Beclin1, Bcl-2 and LC3B. Results: 24 hours incubation of cancer cells with clinoptilolite reduced cell proliferation in a dose dependent manner. Clinoptilolite lowered the autophagy in cancer cells, in particular, directing the cells towards apoptosis and leading to a fall in the TAS levels. Clinoptilolite to cause a decrease in antioxidant defence. Discussion: Parallel to these findings, it has been seen that there was an increase in apoptosis and a decrease in autophagy in cells induced with hydrogen peroxide effect. in this study, clinoptilolite was shown to cause a decrease in antioxidant defense
SNPs of miR-23b, miR-107 and HMGA2 and their Relations with the Response to Medical Treatment in Acromegaly Patients
No full textPubMed: 32838437Introduction Acromegaly is a chronic disease of increased growth hormone (GH) secretion and elevated insulin-like growth factor-I (IGF-I) levels induced by a pituitary adenoma. HMGA2 (high mobility group A2) and AIP (aryl hydrocarbon receptor-interacting protein) expression levels are related to GH-secreting adenomas, and also a response to Somatostatin Analogs (SSAs). We studied SNPs in miR-107 and miR-23b that related with AIP and HMGA2 genes respectively and control their expression, and also SNP in the 3'UTR of HMGA2 gene. Our aim was to investigate genotype distributions of the studied SNPs, as well as the possible relationship between disease and/or response to SSAs treatment in patients with acromegaly. Material and Methods Genotypes were determined by qRT-PCR method from DNA materials obtained blood samples of acromegaly patients (141) and healthy individuals (99). the genotype distributions of patients and healthy groups, as well as the relationship between the clinical data of the disease and genotypes were statistically compared. Results in acromegaly patients with T-Allele, p53 expression (p=0.049) was significantly higher. in patients with CT+TT genotype and T-Allele who were responder to SSA-Treatment Ki-67 index (respectively p=0.019, p=0.020 respectively) was higher. We did not observe the genotypes for miR-23b and miR-107 polymorphisms in the patients and control group of Turkish population. Conclusion the genetic variations of the miRNAs genes related with HMGA2 and AIP genes were not seen in our study. Although there is no relationship between HMGA2-rs1351394 polymorphism and acromegaly disease, T allele was associated with some clinical features related to adenoma in patients with acromegaly. © 2020 Lippincott Williams and Wilkins. All rights reserved
Comparison of Haploidentical and Unrelated Donor Stem Cell Transplantation in Acute Leukemia Patients
No full textAmaç: Allojeneik kök hücre nakli, günümüzde, yüksek riskli akut lösemi olgularında kullanılabilecek en etkili tedavi seçeneğidir. HLA-uyumlu kardeş vericisi olmayan hastalarda, akraba dışı ve haploidentik vericiler önemli birer seçenektir. Özellikle nakil sonrası siklofosfamid kullanımı ile haploidentik nakil sonuçları, akraba dışı nakillerle karşılaştırıldığında benzer sonuçlar vermektedir. Amacımız, akut lösemi olgularımızda, haploidentik nakil sonuçlarımızın, akraba dışı HLAuyumlu (10/10) (MUD 10/10) ve/veya akraba dışı HLA-uyumlu olmayan (tek loküs; 9/10) (MMUD 9/10) nakil sonuçları ile karşılaştırılmasıdır.Hastalar ve Yöntem: Bu retrospektif çalışmaya, birinci veya ikinci tam remisyonda iken allojeneik kök hücre nakli yapılan, 18-65 yaş aralığındaki toplam 96 akut lösemi tanılı hasta dahil edildi. Tüm hastaların klinik karakteristikleri ve demografik özellikleri tarandı. Sağkalım analizleri için en az nakil sonrası 100 günü tamamlayan hastalar analize uygun kabul edildi.Bulgular: Hastaların ortanca yaşı 39.4 ± 14 yıl idi. Erkek cinsiyet yüzdeleri MUD 10/10, MMUD 9/10 ve haploidentik nakil gruplarında sırasıyla %39.1, %74.2 ve %57.8 saptanmıştır (p= 0.02). Hasta ve verici yaşları, sitomegalovirüs (CMV) durumları, graft versus host hastalığı görülme sıklığı, ortalama nötrofil ve trombosit engraftman süreleri ile nakil sonrası 100. gündeki hastalık durumu gibi diğer faktörlerin, nakil grupları arasında istatistiksel olarak anlamlı farklılık göstermediği izlenmiştir. Sağkalım analizlerinde üç nakil grubu arasında bir farklılık olmadığı, primer hastalık (AML, ALL), transplant öncesi hastalık durumu (TR1, TR2) ve verici CMV durumunun (CMV IgG pozitif veya negatif) sağkalım analizlerinde gruplar arasında önemli bir faktör olmadığı gözlenmiştir (p= 0.406).Sonuç: Çalışmamızda, haploidentik nakilin klinik sonuçlarının MUD 10/10 ve MMUD 9/10 gruplarından daha kötü olmadığı gösterilmiştir. HLA uyumlu vericisi olmayan hastalar için alternatif verici seçiminde, transplantasyonun aciliyeti ve alıcı verici özellikleri de gözönünde bulundurulduğunda, mevcut sonuçlar eşliğinde, haploidentik nakilin uygun bir alternatif nakil seçeneği olduğu söylenebilir.Objective: Allogeneic stem cell transplantation (allo-SCT) remains the most effective curative intent therapy for patients with unfavorable risk acute leukemia. Various donor options are avail?able for the patient who lacks an HLA-matched sibling donor, such as unrelated donors (URD) and haploidentical donors. Recent studies showed promising results of haploidentical donor transplantation (HIDT) using post-transplant cyclophosphamide in comparison with unrelated donor. The goal of this study was to compare the outcome of allo-SCT from haploidentical versus matched unrelated (MUD 10/10) or mismatched unrelated donor at a single HLA-locus (MMUD 9/10) for patients with acute leukemia in remission. Patients and Methods: Ninety-six adult (18-65 years) patients with acute leukemia in first or second remission who underwent allogeneic transplantation with a minimum 100 days follow-up were included in this study. Patient characteristics and medical records of all patients were reviewed retrospectively. Patients who completed minimum 100 days post-transplantation follow-up were identified as eligible for survival analysis. Results: Median age of patients was 39.4 ± 14 years. Proportion of male patients was 39.1%, 74.2% and 57.8% for MUD 10/10, MMUD 9/10 and HIDT groups, respectively, which is significantly different (p= 0.02). The other baseline factors were similar, including patient age, donor age, recipient cytomegalovirus (CMV) status, donor CMV status, graft versus host disease incidence, median neutrophil and platelet engraftment times and disease status at post-transplant 100th day. No significant difference was identified in survival analysis among the MUD 10/10, MMUD 9/10 and HIDT groups, even if they were classified according to primary disease, pre-transplant disease status and donor CMV status. Conclusion: In our study population, clinical outcomes of HIDT patients were inferior to MUD 10/10 and MMUD 9/10 groups. When choosing an alternative donor for patients without an available HLA-matched sibling, urgency of transplantation and host/donor features should be considered