The evaluation of the complications, survival and causes of death in patients with philadelphia chromosome negative myeloproliferative disorders

Philadelphia kromozomu negatif miyeloproliferatif hastalıklar pluripotent hematopoetik kök hücredeki bozukluk nedeni ile oluşan hematopoetik hücre dizi öncü hücrelerinin düzensiz proliferasyonu sonucu granülosit, eritrosit veya trombosit sayısında artış ile birlikte sıklıkla sekonder miyelofibrozis ve nadiren de lösemik dönüşümle karakterize klonal hematolojik hastalıklardır. Bu çalışmada Adnan Menderes Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı, Hematoloji Bilim Dalı tarafından Philadelphia kromozomu negatif 104 miyeloproliferatif hastalıklar hastasında yapılan retrospektif çalışma ile tromboembolik ve hemorajik komplikasyonlar, sekonder miyelofibroz ve lösemik dönüşüm gibi komplikasyonların gelişimi, sağ kalım, sağ kalımı etkileyen faktörler, ölüm nedenleri, JAK2 mutasyonunun tanıda yeri ile sağ kalım ve komplikasyonlar üzerine etkisi araştırıldı. 54'ü (%52) erkek toplam 104 miyleprolifertif hastalıklar hastası çalışmaya alındı. Hastaların yaş ortalaması 59±16 (yaş aralığı 17-84) idi. Miyeloproliferatif hastalıkların dağılımına bakıldığında 60 hastada (%58) esansiyel trombositoz, 25 hastada (%24) polisitemia vera, 19 hastada (%18) primer miyelofibrozis idi. Fizik muayenede en sık saptanan bulgular splenomegali (%46), hepatomegali (%46), solukluk (%28) ve eritromelaljiydi (%14). En sık görülen komplikasyonlar kanama (%50) ve tromboembolik olaylardı (%42). Sekonder miyelofibrozis (%5) ve lösemik dönüşüm (%1) ise daha nadirdi. JAK2 mutasyonu değerlendirilen 66 hastanın 46'sında (%70) mutasyon pozitif olarak saptandı. Polisitemia vera hastalarının %83'ünde, esansiyel trombositoz hastalarının %61'inde, primer miyelofibrozis hastalarının %80'inde JAK2 mutasyonu pozitif saptandı. Ölüm nedenleri sıklık sırasına göre; tromboembolizm (%45), hastalık progresyonu (%18), solunum yetmezliği (%14) ve diğer (%23) nedenlere bağlı olarak görüldü. Tromboembolizm için risk faktörlerini lökositoz (p=0.003) ve ileri yaş (p0.05). Kanama komplikasyonları üzerinede logistik regresyon analizi ile etkin bir faktör yoktu. JAK2 mutasyonunun ve trombosit sayılarının tromboembolizm ve sağ kalım üzerine bir etkisi yoktu. Aspirin kullanan hastaların ortalama sağ kalım süreleri kullanmayan hastalara göre anlamlı derecede farklı idi (p0.05). Also there was not a significiant factor on hemorrhagic complications when used logistic regression analysis. The JAK2 mutation and platelet count had no effect on thromboembolism and survival. Mean survival time was significantly different between patients treated with aspirin and without (p<0.0001). Hydroxiurea was the most commonly used drug in myeloproliferative disorders. When performed Kaplan-Meier analysis, mean survival time was detected as 146±14 months in the patients with PV, 114±7 months in those with essential thrombocythemia, and 125±34 months in those with primary myelofibrosis, respectively. Mean survival time in patients with all myeloproliferative disorders were 157±20 months. However there was not a difference between groups for survival time. In conclusion, thromboembolism and hemorrhagic complications were frequently seen in myeloproliferative disorders. Only leukocyte count and advanced age had effect on thromboembolic complications. While the diagnosis of myeloproliferative disorders have no effect on survival, thromboembolic events and the use of aspirin were significiant factors affecting survival time. For this reason, teh use of aspirin is an important issue to prevent thromboembolic events and to improve survival time

Losartanın yeni tanı hipertansiyon hastalarının hematolojik parametrelerine ve trombosit agregasyonuna etkisi

Objective: Hypertension is associated with increased platelet function. Some antihypertensive drugs have antiplatelet activity. In this study, we aimed to investigate the effects of losartan on platelet aggregation induced by adenosine diphosphate (ADP), collagen, epinephrine, ristocetin, other hematological and, inflammatory parameters. Materials and Methods: Twenty-five patients (19 female, 6 male; mean age: 54±8 years) with newly diagnosed hypertension were included in the study. All patients were with stage 1-2 essential hypertension according to the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Initial blood pressure measurement was performed in all patients and losartan 100 mg/daily together with life style changes, such as diet and exercise was started. Platelet aggregation was evaluated with the use of ristocetin, epinephrine, collagen, and ADP. Complete blood count was also done. Platelet aggregation tests and blood pressure measurements were repeated after 8 weeks of therapy. Results: Systolic and diastolic blood pressure significantly decreased with losartan after 8 weeks (p<0.001). After treatment, there was no significant difference in platelet aggregation with ADP, collagen, and epinephrine (p>0.05). The aggregation with ristocetin significantly decreased (p=0.027). Besides, significantly lower hemoglobin and hematocrit levels were observed (p=0.034, p=0.039, respectively). Conclusion: Losartan may produce independent activities apart from its antihypertensive effects by providing significant reductions in platelet aggregation with ristocetin, and in hematocrit levels with hemoglobin. Therefore, it may be beneficial in the prevention of atherosclerosis and thrombosis.Amaç: Hipertansiyon artmış trombosit fonksiyonu ile ilişkilidir. Bazı antihipertansif ilaçların anti-trombosit aktiviteleri vardır. Biz bu çalışmada, losartanın adenozin difosfat (ADP), kollajen, epinefrin, ristosetin ile trombosit agregasyonuna, diğer hematolojik ve enflamatuvar parametreler üzerine etkilerinin araştırılmasını amaçladık.Gereç ve Yöntem: Çalışmaya yeni tanı hipertansiyonlu ortalama yaşı 54±8 yıl olan 19’u kadın, 6’sı erkek 25 hasta alındı. Yüksek kan basıncını önleme, saptama, değerlendirme ve tedavi üzerine Birleşik Komite’nin yedinci raporuna göre tüm hastaların, evre 1-2 esansiyel hipertansiyon tanısı mevcuttu. Başlangıç kan basınçları ölçüldü ve her bir hastaya diyet, egzersiz gibi yaşam tarzı değişikliği ile birlikte losartan 100 mg/gün tedavisi başlandı. Tedavi öncesi ristosetin, epinefrin, kollagen ve ADP ile trombosit agregasyonu değerlendirildi. Ayrıca tam kan sayımları ölçüldü. Trombosit agregasyon testleri ve kan basıncı ölçümleri tedaviden 8 hafta sonra tekrar değerlendirildi. Bulgular: Losartan ile 8 haftanın sonunda sistolik ve diyastolik kan basıncında anlamlı düşüş saptandı (p<0,001). Tedavi sonrası, ADP, kollajen ve epinefrin seviyeleri ile trombosit agregasyonunda anlamlı farklılık saptanmadı (p>0,05). Ristosetin ile agregasyon önemli ölçüde azaldı (p=0,027). Aynı zamanda, önemli ölçüde düşük hemoglobin ve hematokrit seviyeleri gözlemlendi (p=0,034 ve 0,039, sırasıyla). Sonuç: Losartan, hemoglobin ile hematokrit seviyelerinde ve ristosetinle trombosit agregasyonunda önemli ölçüde düşüş sağlayarak antihipertansif etkisinden bağımsız aktiviteler ortaya koyabilir. Bu sayede aterosklerozun ve trombozun önlenmesinde faydalı olabilir

Histopathologic Evaluation of Nonalcoholic Fatty Liver Disease in Hypothyroidism-Induced Rats

It is speculated that thyroid hormones may be involved in nonalcoholic fatty liver disease (NAFLD) pathogenesis. A literature scan, however, demonstrated conflicting results from studies investigating the relationship between hypothyroidism and NAFLD. Therefore, our study aims to evaluate NAFLD, from the histopathologic perspective, in hypothyroidism-induced rats. Wistar rats were divided into 2 groups: the experimental group consumed water containing methimazole 0.025% (MMI, Sigma, USA) for 12 weeks and the control group consumed tap water. At the end of week 12, serum glucose, ALT, AST, triglyceride, HDL, LDL, TSH, fT4, fT3, visfatin, and insulin assays were performed. Sections were stained with hematoxylin-eosin and &quot;Oil Red-O&quot; for histopathologic examination of the livers. In our study, we detected mild hepatosteatosis in all hypothyroidism-induced rats. There was statistically significant difference with respect to obesity between the two groups ( &lt; 0.001). The mean fasting blood glucose was 126.25 ± 23.4 mg/dL in hypothyroidism-induced group and 102.63 ± 15.51 mg/dL in the control group, with a statistically significant difference between the groups ( = 0.032). The two groups did not differ statistically significantly with respect to visfatin levels ( &gt; 0.05). In conclusion, we found that hypothyroidism-induced rats had mild hepatosteatosis as opposed to the control group histopathologically. Our study indicates that hypothyroidism can cause NAFLD

Histopathologic Evaluation of Nonalcoholic Fatty Liver Disease in Hypothyroidism-Induced Rats

It is speculated that thyroid hormones may be involved in nonalcoholic fatty liver disease (NAFLD) pathogenesis. A literature scan, however, demonstrated conflicting results from studies investigating the relationship between hypothyroidism and NAFLD. Therefore, our study aims to evaluate NAFLD, from the histopathologic perspective, in hypothyroidism-induced rats. Wistar rats were divided into 2 groups: the experimental group consumed water containing methimazole 0.025% (MMI, Sigma, USA) for 12 weeks and the control group consumed tap water. At the end of week 12, serum glucose, ALT, AST, triglyceride, HDL, LDL, TSH, fT4, fT3, visfatin, and insulin assays were performed. Sections were stained with hematoxylin-eosin and “Oil Red-O” for histopathologic examination of the livers. In our study, we detected mild hepatosteatosis in all hypothyroidism-induced rats. There was statistically significant difference with respect to obesity between the two groups (p<0.001). The mean fasting blood glucose was 126.25 ± 23.4 mg/dL in hypothyroidism-induced group and 102.63 ± 15.51 mg/dL in the control group, with a statistically significant difference between the groups (p=0.032). The two groups did not differ statistically significantly with respect to visfatin levels (p>0.05). In conclusion, we found that hypothyroidism-induced rats had mild hepatosteatosis as opposed to the control group histopathologically. Our study indicates that hypothyroidism can cause NAFLD

Identifying clinical characteristics of hypoparathyroidism in Turkey: HIPOPARATURK‑NET study

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients

Rehabilitation for Addicted Patients: Erenköy BAHAR Model

Rehabilitation is any action taken on an individual who has lost their physical or mental capabilities due to a disease or accident to recover their health or improve their capabilities in physical, mental, psychological, social and economic terms within their limitations. Rehabilitation application is divided into medical, social, occupational and psychiatric rehabilitation categories. Main purpose of rehabilitation application for addicted patients is the cessation of drug use in order to begin dealing with the psychological, legal, economic, social and physical damages done of the patients. The purpose of this study is to share several rehabilitation models applied on addicted patients of several countries, and to provide up-to-date knowledge on the development of rehabilitation models applied on addicted patients in our country with a relatively topical application example. In the practice of rehabilitation for addicted patients, we share the capacity and procedural operations, two years of research data and the experiences of what we believe is an important model for our country, the Erenköy Bağımlı Hastalar İçin Rehabilitasyon (BAHAR) Center’s model, for their individualized and integrated approach in recovery. The Center’s rehabilitation programs are cascaded into adaptation program, 0 to 3, 3 to 6, and 6 to 12 months long programs. In Erenköy BAHAR Center, patients’ recoveries in medical and spiritual sense were observed; and positive developments in social standing, family relations and occupational and social roles were recorded. It is seen that this center’s treatment methods for addiction are crucial for individual’s general wellbeing and functionality recovery, thus giving rise to the thought of establishing similar centers in our country. In conclusion, rehabilitation for addicted patients in our country is an emerging field and it requires more effort

Exenatide-Induced Acute Renal Failure: A Case Report

Exenatide is a glucagon-like peptide-1 receptor agonist that is commonly used in the treatment of type II diabetes mellitus for its effects on the incretin system. The use of exenatide is also related to weight loss and it has reportedly been known to induce acute renal failure (ARF) according to clinical reports. We observed ARF and severe weight loss two months after beginning the treatment with exenatide in a 59-year-old female patient with type II diabetes mellitus. We present this case in which ARF was considered to be a rare adverse effect of exenatide use. In conclusion, renal functions should be closely monitored, especially in patients prescribed nephrotoxic agents and for those with a high risk of nephropathy and dehydration due to their treatment with exenatide. The usage of this drug should also be carefully planned in these patients. Turk Jem 2013; 17: 68-7

Clinical Features of 294 Turkish Patients with Chronic Myeloproliferative Neoplasms

Objective: Myeloproliferative neoplasms (MPNs) share common clonal stem cells but show significant differences in their clinical courses. The aim of this retrospective study was to evaluate thrombotic and hemorrhagic complications, JAK2 status, gastrointestinal and cardiac changes, treatment modalities, and survival in MPNs in Turkish patients. Materials and Methods: Medical files of 294 patients [112 essential thrombocythemia (ET), 117 polycythemia vera (PV), 46 primary myelofibrosis, and 19 unclassified MPN cases] from 2 different universities in Turkey were examined. Results: Older age, higher leukocyte count at diagnosis, and JAK2 mutation positivity were risk factors for thrombosis. Platelet count over 1000x109/L was a risk factor for hemorrhagic episodes. Hydroxyurea treatment was not related to leukemic transformation. Median follow-up time was 50 months (quartiles: 22.2-81.75) in these patients. Patients with primary myelofibrosis had the shortest survival of 137 months when compared with 179 months for ET and 231 months for PV. Leukemic transformation, thromboembolic events, age over 60 years, and anemia were found to be the factors affecting survival. Conclusion: Thromboembolic complications are the most important preventable risk factors for morbidity and mortality in MPNs. Drug management in MPNs is done according to hemoglobin and platelet counts. Based on the current study population our results support the idea that leukocytosis and JAK2 positivity are more important risk factors for thrombosis than hemoglobin and platelet values

Effectiveness and Safety of Initiation and Titration of Insulin Glargine 300 U/mL in Insulin-Naive Patients with Type 2 Diabetes Mellitus Uncontrolled on Oral Antidiabetic Drug Treatment in Turkey: The EASE Study

Objective: The aim of the study was to evaluate the effectiveness and safety of insulin glargine 300 U/ mL (Gla-300) in insulin-naive patients with type 2 diabetes mellitus (T2DM) inadequately controlled on oral antidiabetic drug (OADs) treatment in Turkey. Methods: One hundred eight patients from 20 centers enrolled in the study. Starting from baseline, Gla-300 was self-administered subcutaneously and once daily in the evening. The primary outcome was the mean change in glycated hemoglobin A1c (HbA1c) from baseline to week 24. Results: The mean (±SD) Hb1Ac level of 9.4% (±0.8) at baseline decreased to 7.5% (±0.9) at week 12 (P <.1) and to 7.3% (±0.9) at week 24 (P <.1). Although none of the patients were within the target Hb1Ac level of ≤7% at baseline, the percentage of patients who achieved the target Hb1Ac level was 30.4% at week 12 and increased to 42.9% at week 24. Gla-300 treatment achieved the Hb1Ac target in 21 (19.4%) patients without experiencing a hypoglycemic event and in 27 (25.0%) patients who experienced at least one hypoglycemic event. For each self-monitoring blood glucose time point, significant improvements were observed as compared to baseline (P <.001). Statistically significant improvement (P <.001) was seen in the treatment satisfaction questionnaire – status version scores between baseline and week 24. Conclusion: This study indicated that Gla-300 is effective to provide a successful glycemic control with low risk of hypoglycemia added to OADs in insulin-naive patients with T2DM, and it has the potential to improve the quality of life of patients