Letter to the Editor concerning "New Predictive Parameters of Bell's Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio"

To the Editor, I have read with great interest the article on Bell's palsy and related blood count assessments by Atan et al. (1). The authors found that the neutrophil to lymphocyte ratio and platelet to lymphocyte are increased in patients with Bell's palsy. Though increased compared to healthy controls, these ratios were not associated with increased paralysis severity. The authors state that these changes may be concordant with the pathogenesis because Bell's palsy is an inflammatory disease. However, from a hematological perspective, there are certain points that need to be emphasized to avoid misunderstanding and clinical confusion. The American Academy of Autolaryngology Head and Neck Surgery Foundation Clinical Practice Guideline on Bell's Palsy highly recommend that oral corticosteroids should be started within 72 hours of symptom onset (2). Corticosteroids are well known to show dramatic effects on blood cell counts. Specifically, the administration of glucocorticoids results in neutrophilic leukocytosis, accompanied by marked reductions in circulating eosinophils, monocytes and lymphocytes (3). These changes are so dramatic that a single dose of glucocorticoid leads to lymphopenia within 2 hours of the dose, peaked at 6 hours and resolved by 24 hours (4). The increase in circulating neutrophil is due to impaired neutrophilic migration to sites of inflammation, enhanced release of cells from the bone marrow and inhibition of apoptosis. Regarding lymphocytes, glucocorticoids rapidly deplete circulating T cells by enhanced circulatory emigration, inhibition of interleukin-2, a major T cell growth factor, impaired release of cells to the circulation and apoptosis induction (5). Number of circulating B cells are also reduced but to a lesser extent. Although the major argument of this study is based upon altered blood cell count in Bell's palsy, treatment is highly recommended to commence within 72 hours. The study presents no such treatment to achieve dramatic and rapid changes in white blood cell count. In a hematological perspective, these changes may be attributable to the effects of treatment (glucocorticoids) rather than the disease itself. The authors' not finding any relation between the severity of paralysis with the cell ratios, also support my assessment. Furthermore, in retrospective studies, the countenance and reliability of factors, which may confound the main finding, are not easily managed. As stated as a retrospective study, derivation of the data leaves an obscure sensation in the reader's mind. In conclusion, I believe that this study, as presented to contribute to the literature with new findings should be considered under the information I have mentioned above. Ethics Committee Approval: N/A. Informed Consent: N/A. Peer-review: Externally peer-reviewed. Conflict of Interest: No conflict of interest was declared by the author. Financial Disclosure: The author declares that this study has received no financial support

Effectiveness of Pet/Ct in Evaluation of the Lymphoma

DergiPark: 640241tmsjAims: Prognosis and survival of Hodgkin lymphoma have been improved dramatically by the development of treatments as well as the sensitivity of evaluation tools. In this case report, we aimed to emphasize the importance of positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography in the initial staging of Hodgkin’s lymp-homa, evaluating the response to treatment, and to demonstrate residual tissue or recurrence. Case Report: A 25-year-old male patient presented to Trakya University Hospital with swelling in the right groin and was diagnosed with Hodgkin’s lymphoma. Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography scan was used for initial staging and assessment of response to treatment. Conclusion: Positron emission tomography is a feasible imaging modality for the evaluation of lymphomas. It is sensitive to detect minimal recurrence as well as alterations of lesions’ metabolic activity. Keywords: Positron emission tomography, lymphoma, hodgkin diseas

Drug Induced Thrombotic Microangiopathy with Certolizumab Pegol

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

Risk Factors and Management of Hepatitis B Virus Reactivation in Patients With Hematological Disorders

DergiPark: 420829tmsjAims: The aim of this study is to evaluate hepatitis B virus serological status and to categorize the risks of our treatmentmodalities in patients with both benign and malignant hematological disorders.Methods: This was a retrospective study of 552 patients who were admitted to the Trakya University Hospital Hematologyunit between 01.01.2017 and 31.12.2017. All data regarding the diagnosis, treatment and HBV serologicalstatus were collected from patient files. Data were analyzed with IBM SPSS V.20 using descriptive statistical analysis.Results: Hepatitis B surface antigen was positive in 45 (8.2%) patients, antibody to the hepatitis B surface antigenwas positive in 279 (50.5%) patients and antibody to the hepatitis B core antigen was positive in 247 (44.7%) patients.According to these results, 32 patients were found to be vaccinated for hepatitis B virus. Reactivation was observed in4 (0.7%) patients who have been hepatitis B surface antigen positive and have received adequate duration of antiviralprophylaxis with tenofovir. These 4 patients have received monoclonal antibody for immunosuppressive treatment.Conclusion: To conclude, although the rate of hepatitis B surface antigen reactivation is quite low, as many patientsas possible should be vaccinated to reduce the costs of antiviral treatments and monitorization. If there is notime to vaccinate, patients should be categorized according to guidelines by their hepatitis B surface antigen serologicalstatus and by the planned immunosuppressive treatments

Atherosclerosis and related factors in patients with systemic lupus erythematosus

Tıpta Uzmanlık TeziÇalışmamızda, öncelikle Sistemik lupus eritematozus tanısı ile izlenen hastaların genel özelliklerini, organ ve sistem tutulumlarını, ilaç kullanımını, kardiyovasküler risk faktörlerini saptamayı amaçladık. Bununla birlikte kronik inflamasyona maruz kalan bu hasta grubunda ateroskleroz ile inflamasyon arasındaki ilişkiyi tespit etmek için önemli inflamasyon ve ateroskleroz parametreleri olan migrasyon inhibe edici faktör, LIGHT, endotelyal lipaz'ın değerlendirilmesi amaçlandı. Subklinik aterosklerozun değerlendirilmesi amacı ile karotis arter intima-media kalınlığının ultrasonografi ile değerlendirilmesi amaçlandı. Trakya Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Romatoloji Bilim Dalı'ında yürütülen çalışmaya, Sistemik lupus eritematozus tanısı ile izlenen 87 hasta ve kontrol grubu olarak 84 sağlıklı birey alındı. Sistemik lupus eritematozuslu hastaların klinik özellikleri, poliklinik kontrolleri sırasında değerlendirilen lipid düzeyleri ve insülin direncine ilişkin veriler kaydedildi. Tüm hastalarda ve kontrol grubunda enzyme-linked immunosorbent assay yöntemi ile migrasyon inhibe edici faktör, LIGHT ve endotelyal lipaz düzeyleri bakıldı. Tüm hastalara ve kontrol grubundan 30 bireye karotis arter intima-media kalınlık değerlendirilmesi yapıldı ve Framingham risk skorları değerlendirildi. Çalışmamızda Sistemik lupus eritematozuslu olgularımızda Framingham 10 yıllık kardiyovasküler risk skoru ortalama %2,67 bulundu. Hastalarımızda subklinik ateroskleroz sıklığını ise %12,6 olarak saptadık. Karotis intima-media kalınlığı ile Framingham risk skoru ve faktörleri arasında anlamlı ilişki bulunmadı. Aynı şekilde subklinik ateroskleroz ile hastalık genel özellikleri arasında ilişki saptanmadı. Antifosfolipid antikor pozitifliği ile subklinik ateroskleroz arasında anlamlı ilişki gözlendi (p<0001). Tedavi parametrelerinde steroid, siklofosfamid ve antimalaryal ilaçlar ile karotis intima-media kalınlığı arasında ilişki gözlenmez iken, azatiopirin ile karotis intima-media kalınlığı arasında ilişki gözlendi (p=0,05). Bunun yanında, hasta ve kontrol grupları arasında migrasyon inhibe edici faktör, LIGHT ve endotelyal lipaz değerlendirilmesi ile karotis intima-media kalınlığı arasında anlamlı farklılık gözlenmedi.AbstractIn our study, we first aimed to evaluate the general features, organ and system involvements, drug usage and cardiovascular risk factors in patients with Systemic Lupus Erythematosus. Moreover, in such a group of patients who are exposed to chronic inflammation, we aimed to evaluate certain important markers of inflammation and atherosclerosis, migrasyon inhibiting factor, LIGHT and endothelial lipase to assess the relation between atherosclerosis and inflammation. To determine the subclinical atherosclerosis, we aimed to evaluate the carotid artery intima-media thickness with ultrasonography. Eighty-seven patients with the diagnosis of Systemic Lupus Erythematosus who are followed up by the Division of Rheumatology of the Department of Internal Medicine, Trakya University Faculty of Medicine and 84 healthy controls were enrolled in the study. The clinical features, lipid profiles and data regarding the insulin resistance from their medical files were recorded. Serum values of migration inhibiting factor, LIGHT and endothelial lipase were evaluated in all patients and controls by enzyme-linked immunosorbent assay method. Carotid artery intima-media thickness was evaluated in all patients and 30 of the healthy controls as well as their Framingham cardiovascular risk scores were calculated. The mean ten years? Framingham cardiovascular risk score was calculated as 2,67%. The frequency of subclinical atherosclerosis was observed to be 12,6%. No relation was observed between the Framingham risk scores and factors with carotid intima-media thickness. Likewise, the general features of the patients were observed to be non-related with subclinical atherosclerosis. Antiphospholipid antibody positivity was related with subclinical atherosclerosis (p<0,001). As treatment parameters, use of steroids, cyclophosphomide and antimalarials were observed to be non-related with carotid intima-media thickness while azathiopurine use was related with carotid intima-media thickness (p=0,05). Moreover, no significant relation was found within patient and control groups regarding carotid intimamedia thickness and serum values of migration inhibiting factor, LIGHT and endothelial lipase

Hypogammaglobulinemia and Poor Performance Status are Predisposing Factors for Vancomycin-Resistant Enterococcus Colonization in Patients with Hematological Malignancies

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

Retrospective Analysis of Flow Cytometry Results: Experience of a single center

Amaç: Akış sitometrisi (AS) çeşitli hücrelerin bir süspansiyon halinde bir akış kanalı boyunca tek tek geçmesi ve bu esnada hücre büyüklük ve içeriğine göre sınıflandırılması esasına dayanan florokromojenik-lazer tabanlı bir tanı yöntemidir. Hematolojik malignitelerin tanısı AS cihazının en fazla kullanım alanıdır. Mevcut çalışmada hastanemiz AS laboratuvarına gönderilen örneklerin yıllara göre dağılımlarını, istek yapan bilim dalının dağılımını, gönderinin yapıldığı 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 tarihleri arasında 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 çocuk yaştaki 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 dokularından gönderilmişti. 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 akut myeloid 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 hastalık ve %0,1i bifenotipik lösemiydi. Tartışma: Tek merkez verilerinin değerlendirildiği bu çalışma tanı konulması istenilen hastalıkların ülkemizdeki sıklıklarını göstermesi açısından önemli veriler sunmaktadır. Yıllara göre dağılım ise merkezimizin deneyim artı- şını ve hastaların merkezimize ulaşımının kolaylaşması olarak değerlendirilebilir. Hastane verilerine dayalı geriye dönük çalışmaların yararları arasında hastalık sıklık verilerinin saptanmasında dolaylı bir yöntem olması sayılabilir.Aim: Flow Cytometry (FC) is a flourochromogenic-laser based diagnosis tool that is used to subclassify the cells due to their cell size and cytoplasmic content. Diagnosis of hematological malignancies is one of the most com- monly used field of application. In the present study we aimed to determine the distribution of samples per year, distribution of requesting departments (whether pediatric or adult), sample type (bone marrow, peripheral blood, cerebrospinal fluid or pleural fluid), and the usage of FC during diagnosis/follow up. Material and Methods: FC results were screened retrospectively from 01.01.2002 to 01.01.2014. Descriptive statistics were performed to analysis the results. Results: 4874 samples were revised (with a mean of 406 sample per year). 18.7% of the samples were from pediatric patients, 81.3 % were from adult patient population. %35.3 of the samples (n=1725) were obtained from bone marrow, 58.2 % (n=2828) were obtained from peripheral blood, 6.5 % (n=321) of the samples were obtained from other body fluids. FC was the leading diagnostic tool in 20.2 % (n=989) of the samples. 18.5% (n-880) of the samples were used for follow up of the patients. The distribution of the diagnoses that were established by the use of FC were 34.6 % acute myeloid leukemia, 32 % chronic B-lymphoprolipherative disease, 19.5 % acute lymphoid leukemia, 10.2 % myelodysplastic syndrome, 3.2 % chronic myeloid leukemia, 0.3% Burkitt leukemia/lymphoma, 0.1 % T-lymphoprolipherative disease ve 0.1 % biphenotypic leukemia. Discussion: The present study demonstrated important results about the disease incidence in Turkey. The elevated sample size in following years might be due to increased experience, and easy accessibility of patients to our facility. To be an indirect tool to demonstrate disease distribution is one of the benefits of retrospective analysis of hospital data

Zależność między stężeniem osteoprotegeryny a zaawansowaniem choroby wieńcowej u pacjentów z ostrym zespołem wieńcowym i stabilną dławicą piersiową

Background: Osteoprotegerin (OPG), an inhibitor of osteoclastogenesis, has recently been under the spotlight in studies regarding the pathophysiology of atherosclerosis.Aim: To evaluate the value of serum OPG in the diagnosis and severity in patients with stable angina pectoris (SA) and unstable angina pectoris/non ST elevation myocardial infarction.Methods: This study involved 160 patients, SA (n = 65), acute coronary syndrome (NSTE-ACS; n = 65), and a control group (n = 30). Blood samples were collected in the first hour, after 24 hours and on the fifth day. The prevalence of coronary artery atherosclerotic lesions was determined using the Gensini scoring system.Results: A statistically significant difference was observed in the first hour OPG levels between the control group and both the SA and NSTE-ACS group (p &lt; 0.001). When the cut-off value was determined as 247.71 pg/mL, the sensitivity and specificity of the first hour OPG levels indicating coronary artery disease were 91.54% and 46.67%, respectively, while the positive predictive value was 88.1% and the negative predictive value was 56%. No correlations were observed between the first, 24th hour and the fifth day OPG levels and the Gensini scores. No relation was denoted between the OPG levels and number of diseased coronary arteries.Conclusions: In our study, serum OPG level seemed to be unrelated to the severity or the degree of coronary artery disease in patients with SA and unstable angina pectoris/non ST elevation myocardial infarction. OPG may only be accepted as an indicator of coronary artherosclerosis.Wstęp: Osteoprotegeryna (OPG), inhibitor osteoklastogenezy, jest ostatnio przedmiotem badań dotyczących patofizjologii miażdżycy.Cel: Celem niniejszego badania była ocena stężenia OPG w surowicy u osób ze stabilną dławicą piersiową (SA) i niestabilną dławicą piersiową/zawałem serca bez uniesienia odcinka ST.Metody: Badaniem objęto 160 pacjentów, w tym chorych z SA (n = 65) lub z ostrym zespołem wieńcowym (NSTE-ACS) (n = 65) oraz osoby stanowiące grupę kontrolną (n = 30). Próbki krwi pobrano w 1. godzinie, 24. godzinie i w 5. dniu. Występowanie zmian miażdżycowych w naczyniach wieńcowych określono, stosując skalę Gensiniego.Wyniki: Stwierdzono statystycznie istotne różnice między grupą kontrolną a grupami SA i NSTE-ACS w stężeniach OPG w 1. godzinie (p &lt; 0,001). Po przyjęciu wartości progowej wynoszącej 247,71 pg/ml czułość i swoistość stężeń OPG w 1. godzinie w odniesieniu do wykrywania choroby wieńcowej wynosiły odpowiednio 91, 54% i 46.67%, a wartości prognostyczne dodatnia i ujemna — 81,1% i 56%. Nie stwierdzono korelacji między stężeniami OPG w 1. godzinie, 24. godzinie ani w 5. dniu a punktacją w skali Gensiniego. Nie zanotowano żadnych zależności między stężeniami OPG a liczbą zmienionych miażdżycowo tętnic wieńcowych.Wnioski: W niniejszym badaniu nie wykazano zależności między stężeniem OPG w surowicy a ciężkością lub zaawansowaniem choroby wieńcowej u pacjentów z SA i z niestabilną dławicą piersiową/zawałem serca bez uniesienia odcinka ST. Można jedynie uznać OPG za wskaźnik miażdżycy tętnic wieńcowych

Efficacy and Safety of Ibrutinib Use in Patients with Chronic Lymphocytic Leukemia in Real World Experiences: Results of a Prospective Multicenter Study

61st Annual Meeting and Exposition of the American-Society-of-Hematology (ASH) -- DEC 07-10, 2019 -- Orlando, FLBERBER, Ilhami/0000-0003-3312-8476;WOS:000577164606194[No Abstract Available]Amer Soc Hemato

Assessment of patients with von willebrand disease with ISTH/BAT and PBQ scores

UNAL, Ekrem/0000-0002-2691-4826WOS: 000514819900011PubMed: 31718118To the Editor, The Turkish Society of Hematology initiated the Turkish Hemophilia Masterclass Academy program in 2016 to encourage young hematologists entering the field of hemophilia. The program involved 6 months of training, supported by monthly exams. We, as a group of mentees from the Hemophilia Masterclass Academy, aimed to evaluate the bleeding phenotype of patients with von Willebrand Disease (VWD) using the International Society of Thrombosis and HaemostasisBleeding Assessment Tool (ISTH-BAT) and the Pediatric Bleeding Questionnaire (PBQ) scores and investigate the correlation of von Willebrand factor antigen (VWF:Ag) levels and bleedingm scores of the patients, as well as present the initial output of our Masterclass Academy