The Experience of Ibrutinib in Chronic Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Single Center Experience

Introduction:Chronic graft-versus host disease (GVHD) is a serious complication that develops in 35-50% of patients in the late period after allogeneic hematopoetic stem cell transplantation. About half of the patients are resistant to corticosteroids, which is the first-line treatment of chronic GVHD, and therefore new treatment options that can be effective in chronic GVHD are needed. In the present study, we aimed to share our experience with the use of ibrutinib therapy in patients with steroid-resistant chronic GVHD who have previously received multiple lines of systemic therapy.Methods:The characteristics and clinical outcomes of steroid-resistant chronic patients with GVHD receiving ibrutinib were retrospectively reviewed.Results:A total of 10 steroid resi-stant chronic patients with GVHD who received ibrutinib was included. While 50% of the patients had more than one organ involvement, 50% had a single organ involvement. The most commonly affected organs were the skin and liver. The patients received a median of three lines of systemic therapy before ibrutinib. After a median of 210 days of ibrutinib usage, the complete response rate of patients was 40% and the partial response rate was 40%. Corticosteroids were completely discontinued in 30% of patients after ibrutinib were initiated. Before ibrutinib, patients were given a median of 0.3 mg/kg methylprednisolone. The median methylprednisolone dose after ibrutinib was 0.03 mg/kg.Conclusion:Ibrutinib therapy causes a quite high overall response in steroid resistant chronic patients with GVHD and appears to be a good option in these patients

The rumination syndrome: Clinical and manometric profile, therapy, and long-term outcome

The aims of this study were to investigate the diagnostic studies necessary to identify rumination syndrome and the long-term therapeutic outcomes of patients with rumination syndrome. Sixteen patients with rumination were evaluated between 1989 and 1995. Esophageal motility, gastric emptying, upper gastrointestinal motility, and electrogastrography of all patients were reviewed; follow-up information about their current status was available from 10 of the 16 patients. Duration of symptoms was 77.2 months and the mean age was 28.5 years at the time of diagnosis. Esophageal and upper gastrointestinal motility, gastric emptying, and electrogastrographic studies were all normal. Mean lower esophageal pressure was 12.7 mm Hg and three of the 16 patients had a decreased pressure of less than 6 mm Hg. Ten patients were followed for a mean duration of 31.2 months. Five of 10 patients used biofeedback and relaxation techniques and reported subjective improvement. Our results indicate that rumination syndrome is often confused with a gastric motility disorder and diagnosis is possible if one is aware of this condition. Although there is not a definitive management protocol for this condition, reassurance and education of the patient and the family are crucial first steps followed by behavioral and relaxation programs

Geleneksel şınav ve fonksiyonel egzersiz kayışı ile uygulanan şınav sırasındaki yük değişimleri ve algılanan zorluk düzeylerinin incelenmesi

Geleneksel ve fonksiyonel egzersiz kayışı ile yapılan şınav uygulamalarında, dirseklerin ekstansiyon ve fleksiyon pozisyonunda el ve ayaklara yansıyan yük değişimlerinin ve algılanan zorluk derecesinin incelenmesidir. Gereç ve Yöntemler: Araştırmaya, spor bilimleri fakültesinde öğrenim gören toplam 25 (yaş: 22,84±2,7 yıl; boy 177,96±7,8 cm; vücut ağırlığı: 82,024±10,9 kg) erkek gönüllü öğrenci katılmıştır. Her iki şınav uygulaması üç farklı yükseklikte (0 cm, 30 cm, 60 cm) gerçekleştirilmiş, dirsekler ekstansiyon ve fleksiyon pozisyonunda 5 sn bekletilmiştir. Uygulama sonrasında modifiye edilmiş algılanan zorluk derecesi skalası kullanılarak değerlendirme yapılmıştır. Yüklerin tespitinde geleneksel şınav düzeneğine ve fonksiyonel egzersiz kayışlarına yerleştirilen yük ölçerler kullanılmıştır. İki farklı düzeneğin ve aynı düzenekteki fleksiyon-ekstansiyon verilerinin karşılaştırılmalarında eşleştirilmiş örneklem t-testi, 3 farklı yüksekliğin etkisinin tespitinde ise tek yönlü varyans analizi kullanılmıştır. Bulgular: Her iki şınav uygulamasında el ve ayaklardan yansıyan yüklerin yüzde (%) dağılımı karşılaştırıldığında, ellerin yerden 30 cm ve 60 cm olduğu yükseklikte, sol el dirsekler fleksiyon pozisyonundaki değerlerin istatistiki olarak anlamlı düzeyde farklı olduğu (p<0,05) tespit edilmiştir. Her iki şınav türü, algılanan zorluk derecesi açısından karşılaştırılmıştır. Fonksiyonel egzersiz kayışı ile şınav uygulamasındaki eller 0 cm’de dirsekler fleksiyon pozisyonunda en yüksek zorluk derecesi hissedilmiştir. Geleneksel şınav uygulamasında ise eller 60 cm yüksekte dirsekler fleksiyon pozisyonunda en düşük zorluk derecesi hissedilmiştir. Sonuç: Geleneksel ve fonksiyonel egzersiz kayışı kullanılarak yapılan şınavların farklı yüksekliklerdeki uygulamaları sırasında hem fleksiyon hem de ekstansiyon pozisyonunda el ve ayaklara yansıyan yükler benzer bulunmuştur. Ancak her iki şınav türü algılanan zorluk derecesi açısından değerlendirildiğinde, fonksiyonel egzersiz kayışı kullanılarak yapılan şınavın geleneksel şınava göre daha zorlayıcı bir şınav türü olduğu gözlemlenmiştir.Comparison of the loads reflected on the hands and feet during the traditional push-up and suspension push-up exercises applied at different heights and to examine the perceived exertion push-up levels. Material and Methods: Twenty-five male faculty of sport sciences volunteer students (age: 22.84±2.7 years; height 177.96±7.8 cm; body weight: 82.024±10.9 kg) participated in this study. Volunteers were tested at three different heights (0 cm, 30 cm, 60 cm) of traditional push-up and suspension push-up, respectively. In both push-ups, the elbows were held in extension and flexion positions for 5 seconds. The data were recorded with a specially prepared traditional push-up mechanism and a load-cell system placed on suspension device’s straps. \"Paired samples t-test\" and \"Oneway ANOVA\" test were used to evaluate the data. Results: The loads obtained from the hands and feet were found to be similar in the flexion-extension position of the elbows during the traditional push-ups and suspension pushups at different heights. When the percentage (%) distribution of the loads reflected on the handles and the floor is compared in both push-ups; it was determined that the values of the left hand elbows at 30 cm and 60 cm height in the flexion position were significantly different (p<0.05). When both push-up types are compared in terms of perceived exertion levels; while the participants felt the highest difficulty in the 0 cm flexion position in the suspension push-up, the lowest difficulty in the traditional push-up 60 cm flexion. Conclusion: During the traditional push-up and suspension push-up exercises at different heights, the loads reflected from the upper and lower extremities to the handle and the floor were found to be similar in both flexion and extension positions. However, when both pushups were evaluated in terms of perceived exertion (Modified Borg Scale), suspension pushup was found to be a more challenging push-up exercises than traditional push-up

The relevance of multiplex PCR and heterodublex analysis on differentiating the reactive versus neoplastic T cells in the spectrum of gluten sensitive enteropathy - Enteropathy associated T cell lymphoma.

WOS: 00024945460018

Etiological evaluation and the role of plasma exchange treatment in trombotic microangiopathies: A retrospective analysis from Eastern Anatolia

The aim is this study was to make the etiological classification of patients diagnosed with TMA in our region and to statistically evaluate the effect of therapeutic plasma exchange, which we use in treatment, on laboratory recovery and mortality. In our study, between 2009-2017, 85 patients diagnosed with TMA in our center evaluated retrospectively. Thirty- one (36.5%) of our patients were followed up with HELLP, 23 with thrombotic thrombocytopenic purpura (TTP) (27.1%), 20 (23.5%) snake bites, and 11 (12.9%) with atypical hemolytic uremic syndrome (aHUS). TPE treatment was performed in all patients. TPE treatment was found effective in patients with HELLP syndrome, TTP and snake bite and statistically significant improvement was obtained in laboratory parameters (p0.05). Mortality rates were found 9.7%, 21.7%, 27.3%, and 0% in patients with HELLP Syndrome, TTP, aHUS, and snake bite, respectively. The primary treatment in HELLP syndrome was termination of pregnancy, it was observed in our study that TPE was effective in TTP, HELLP syndrome and snake bites and treatment should be started without delay. [Med-Science 2022; 11(2.000): 762-5