Eltrombopag for the treatment of immune thrombocytopenia: The aegean region of Turkey experience

Objective: Immune thrombocytopenia (ITP) is an immune-mediated disease characterized by transient or persistent decrease of the platelet count to less than 100x109/L. Although it is included in a benign disease group, bleeding complications may be mortal. With a better understanding of the pathophysiology of the disease, thrombopoietin receptor agonists, which came into use in recent years, seem to be an effective option in the treatment of resistant cases. This study aimed to retrospectively assess the efficacy, long-term safety, and tolerability of eltrombopag in Turkish patients with chronic ITP in the Aegean region of Turkey. Materials and Methods: Retrospective data of 40 patients with refractory ITP who were treated with eltrombopag in the Aegean region were examined and evaluated. Results: The total rate of response was 87%, and the median duration of response defined as the number of the platelets being over 50x109/L was 19.5 (interquartile range: 5-60) days. In one patient, venous sinus thrombosis was observed with no other additional risk factors due to or related to thrombosis. Another patient with complete response and irregular follow-up for 12 months was lost due to sudden death as the result of probable acute myocardial infarction. Conclusion: Although the responses to eltrombopag were satisfactory, patients need to be monitored closely for overshooting platelet counts as well as thromboembolic events. © 2015 Turkish Society of Hematology. All rights reserved

Does apical prolapse in addition to early stage anterior prolapse have any effect on lower urinary tract symptoms?

OBJECTIVE: To investigate whether apical prolapse in addition to early-stage anterior prolapse has any effect on lower urinary tract symptoms (LUTS). METHODS: Patients with early-stage pelvic organ prolapse (POP) were retrospectively analyzed at the urogynecology unit of a tertiary referral center. Cases with posterior POP were excluded, and the remaining women were distributed across four main groups: (1) no determinable anterior and/or apical POP (control); (2) isolated anterior POP; (3) anterior + apical POP; and (4) isolated apical POP. Each LUTS symptom in these groups was recorded. Women with isolated anterior POP and women with anterior + apical POP were then compared to define the additional effects of apical prolapse on LUTS. In order to asses; symptoms of urgency, urinary incontinence, stress urinary incontinence, frequency, abnormal emptying, hesitancy, interrupted stream, nocturia, post-micturition dribble, and dysuria were noted and Incontinence Impact Questionnaire (IIQ-7), and domains of Urinary Distress Inventory (UDI-6) were compared between the groups. RESULTS: Of the 225 patients, 66 were excluded from the analysis due to accompanying posterior compartment defect. There was no statistically significant difference for age, systemic disease history, or smoking status between the groups (p > 0.05). However, history of traumatic vaginal delivery was significantly lower in the control group than in the other groups (p = 0.039). The prevalence of hesitancy and interrupted stream were found to be significantly higher in the anterior + apical POP group than in the isolated POP group (p<0.05). Obstructive subscale of the Urinary Distress Inventory was higher both in the isolated anterior POP and anterior + apical POP groups than the control group (p<0.05). CONCLUSION: The current study demonstrates that even minimal loss of apical support accompanying anterior prolapse exacerbates LUTS

Hospitalized children: A study on the factors affecting psychosocial adjustment

Objective: The aim of our study is to investigate the relationship between the psychosocial difficulties of children who were hospitalized for various reasons, with child related, familial, environmental and disease/treatment-related factors. Method: Between February 2018 - May 2019 the caregivers of 6 - 12 years old children (n = 171; 92 girls, 79 males; mean age = 9.26 +/- 2.17) who were treated in the inpatient services of a University Hospital were interviewed and an "Information form" constructed for the present study and "Psychosocial Symptom Diagnosis Scale for Inpatient Children" were filled. The anxiety, hopelessness, communication difficulties, anger-aggression, regression and total psychosocial difficulties of the children were evaluated over 5 sub-dimensions with the total scale score; the effects of child, family-environment and disease-treatment related parameters on psychosocial difficulties were assessed. Results: Younger ages, low maternal education, low perceived social support of the family, long hospital stay and invasive procedures in the treatment were associated with impaired psychosocial adjustment (p.05). Discussion: It is important to be aware of children who are at greater risk for adjustment difficulties during inpatient treatment. We should be sensitive and take supportive and protective measures to improve their psychosocial compliance.C1 [Basay, Burge Kabukcu; Basay, Omer] Pamukkale Univ, Tip Fak, Cocuk Ergen Ruh Sagligi Hastaliklari AD, Denizli, Turkey.[Orut, Atacenk; Hasmercan, Berkay; Uysal, Melisa; Usul, Beyzanur Eren] Pamukkale Univ, Tip Fak, Tip Fak Ogrencisi, Denizli, Turkey

Evaluation of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea by automated function imaging method; an observational study [Obstrüktif uyku apneli hastalarda subklinik sol ventrikül sistolik disfonksiyonunun otomatik fonksiyonel görüntüleme yöntemiyle degerlendirilmesi: Gözlemsel bir çali{dotless}şma]

PubMed ID: 22466365Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction. Methods: Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3- and 4- chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GL S) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis. Results: The GL S values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA severity (Healthy:-25.58±-2.16%, Mild:-23.93±-3.96%, Moderate:-21.27±-2.60%, Severe:-16.94±-2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p&lt;0.03). The apnea-hypopnea index was found to be correlated with the GL S (ß=-0.659, 95% CI: 0.09-0.17, p&lt;0.001). Conclusion: Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the severity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time. © Copyright 2012 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd

From the Newspapers of Istanbul in Tanzimat Period the Newspaper Basiret, 1871: Assessment - Index

"Menâfi'-i vataniyye ve havâdis-i umûmiyeye dâir millet gazetesidir." İbaresi ile misyonunu en güzel şekilde ifade eden Basîret gazetesi, yayımladığı haberler ve haberlere ilişkin yazılan makaleler ve yorumlarla bu misyonunu gerçekleştirmek için uğraştığını göstermiştir. Basîret, yayınının ikinci yılı olan 1871 senesinde özellikle Prusya-Fransa Savaşı'nın sonuçları, Fransa Vukuâtı, İşkodra Vak'ası, Asîr Muzafferiyeti, şimendifer hatları yapımı, yapılan ıslâhâtlar, tenkîhâtlar ve İstanbul ile ilgili konuları günü gününe okuyucularına aktarmıştır. Bu çalışma ile adı geçen yıl ve konuların yanında gerek Osmanlı İmparatorluğu içerisinde ve gerek Dünya'da meydana gelen ekonomik, sosyal, politik, eğitim, askeri ve sağlık alanlarındaki gelişim ve değişimler tespit edilmeye çalışılmıştır. Bunun için de Basîret gazetesinin 1871 yılını ihtiva eden (281-557) nüshaları taranmıştır.The best phrase that can summarize the Basiret and its mission is; "It is a national newspaper which is about national benefits and general news". This is well documented with the publicated news and the related articles and opinions that try to accomplish that mission. In 1871 at the second year of its publication, the major topics that were published on daily basis were the consequences of France-Prussian War, Paris Events, Shkodra Events, the Victory of Asir, Chemin de Fer ( railway) construction, Reforms, Tenkihat (establishing a balance between revenue and expenses reducing wages and the number of officers in a state agency) and Istanbul. In this study, in addition to aforementioned years and events It is also examined developments and changes in the field of economics, social, political, educational system, military and health care systems inside of the Ottoman Empire and all over the World. Hence, It has been searched (281-557) issues of the Basiret newspaper that describes year 1871

Therapeutic plasma exchange in patients with neurologic diseases: Retrospective multicenter study

Therapeutic plasma exchange (TPE) is commonly used in many neurological disorders where an immune etiology was known or suspected. We report our experience with TPE performed for neuroimmunologic disorders at four university hospitals.The study was a retrospective review of the medical records of neurological patients (n = 57) consecutively treated with TPE between April 2006 and May 2007. TPE indications in neurological diseases included Guillain-Barre Syndrome (GBS) (n = 41), myasthenia gravis (MG) (n = 11), acute disseminated encephalomyelitis (ADEM) (n = 3), chronic inflammatory demyelinating polyneuropathy (CIDP) (n = 1) and multiple sclerosis (MS) (n 1). Patient median age was 49; there was a predominance of males. Twenty-two patients had a history of other therapy including intravenous immunoglobulin (IVIG), steroid, azothioprin, and pridostigmine prior to TPE. Another 35 patients had not received any treatment prior to TPE. All patients were classified according to the Hughes functional grading scores pre- and first day post-TPE for early clinical evaluation of patients.The TPE was carried out 1-1.5 times at the predicted plasma volume every other day. Two hundred and ninety-four procedures were performed on 57 patients. The median number of TPE sessions per patient was five, and the median processed plasma volume was 3075 mL for each cycle. Although the pre-TPE median Hughes score of all patients was 4, it had decreased to grade I after TPE. While the pre-TPE median Hughes score for GBS and MG patients was 4, post-TPE scores were decreased to grade 1. Additionally, there was a statistically significant difference between post-TPE Hughes score for GBS patients with TPE as front line therapy and patients receiving IVIG as front line therapy (1 vs. 3.5; p = 0.034). Although there was no post-TPE improvement in Hughes scores in patients with ADEM and CIDP, patients with MS had an improved Hughes score from 4 to 1. Mild and manageable complications such as hypotension and hypocalcemia were also observed