Fondaparinuks heparinin indüklediği trombositopeni hastalarında etkili bir alternatif antikoagülan mıdır? Olgu sunumu ve literatür derlemesi

Heparine bağlı trombositopeni (HIT) nadir olmasına karşın heparin tedavisinin en çok korkulan komplikasyonlarından biridir. Heparine bağlı trombositopeni heparin ile temas sonrası oluşan, antikor aracılı edinsel ve geçici bir trombotik bozukluktur. Fraksiyone olmayan heparin hemodiyaliz sırasında kullanılan standart antikoagülandır ve heparin ile sürekli temas eden hemodiyaliz hastalarında HIT riski artmıştır. Burada kronik zeminde akut böbrek yetersizliği olan ve hemodiyaliz sonrasında HIT gelişen 75 yaşında bir erkek hastayı bildiriyoruz. Hastada derin ven trombozu saptandı ve fondaparinuks ile başarıyla tedavi edildi. Bu yazımızda ayrıca HIT hastalarında gelişen trombozun profilaksi ve tedavisinde fondaparinuksun endikasyon dışı kullanımını derledik. Fondaparinuks heparin ile reaksiyon veren antikorların çoğunluğunca tanınmayacak kadar küçük olduğundan lepirudin ve danaparoid gibi lisanslı ilaçların bulunmadığı durumlarda, semptomatik HIT hastaları için mantıklı bir alternatif antikoagülan olabilir.Although rare, heparin-induced thrombocytopenia (HIT) is one of the most feared complications of heparin therapy. It is an antibody-mediated, acquired and transient thrombotic disorder following exposure to heparin. Unfractionated heparin is the standard anticoagulation used in hemodialysis sessions and hemodialysis patients who are continually exposed to heparin are at increased risk for HIT. We report a 75-year-old male patient with acute-on-chronic renal failure who subsequently developed HIT while on hemodialysis. The patient was presented with deep vein thrombosis and successfully treated with fondaparinux. In this report we also review the off-label use of fondaparinux for the treatment and prophylaxis of thrombosis in patients with HIT. As fondaparinux is too small to be recognized by the majority of heparin-reactive antibodies it could be a reasonable alternative anticoagulant for symptomatic HIT patients where licensed drugs like lepirudin and danaparoid are not available

Clinical Features and Treatment Strategies of Primary Central Nervous System Lymphoma: a Multicenter Retrospective Study

DergiPark: 379015tmsjAims: Primary central nervous system lymphoma is a rare, highly malignant disease with poor prognosis. Thecurrent knowledge about the disease is mostly gathered from prospective clinical trials and the optimal treatment modality is still a matter of debate. In this study it is aimed to acquire more information about the clinical features of the disease and the responses to different treatment modalities.Methods: The archives in Trakya University Hospital, İnönü University Turgut Özal Medical Center, PamukkaleUniversity Hospital and Erciyes University Hospital researched retrospectively. Demographic, treatment and survival data were retrieved and their statistical analysis was performed. As descriptive statistics number and percentages, arithmetic mean ± standard deviation, median (maximum-minimum) were used. Survival analysis was performed using Kaplan- Meier method.Results: Median age of patients at diagnosis was 53 and out of 28 patients 15 (53.6 %) of them were male. As the symptoms of the disease 18 (66.7%) patients presented headache, 15 (53.8%) presented focal deficit. As initial treatment 26 (92.9%) patients received chemotherapy, while 19 (67.9%) patients were treated with surgical resection and the median overall survival time was 7 months. Conclusion: Achieving complete remission as response to the initial treatment is associated with an improvedoverall survival. Other survival analysis to compare the impact of all initial treatment methods on overall survival resulted statistically insignifican

“The Lolelaplap (Marshall Islands) in Us: Sailing West to East (Ralik→Ratak) to These Our Atolls (Aelon Kein Ad) Ad Jolet Jen Anij (Our Blessed Inheritance from God)”

This paper discusses the expansion of Oceania through a Marshallese indigenous lens as a focal point. It explains that decolonizing methodologies allows reclaiming of space for mental liberation and reassurement of constitutional rights. It highlights similar occurrences of decolonization practices meeting resistance in the 21st century all while strengthening the human right argument that no human deserves any less than their fellow human brothers and sisters. It argues that an indigenous imagery can only be viewed through an indigenous lens where the researches’ level of purity is retained and unfiltered. It nevertheless argues that Marshallese ethnolinguistics reveal the same cultural practices in America, Judeo-Christianity, and Oceania thus dictating the reality that “we are the same not withstanding one stays here and one there (Bedbedjin Bedbedjen, Bedbedjinma wot Kwe)”. It further explains the importance in these similarities and how Marshallese spirituality predates introduced American Judeo-Christianity despite the latter attempting to marginalize the former. It concludes by stating that Marshallese contributions on the global stage are rooted in that culture of love (IaKwe) which is echoed by the custom(s) revealing the significance of Marshallese validation academically, spiritually, economically, & socially to prevent institutionalized discrimination. This paper ends stating that the agency to know one’s self and how one should fit in the world, is a human right in itself and Marshallese are entitled to this sense of self worth through knowing thy self by thy self where real thinking takes place in one’s own mind as we all live our own lives

Systemic Nocardia Infection in a Patient with Behcet's Disease

Behcet’s disease is a systemic inflammatory vascular disease with different clinical features. It may be necessary to use high-dose corticosteroids or other immunosuppressive agents during the course of the disease due to different complications. Nocardia is an opportunistic infection with a quite high mortality which is frequently seen in immunocompromised subjects. We want to present a patient who was being followed with the diagnosis of uveitis resistant to therapy and who used long-term, high-dose immunosuppressives; consequently, he died due to systemic Nocardia infection. We diagnosed pulmonary infection, intramuscular abscess in the abdomen and multiple brain abscesses due to Nocardia infection. The patient whose clinical condition deteriorated under therapy died. We think that the disseminated Nocardia infection was related to immunosuppressive therapy rather than Behcet’s disease. In our review of literature, we could not cite any report about disseminated Nocardia infection in a patient with Behcet's disease during this period (Medline 1966-August 2000)

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

Herpes Simplex Esophagitis in an Immunocompetent Host with Sepsis

Herpes simplex esophagitis is generally seen in immunosuppressive patients; however, it has rarely been encountered in healthy subjects. We diagnosed herpes esophagitis in an immunocompetent patient with acute pyelonephritis-sepsis who developed odynophagia. The patients odynophagia recovered rapidly after parenteral acyclovir therapy. We diagnosed herpes esophagitis based on the typical endoscopic findings and the detection of HSV DNA by PCR in the esophageal biopsy specimen. We think that the predisposing factor for the development of esophagitis in our patient was temporary cellular immune dysfunction secondary to sepsis. We conclude that herpes esophagitis may develop in patients with sepsis without any other predisposing factor

Differences in platelet-leukocyte aggregates among subtypes of acute cerebral ischemia

Background: Acute cerebral ischemia is caused by different pathophysiological mechanisms. The role of platelets and other blood cells can be different among the stroke subtypes. Methods: Seventy-two patients with acute ischemic cerebrovascular disease, including 31 patients with large vessel disease, 21 patients with cardioembolic disease, and 20 patients with small vessel disease, were evaluated. P-selectin (CD62P) expression and platelet leukocyte aggregates were measured with flow cytometry at the acute phase after the ischemic event. Markers were also measured in 37 control subjects. In all subjects, the serum high-sensitivity C-reactive protein (CRP) was also measured. Results: The platelet-monocyte aggregates (PMA) and platelet-granulocyte aggregates (PGA) in the large vessel disease group were higher than in control group (P=0.002, and P < 0.0001, respectively). The PMA and PGA in the small vessel disease group were also higher than in the control group (P=0.004 and P < 0.0001, respectively). In contrast, in the cardioembolic disease group, the PMA and PGA were not significantly different from the control group. CD62P expression was higher in all of the patient groups relative to the control group (P < 0.05 for all comparisons). Serum CRP levels were also higher in all of the patient groups than in the control group (P < 0.0001 for all comparisons). Conclusions: In contrast to large vessel and small vessel disease, it seems that platelet-leukocyte association does not play a crucial role in the pathogenesis of cardioembolic stroke. (C) 2011 Elsevier B.V. All rights reserved.Trakya UniversityTrakya UniversityThis study was supported by grants from The Research Fund of Trakya University. We wish to thank S. Azcan for her valuable technical assistance