A Very Rare Presentation of Multiple Myeloma: Unilateral Raccoon Eye

Multiple myeloma (MM), the second most common hematological malignancy, is caused by the accumulation of monoclonal plasma cells in bone marrow. It accounts for 10–15% of deaths from hematological malignancies and approximately 2% of deaths from cancer. The median age at presentation is 70 years old. The diagnosis is incidental in 30% of cases. MM is often discovered through routine blood screening with a large gap between the total protein and the albumin levels.Two thirds of patients complain of bone pain, especially lower back pain. MM could be diagnosed after a pathologic fracture occurs in one third of patients. Presentation with symptoms related to hyperviscosity, hypercalcemia and bleeding tendency could also be observed. A rare presentation of MM is peri-orbital ecchymotic lesion (raccoon eye). Here, we report a 64 years old, male patient presented with unilateral raccoon eye and high erythrocyte sedimentation rate (ESR) to internal medicine outpatient. The patient was referred to hematology outpatient and was diagnosed with multiple myeloma

Polatuzumab vedotin, rituximab, and bendamustine combination in relapsed or refractory diffuse large B-cell lymphoma: A real-world data from Turkey

Polatuzumab vedotin (Pola) with bendamustine and rituximab (BR) is a promising option for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We analyzed the data of 71 R/R DLBCL patients who had been treated with Pola-BR in the named patient program from March 2018 to April 2021 from 32 centers in Turkey. All patients received up to six cycles of Pola 1.8 mg/kg, rituximab 375 mg/m2 on day 1, and bendamustine 90 mg/m2 on days 1–2 of each cycle. Median age at Pola-BR initiation was 55 (19–84). The overall response rate was 47.9%, including 32.4% CR rate when a median of 3 cycles was applied. With a median follow-up of 5 months, the median OS was 5 months. Grade 3–4 neutropenia and thrombocytopenia were the most common hematological toxicities. The real-world data from our cohort showed the Pola-BR is an effective option with a manageable toxicity profile

Vitiligo hastalarında çölyak hastalığı sıklığı

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi111139

Prevalence of celliac disease in vitiligo patients

YÖK Tez ID: 271823Amaç: Çölyak hastalığı (ÇH) genetik olarak yatkın bireylerde gluten alımı ile ince barsaklarda oluşan otoimmün inflamatuar bir hastalıktır. Genellikle çok çeşitli semptom ve bulgulara neden olabildiğinden ÇH tanısının konulması zor olabilmektedir. Otoimmün faktörlerin önemli rol oynadığı vitiligo, epidermal melanositlerin kaybına bağlı depigmentasyon ile ilişkilidir. Pek çok otoimmün hastalığın vitiligo ile ilişkili olduğu bilinmektedir. Bu çalışmanın amacı, vitiligosu olan olgularda ÇH sıklığını saptamaktır.Hastalar ve Yöntem: Altmış bir vitiligo hastasının 32'si (% 52,4) kadın, 29' u (% 47.6) erkek; 119 sağlıklı gönüllünün 58' i (% 48.7) kadın, 61' i (% 51.3) erkekti. Bütün katılımcıların doku transglutaminaz (tTG) IgA ve tTG IgG antikorlarının serum düzeyleri ölçüldü. Bu iki antikordan en az birinin pozitif olması durumunda endoskopi ile duodenum ikinci kesiminden mukozal biyopsiler alındı.Bulgular: Çalışma grubunun yaş ortalaması 34.63±13.28 yıl, beden kitle indeksleri (BKI) ortalaması 25.88±4.65 kg/m² idi. Kontrol grubu yaş ortalaması 37.20±7.22 yıl, BKI ortalaması 25.69±4.64 kg/m²'idi. Çalışma grubu ile kontrol grubu arasında yaş ve BKI bakımından anlamlı bir fark yoktu (sırası ile p=0.16, p=0.80). Hasta grubu ve kontrol grubundan birer bireyde tTG IgA ve tTG IgG pozitif bulundu. Her ikisinin de duodenal biyopsi sonuçları, histopatolojik olarak ÇH ile uyumluydu. Vitiligo grubu ile kontrol grubu arasında ÇH sıklığı bakımından fark yoktu (p=0.56).Sonuç: Vitiligo hastalarında ÇH sıklığı kontrol grubundakine benzerdi. Örneklemimiz küçük olduğu için, sonuçlarımız daha büyük ölçekli çalışmalarla doğrulanmalıdır. Ancak, vitiligo hastalarında rastlantısaldan daha sık ÇH olabileceği akılda tutulmalı ve böyle hastalar erken tanı için araştırılmalıdır.Anahtar kelimeler: Çölyak hastalığı, vitiligo, prevelansAim and Backround: Celiac disease (CD) is an autoimmune inflammatory disease of the small intestine, resulting from gluten ingestion in genetically susceptible individuals. The diagnosis can be difficult to make, because CD may cause the wide variety of signs and symptoms. Vitiligo, in which autoimmune factors play important roles, is associated with depigmentation due to loss of epidermal melanocytes. It is known that several autoimmune diseases are related to vitiligo. The aim of this study was to determine the prevalence of CD in patients with vitiligo.Patients and Methods: Of 61 patients with vitiligo, 32 (52.4%) were female and 29 (47.6%) were male; of 119 healthy volunteer, 58 (48.7%) were female and 61 (51.3%) were male. Serum levels of tissue transglutaminase (tTG) IgA and tTG IgG antibodies were measured for all participants. If at least one of the antibodies was positive in sera, mucosal biopsies were taken from second part of the duodenum via endoscopy.Results: The mean age was 34.63±13.28 years and the mean BMI was 25.88±4.65 kg/m² in the study group. In the control group, the mean age was 37.20±7.22 years and the mean BMI was 25.69±4.64 kg/m². There was no statistically significant differences with regard to the mean age and BMI between the study and the control groups (p=0.16, p=0.80, respectively). It was found that tTG IgA and tTG IgG serology was positive in one individual from each group (1.63%, 0.84%, respectively). The duodenal biopsy results of these two individuals were consistent with CD histopathologically. There was no statistically significant difference between the groups with regard to the prevalance of CD (p=0.56).Conclusion: CD prevalance in vitiligo patients was similar to that in the control group. Since our sample size was small, the findings must be confirmed by further studies with larger sample sizes. However, it should be kept in mind that CD may be seen more often in vitiligo patients than coincidental and all such patients should be evaluated for early diagnosis of CD.Key words: Celiac disease, vitiligo, prevalanc

The unknown impact of multiple myeloma: assessing the impact of financial well-being on quality of life of caregivers

Purpose: Patients with multiple myeloma and their caregivers are financially burdened, and their quality of life is significantly affected by treatment costs and care expenses. The aim of our study is to examine the impact of financial well-being of the caregiver on the life quality of patients with multiple myeloma. Methods: The study included 113 patients with multiple myeloma and 113 caregivers in two hospitals located in Western Turkey. This study evaluated the demographic characteristics of patients and their caregivers, financial status, financial well-being, and quality of life of caregivers. Simple linear regression analyses were used to examine the impact of financial well-being on caregiver quality of life. Results: The average age of multiple myeloma patients and caregivers is 64.00 ± 11.05 and 48.02 ± 11.4, respectively. Of patients, 50.4% and 62.8% of their caregivers were female. It is determined that 51.3% of the patients were diagnosed in 1–5 years, 85% received chemotherapy, and 80.5% had an ECOG performance status between 0 and 1. Caregivers’ quality of life and financial well-being were found to be low. On one hand, while caregivers’ financial well-being (β = − 1.003; t = − 3.831; p =.000) negatively affected the quality of their lives, their financial satisfaction (β = 2.507; t = 3.820; p =.000) positively affected the quality of their lives, on the other hand. Conclusions: Caregivers’ quality of life declined as their financial well-being got worse. Decreased quality of life of caregivers may affect the quality of care they provide to patients with MM. Hence, this study recommends the following. First, nurses who care for patients with MM should always assess the financial situation of patients and caregivers. Second, patient navigators, hospital billing specialists, and social workers should provide financial guidance to multiple myeloma patients and caregivers and provide help in solving their financial problems. Finally, policies that support the financial situation of patients and caregivers should be developed

İntraoperatif splenik hilus kanaması ve splenomegali robotik ve laparoskopik splenektomiden açık cerrahiye geçişe etki eden risk faktörleridir

Objective: Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different_x000D_ clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum_x000D_ dissection technique._x000D_ Material and Methods: A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the_x000D_ study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8)._x000D_ Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity._x000D_ Results: No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease,_x000D_ operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet_x000D_ distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular_x000D_ thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p< 0.05) were higher_x000D_ in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-_x000D_ 981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to_x000D_ open surgery._x000D_ Conclusion: Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3_x000D_ ) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.Giriş ve Amaç: Minimal invaziv cerrahi tüm dünyada farklı klinik pratiklerde etkili ve güvenli popüler tedavi yöntemlerinden biridir. Bu çalışmada_x000D_ amacımız, robotik veya laparoskopik splenektomi (RLS)’den açık cerrahiye geçişe etki eden risk faktörlerini ve indirekt hilum diseksiyonu tekniğinin performansını ortaya koymaktır._x000D_ Gereç ve Yöntem: Çalışmaya izole dalak hastalıkları nedeniyle RLS splenektomi yapılan 56 hasta kabul edildi. Hastalar iki gruba ayrıldı; RLS yapılan_x000D_ hastalar (grup 1) (n= 48) ve açık cerrahiye geçilen hastalar (grup 2) (n= 8). Hastalar yaş, cinsiyet, beden kütle indeksi (BKİ), yandaş hastalık, tanı, ASA_x000D_ skoru, dalak çapı, biyokimyasal, mikrobiyolojik parametreler ve morbiditeler açısından retrospektif olarak değerlendirildi._x000D_ Bulgular: Yaş, cinsiyet, BKİ, ASA skoru, yandaş hastalık, operasyon süresi, hastanede kalış süresi, takip süresi, aksesuar dalak, tanı, Uluslararası_x000D_ Normalizasyon Oranı (INR), eritrosit dağılım genişliği (RDW), trombosit dağılım genişliği (PDW), trombosit-lenfosit oranı (PLR), nötrofil-lenfosit_x000D_ oranı (NLR), tekrar başvuru, splenozis, cerrahi alan infeksiyonu, vasküler trombüs ve insizyonel herni açısından gruplar arasında istatistiksel olarak_x000D_ farklılık yoktu (p> 0,05). Diğer taraftan, açık splenektomiye geçilen grupta intraoperatif splenik hilustan kanama ve dalak çapı istatistiksel olarak_x000D_ daha fazlaydı (p< 0,05). Multivaryant analizde açığa geçişe etki eden faktörler; intraoperatif hilustan kanama (B= 4,127) (OR= 61,974) (%95 GA=_x000D_ 3,913-981,454) (p= 0,003) ve artmış dalak çapı (> 400 cm3) (B= 3,114) (OR= 22,509) (%95 GA= 1,818-278,714) (p= 0,015) olarak tespit edilmiştir._x000D_ Sonuç: İntraoperatif splenik hilustan kanama ve artmış dalak çapı (> 400 cm3_x000D_ ) elektif RLS’den açık splenektomiye geçişe etki eden risk faktörleridir._x000D_ İndirekt splenik hilum diseksiyonu intraoperatif kanama ve açık cerrahiye geçişi azaltabilir

Long-Term Efficacy of Erythropoiesis-Stimulating Agents in Patients with Low-Risk or Intermediate-1-Risk Myelodysplastic Syndrome: Multicenter Real-Life Data

Objective: This study was undertaken to evaluate the long-term clinical efficacy of epoetin alfa and darbepoetin alfa in patients with myelodysplastic syndrome (MDS) in a real-life setting. Materials and Methods: A total of 204 patients with low-risk or intermediate-1-risk MDS who received epoetin alfa or darbepoetin alfa were included. Hemoglobin levels and transfusion needs were recorded before treatment and at 12 months, 24 months, 36 months, and 48 months of treatment. Results: At the 36-month (p=0.025) and 48-month (p=0.022) visits, epoetin alfa yielded significantly higher hemoglobin levels compared to darbepoetin alfa. Transfusion needs were also significantly lower with epoetin alfa compared to darbepoetin alfa at 24 months (p=0.012) and in the low-risk group compared to the intermediate-risk group at 24 months (p=0.018), 36 months (p=0.025), and 48 months (p<0.001). Treatment response rates at the 24-month, 36-month, and 48-month visits in the epoetin alfa (43.0%, 33.6%, and 27.1%), darbepoetin alfa (29.9%, 22.7%, and 16.5%), low-risk (39.3%, 30.0%, and 26.0%), and intermediate-risk (29.6%, 24.1%, and 11.1%) groups were lower than those obtained at 12 months, and the values differed significantly for the 36-month and 48-month visits with values ranging from p<0.05 to p<0.001. Conclusion: This real-life long-term ESA extension study investigated the clinical efficacy of epoetin alfa and darbepoetin alfa for up to 48 months, revealing that treatment efficacy reached a plateau starting from the 24th month of therapy with a continuing decrease in treatment response rates regardless of treatment type, risk status, or gender. Nonetheless, significantly higher hemoglobin levels and marked improvement in transfusion needs were evident in epoetintreated patients compared to darbepoetin-treated patients and in the low-risk group compared to the intermediate-risk group

Polatuzumab vedotin, rituximab, and bendamustine combination in relapsed or refractory diffuse large B-cell lymphoma: a real-world data from Turkey

Polatuzumab vedotin (Pola) with bendamustine and rituximab (BR) is a promising option for patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We analyzed the data of 71 R/R DLBCL patients who had been treated with Pola-BR in the named patient program from March 2018 to April 2021 from 32 centers in Turkey. All patients received up to six cycles of Pola 1.8 mg/kg, rituximab 375 mg/m(2) on day 1, and bendamustine 90 mg/m(2) on days 1-2 of each cycle. Median age at Pola-BR initiation was 55 (19-84). The overall response rate was 47.9%, including 32.4% CR rate when a median of 3 cycles was applied. With a median follow-up of 5 months, the median OS was 5 months. Grade 3-4 neutropenia and thrombocytopenia were the most common hematological toxicities. The real-world data from our cohort showed the Pola-BR is an effective option with a manageable toxicity profile

A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia

Objective: The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP). Materials and Methods: A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results: The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%). Conclusion: Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.PubMedWoSScopu