Yenidoğan sepsisinde tam kan sayımı parametrelerinin tanısal değeri

Objective: This study was planned to determine whether complete blood count parameters and scores based on complete blood count can be used as a diagnostic marker in neonatal sepsis. Methods: This retrospective study included 70 patients with neonatal sepsis (Group 1) and 65 healthy neonates (Group 2) with similar age, sex, birth weight, and gestational age. The demographic data, blood culture results, clinical and laboratory findings were obtained from the medical records. Scores based on complete blood count such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), eosinophil-to-lymphocyte ratio (ELR), basophil-to-lymphocyte ratio (BLR) and monocyte-to-lymphocyte ratio (MLR) were calculated by dividing the number of neutrophils, platelets, eosinophils, basophils and monocytes by the number of lymphocytes, respectively. Results: There were no significant differences between the groups in terms of demographic characteristics such as age, gender, birth weight, type of delivery and gestational week. C-reactive protein level was significantly higher in the neonatal sepsis group (p 0.05). While NLR was significantly higher (2.19±1.39 vs 1.44±1.07, p<0.001), ELR was significantly lower (0.08±0.07 vs 0.09±0.05, p=0.007) in neonatal sepsis group. NLR was positively correlated while ELR, lymphocyte, platelet, eosinophil and monocyte counts were negatively correlated with CRP (p<0.05). According to the results of ROC curve analysis, CRP, NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts were significant parameters for the diagnosis of neonatal sepsis. Cut-off values were 6.09 mg/L for CRP (sensitivity 88.57%, specificity 100%, AUC: 0.964, p <0.001), 1.01 for NLR (sensitivity 78.57%, specificity 63.08%, AUC: 0.727, p <0.001, 0.079 for ELR (sensitivity 64.29%, specificity 56.92%, AUC: 0.634, p = 0.007), 4.66x109/L for neutrophil count (sensitivity 68.57%, specificity 61.54%, AUC: 0.683, p<0.001), 4.33x109/L for lymphocyte count (sensitivity 65.71%, specificity 60.00%, AUC: 0.668, p=0.001), 259.00x109/L for platelet count (sensitivity 62.86%, specificity 58.46%, AUC: 0.659, p=0.001), 0.27x109/L for neutrophil count (sensitivity 61.42%, specificity 69.23%, AUC: 0.708, p<0.001) and 1.33x109/L for monocyte count (sensitivity 62.86%, specificity 56.92%, AUC: 0.647, p=0.003) Conclusion: Although their sensitivities and specificities lower than CRP; NLR, ELR, neutrophil, lymphocyte, platelet, eosinophil and monocyte counts can be accepted as adjunctive data that contribute to the diagnosis of neonatal sepsis. In particular, NLR seems to be the most useful complete blood count parameter in the diagnosis of neonatal sepsis with the highest sensitivity and specificity

İmmün trombositopenik purpuralı sirozlu bir hastada eltrombopag tedavisi sırasında portal ven trombozu

Portal ven trombozu karaciğer sirozunda görülen nadir ancak ciddi bir komplikasyondur. Eltrombopag immün trombositopenide kullanılan ikinci jenerasyon bir ajandır. Trombotik komplikasyonlara yol açabilmektedir. Portal ven trombozu eltrombopag kullanılan bazı siroz hastalarında nadir rapor edilen yaşamı tehdit eden bir komplikasyondur. Burada eltrombopag kullanımı sonrası portal ven trombozu gelişen 63 yaşındaki immün trombositopenik bir siroz vakası sunulmuştur.Portal vein thrombosis (PVT) is a rare but serious complication in liver cirrhosis. Eltrombopag is a new, second generation agent used for immune thrombocytopenic purpura (ITP). It may cause thrombotic events. PVT has been rarely reported as a life threatening complication in some cirrhotic patients during eltrombopag using. We presented 63 years old cirrhotic and immune thrombocytopenic patient who had PVT after eltrombopag

Protective effect of hesperidin on methotrexate-induced intestinal epithelial damage in rats.

TEZ9147Tez (Yandal Uzmanlık) -- Çukurova Üniversitesi, Adana, 2011.Kaynakça (s. 73-84) var.x, 86 s. : res. (bzs. rnk.), tablo ; 29 cm.Amaç: Metotreksat, çeGitli tümör ve inflamatuvar hastalıklarının tedavisinde yaygın olarak kullanılan bir folik asit antagonistidir. Yan etki olarak; kemik iliği hücreleri ve gastrointestinal mukoza hücreleri gibi, yüksek çoğalma hızı olan normal dokuları da etkiler. Reaktif oksijen türleri metotreksat ile uyarılmıG barsak hasarının patogenezinde önemli rol oynamaktadır. Hesperidin bir antioksidandır. Bu çalıGma, sıçanlarda metotreksat ile oluGturulan barsak hasarını önlemede hesperidin etkinliğini araGtırmak amacıyla planlandı. Gereç ve Yöntem: ÇalıGma ağırlıkları 275-420 g, 16 haftalık, 78 erkek Wistar albino sıçan ile yapıldı. Sıçanlar randomize olarak 4 gruba bölündü: Serum fizyolojik verilen kontrol grubu (n=19), hesperidin verilen grup (n=19), metotreksat verilen grup (n=19) ve metotreksat verilip hesperidin tedavisi uygulanan grup (n=21) idi. Sıçanlara tek doz metotreksat (20 mg/kg) intraperitonel olarak uygulandı. Hesperidin grubuna, hesperidin (200 mg/kg/gün) gavaj ile ardıGık 5 gün, metotreksat+hesperidin grubuna, tek doz metotreksat tedavisinden sonra ardıGık 5 gün hesperidin (200 mg/kg/gün) uygulandı. Sıçanlar 2., 4. ve 6. gün sakrifiye edildi. Jejunum doku örnekleri alınarak, histopatolojik ve immünohistokimyasal analizler yapıldı. Bulgular: Yapılan 4. gün örnek incelemelerinde; metotreksat verilen grupta villus hasarı, kript hasarı, hücresel infiltrasyon, goblet hücre azalması ve total ince barsak hasarı skorunun, kontrol grubuna göre daha fazla olduğu saptandı (p=0,003, p=0,002, p=0,001, p=0,002, p=0,003). Metotreksat+hesperidin grubunda ise kript hasarı, metotreksat grubundan daha azdı ve istatistiksel olarak aralarında anlamlı farklılık bulundu (p=0,002). Metotreksat grubunda 4.gün indüklenebilir nitrik oksit sentazla immün boyanma kontrol grubuna göre anlamlı derecede artmıGtı (p=0,031). Metotreksat+hesperidin grubunda indüklenebilir nitrik oksit sentetaz ve interlökin 8 değerleri metotreksat grubundan daha düGüktü, aralarında istatistiksel anlamlı fark bulundu (p=0,019, p=0,036). Yapılan 6. gün örnek incelemelerinde; metotreksat grubu ile metotreksat+hesperidin grubunda epitelin düzelmeye baGladığı görüldü. Metotreksat grubunda Ki-67 proliferasyon indeksi kontrol ve metotreksat+hesperidin grubuna göre daha düGük bulundu. Metotreksat grubunda miyeloperoksidaz aktivitesi diğer gruplara göre daha yüksek olmakla beraber, istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Bizim sonuçlarımız, hesperidin uygulaması ile metotreksatla oluGturulan ince barsak hasarının azaldığını göstermiGtir. Hesperidinin, metotreksatın kullanıldığı tedavilerde, barsak epitel hasarını azaltmak için klinik uygulamalarda kullanılabilir.Aim: Methotrexate, a folic acid antagonist is widely used for the treatment of a variety of tumors and inflammatory diseases. Methotrexate affects normal tissues which have a high rate of proliferation, including the hematopoietic cells of bone marrow and the gastrointestinal mucosal cells. Reactive oxygen species play an important role in the pathogenesis of methotrexate-induced intestinal damage. Hesperidine is an antioxidant molecule. This study was performed to investigate the effectivity of hesperidin in the prevention of MTX-induced intestinal injury in rats. Materials and Methods: Seventy-eight male Wistar albino rats, 16 weeks old, weighing between 275-420 g, were divided into four groups: (1) rats receiving only saline (n=19), (2) rats receiving only hesperidin (n=19), (3) rats receiving only methotrexate (n=19), and (4) rats receiving methotrexate plus hesperidin treatment (n=21). A single dose of methotrexate (20 mg/kg) was administered to the rats intraperitoneally. In hesperidin treated group, hesperidin was administered by gavage for 5 days. For methotrexate plus hesperidin treated groups, hesperidin was administered by gavage for 5 days after methotrexate treatment. The rats were sacrificed on the 2nd, 4th and 6th day after methotrexate treatment. Tissue samples from the jejunum were taken for histopathological and immunohistochemical analysis. Result: On the 4th day sample reviews showed that villi and cryptas injuries; cellular infiltration; goblet cell depletion and high total intestinal injury score were seen more often compared to the control group (p=0.003, p=0.002, p=0.001, p=0.002, p=0.003). Crypt injury in the methotrexate plus hesperidine group was less than the methotrexate group and was found statistically significant (p=0.002). Staining with inducible nitric oxide synthase in the methotrexate group was significantly increased when compared to the control group (p=0.031). Inducible nitric oxide synthase and interleukin 8 values in the methotrexate plus hesperidine group were less than those in the methotrexate group, and there was significant difference (p=0.019, p=0.036). On the 6th day sample reviews, reepithelisation was seen in methotrexate and methotrexate plus hesperidine groups. Ki-67 proliferation index in the methotrexate group was found less than that in the methotrexate plus hesperidine and control group on 6th day. Myeloperoxidase activity in the methotrexate group was more than other groups, but this was statistically insignificant. Conclusion: Our results confirmed that administration of hesperidin decreased the methotrexate-induced injury to the small intestine. Hesperidin can be used in clinical practice with methotrexate treatment in order to prevent intestinal epithelial injury.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi tarafından desteklenmiştir. Proje No: TF2010LTP45

Seroprevalence of Hepatitis B, Hepatitis C and HIV in patients with hemoglobinopathy hatients

Amaç: Talasemi ve orak hücreli anemi hastaları sık transfüzyon almaktadır. Hepatit B (HBV), hepatit C (HCV) ve insan immün yetmezlik virüsü (HIV) kanla geçmektedir. Bu çalışmanın amacı hemoglobinopati hastalarımızda bu enfeksiyonların sıklığını belirlemektir. Materyal ve Metod: Dört yüz on hemoglobinopati hastasını inceledik.Viral serolojiler "ikinci jenerasyon enzim bağlantılı immün absorban tahlil" metoduyla incelendi. Dört yüz on hastanın (116 talasemi major, 16 talasemi intermedia, 12 hemoglobin H, 222 orak hücreli anemi, 43 orak-beta talasemi ve 1 Hb E) 258'i erkek, 152'si kadındı. Bulgular: HBV sıklığı %1,2, HCV %3,2 ve HIV %0 bulundu. Sonuçlarımız göstermektedir ki transfüzyon ilişkili viral enfeksiyon sıklığı literatüre kıyasla daha yüksek değildir. Sonuç: Peryodik olarak duyarlı tarama testlerinin kullanılması ve doğru verici seçimi yüksek risk altındaki hemoglobinopati hastalarının bu enfeksiyolarda korunmasında çok önemlidir.Purpose: Thalassemia and sickle cell anemia patients have frequent transfusions. Hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) are tramsmitted infections with blood. The objective of this study is to determine frequency of these infections in our hemoglobinopathy patients. Material and Methods: We investigated 410 hemoglobinopathy patients. Viral serologies were detected with secondgeneration enzyme-linked immunosorbent assay method. In 410 patients (116 thalassemia major, 16 thalassemia intermedia, 12 hemoglobin H, 222 sickle cell anemia, 43 sickle-beta thalassemia and 1 Hb SE), there were 258 males and 152 females. Results: The rate of HBV is 1,2%, HCV is 3,2% and HIV is 0%. Our results shows that transfusion transmitted viral infection prevelance is not high compared to the literature. Conclusion: Using sensitive screening tests with periodically and right donor selection are very important for preventing these infections in hemoglobinopathy patients who are under high risk

VASO-OKLUSİV KRİZ ORAK HÜCRELİ ANEMİDE HEMATOLOJİK PARAMETRELERİ NASIL DEĞİŞTİRİR?

Aim: To compare hematological parameters between children with steady-state sickle cell disease (SCD) and those with vaso-occlusive crisis. Materials and methods: Forty-seven patients (under 18 years of age) , 23 in the steady state and 24 in crisis were in this study. Control group included 24 age-matched children without chronic disease. Hematological parameters were recorded. Complete blood counts were measured by automated analyzer. Results: In crisis group, white blood cells (WBC), red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), platelet (PLT), neutrophil and monocytes mean values (17045 /mm3, 21.62 %, 28.12 pg, 34.96 gr/dl, 432 x 109/L, 10858 /mm3, 1676 /mm3) were higher than control (7429 /mm3, 14.66 %, 26.49 pg, 33.65 gr/dl, 288 x 109/L, 3883 /mm3, 508 /mm3), (

Türkiye'nin güneyinde Hatay'da hemoglobinopati tarama sonuçları

Amaç: ?-Talasemi ve hemoglobinopatiler yaygın genetik bozukluklardır. Bu nedenle evlilik öncesi çiftler ya da her anemik kişi rutin hemoglobinopatiler açısından incelenmelidir. Bu retrospektif çalışmada amacımız, ?-Trakya Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Edirnetalasemi ve hemoglobinopati sıklığını Türkiye'nin güney kesiminde bulunan Hatay'da, saptamaktır. Gereç ve Yöntem: Bu çalışmada veriler, Ocak 2006 ve Ekim 2012 tarihleri arasında anemi nedeni ile ve evlilik öncesi araştırma için Hatay Antakya Devlet Hastanesi Hemoglobinopati Merkezi'ne başvuran 70226 bireyden alınmıştır. Kan örnekleri EDTA'lı tüplere alınmış ve hematolojik parametreler bir Sysmex XT-2000i Hematology Analyzer kullanılarak analiz edilmiştir. Yüksek performanslı sıvı kromatografisi tekniği hemoglobin tiplerini belirlemek için kullanılmıştır. Bulgular: Hemoglobinopati sıklığı ?-Talasemi taşıyıcılığı % 6, orak hücre anemisi taşıyıcılığı %6,3, ?-talasemi taşıyıcılığı? %12,9 ve diğer anormal hemoglobinopatili varyantları % 4,2 idi. Homozigot ?-talasemi 49 olguda, homozigot hemoglobin S 60 olguda, HbH hastalığı (bir talasemi intermedia) 33 olguda tespit ettik. Tartışma: ?-talasemi taşıyıcılığı ve diğer hemoglobinopati sıklığının Hatay'da Türkiye'de diğer iller ile karşılaştırıldığında oldukça yüksek olduğu bulunmuştur.Aim: ?-Thalassemia and hemoglobinopathies are common genetic disorders in Turkey. Because of this reason, either anemic people or couples before marriage are investigated for hemoglobinopathies routinly. In this retrospective study, our aim was to determine the frequency of ?-thalassemia and hemoglobinopathies in Hatay, which is located in the southern part of Turkey. Material and Method: In this study, data from 70226 individuals, admitted to Antakya State Hospital Hemoglobinopathy Center in Hatay, both for the reason of anemia and before marriage investigations, were evaluated between January 2006 and October 2012. The blood samples were collected into EDTA-containing tubes and hematological parameters were analyzed using a Sysmex XT-2000i Hematology Analyzer. High performance liquid chromatography technique was used to determine the type of hemoglobin. Results: The frequency of hemoglobinopaties were 6% ?-Thalassemia trait, 6.3% sickle cell trait, 12.9% ?-thalassaemia trait? and 4.2 % other abnormal hemoglobinopaties variants. We detected 49 cases with homozygot ?-thalassaemia, 60 cases with homozygot haemoglobin S, 33 cases with HbH disease (thalassaemia intermedia) among all. Discussion: The frequency of ?-thalassemia trait and other haemoglobinopathies in Hatay is found to be quite high as compared with other provinces in Turkey

Wilson's Disease Presenting With Pancytopenia

Wilson’s disease is an autosomal recessive disorder of copper metabolism characterized by excessive amount of copper in liver, brain, eye and other body tissues. Diagnosis is based on the presence of Kayser-Fleischer rings, typical neurological symptoms, and/or a low serum ceruloplasmin concentration. The main clinical symptoms are usually due to hepatic and/or neurologic involvement. Pancytopenia is a rare initial symptom of Wilson Disease. An 11-year-old female presented with pancytopenia. This raised suspicion of Wilson’s disease, which was confirmed by Kayser-Fleischer rings, a low ceruloplasmin level and raised 24- hour urine copper level. Thus a pancytopenia may be the initial manifestation of Wilson’s disease in some patients of Wilson’s disease.Key Words: Wilson’s disease, pancytopenia, Kayser-Fleischer ring

Pediatric patient with both leukocyte adhesion deficiency II and bombay blood group

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Treatment experience with liposomal amphotericin B in pediatric patients with kala-azar

Amaç: Kala-azar retikuloendotelial sistemin multisistemik enfeksiyonudur. hepatosplenomegali ve hipergamaglobulinemi ile karakterizedir. pentavalan antimon bileşikleridir. Tedavide antimon içeren ilaçlara karşı direnç gelişmesi ve antimon bileşiklerinin yan etkileri nedeniyle lipozomal amfoterisin B kullanımı gündeme gelmiştir. Çalışmamızda kala-azarlı çocuk hastaların tedavisinde 6 aylık lipozomal amfoterisin B tedavisi deneyimlerimizi sunmayı amaçladık. Yöntem: Ocak 2014-Haziran 2014 tarihleri arasında Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesi'nde tanı alan 6 visseral leishmaniasisli olgu retrospektif olarak incelendi. Tüm hastalar lipozomal amfoterisin B (AmBisome®) ile tedavi edildi. Bulgular: Tüm hastalara kemik iliği aspirasyonu yapıldı ve tümünde Leishmania amastigotları görüldü. Olguların hepsinde ateş, hepatomegali ve splenomegali vardı. En sık hematolojik bulgu anemi (%100) ve nötropeni (%100) idi. Olguların beşinde hipergamaglobulinemi saptandı. Bir olguda Hemofagositik lenfohistiyositozis (HLH) saptandı. Uygun leishmaniasise.Objective: Kala-azar is a multisystem infection of the reticuloendothelial system. It is characterized by prolonged fever, hypergammaglobulinemia. The conventional treatment of kala-azar consists of pentavalent antimony compounds. Because of the resistance to drugs, including antimony and the side effects of antimony compounds, liposomal amphotericin B therapy is now being used. In our study, we aimed to present our 6 months of experience about treatment with liposomal amphotericin B of pediatric patients with kala-azar. Method: In this study, 6 consecutive cases of visceral leishmaniasis admitted to Mustafa Kemal University Medical Faculty Hospital between January 2014 and June 2014 were analyzed retrospectively. All patients with kalaazar were treated with liposomal amphotericin B (AmBisome&reg;). Results: Bone marrow aspirate was obtained in all cases and Leishmania amastigotes were detected in all of them. Fever, hepatomegaly and splenomegaly were present in all cases. Anemia (100%) and neutropenia (100%) were the most Hypergammaglobulinemia was noted in 5 cases. Severe Hemophagocytic lymphohistiocytosis (HLH) secondary to visceral leishmaniasis revealed in 1 patient. Despite initiating appropriate antileishmanial and HLH 2004 protocol treatments, She died after 19 days of hospitalization due to acinetobacter septicemia. In 5 patients were finally cured. Conclusion: Kala-azar should be suspected in the differential diagnosis with prolonged fever, marked splenomegaly hepatomegaly, and cytopenia. Liposomal amphotericin B seems to be the effective therapy in the treatment of pediatric visceral leishmaniasis in Turkey

Lamin protein gene expression in childhood acute myeloid leukemias

Amaç: Bu çalışmanın amacı çocukluk çağı akut myeloid lösemilerinde (AML) hücre çoğalması ve apoptozis ile ilgili yollarla bağlantılı olduğu düşünülen lamin A/C, lamin B1 ve lamin B2 proteinlerinin gen ekspresyon durumunun saptanması ve prognoz ile olan ilişkilerinin değerlendirilmesidir. Gereç ve Yöntem: AML tanısı alan 25 olgu ve 35 kontrol olgu çalışmaya alındı. Tanı anında ve indüksiyon tedavisi bitiminde lamin A/C, lamin B1 ve lamin B2 protein gen ekspresyonları Real Time-Polimeraz Zincir Reaksiyonu (RT-PCR) yöntemi ile çalışıldı. Bulgular: AML hastalarında, tanı anında bakılan lamin B1 protein gen ekspresyonu kontrol grubuna göre belirgin olarak düşük bulundu. İndüksiyon tedavisi sonrası bakılan lamin A/C ve B2 protein gen ekspresyonu, tanı anına göre anlamlı olarak düşük saptandı. Lamin B1’de istatistiksel olarak anlamlı değişiklik saptanmadı. Hepatomegalisi olan AML hastalarında, hepatomegalisi olmayanlara göre lamin A/C, splenomegalisi olan AML hastalarında, splenomegalisi olmayanlara göre hem lamin A/C, hem de lamin B2 protein gen ekspresyonu artmış bulundu. Sonuç: Çocukluk çağı akut myeloid lösemilerinde, lamin B1 protein gen ekspresyonu, tanısal bir belirteç olarak, indüksiyon tedavisi sonrasında lamin A/C ve B2’nin azalması ise tedaviye alınan yanıtın bir göstergesi olarak kullanılabilir.Purpose: The aim of this study is to evaluate the prognostic value and expression pattern of lamin A/C, lamin B1 and B2 in childhood acute myeloid leukemias, which are thought to be related with cell proliferation and apoptosis. Materials and Methods: Twenty-five patients diagnosed with acute myeloid leukemia (AML) and 35 control cases were included in the study. Real Time-Polymerase Chain Reaction (RT-PCR) method was used to detect lamin A/C, lamin B1 and lamin B2 protein gene expression at the time of the diagnosis and at the end of the induction treatment. Results: At the time of the diagnosis, lamin B1 protein gene expression was lower in AML patients when compared to the control group. When lamin protein expression levels at the time of diagnosis and after induction therapy were compared, the lamin A/C and B2 protein gene expressions were lower after the administration of induction chemotherapy. AML patients with hepatomegaly when compared to patients without hepatomegaly, had only increased lamin A/C protein gene expression. Patients with splenomegaly had both increased lamin A/C and lamin B2 protein gene expressions when compared to the patients without splenomegaly. Conclusion: In childhood acute myeloid leukemias, lamin B1 protein gene expression could be used as a diagnostic marker, while decrease in the lamin A/C and B2 protein gene expressions after induction could be used as a marker for response to therapy