Imdat Dilek

Acute pancreatitis caused by bortezomib

Drug-induced pancreatitis has been reported rarely. Bortezomib is a selective and reversible proteasome inhibitor used for the treatment of patients with multiple myeloma (MM). Recently, one case report about acute pancreatitis (AP) caused by bortezomib was published in the international literature. Herein we report a case of AP in a 67-year-old male on bortezomib therapy. On the fourth day after the first administration of bortezomib, the patient admitted to the hospital with symptoms of AP. The common etiological factors for AP were all excluded. Than the patient was diagnosed as bortezomib-induced pancreatitis.

Assessment of serum thiol/disulfide homeostasis in multiple myeloma patients by a new method.

Objectives: The etiology of multiple myeloma (MM) is not exactly known. This study investigated the role of thiol/disulfide homeostasis in the etiopathogenesis of MM. Methods: Some 50 patients with MM (aged 39–84 years) and 50 sex-matched healthy volunteer controls (aged 50–91 years) participated in this study. Venous blood samples were collected, and levels of native thiols, total thiols, and disulfide were measured. Results: Native and total thiol levels in the control group were determined to be higher than in the study and patient groups (P<0.001). Disulfide levels were found to be higher in the control group than in the study group and higher in newly diagnosed patients than in outpatients who were undergoing treatment (P=0.002). The ratios of thiol levels were found to be similar in both the study and control groups (P>0.05). Discussion: The results of the study show that although there was a decrease in the levels of disulfide, native thiol, and total thiol, the balance of thiol/disulfide was maintained. This is the first study to research the homeostasis of dynamic thiol/disulfide from the perspective of the new method that was used. We hope that this study will encourage and facilitate further studies in this area.

Neutrophil to lymphocyte ratio--not an independent prognostic factor in patients with the myelodysplastic syndrome.

PURPOSE Neutrophil-to-lymphocyte ratio (NLR) was evaluated as a potential prognostic factor in patients with myelodysplastic syndrome (MDS). MATERIALS AND METHODS Between December 2009 and April 2014, 14 female (35%) and 26 male (65%) MDS patients who were followed up in our hematology clinic were included in the study for NLR during diagnosis. Division was into two groups according to the NLR, and the correlation with mortality was evaluated. The prognostic significance of NLR regarding treatment outcome was also evaluated with adjustment for known confounding risk factors. RESULTS The mortality rate of the patient group was 55%, and median survival was 18 months. There was no significant correlation between mortality and NLR at a median value of 1.8 (p=0.75). Thrombocytopenia was observed to increase mortality (p=0.027), and there was a significant correlation between mortality and pancytopenia (p=0.017). CONCLUSIONS This first study of NLR and mortality did not show any significant correlation . In centres with limited access to genetic evaluation for the presence of pancytopenia and/or thrombocytopenia at the time of diagnosis, a platelet level less than 50?109/l may be poor prognostic markers in MDS patients.

Hospitalization Risk According to Geriatric Assessment and Laboratory Parameters in Elderly Hematologic Cancer Patients

BACKGROUND Utilizing geriatric screening tools for the identification of vulnerable older patients with cancer is important. The aim of this study is to evaluate the hospitalization risk of elderly hematologic cancer patients based on geriatric assessment and laboratory parameters. MATERIALS AND METHODS In this cross sectional study 61 patients with hematologic malignancies, age 65 years and older, were assessed at a hematology outpatient clinic. Standard geriatric screening tests; activities of daily living (ADL), instrumental activities of daily living (IADL), Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE), timed up and go test (TUG), geriatrics depression scale (GDS) were administered. Demographic and medical data were obtained from patient medical records. The number of hospitalizations in the following six months was then recorded to allow analysis of associations with geriatric assessment tools and laboratory parameters. RESULTS The median age of the patients, 37 being males, was 66 years. Positive TUG test and declined ADL was found as significant risk factors for hospitalization (p=0.028 and p=0.015 respectively). Correlations of hospitalization with thrombocytopenia, vitamin B12 and folic acid deficiency were statistically significant (p=0.004, p=0.011 and p=0.05 respectively). CONCLUSIONS In this study, geriatric conditions which are usually unrecognized in a regular oncology office visit were identified. Our study indicates TUG and ADL might be use as predictive tests for hospitalization in elderly oncology populations. Also thrombocytopenia, and vitamin B12 and folic acid deficiencies are among the risk factors for hospitalization. The importance of vitamin B12 and folic acid vitamin replacement should not be underestimated in this population.

Pseudothrombocytosis due to microerythrocytosis: a case of beta thalassemia minor complicated with iron deficiency anemia.

as well as bone marrow examination were done and chronic myeloproliferative disorders were ruled out. A month after iron and vitamin B 12 replacement therapy, the CBC revealed Hb 8.8 g/dl, MCV 52.4 fl and platelet count 3,223 × 10 9 /l. Peripheral smear examination revealed similar findings and thrombocytosis was still not evident. After completion of the second month of therapy, the CBC revealed Hb 8.4 g/dl, MCV 54.9 fl and platelet count 164 × 10 9 /l ( table 1 ). Since there was an insufficient increase in the Hb level, a further examination with Hb electrophoresis with high-performance liquid chromatography was done and β-thalassemia minor was detected. When all the peripheral smears were re-examined together, many microerythrocytes in each highpower field could be noticed. It was understood that these microerythrocytes were spuriously counted as platelets by the blood counter. The normalization of platelet count after 2 months which was associated with increased erythrocyte volume as a result of therapy supported our observation. The first case of pseudothrombocytosis in the literature was reported by Stass et al. [4] in a case of hairy cell leukemia in 1977. In our literature search, we could identify several cases of pseudothrombocytosis, some of which are summarized in table 2 [4–12] . This phenomenon has also been reported with fungal contamination, accidental Thalassemia minor and iron deficiency anemia are the two major causes of microerythrocytosis. Reactive thrombocytosis is frequently observed in iron deficiency anemia. The normal erythrocyte and thrombocyte volumes are 80–96 and 7–10 fl, respectively. In microcytic anemias like iron deficiency, the erythrocyte volume can be reduced to 30 fl, whereas in diseases like chronic myeloproliferative disorders or May-Hegglin anomaly, the platelet volume can be enlarged up to 30–80 fl [1–3] . Volume changes in blood cells may result in erroneous analysis in the automatic blood counters. Thus, abnormal complete blood count (CBC) results should be evaluated with caution. A 35-year-old female patient was admitted to the outpatient clinics with fatigue. At the physical exam she had pale conjunctiva, subicteric sclera and palpable liver and spleen below the costal margins. Her laboratory examination revealed hemoglobin (Hb) 5.3 g/dl, mean corpuscular volume (MCV) 41.8 fl, white blood cells 4.36 × 10 6 /l, platelet count 5,074 × 10 9 /l (normal range 150–450 × 10 9 /l), red cell distribution width 26.2%, ferritin 2.16 ng/ ml, and vitamin B 12 134.9 pg/ml. In the peripheral smear, hypochromia, microcytosis, anisocytosis and target cells were observed. The platelets were large and seen as aggregates without any evidence of thrombocytosis ( fig. 1 ). Investigation for JAK2 mutation and BCR-ABL1 fusion Received: July 16, 2012 Accepted after revision: November 21, 2012 Published online: March 8, 2013

Paraoxonase and arylesterase activities in adults with vitamin B12 deficiency

Objective: The purpose of this study was to investigate paraoxonase (PON) and arylesterase (ARES) enzyme activity in adults with vitamin B12 deficiency, and specific changes in the activities of these enzymes following vitamin B12 treatment. Methods: A total of 46 patients with vitamin B12 deficiency (aged 18–82 years) and 45 healthy volunteer controls (aged 19–64 years) participated in this study. Venous blood samples were collected, and serum vitamin B12, homocysteine (HCY), methylmalonic acid, PON1, and ARES levels were measured. Results: Paired comparison showed that pre- and post-treatment values for PON and ARES were similar between patients and controls (both P > 0.05). There was no statistically significant relationship between patients’ pre-/post-treatment PON or HCY levels and serum vitamin B12 levels, compared with those of the control group (P > 0.05). Discussion: The results of the present study do not support the hypothesis that the antioxidant enzymes PON and ARES have an underlying role in vitamin B12 deficiency and related hyperhomocysteinemia. Our findings suggest that PON and ARES do not play a role in the systemic effects of vitamin B12 deficiency.

Evaluation of Inflammation Parameters in Philadelphia Negative Chronic Myeloproliferative Neoplasia Patients.

BACKGROUND Chronic myeloproliferative diseases are clonal stem cell diseases which occur as a result of uncontrollable growth and reproduction of hematopoietic stem cells, which are the myeloid series source in bone marrow. Recent studies have suggested that chronic inflammation can be a triggering factor in the clonal change in chronic myeloproliferative neoplasia (CMPN). In our study, we evaluated the existence of a chronic inflammation process in our Philadelphia negative (Ph-)CMPN patients using inflammation parameters in combination with demographic, laboratory and clinical characteristics of the patients. MATERIALS AND METHODS Demographic characteristics, clinical and laboratorial data, and thrombosis histories of 99 Ph-CMPN patients, who were diagnosed at our outpatient clinic of hematology in accordance with WHO 2008 criteria, were analyzed retrospectively,with 80 healthy individuals of matching gender and age included as controls. Complete blood counts, sedimentation, C reactive protein (CRP), JAK V617F gene mutations, abdomen ultrasound images and previous thrombosis histories of these patients were retrospectively analyzed. RESULTS Ph-CMPN and healthy control groups included 99 and 80 cases, respectively. PV, ET and MF diagnoses of patients were 43 (%43.4), 44 (44.4%) and 12 (12.1%), respectively. JAK V617F gene mutation was found to be positive in 64 (71.1%) of all cases and in 27(65.8%), 32 (82%), 5 (50%) of the cases in PV, ET and PMF groups, respectively. Thrombosis was determined as 12 (12%) in the entire group, 12.5% in the JAK V617F negative and 15.3% in the positive patients, with no statistical significance (p=0.758). No significant difference was observed between patients with and without previous thrombosis history in respect to hemogram parameters, sedimentation and CRP (p>0.05), neutrophil to lymphocyte ratio (NLR), erythrocyte distribution width (RDW), mean platelet volume (MPV) and sedimentation levels of the patient.

Development of plasma cell leukemia in a patient with chronic myeloid leukemia while on treatment with imatinib mesylate

Plasma cell leukemia (PCL) is a rare and an aggressive form of plasma cell dyscrasias. We report a 67-year-old male with PCL which developed while on imatinib mesylate (IM) therapy 38 months after diagnosis of chronic myeloid leukemia (CML). The patient has been treated successfully with bortezomib, melphalan and prednisolone. To our knowledge, only one case of PCL superimposed on Philadelphia positive CML has been reported in the literature and this was before the IM era.

Epidemiology of Vitamin B12 Deficiency

Vitamin B12 is only synthesized by microorganisms in nature and thus, is obtained by human beings through their diet. Since the most important source of vitamin B12 is animal proteins, vegetarians may lack sufficient quantities of this vitamin in their diets. Vitamin B12 deficiency may stem from a lower dietary intake, an autoimmune issue related to intrinsic factors or gastrointestinal system diseases resulting in vitamin B12 malabsorption. The most important symptoms and findings of severe vitamin B12 deficiency are anemia and neurological problems. If it is not treated, anemia symptoms and neurological disturbances resulting in spinal cord and cerebral cortex demyelination may emerge. Vitamin B12 deficiency is one of the most frequent vitamin deficiencies worldwide. This deficiency is a highly important public health issue because of its serious complications if it is not detected and treated appropri‐ ately, although its treatment is very simple. Epidemiological studies in this field are, therefore, of great value. Most of the studies on this subject have been examined vitamin status of the general population. The research generally contains to the national or provincial populations data. Nevertheless, the few data are not fully representative in the general population. Determining risk factors and at‐risk groups, and educating them about vitamin B12 deficiency and proper diet would prevent the irreversible complications of this type of deficiency. The goal of this study is to review epidemiological studies related to vitamin B12 deficiency and to point out the importance of identifying and treating it.

The myth of not disclosing the diagnosis of cancer: does it really protect elderly patients from depression?

BACKGROUND The disclosure of a diagnosis of cancer is complex, particularly in older patients. The aim of this study was to investigate the association between age and not knowing the diagnosis, and its impact on mood. MATERIALS AND METHODS The study included 70 patients with various types of solid and hematologic cancer in early stages, which were followed up in an outpatient oncology/hematology clinic in Turkey between January, 2014 and June, 2014. Initially the caregivers of patients were asked whether the patients knew their diagnosis or not. A questionnaire for the Geriatric Depression Scale was then administered to the patients. Patient age, gender, marital status and education level were noted and analyzed with respect to knowing the diagnosis and depression. RESULTS Of the 70 patients, 40% of them were female. The mean age was 68.2±8.9. The rate of the patients who does not know their diagnosis was 37.1% (n=26). The overall depression rate with GDS was found 37.1% (n=26) among the participants. There was no association with knowing the diagnosis (p=0.208) although the association between not knowing the diagnosis and age was significant (p=0.01). CONCLUSIONS In this study we revealed no association between not knowing the diagnosis and depression in elderly patients. Contrary to what some has thought, the patient is not protected from psychological distress by not being informed about the diagnosis. We believe this study and similar ones will help to discuss and further explore patient autonomy, the principle of respect to self-determination and end of life issues in different cultures.