Mehmet Sonmez

Crimean-Congo hemorrhagic fever in Turkey.

Nineteen cases of suspected Crimean-Congo hemorrhagic fever reported from Turkey.

Breakthrough Trichosporon asahii Fungemia in Neutropenic Patient with Acute Leukemia while Receiving Caspofungin

A 47-year-old man with newly diagnosed acute myeloblastic leukemia and non-insulin-dependent diabetes mellitus developed Trichosporon asahii fungemia while receiving caspofungin as empirical antifungal therapy. The diagnosis was based on repeated isolation of T. asahii in culture of blood for three times. Despite treatment with amphotericin B and voriconazole, the patient died. The in vitro antifungal susceptibilities of the T. asahii isolates were only available after the patient died. In vitro antifungal susceptibility tests showed high caspofungin and amphotericin B minimal inhibitory concentrations (MICs) value for this Trichosporon strain (MICs, 16 μg/ml, and > 32 μg/ml, respectively). Fluconazole, itraconazole, and voriconazole exhibited low MICs in vitro (MICs, 4 μg/ml, 0.5 μg/ml, and ≤ 0.015 μg/ml, respectively). Our experience strongly suggest that identification and antifungal susceptibility testing for T. asahii in neutropenic patients who may develop signs of infection in the presence of caspofungin as well as broadspectrum antibiotics treatment should not be overlooked.

Effect of pathologic fractures on survival in multiple myeloma patients: a case control study

BackgroundMultiple Myeloma (MM) is a B cell neoplasm characterized by the clonal proliferation of plasma cells. Skeletal complications are found in up to 80% of myeloma patients at presentation and are major cause of morbidity.Methods49 patients were enrolled with MM admitted to Black Sea Technical University Hospital between 2002–2005. Pathologic fractures (PFs) were determined and the patients with or without PF were followed up minumum 3 years for survival analysis.ResultsPF was observed in 24 patients (49%) and not observed in 25 patients (51%). The risk of death was increased in the patients with PF compared with patients who had no fractures. While overall survival was 17.6 months in the patients with PFs, it was 57.3 months in the patients with no PFs.ConclusionThese findings suggest that PFs may induce reduced survival and increased mortality in the MM patients, however, larger sample size is essential to draw clearer conclusions added to these data.

A Case of Acute Colitis with Severe Rectal Bleeding in a Patient with Chronic Myeloid Leukemia after Dasatinib Use

matologic remission. Ten weeks after starting dasatinib treatment, the patient was admitted to our hospital with abdominal pain and rectal bleeding. Laboratory results were as follows: hemoglobin 10.3 g/dl, white blood cells 6 ! 10 9 /l, platelets 185 ! 10 9 /l, prothrombin time 14 s, active partial thromboplastin time 33.3 s, international normalized ratio 1.25. Stool examination was negative for parasites and other pathogenic bacteria. Sigmoidoscopic examination was performed with only rectal osmotic laxative without entire colon cleansing. There was no active bleeding, but multiple milimetric nodular hyperemic lesions on the mucosa were seen in the left side of colon and biopsies were taken during sigmoidoscopic examination ( fig. 1 ). Histopathological findings revealed nonspecific active colitis ( fig. 2 ). The patient was hospitalized and dasatinib treatment was stopped. No bleeding was observed during follow-up and colonoscopy was performed 2 weeks later. Endoscopic and histopathological findings were all normal, and dasatinib treatment was restarted. The patient was admitted to the hospital again with hematochezia 1 month after dasatinib administration. Colonoscopy repeated and findings were consistent with acute colitis. Again dasatinib treatment was stopped and patient was observed for 5 days in hospital without any bleeding. Repeated colonoscopy was normal after dasatinib treatment discontinuation. Nilotinib (400 mg/day) was started as an alternative to dasatinib for CML treatment. The patient remained in hematological remission during 6 months of follow-up without any further complication. Dasatinib is a second-line tyrosine kinase inhibitor used in imatinib resistant or intolerant chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia. It inhibits several critical oncogenic proteins, including bcr-abl, Src familial kinase, Kit, platelet-derived growth factor receptor and ephrin A receptor kinase. Dasatinib, which binds both active and inactive conformation of bcr-abl oncoprotein, has greater potency than imatinib for both wild-type and mutant BCR-ABL, except the T315I mutation [1, 2] . Mild to moderate thrombocytopenia and neutropenia occurred in approximately 50% of patients, but it is generally well tolerated. Other side effects are diarrhea, headache, weakness, pleural effusion, nausea and peripheral edema. Gastrointestinal bleeding may occur in up to 7% of patients using dasatinib [3] . Current literature suggests severe rectal bleeding due to acute colitis during dasatinib treatment has been reported only in 1 pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia patient [4] . Here, we report an adult case with acute colitis with severe rectal bleeding after dasatinib use. This complication has not been previously reported in an adult population. A 55-year-old patient had been diagnosed with blastic phase of CML 2 years ago. After remission induction treatment including cytosine arabinoside, idarubicin and imatinib (400 mg/day), maintenance treatment was continued with imatinib. During the follow-up, dasatinib (100 mg/day) was started because of disappearance of heReceived: December 14, 2009 Accepted after revision: January 28, 2010 Published online: April 8, 2010

The relation of lymphoma and hepatitis B virus/hepatitis C virus infections in the region of East Black Sea, Turkey.

Aim and background Hepatitis B virus (HBV) and hepatitis C virus (HCV) are not only hepatotropic, but also lymphotropic viruses. Infections with these viruses induce chronic antigenicity and may stimulate clonal expansion of malignant B-cell neoplasms. Moreover, these viruses can proliferate in lymphatic structures and bone marrow. However, the relationship between lymphomas and HBV/HCV infections is not clear. In our region of the East Black Sea, Turkey (the city of Trabzon), we intended to demonstrate a relation of lymphoma and HBV/HCV infections with a case-controlled study. Methods A total of 109 patients diagnosed with lymphoma between 2002–2005 in the Black Sea Technical University Hospital was investigated. Seventy-one patients had a high-grade and 38 patients a low-grade lymphoma. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV Ab) were screened. The control group consisted of patients (n = 551) from other departments with diagnoses other than lymphoma. Results HBsAg was 3.7% and anti-HCV Ab positivity was 2.8% in lymphoma patients, compared with control of 5.3%, 5.1%, respectively. There was no statistically significant difference between two groups (P = 0.7, OR = 0.69, 95% CI, 0.20–2.10; P = 0.4, OR = 0.53, 95% CI, 0.13–1.86, respectively). Conclusion Our findings suggest that the incidence of HBV and HCV infections in lymphoma patients is no different than that of nonlymphoma patients. Therefore, no direct correlation can be deduced between lymphoma and HBV-HCV infections in our East Black Sea region of Turkey.

The expression of LMO2 protein in acute B-cell and myeloid leukemia

Abstract LIM domain only-2 (LMO2) is an important regulator of hematopoietic stem cell development. LMO2 is also expressed in blast cells of different types of acute leukemia. Here, we analyzed the LMO2 protein expression in acute myeloid leukemia (AML) and B-cell acute lymphoblastic leukemia (B-ALL) and examined whether the LMO2 protein expression can predict outcomes of patients with acute leukemia. Patients with acute B-ALL (22 cases) and AML (57 cases) were examined using immunohistochemistry for LMO2 on paraffin-embedded bone marrow biopsies. We report that LMO2 protein is expressed in a significant proportion of B-ALL and AML and the staining of LMO2 protein does not predict survival in acute leukemia.

The use of Ankaferd blood stopper in a patient with Glanzmannʼs thrombasthenia with gingival bleeding

The Journal of Blood Coagulation and Fibrinolysis has printed an article comparing the efficacy of Ankaferd Blood Stopper (ABS; Ankaferd Drug, Inc., Istanbul, Turkey) in antithrombotic drug-induced primary and secondary hemostatic abnormalities of a rat-bleeding model [1]. ABS is a folkloric medicinal plant extract that has been used in Turkey traditionally for hemostasis. The use of topical ABS has been approved in the management of dental surgery and external hemorrhage by the Ministry of Health in Turkey. Glanzmann’s thrombasthenia, a life-threatening bleeding disorder, is an inherited platelet function disorder characterized by a severe reduction in, or absence of, platelet aggregation in response to multiple physiologic agonists due to abnormalities of platelet glycoprotein (GP) GPIIb and/or GPIIIa receptors. Bone marrow transplantation (BMT) is the only potentially curative treatment for Glanzmann’s thrombasthenia, in which platelet transfusion is considered a standard therapy for securing hemostasis in individuals with Glanzmann’s thrombasthenia, when the local measures and antifibrinolytic agents are inadequate. Recombinant activated factor VII (rFVIIa) is used for treating severe bleeding in patients with isoantibodies [2]. We report the use of ABS in a type II Glanzmann’s thrombasthenia patient with gingival bleeding due to periodontal therapy. A 24year-old man with Glanzmann’s thrombasthenia underwent periodontal treatment (scaling and root planning) in our university because of frequently recurrent bleeding secondary to early periodontitis. Physical examination revealed no abnormalities. Routine laboratory investigations revealed normal hemoglobin, platelet count, prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time performed by the Ivy method was 15 min (normal 2–9 min). The platelet aggregation test presented no agglutination with epinephrine, ADP, and collagen. Periodontal treatments were performed resulting minor gingival bleeding with no need for erythrocyte transfusion (Fig. 1). ABS was

Raoultella ornithinolytica causing fatal sepsis

Raoultella ornithinolytica, an encapsulated Gram-negative bacterium, is a member of the Enterobacteriaceae family. It rarely causes invasive infections.1,2 There are underlying conditions such as pathology of biliary system and malignancy in most cases. Although the majority can recover with adequate antibiotic therapy, some cases have a fatal outcome.2–4 A patient from our country with diabetic foot with ensuing bacteremia had been reported.5 That case was successfully treated by tigecycline. A 37-year old male patient with relapsing acute lymphocytic leukemia (ALL) was admitted to the hematology department for chemotherapy. He had been diagnosed 1.5 year before and had a history of bone marrow transplantation in the previous year. At first day of FLAG (Fludarabine 30 mg/m2, cytosine arabinoside (Ara-C) 2 g/m2, granulocyte colony stimulating factor (G-CSF) 5 g/kg/day) chemotherapy, febrile neutropenia developed and piperacillin–tazobactam 4.5 g intravenously (iv) every 6 h was started. Fever was under control in third day, but recurred after 12 days of treatment. Amphotericin-B 3 mg/kg/day was started with monitoring of galactomannan levels; based on the findings of high resolution computed tomography (HRCT) antibiotic therapy was switched to imipenem 500 mg iv every 6 h. Tigecycline 150 mg iv every 12 h was also added because of Gram-negative bacilli growth in subsequent three blood cultures. Despite that antibiotic modification, there was persistence of fever. Blood cultures grew Gram-negative bacilli, which were identified as “Raoultella ornithinolytica” by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (Bruker Biotyper) and confirmed by conventional biochemical tests. MICs of antibiotics were determined by BD Phoenix automated microbiological system (Becton Dickinson, Sparks, MD, USA). Amoxicillin–clavulanic acid 1 g PO every 8 h was then added to the regimen. Clinical response did not ensue and it was switched to ciprofloxacin 400 mg iv every 12 h according to the results of antibiotic sensitivity testing (Table 1). The patient Table 1 – Susceptibility profile of Raoultella ornithinolytica.

Induction of potent protection against acute and latent herpes simplex virus infection in mice vaccinated with dendritic cells

BACKGROUND AIMS Dendritic cells (DCs) are the most potent antigen presenting cells of the immune system and have been under intense study with regard to their use in immunotherapy against cancer and infectious disease agents. In the present study, DCs were employed to assess their value in protection against live virus challenge in an experimental model using lethal and latent herpes simplex virus (HSV) infection in Balb/c mice. METHODS DCs obtained ex vivo in the presence of granulocyte-macrophage colony-stimulating factor and interleukin-4 were loaded with HSV-1 proteins (DC/HSV-1 vaccine). Groups of mice were vaccinated twice, 7 days apart, via subcutaneous, intraperitoneal or intramuscular routes with DC/HSV-1 and with mock (DC without virus protein) and positive (alum adjuvanted HSV-1 proteins [HSV-1/ALH]) control vaccines. After measuring anti-HSV-1 antibody levels in blood samples, mice were given live HSV-1 intraperitoneally or via ear pinna to assess the protection level of the vaccines with respect to lethal or latent infection challenge. RESULTS Intramuscular, but not subcutaneous or intraperitoneal, administration of DC/HSV-1 vaccine provided complete protection against lethal challenge and establishment of latent infection as assessed by death and virus recovery from the trigeminal ganglia. It was also shown that the immunity was not associated with antibody production because DC/HSV-1 vaccine, as opposed to HSV-1/ALH vaccine, produced very little, if any, HSV-1-specific antibody. CONCLUSIONS Overall, our results may have some impact on the design of vaccines against genital HSV as well as chronic viral infections such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus.

Is SCUBE 1 a new biomarker for gastric cancer

PURPOSES This study was intended to determine the diagnostic significance of signal peptide-CUB-EGF domain-containing protein 1 (SCUBE 1) levels in gastric cancer. METHODS This retrospective study was conducted with patients with gastric cancer. SCUBE 1 titers of plasma in patients with gastric cancer were determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS SCUBE 1 titers of gastric cancer patients were significantly higher compared with the control group (P=0.0001). At a SCUBE 1 cut-off point of 43 ng/mL, sensitivity was 67%, specificity 91%, positive predictive values (PPV) 92% and negative predictive values(NPV) 63%. SCUBE 1 levels of patients with methastase were not different from patients without methastase (P> 0.05). DICUSSIONS: SCUBE 1 levels in patients with gastric cancer were found higher compared to healthy subjects.