Meltem Ayli

Is mean platelet volume associated with the angiographic severity of coronary artery disease

BACKGROUND Platelet activation and aggregation play key roles both in the pathogenesis of atherosclerosis and in the developmentof acute thrombotic events. Platelet volume is a marker of platelet activation and function, and is measured usingmean platelet volume (MPV). AIM To determine the relationship between MPV and angiographic Gensini and SYNTAX scores, which give information about the severity and complexity of coronary artery disease (CAD). METHODS This study included 435 consecutive patients undergoing elective coronary angiography. The complete blood countand biochemical examination of blood were obtained after 12 h of fasting. The independent association between MPV andthe severity of CAD was statistically evaluated using PASW Statistics 18 for Windows. RESULTS Mean age of the study population was 58.4 ± 9.3 years, of whom 196 were female (45.1%) and 239 male (54.9%). Of the patients, 63.2% had CAD, 31.7% had diabetes mellitus, 61.8% had hypertension, 56.6% had hyperlipidaemia, and 38.6% were smokers. Mean Gensini score was 20.7 ± 31.1. According to Gensini scores, 160 of the patients (36.8%) hadnormal coronary arteries (Gensini score: 0), 134 of the patients (30.8%) had minimal CAD (Gensini score: 1-19), and 141 ofthem (32.4%) had severe CAD (Gensini score ≥ 20). Mean MPV values were 8.4 ± 1.0 fL in the group that had no CAD,8.7 ± 1.0 fL in the group with minimal CAD, and 9.3 ± 1.5 fL in the group with severe CAD. According to Spearman correlationanalysis, the positive relationship found between MPV and Gensini score was statistically significant (p < 0.001,r = 0.290). Likewise, SYNTAX score was also associated with MPV (p < 0.001, r = 0.504). CONCLUSIONS We determined a positive correlation between MPV and Gensini and SYNTAX scores. Therefore, this simple haematology test can be used in determining cardiovascular disease burden besides other risk factors during routine clinical practice. For further information about this topic, large-scale studies are needed.

Acupuncture for neuropathic pain due to bortezomib in a patient with multiple myeloma.

Multiple myeloma (MM) is characterised by an increase in plasma cells, particularly in the bone marrow but also in other organs and systems, and with the abnormal production of immunoglobulin. Bortezomib, a current treatment option, inhibits angiogenesis by proteasome inhibition and is known to be effective in the treatment of MM. Peripheral neuropathy (PN) is a common dose-related side effect of bortezomib in patients with MM. We describe a case of PN due to bortezomib treatment which responded dramatically to acupuncture treatment, enabling his bortezomib treatment to continue. The patient was a 74-year-old man with pain, numbness, tingling and weakness in his hands and feet after 22 days of bortezomib treatment given by the haematology clinic. His neuropathic pain score was 8/10. There were no autonomic symptoms. Electroneurophysiological testing confirmed sensorimotor PN. Acupuncture treatment was planned as his neuropathic pain continued. Acupuncture was administered bilaterally to ST36, SP6 and LI4 15 times (every other day in the first five sessions and then twice a week). The numbness, tingling and pain symptoms substantially decreased after the first two treatments. After the 15th session acupuncture treatment was continued once a month. At the end of the sixth month the neuropathic pain assessment score was 0/10. There was no side effect of acupuncture treatment. Acupuncture seems promising as a complementary medical treatment for neuropathic pain from bortezomib-induced PN. Clinical studies involving more cases and electrophysiological studies are necessary to investigate the effectiveness of acupuncture.

Xanthelasma palpebrarum: a new side effect of nilotinib

Chronic myeloid leucaemia (CML) is a chronic myeloproliferative disorder characterised by a reciprocal translocation between the chromosomes 9 and 22 resulting in constitutionally active tyrosine kinase signalling. BCR-ABL tyrosine kinase inhibitors (TKIs) are highly effective molecules in the treatment of CML. Unfortunately, these novel therapeutic agents are accompanied by various side effects, and haematological, cutaneous and metabolic abnormalities are among the most prevalent. Nilotinib, a second-generation TKI, has been shown to cause both—cutaneous lesions and lipid profile abnormalities. We present two CML cases developing xanthelasma palpebrarum while receiving nilotinib. Case 1 also acquired a lipid abnormality following the start of nilotinib therapy, while case 2 meanwhile stayed normolipidemic. In addition to a low cholesterol diet, atorvastatin was prescribed to case 1. Currently, both cases are normolipidemic and continuing their nilotinib therapy. Xanthelasma palpebrarum secondary to nilotinib therapy is new to the literature.

Ruxolitinib Treatment in a Patient with Primary Myelofibrosis Resistant to Conventional Therapies and Splenectomy: A Case Report.

A 67-year-old male patient who was diagnosed with primary myelofibrosis 4 years ago did not respond to conventional therapies. The splenomegaly progressively increased, which caused spleen infarctions and led to the decision to perform a splenectomy procedure. After splenectomy, the patient started treatment with ruxolitinib. In the first month of ruxolitinib treatment, the patient became transfusion-free and all constitutional symptoms disappeared. However, in the sixth month of ruxolitinib treatment, the disease transformed to acute myeloblastic leukemia, and the patient died 1 month later. This is the first case report that shows the effects of ruxolitinib in a splenectomized patient.

Gonadotoxic Effects Of Nilotinib In Chronic Myeloid Leukemia Treatment Dose In Mouse Model.

Objective: Tyrosine kinase inhibitors may have deleterious effects on spermatogenesis or folliculogenesis, resulting in male or female subfertility. The aim of this study is to determine the effect of nilotinib, which is used routinely to treat chronic myeloid leukemia, on spermatogenesis and folliculogenesis by using histopathological parameters. Materials and Methods: Ten male and ten female mice were orally treated with nilotinib at 20 mg/kg body weight dissolved in drinking water daily for 2 months. Results: When compared with the control group, a statistically significant decrease was demonstrated in the total follicle numbers of the female mice in the nilotinib group (268±110 vs. 170±60; p=0.03). Active spermatogenesis was observed in each tubule sample taken from the mice in the control and nilotinib groups. Spermatogenic activity was similar in the two groups. Conclusion: We have demonstrated that even though spermatogenesis is preserved, folliculogenesis is inhibited by the usage of a continuous nilotinib treatment dose in chronic myeloid leukemia.

Serum Cystatin C in Patients with Acute Leukemia and its Prognostic Importance

Objective: Serum cystatin C may be over-expressed in some tumour cells and its high serum levels are associated with the poor out come of disease. The aim of this study was to evaluate the serum levels of cystatin-C in acute leukemia patients, explore possible correlations with prognosis. Patients and Methods: Serum samples of patients with newly diagnosis of acute leukemia have been collected at the time of diagnosis from February 2012 until January 2013. Güldane CENGİZ SEVAL1, Tuba CANDAR2, Meltem AYLI3, Çağlar COŞARDERELİOĞLU4, Selda DEMİRTAŞ2, Gülsüm ÖZET5, Simten DAĞDAŞ5, Murat ALBAYRAK6, Harika OKUTAN6 1 Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Yenimahalle Eğitim ve Araştırma Hastanesi, Hematoloji Bilim Dalı, Ankara, Türkiye 2 Ufuk Üniversitesi Tıp Fakültesi, Biyokimya Anabilim Dalı, Ankara, Türkiye 3 Sağlık Bilimleri Üniversitesi Tıp Fakültesi, Gülhane Eğitim ve Araştırma Hastanesi, Hematoloji Bilim Dalı, Ankara, Türkiye 4 Ufuk Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Ankara, Türkiye 5 Ankara Numune Eğitim ve Araştırma Hastanesi, Hematoloji Kliniği, Ankara, Türkiye 6 Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Hematoloji Kliniği, Ankara, Türkiye Uzm. Dr. Güldane CENGİZ SEVAL Yıldırım Beyazıt Üniversitesi Tıp Fakültesi, Yenimahalle Eğitim ve Araştırma Hastanesi, Hematoloji Bilim Dalı, AnkaraTürkiye Geliş: 20.12.2016 Kabul: 24.01.2017 E-posta: guldanecengiz@gmail.com Yazışma Adresi ARAŞTIRMA LLM Dergi 2017;1(1):1-4 • 10.5578/llm.46510 Akut Lösemide Sistatin C’nin Önemi LLM Dergi 2017;1(1):1-4 2 GİRİŞ Sistatin C; 122 aminoasitli, 13 kDa ağırlığında nonglikolize polipeptidli bir sistein proteinaz inhibitörüdür (1). 20. kromozom üzerinde lokalize olan bir “Housekeeping gen” ürünü olup tüm çekirdekli hücrelerde sabit bir hızda üretilir (1). Protein katabolizmasının kontrolünde, hormon sentezinin ve kemik resorbsiyonun düzenlenmesinde, inflamasyon, antijen sunumu ve T hücre bağımlı immün yanıt regülasyonunda rol almaktadır (2,3). Sistatin C’nin belirgin bir diurnal ritmi yoktur. Bütün çekirdekli hücrelerden sabit üretim hızı, renal glomerüllerden serbestçe süzülmesi ve hemen hemen tümünün proksimal tübüllerden geri emilmesi ve kreatininden farklı olarak vücut kas kitlesinden etkilenmemesi nedeniyle glomerüler filtrasyon hızı (GFR)’nın değerlendirilmesi için daha duyarlı bir parametre olduğu birçok çalışmada gösterilmiştir (4). Sistatin C’nin kanser dahil birçok hastalığın proteolitik sistem değişikliği ile ilişkili olduğu ve birçok malignitede de yüksek sistatin C düzeylerinin zararlı tümör ilişkili proteolitik aktiviteyi artırdığı ileri sürülmüştür (5). Kolorektal, akciğer, melanoma karsinomları, multipl miyeloma (MM) ve Hodgkin dışı lenfoma tanısı olan hastalarda, yüksek serum sistatin C seviyelerinin kötü prognozla ilişkisini gösteren çalışmalar vardır (6,7). Sistatin C’nin hepatosellüler kanser olgularında serum seviyesinin yükseldiği ve bir tümör belirteci olarak kullanılabileceği, nozofarengeal karsinomlarda da tanısal ve prognostik değer taşıdığı ve kötü prognostik bir belirteç olduğu bildirilmektedir (8,9). Seksen iki renal fonksiyonları normal sınırlarda olan kanser tanılı hasta ile sağlıklı kontrol grubunun karşılaştırmalı çalışmasında ise kanser grubunda sistatin C düzeylerinin yüksek bulunduğu, bu nedenle kanserli hastalarda renal fonksiyonları göstermede iyi bir belirteç olamayacağı sonucuna varılmıştır (10). İn vitro çalışmalarla da birçok tümör hücresinde sistatin C varlığı gösterilmiştir ve temel hücreden malign hücreye dönüşümün sistatinlerin ekspresyonundaki azalma ile ilişkili olduğu öne sürülmüştür. P-53 mutasyonu olan meme kanseri hücre dizilerinde sistatin C sunumunun azaldığı gösterilmiştir (11). Yine benzer bir çalışma özefagus karsinomu hücre dizilerinde yapılmış ve tümöral hücrelerde azalmış sistatin C sunumunun gösterilmesinin yanı sıra bunun özefagus karsinom hücrelerinin invazyon kabiliyetini inhibe edebileceği yönünde bir sonuç bildirilmiştir (12). Bu nedenle, sistatin C seviyelerinin malignite tanılı, normal renal fonksiyonları olan hastaların takibinde, kemoterapi yanıt değerlendirmede, hastalık sonuçlarını ve prognozu ön görmede kullanılabileceği yönünde görüşler vardır. Literatürde akut lösemi ile sistatin C düzeyleri arasındaki ilişkiye dair veri sınırlıdır. Türkiye’den yapılmış bir çalışmada 19 akut lösemi hastasının pretransplant ve posttransplant sistatin C düzeyleri araştırılmıştır. Bu çalışmada nefrotoksik ilaç kullanımı ile sistatin C yüksekliğindeki paralelliğe dikkat çekilmiştir (13). Biz de bu çalışmamızda; akut lösemi hastalarında, serum sistatin C düzeylerinin ne yönde etkilendiğini, serum sistatin C düzeylerinin tümör yükü, hastalık aktivitesi ve prognoz ile ilişkisini öngörmede kullanılabilecek bir belirteç olup olamayacağını ortaya koymayı amaçladık.

Nonsecretory Multiple Myeloma and AL Amyloidosis Presenting with Nephrotic Range Proteinuria

Nonsecretory multiple myeloma (NSMM) is the absence of a detectable monoclonal protein in serum and urine of a multiple myeloma (MM) patient and immunoglobulin light chain (AL) amyloidosis is a significantly rare complication. A case of NSMM with AL amyloidosis and nephrotic range proteinuria is presented. Sharing clinical, therapeutic, and prognostic characteristics with MM, real challenge may be during initial diagnosis of NSMM and assessment of treatment response. In elderly patients with unexplained renal dysfunction, MM should be in the differential diagnosis and the absence of a monoclonal protein should not rule out MM but should remind us of the possibility of NSMM.

The association between calcium dobesilate and pancytopenia in type 2 diabetes: A case report

Tip 2 diyabet hastasında kalsiyum dobesilat ile pansitopeni ilişkisi: Bir olgu sunumu Diabetic patients with polypharmacy are prone to unexpected drug side effects. Chronic venous insufficiency (CVI) is frequent in the type 2 diabetic population due to advanced age and obesity, and is associated with increased podiatric risk [1,2]. Calcium dobesilate (CaD) is a widely prescribed veno-tonic drug for CVI, diabetic retinopathy, and the symptoms of hemorrhoid attacks [3]. To date, all published cases of CaD-induced agranulocytosis are >60 years of age [4,5-10]. Ibanez et al. recently reported that CaD was strongly associated with the risk of agranulocytosis [10]. Herein we present a case of CaD-induced pancytopenia in an 80-year-old male diabetic patient. We had written informed consent from the patient. The patient presented to our hospital with a fever of 39°C. He had been type 2 diabetic for 25 years and was treated with repaglinide 2mg b.i.d. and insulin glargine 20U o.p.d. He was also hypertensive and dyslipidemic, and was using atenolol 50 mg/day, lisinopril 20 mg/day, amlodipine 10 mg/day, hydrochlorothiazide 50 mg/day, atorvastatin 10 mg/ day, and acetylsalicylic acid 100 mg/day for last 8 years. Six weeks before he presented to hospital he was diagnosed with CVI and CaD 500 mg b.i.d. was started following a cardiovascular surgery consultation. After 6 weeks of the treatment leukopenia, thrombocytopenia, and anemia were observed. His hematoxylin-eosin-stained blood smear confirmed markedly decreased platelet and leucocyte counts, accompanied by normochromic normocytic red cells (Table). CaD treatment was withdrawn because of the potential side effects. On physical examination the patient did not have organomegaly or palpable lymph nodes. His iron, ferritin, vitamin B12, and folate levels, and reticulocyte count were within normal limits, and ANA (anti nuclear antibody) and anti-double stranded DNA test results were negative. The patient was hospitalized and was prescribed intravenous ceftriaxone 2 g/day and clarithromycin 400 mg/day, following the diagnosis