Clinical and morphological evaluation of permanent first molars in Turkey

Aim

The aim of this study was to investigate the pit and fissure morphology of the permanent first molars (PFMs) in the dentition of 7- to 12-year-old patients in Turkish children.

Patients and Methods

The study was conducted on 706 patients who attended the Dokuz Eylul University Child Clinic. Examinations of the patients were carried out with dental unit light, mouth mirror, and probe by two dentists. Age, gender, plaque scores, pit and fissure morphology, caries, restorations, and missing teeth were recorded.

Results

Of the 706 patients included in this study, 441 (62.5%) of them have affected PFMs. Intermediate type fissure morphology (57.5%) was seen as the most common type. A positive correlation was observed between the age and the caries experience (p = 0.000). Patients with deep pits and fissure morphology have more caries affected teeth than patients with shallow pit and fissure morphology, and the difference was statistically significant (p = 0.000). Patients with deep pits and fissure morphology have significantly more plaque accumulation on PFMs compared to the patients with shallow and intermediate fissure morphology (p = 0.000).

Conclusions

Despite the limitations of the study, we can conclude that the patients with deep pit-fissure morphology are more susceptible to caries development and plaque accumulation than the patients with shallow and intermediate type pit and fissure morphology.

Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study

OBJECTIVES

Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients.

DESIGN

In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given.

PARTICIPANTS

Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients.

MEASUREMENTS

Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group.

RESULTS

The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both).

CONCLUSION

Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.

The prognostic value of ischemia-modified albumin in patients with sepsis

Background

Sepsis is a significant contributor of mortality all over the world. Emergency departments have a critical role for diagnosing a suspected sepsis in a patient, since early and proper administration of antibiotics may decrease mortality significantly. But, the unavailability of an objective and reliable diagnostic test is the major challenge of this critical issue.

Aims

The aim of this study is to evaluate the prognostic value of a novel biomarker, the ischemia-modified albumin (IMA) in patients with sepsis and septic shock in emergency department.

Subjects and Methods

This prospective, observational study included 81 patients with sepsis or septic shock and 75 controls. Sociodemographic characteristics of the patients, site of infection, IMA levels, other biomarkers (procalcitonin, pH, lactate), mortality at 24-h and 28-day were evaluated.

Results

The serum IMA levels in patient and control groups were 117.8 ± 85 IU/g and 115.8 ± 134.0 IU/g, respectively (P = 0.072). There was a weak but statistically significant positive correlation between IMA and lactate levels (P = 0.009). The mortality rates of patient group at 24-h and 28 days were 21% and 79%, respectively, but serum IMA levels were not found to be a prognostic marker to predict mortality.

Conclusion

The main reason for the similarity between groups regarding IMA levels was thought to be associated with the distribution of the acute and chronic health problems other than sepsis in the control group. Emergency department physicians should not only depend on serum IMA levels for predicting the prognosis of patients with sepsis or septic shock.

[Hepatocellular Carcinoma Cells with Downregulated ZEB2 Become Resistant to Resveratrol by Concomitant Induction of ABCG2 Expression]

In hepatocellular carcinoma (HCC), the presence of cancer stem cells (CSCs) have been linked to drug resistance, epithelial-mesenchymal transition (EMT), and cancer relapse. This study investigates the expression profile of ZEB1, ZEB2, ABCG2 in HCC-CSCs, and the role of EMT promoter ZEB2 in cells treated with resveratrol. The expression of ZEB1, ZEB2 and ABCG2 transcripts were analyzed in CD133^(+)/CD44^(+) cells isolated from the PLC/PRF/5 cell line. ZEB2-dependent ABCG2 gene expression and the effects of resveratrol on proliferation, cell cycle and apoptosis were explored in SNU398 cell clones. An inverse correlation between ZEB1/ZEB2 and ABCG2 levels were observed both in CSCs and in ZEB2-knock-down cells. The resveratrol treatment significantly decreased cell viability, while promoting cell cycle arrest in ZEB2-independent manner. Interestingly, resveratrol-treated cells with low levels of ZEB2 were resistant to apoptosis. The interplay of expression levels of ABCG2 and ZEB family EMT transcription factors may play a role in establishing CSC-like phenotype in HCC cells resistant to resveratrol.

Successful Treatment With Granulocyte Transfusion and Early Neutrophil Engraftment in Allogeneic Transplant Patients With Febrile Neutropenia: Does Granulocyte Transfusion Effect on Neutrophil Engraftment?

Background: Febrile neutropenia is very severe and urgent early complication after bone marrow transplantation before engraftment. Infection delays engraftments in these periods. Aim: In this study we evaluated the effect and outcome of granulocyte transfusion on febrile neutropenia and neutrophil engraftment in patients receiving allogeneic transplantation. The reasons for the use of the granulocyte transfusion were prolonged febrile neutropenia episode. Methods: Between 2015-2017, 16 patients receiving allogeneic bone marrow transplantation (BMT) were treated with granulocyte transfusion at the time of febrile neutropenia before engraftment. Sixteen patients (9 AML, and 7 ALL) underwent allogeneic transplantation. Nine of them transplanted from match sibling donors, 1 from unrelated donor, and 6 from mismatch family donor (haploidentic transplantation). They had febrile neutropenia after transplantation, before engraftment. They were given antimicrobial therapy. Granulocyte was collected from unrelated and same blood groups donors. We started granulocyte transfusion for 3-4 days. Results: Mean infused granulocyte counts were 3 × 1010 (1.2-4.8 × 1010)/d, and about 15%-20% of transfused granulocyte was monocyte. Before the granulocyte transfusion, on the 12th to 19th days of transplantation, their neutrophil counts were 0.02-0.09 × 103/dL. Twenty-four hours after granulocyte transfusion, mean neutrophil counts were 0.7 × 103/dL (0.4-1.2 × 103/dL). Neutrophil counts were 2.2 × 103/dL (1.7-2.6 × 103/dL) after 48 hour. After 72 hours, neutrophil counts were 3.2 × 103/dL (2.0- 4.6 × 103/dL). After 4th days of granulocyte transfusion, neutrophil counts were normal level (>0.5 × 103/dL) in 12 patients, and less than normal level (<0.5 × 103/dL) in 4 patients. Conclusion: Granulocyte transfusions during the febrile neutropenia, helped to better overcome febrile neutropenia periods in allogeneic transplant patients before engraftment. In addition, granulocytes transfusion also may help early neutrophil engraftments. The useful effect of granulocyte transfusion on neutrophil engraftment may be cause of cytokine (G-CSF) injection to donor before collection of granulocyte. Increased cytokine (G-CSF–GM-CSF–IL-3) level of transfused neutrophil and monocyte can also effect the neutrophil engraftment.

The Comparison of Melphalan Administration on Day −3 With Administration on Day −1 on Neutrophil and Platelet Engraftment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation

Background: High dose chemotherapy followed by ASCT is the most important step of MM treatment. Melphalan, an alkylating agent, is the most preferable drug for conditioning regimens and dosage and timing is important with regard to side effects or engraftment timing. Engraftment time is determinative on infections and hospitalization duration. Aim: To compare of the neutrophil and thrombocyte engraftment time in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day −3 and day −1 as conditioning regimen. Methods: We compared the neutrophil and thrombocyte engraftments retrospectively in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day −3 and day −1 as conditioning regimen. There were 29 patient receiving melphalan on day −1 and 42 patient on day −3. Results: Administration of melphalan on day −3 was better than on day. Neutrophil engraftment time and hospitalization duration was shorter in patients who received melphalan on day −3 than patients who received melphalan on day −1. In day −3 group, there was no failure neither in neutrophil nor in thrombocyte engraftment but 1 patient could just get thrombocyte engraftment on day 33. In day −1 group, 2 patients could not get engraftment. Conclusion: Administration of melphalan on day −3 is better than on day −1 in terms of neutrophil engraftment and hence in terms of hospitalization duration.

The relationship between the type of unstable intertrochanteric femur fracture and mobility in the elderly

Background

The purpose of this study was to assess the impact of uniform anti-rotational proximal femoral intramedullary nail (APFN) use on patient mobility status with the treatment of two different unstable intertrochanteric femur fracture groups of geriatric patients.

Methods

The study included patients aged > 65 years who underwent surgery with APFN. Group 1 comprised AO classification, AO/OTA 31-A22, and A23 patients, and group 2, A31 and A32 patients. The demographic data of the patients, postoperative complications, follow-up, mortality status, postoperative reduction, tip-apex distance (TAD), and the Parker-Palmer mobility (PPM) score were evaluated.

Results

There were no statistically significant differences between the groups in terms of gender, affected side, time from trauma to surgery, ASA score, anesthesia type, duration of hospitalization, duration of surgery, TAD values, reduction values, or mortality rate. The average age of patients in group 2 was significantly higher than that of patients in group 1 (p < 0.05). The mobility scores of group 1 patients were significantly higher than those of group 2 (p < 0.05).

Conclusions

While no relationship was found between the TAD values and the reduction status of the cases, the PPM scores of the AO 31 A3 cases were determined to be significantly worse. Therefore, fractures with a preoperative classification of AO type 31 A3 can be expected to have worse results than A2 ITF fractures. The fracture type seems to have as great an effect as other factors on the postoperative mobility score.

Immunohistochemical investigation of P16, P53 and Ki-67's prognostic values in diffuse large B-Cell lymphomas

AIM

The aim of this study is to determine the immunohistochemical properties of Ki-67, P53 expression and loss of P16, and to assess their relationship with both clinical parameters and patient survival in DLBCL.

METHOD

Forty patients, diagnosed at the Pathology Department of our institute with nodal DLBCL were selected as the study group. The relationship between P16, P53, Ki-67 expressions and clinical and laboratory parameters like age, gender, performance status, Eastern Cooperative Oncology Group (ECOG), clinical stage, presence of B-symptoms, bone marrow involvement, International Prognostic Index (IPI) score, lactate dehydrogenase (LDH) level, extranodal extension, relapse, C-reactive protein (CRP), sedimentation, number of leukocytes in patients and patient survival were then statistically evaluated.

RESULTS

Our results display no statistically significant correlation between P53 expression and loss of P16, Ki-67 proliferation index and clinical parameters and overall survival (p > 0.05). The only statistically significant relationship was between loss of P16 and stage (p 0.05).

CONCLUSION

According to the results of our study, the loss of P16, P53 gene expression and Ki-67 proliferation index have no effect on life expectancy of patients with DLBCL (Tab. 2, Fig. 2, Ref. 29).

Combination of paracetamol or ketamine with meperidine enhances antinociception

OBJECTIVES

Dealing with pain is one of the most important issues of medicine. All of the studies aim to find a drug or combination of drugs in order to have more effective analgesia and less side effects. In this study, we aimed to investigate the antinociceptive effects of combination of paracetamol or ketamine with meperidine.

METHODS

In this study, we evaluated the systemic antinociceptive effects of meperidine, paracetamol, and ketamine one by one with their combinations. We used 50 mice (weighing 25-30 g), which were divided into 5 groups with each group consisting of 10 mice. Meperidine was applied to animals with increasing doses and their tail flick latencies (TFL) were noted at 20, 40, 60, 90, 120, 180, and 240 min. The same protocol was repeated after the combination of meperidine with paracetamol or ketamine.

RESULTS

There was no analgesic effect on low doses of ketamine and paracetamol at TFL measurements. But the combination of low doses of these drugs with meperidine significantly increased TFL (p < 0.05).

CONCLUSION

It was observed that meperidine + ketamine and meperidine + paracetamol combinations have potent analgesic effect.

Androgenetic alopecia is associated with increased arterial stiffness in asymptomatic young adults

BACKGROUND

Association of androgenetic alopecia (AGA) with increased incidence of hypertension, a strong risk factor for coronary artery disease, has been suggested. However, there are no data on arterial stiffness measures of asymptomatic young adults with AGA.

OBJECTIVE

In this study, we aimed to investigate the association of the AGA with arterial stiffness assessed by cardio-ankle vascular index (CAVI), in asymptomatic young men.

METHODS

A total of 162 asymptomatic men aged between 18 and 45 years were consecutively enrolled to the study. Subjects were considered to have AGA if they have ≥3 grade vertex alopecia according to Hamilton-Norwood scale. Arterial stiffness was assessed by CAVI and defined as abnormal if CAVI is ≥8.

RESULTS

Frequency of abnormal CAVI was higher in patients with AGA (29.3% vs. 10.0%, P = 0.003). Subjects with AGA had higher mean CAVI than subjects without AGA (7.56 ± 0.93 vs. 7.15 ± 0.79, P = 0.004). Binary logistic regression analysis demonstrated that presence of AGA (OR, 5.6; 95% CI, 1.7-20.0, P = 0.006), age (OR, 1.1; 95% CI, 1.0-1.2, P = 0.03) and diastolic blood pressure (OR, 1.1; 95% CI, 1.0-1.3, P = 0.005) were independently associated with abnormal CAVI.

CONCLUSION

We concluded that, AGA might be an indicator of arterial stiffness in asymptomatic young adults.

Comparison of chemotherapy and hematopoietic stem cell transplantation pre and postterm DMFT scores: a preliminary study

AIMS

Chemotherapy is frequently used as a conditioning regimen to destroy malignant marrow cells before transplantation. Xerostomia, dysphagia, altered taste perception, mucositis, soft-tissue ulceration, and infection are common adverse oral effects of chemotherapy. The study was aimed to compare decayed, missing, filled teeth (DMFT) scores before and after hematopoietic stem cell transplantation (HSCT) and chemotherapy.

MATERIALS AND METHODS

Thirty-six patients undergoing HSCT were included in the study. A pre-HSCT dental treatment protocol was implemented that consisted of restoration of all active carious lesions, treatment of periodontal infections, and extraction of all teeth with advanced periodontal disease. Upon completion of dental treatment, the importance of rigorous and effective oral hygiene was reemphasized, and patients were recalled 6 months later. DMFT scores were calculated prior to the initiation of HSCT treatment and 6 months after transplantation.

STATISTICAL ANALYSIS USED

Regression analysis was used to evaluate the effects of HSCT and chemotherapy on DMFT scores.

RESULTS

Wilcoxon T test showed a statistically significant difference in DMFT scores before and after HSCT ( P < 0.001).

CONCLUSIONS

DMFT scores were found to increase after chemotherapy and HSCT, suggesting that the risk of infection is higher among HSCT patients when compared to other individuals. The results emphasize the need for dental examinations as an integral part of examination and treatment planning for patients undergoing HSCT and chemotherapy.

The impact of pretransplant hypoalbuminemia on survival in patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT): a nutritional problem?

OBJECTIVE

Serum albumin level is considered to be a marker reflecting the nutritional status in both healthy subjects and patients with malignancies. In this study we sought to investigate the association between pretransplantation serum albumin levels and prognosis among patients with leukemia who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT).

METHODS

We retrospectively analyzed the data of 102 patients who underwent alloHSCT from 2004 to 2010. Pretransplant serum albumin, D-dimer, creatinine, and fibrinogen levels drawn within 10 days before transplantation were obtained from patient files. All parameters were divided into 2 groups: normal levels (group 1) versus abnormal levels (group 2). Our normal range of serum albumin is 3.2-5.2 g/dL; patients with pretransplantation albumin level ≥3.2 g/dL were included in group 1 versus group 2 with <3.2 g/dL.

RESULTS

The patients included 42 (41.1%) female and 60 (58.9%) male patients. The diagnoses were acute myeloblastic leukemia in 65 (63.7%) and acute lymphoblastic leukemia in 37 (36.3%). The median age was 26.0 years (range, 13-57). Univariate and multivariate analysis showed that patients with serum albumin levels <3.2 g/dL experienced significantly lower overall survival (OS) compared with ≥3.2 g/dL (hazard ratio [HR] 2.32 [range, 1.23-4.54] and HR 2.70 [range 1.38-5.26], respectively; P = .009). The median (range) OS in group 2 was 230.0 (184.0-544.0) days versus 570.5 (249.5-1,101.0) days in group 1 (P = .007). For disease free survival (DFS) evaluation, univariate and multivariate analysis showed that patients with serum albumin levels <3.2 g/dL had significantly lower values compared with patients with serum albumin ≥3.2 g/dL. (HR 2.17 [range 0.98-4.76] and HR 2.85 [range, 1.25-6.66], respectively; P = .046). The median (range) DFS in group 2 was 184.0 (61.0-524.0) days versus 445.0 (199.0-917.5) days in group 1 (P = .045). Among the patient characteristics the presence of infection was a significant independent variable for worse OS (HR 2.12 [range, 0.98-4.36], P = .036). The other parameters-age, sex, donor status, time to transplant interval, conditioning regimens, HLA status, and number of total infused CD34(+) cells-showed no significant effect on OS and DFS (P = .05).

CONCLUSIONS

Pretransplantation decreased serum albumin levels were associated with poor survival in patients with leukemia who underwent alloHSCT.

Langerhans cell sarcoma of the nasopharynx: a rare case

Langerhans cell sarcoma, a tumour with markedly malignant cytological features that originates from Langerhans cells, is a very rare disease. We report the first case of 39-year-old male with Langerhans cell sarcoma arising in the nasopharynx. We chose the 2-chlorodeoxyadenosine (2-CDA) regimen as first-line chemotherapy, and clinical improvement of Langerhans cell sarcoma was obtained. After the fourth cycle of 2-CDA therapy, however, disease progression was observed, and we administered ESHAP regimen (etoposide, carboplatin, cytarabine, methylprednisolone) as a second-line therapy. After we administered two cycles of ESHAP, however, the patient developed aggressive progression and he died. The importance of immunohistochemical findings is obvious in Langerhans cell sarcoma diagnosis. Considering that Langerhans cell sarcoma behaves in a very malignant fashion, a more aggressive treatment approach is necessary for patients with Langerhans cell sarcoma.

Renal impairment and coronary collaterals in patients with acute coronary syndrome

OBJECTIVE

We aimed to elucidate the relationship between mild-to-moderate renal impairment and the development of coronary collateral vessels (CCV) in patients with acute coronary syndrome (ACS).

METHODS

We enrolled 461 patients with ACS who underwent coronary angiography for the first time. The development of CCV was assessed with the Rentrop score. Kidney function was classified according to the estimated glomerular filtration rate (eGFR). The Gensini score was used to show the extent of atherosclerosis.

RESULTS

The mean eGFR value was 89.9 ± 24.3 U/l for patients with no development of collaterals and 82.7 ± 20.5 for patients who had CCV. The mean age was 59 ± 11 years and 349 patients (75.7 %) were male. Rentrop classifications 1-2-3 (presence of CCV) were determined in 222 (48.1 %) patients. The presence of CCV was significantly associated with low levels of eGFR (p = 0.001), increased serum creatinine levels (p = 0.034), high levels of serum albumin (0.036), and the Gensini score (p < 0.001). Multivariate analysis showed that the Gensini score was an independent predictor of the presence of CCV (OR = 1.090, 95 % CI: 1.032-1.151, p = 0.002).

CONCLUSION

We suggest that the association between mild-to-moderate renal impairment and the presence of CCV may be explained by increased myocardial ischemia and severe CAD.

Comparision of inflammatory biomarkers for detection of coronary stenosis in patients with stable coronary artery disease

BACKGROUND

The objective of the current study was to evaluate the role of various inflammatory biomarkers in detection of coronary stenosis in patients with stable coronary artery disease (CAD) and healthy people.

METHODS

A total of 111 patients with stable coronary artery disease, and 66 healthy subjects were enrolled in the study. Serum levels of lipoprotein-associated-phospholipase A2 (Lp-PLA2), high-sensitivity C-reactive protein (hs-CRP), and myeloperoxidase (MPO) were measured to compare patient and control groups.

RESULTS

Baseline characteristics were similar between healthy and patient groups, with the exception of age. ANCOVA and log-transformed data of inflammatory biomarkers revealed that, Lp-PLA2 (p < 0.001) and hs-CRP (p < 0.05) levels in all patient groups were significantly higher than in the control group. Conversely, there was no significant difference in MPO levels among groups.

CONCLUSIONS

In stable CAD patients, serum Lp-PLA2 levels are more compatible than hs-CRP and MPO levels in the detection of coronary stenosis.      

Severity of coronary artery disease and prostate-specific antigen relationship in men

OBJECTIVE

Prostate-specific antigen (PSA) is a well-known prostate cancer marker. Recent studies have shown that serum PSA levels can fluctuate in response to cardiovascular stress. In this study we aimed to determine if serum PSA levels correlate with the presence and stages of coronary artery disease (CAD) and whether PSA can be used as a marker for the diagnosis and severity of CAD.

PATIENTS AND METHODS

This was a retrospective chart review of male patients who underwent coronary angiography for suspected CAD. A total of 100 patients with angiographic data and baseline serum PSA measurements were included. Patients with previous history of coronary angiography, stent implantation, benign prostate hypertrophy, known prostate cancer or prostatitis were excluded.

RESULTS

The mean age was 57±10 years. Coronary angiography results were normal in 13%, non-obstructive CAD (non-critical plaque formation) in 16%, one-vessel disease in 21%, two-vessel disease in 30% and multi-vessel disease in 20%. Mean values of total and free serum PSA were 1.4±1.3 ng/mL and 0.4±0.4 ng/mL, respectively. Although there was an increasing trend of PSA with more advanced stages of CAD, no significant relationship was established (p > 0.05). Patients with hypertension had significantly elevated total and free serum PSA compared to normotensives. There is no comparison of PSA levels between patients with CAD and without CAD.

CONCLUSIONS

Our study suggests that there is no direct relationship between increasing levels of PSA and stage of CAD. Thus, PSA level does not appear to be a suitable marker for diagnosis or severity of CAD.

Research on and clinical importance of duplications in various chromosomal regions in addition to Philadelphia chromosome in chronic myeloid leukemia

PURPOSE

To investigate the chromosomal aberrations in chronic myelogenous leukemia (CML), particularly in chromosomal regions which carried 67 genes pertaining to oncogenes, transcription factors, signal transduction, tumor suppressors, apoptosis etc, in addition to Philadelphia (Ph+) chromosome by multiplex ligation-dependent probe amplification (MLPA) method and to compare them with clinical parameters.

METHODS

The aberrations were investigated in 48 CML patients receiving imatinib therapy and a group of 15 healthy controls, by using the MLPA method between 2000 and 2009. The obtained results were compared both between patient and control groups and with clinical parameters.

RESULTS

Duplication was detected in the fibroblast growth factor receptor 1 (FGFR1) gene of 2 patients, inosine 5' monophosphate dehydrogenase 1 (IMPDH1) gene of 4, postmeiotic segregation increased S. Cerevisiae 2 (PMS2) gene of 1, nuclear factor kappa beta (NFKB) of 5 and T-cell translocation 2 (LMO2) gene of 1 patient. Univariate analysis showed that splenomegaly, advanced age, Sokal risk score (SRS) and the duplications in IMPDH1 and FGFR1 genes significantly shortened 7-year event-free survival (EFS); multivariate analysis showed that only the duplications in IMPDH1 and FGFR1 genes were the factors that significantly affected EFS. No statistically significant correlations were detected between duplications and other clinical parameters.

CONCLUSION

Duplications in 4 genes (FGFR1, IMPDH1, PMS2, LMO2) in addition to Ph+ chromosome in CML patients were detected for the first time. This study indicates that chromosomes 7 and 8 should be particularly investigated in more detail in addition to the Ph+ chromosome for better determination of disease prognosis and selection of alternative treatments.

Hematological features of pediatric systemic lupus erythematosus: suggesting management strategies in children

Aim: The aim of this study was to analyze the hematological features in children with systemic lupus erythematosus (SLE) and to review our current treatment protocols. Methods: We evaluated hematological findings of 43 children with SLE diagnosed and followed at the Pediatric Rheumatology Division of Hacettepe University, Turkey. Thirty-seven patients with hematological abnormalities were analyzed in detail. Results: Median age at presentation was 13 years. Hematological involvement was seen in 86% of patients. The most common hematological finding was anemia ( n = 30). Anemia was either a Coombs (+) hemolytic one, or was due to other causes. Hemolytic anemia was treated with steroids and intravenous gamma globulin (IVIG). Leucopenia and thrombocytopenia were detected in 35.1 % and 37.8 %, respectively. Bone marrow aspiration was performed in 15, mainly for cytopenia. Secondary dysplastic changes were common. Acute lymphoblastic leukemia (ALL) was diagnosed in one patient. Six patients were diagnosed as having macrophage activation syndrome (MAS). One patient died due to secondary infections and multiorgan failure despite aggressive treatment. In patients diagnosed early, treatment with steroids and cyclosporine resulted in an excellent response. Thrombotic microangiopathy was detected in two patients. Both were treated successfully with steroids and plasma exchange. Antiphospholipid and anticardiolipin antibodies were positive in 12 and 15 of the patients, respectively. Five developed deep vein thrombosis (DVT), one cerebral sinus thrombosis and one presented with purpura fulminans. They were effectively treated with anticoagulation protocol. Conclusion: Hematological findings should be carefully assessed and treated vigorously to prevent the morbidity and possible mortality.

Clinical and molecular analysis of RASopathies in a group of Turkish patients

The 'RASopathies' are a group of disorders sharing many clinical features and a common pathophysiology. In this study, we aimed to clinically evaluate a group of Turkish patients and elucidate the underlying genetic etiology. Thirty-one patients with a clinical diagnosis of one of the RASopathy syndromes were included in the study. Of these, 26 (83.8%) had a clinical diagnosis of Noonan syndrome, whereas 5 had a clinical diagnosis of either Costello, LEOPARD or cardio-facio-cutaneous syndromes. Twenty of 31 (64.5%) patients were found to be mutation positive. Mutations in PTPN11, SOS1 and SHOC2 genes were detected in patients with Noonan syndrome (57.6%). Mutations in MEK1, PTPN11, BRAF and HRAS genes were detected in the remaining. Pulmonary stenosis was the most common (61.5%) cardiac anomaly. Among Noonan syndrome patients with a confirmed mutation, mild intellectual disability tended to be more common in patients with PTPN11 mutation than in those with SOS1 mutation. Hematologic evaluation revealed coagulation defects in three Noonan syndrome patients with a mutation. This is currently the largest clinical and molecular study in Turkish RASopathy patients. Our findings indicate that molecular epidemiology and genotype-phenotype correlations in RASopathies are relatively independent from the ethnic population background.

Acute lymphoblastic leukaemia in a child with systemic lupus erythematosus

Haematological involvement of systemic lupus erythematosus (SLE) - which ranges from the well-described haemolytic anaemia to macrophage activation syndrome - has a large impact on both morbidity and mortality. On the other hand, association between haematological malignities and SLE - in terms of pathophysiology and molecular genetics - is an obscure entity which has not been clarified evidently to date. Herein, we present a six-year-old female with the diagnosis of SLE who developed acute lymphoblastic leukaemia following a period of myelodysplasia. It could possibly be coincidental; however, persistent cytopenia, prominent dysplasia on bone marrow smears and azathioprine treatment may be considered as possible triggers for the development of leukaemia in the present case.

Secondary hemophagocytosis in 3 patients with organic acidemia involving propionate metabolism

Hemophagocytic lymphohistiocytosis (HLH) may develop secondary to infections, malignancies, immune deficiency syndromes, and rheumatologic and metabolic disorders. Associations between HLH and inborn errors of metabolism, including lysinuric protein intolerance, multiple sulfatase deficiency, galactosemia, Gaucher disease, Pearson syndrome, and galactosialidosis, have previously been reported in the literature. In this report the authors present 3 children with disorders of propionate metabolism--1 with methylmalonic acidemia and 2 with propionic acidemia--who developed secondary HLH during their metabolic attacks. All patients fulfilled the 5 HLH criteria of the Histiocyte Society. Familial HLH was ruled out by molecular analysis. Plasma exchange was performed for 2 of them. Unfortunately 1 died of multiorgan failure despite intensive therapy. This is the first report of such an association.

Pretransplant serum ferritin level may be a predictive marker for outcomes in patients having undergone allogeneic hematopoietic stem cell transplantation

Iron overload increases the risk of infections, veno-occlusive disease and hepatic dysfunction in post-transplant period. Our objective was to investigate the association of pre-transplant ferritin levels with complications and survival after allogeneic hematopoietic stem cell transplantation (alloHSCT).We retrospectively analysed 84 patients' data who had undergone allogeneic HSCT into two groups: patients with a serum ferritin level ≥ 1000 ng/ml, and patients with <1000 ng/ml at the time of HSCT.Cox-regression analysis showed that pre-transplant serum ferritin levels were significantly higher in patients who had at least one infectious event compared with those who had no any infectious event in the post-transplant 100 days (p<0.023). Overall survival (OS) and disease-free survival (DFS) rates were significantly higher in patients with a time-to-tx interval 12 months (p=0.002 and p=0.008 respectively). A higher risk of death was observed in high-ferritin group (hazard ratio=2.27, CI:1.01-5.09, p=0.023 for OS and hazard ratio=2.49, CI:1.12-5.53 p=0.039 for DFS). No significant effect on OS and DFS among groups was observed for variables conditioning regimen, gender and diagnosis. Acute GVHD was more common in patients with a ferritin level ≥ 1000 ng /mL, but this was not statistically significant (p>0.05). There was no statistical significance in both groups (ferritin ≥ 1000 ng /mL and ferritin <1000 ng/mL) for relapse rates (p>0.05). Platelet and neutrophil engaftment day was not found statistically significant compared with both groups (p=0.273 and p=0.882, respectively). Pre-transplant ferritin levels may predict poor outcomes in patients who had undergone allogeneic hematopoietic stem cell transplantation.

A 39-year-old man with a generalized rash with bupropion XL administration

Introduction

An once-daily formulation, bupropion XL, was developed with the goal of further improving tolerability and compliance (1). Common adverse effects contain dry mouth, nausea, constipation, headache, agitation and skin rash (2).

Objective

A case of skin rash caused by bupropion XL used for depression is discussed.

Results

A 39-year-old man with depression developed a rash on his extremities 13 days after the initiation of bupropion XL followed by pruritus of the arms, feet, and face.

Conclusions

To our knowledge, this is the first reported case of skin rash and urticaria induced by bupropion XL therapy. The most common cutaneous side-effect is urticaria and rash by bupropion XL. This develops from between 8 and 21 days after taking the medicine (3). In our case dermatological side effects developed on 13 days. On discontinuation of bupropion XL, there was whole resolution of symptom. We report this case to notify clinicians of the potential dermatological side effects that can occur with extended release bupropion therapy.

Effects of selective and non-selective cyclooxygenase (COX) inhibitors on postoperative adhesion formation in a rat uterine horn model

OBJECTIVE

To investigate the effects of cyclooxygenase (COX) inhibitors including celecoxib, indomethacin, and nimesulide on postoperative adhesion formation.

MATERIAL AND METHODS

Forty-eight female Wistar-Albino rats were randomly divided into four groups: control (saline solution), celecoxib, indomethacin, and nimesulide groups. The uterine horns of rats were traumatized with unipolar electrocautery. Drugs of each group and saline in the control group were insillated on travmatized areas of horns as intraperitoneally. After three weeks, the extent and severity of adhesions with a standardized scoring system were evaluated.

RESULTS

The extent and severity of postoperative adhesions were significantly reduced in nimesulide group compared with the control group. The extent but not severity of adhesions in rats given indomethacin was significantly reduced. Celecoxib showed no significant reduction in the extent and severity of adhesions.

CONCLUSION

Nimesulide is more effective than the other COX inhibitors in the prevention of postoperative adhesions in rats.