Browsing by Author "Demir, Cengiz"

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Acetylsalicylic Acid Resistance Incidence and Possible Causes in Patients With Type II Diabetes Mellitus
(2010) Taşdemir, Eyyüp; Demir, Cengiz
Giriş: Tip 2 diyabet hastalarında tüm ölüm nedenlerinin %70 inin Kardiyovasküler komplikasyonlar ve tromboembolik olaylar olduğu kabul edilmektedir. Diyabetik hastaların trombositleri aspirine daha az duyarlıdır. Biz bu çalışmada antitrombotik tedavi amacıyla aspirin kullanan tip 2 diyabetli hastalarda mevcut aspirin drencinin sıklığını araştırmayı ve olası nedenlerini ortaya koymayı amaçladık.Materyal-Metod: Çalışmaya aspirin tedavisi kullanan 98'i diyabetik ve 39'u non-diyabetikti toplam 137 hasta dâhil edildi. Hastaların kollojen ADP ve kollojen epinefrin düzeylerine PFA?100® trombosit işlev inceleyicisi yöntemi ile bakıldı. Kollojen epinefrin düzeyine göre de cevaplı (kollojen epinefrin>300sn), yarı cevaplı (kollojen epinefrin 150-300sn) ve cevapsız (kollojen epinefrin <150sn) olarak gruplandırıldı. Hematolojik ve biyokimyasal parametreler aspirin direncine göre karşılaştırıldı.Bulgular: Diyabetik hastaların 32(%34,4)'si, non-diyabetik hastaların 14(%35,8)'ünde direnç vardı. Aspirine dirençlilerde HbA1c daha yüksekti (p=0,028). RDW ise aspirine cevaplı hastalarda daha yüksekti (p=0,045). BMI aspirin direnci varlığında daha yüksek bulunurken (p=0,021), kollojen epinefrin oranları serum kolesterol düzeyleri ile negatif korele (p<0,05). Digoksin kullanmayan hastaların ASA ya tam cevap oranı istatistiksel açıdan daha fazlaydı (p=0,049). Glukoz MPV ile pozitif korele bulundu (p<0,001).Sonuç: Diyabetik hastalarda HbA1c ile aspirin direnci arasında pozitif bir korelasyon bulunması sekonder koruma amaçlı aspirin kullanan tip 2 diyabetik hastalarda kan şekeri regülasyonunun önemini göstermektedir. Ayrıca hiperlipidemi ve obezite aspirin direnci nedenleri arasında ön plana çıkmaktadır.
Adrenal Yetmezlik Ile Seyreden Bilateral Adrenal Bez Primer Non-Hodgkin Lenfoması
(2006) Demir, Cengiz; Arslan, Halil; Dilek, İmdat; Erkoç, Reha; Gökdeniz, Erdem
Adrenal glandın primer malign lenfoması oldukça nadirdir. Tanı histopatolojik olarak konulur. En sık şekli diffüz büyük hücreli formudur. Adrenal lenfomalar genellikle tesadüfen saptanırlar. Adrenal yetmezlik primer adrenal lenfomalı hastaların 1/3 ünden fazlasında görülmesine rağmen yetmezlik genellikle subkliniktir ve sadece laboratuvar testleri ile tespit edilir. Burada, primer adrenal yetmezlik ve batın tomografisinde bilateral adrenal kitle tespit edilen ve ultrason eşliğinde kitleden alınan biyopsi ile diffüz büyük B hücreli lenfoma tanısı konulan 52 yaşında bir erkek olgu sunduk.
Akut Lenfoblastik Lösemi Tanılı Hastada Gelişen Mukormikozis: Olgu Sunumu
(2019) Ekinci, Ömer; Demir, Cengiz; Dogan, Ali; Düzenli, Ufuk; Demircioğlu, Sinan; Baran, Ali Irfan; Bayram, İrfan
Mukormikoz, yüksek morbidite ve mortaliteye sahip, nadirgörülen bir mantar enfeksiyonudur. Rino-orbito-serebralformu sık görülmektedir. Bu formun tedavisinde amfoterisinB ve cerrahinin birlikte uygulanması önerilmektedir. Ancak butedavilere rağmen mortalitesi oldukça yüksektir. Bizde akutlenfoblastik lösemi tanılı hastamızda gelişen 3 kez cerrahiuyguladığımız eş zamanlı hem intravenöz hemde burun içilipozomal amfoterisin B uygulayarak başarılı bir şekilde tedaviettiğimiz mukormikozis olgusunu sunduk.
Akut Lösemili Hastalarda Notropenik Ateş Ataklarının Değerlendirilmesi
(2002) Demir, Cengiz; Dilek, İmdat; Akdeniz, Hayrettin; Buzğan, Turan; Evirgen, Ömer; Irmak, Hasan; Demiröz, A. Pekcan
Amaç: Bu çalışmada akut lösemili hastalarda nötropenik ateşe neden olan etkenler belirlenerek, uygulanan tedavi protokolleri ve tedavi sonuçları tartışıldı. Yöntem: Bu amaçla Temmuz 1997 - Şubat 2002 tarihleri arasında Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Hematoloji Kliniğinde akut lösemi tanısı ile tedavi edilen 40 hastada (33 AML, 7 ALL) toplam 84 febril nötropenik atak prospektif ve retrospektif olarak değerlendirildi. Bulgular: Mikrobiyolojik tanı, 7'si bakteriyemili, 6'sı bakteriyemisiz olmak üzere 13 atakta (%15.4) kültür yöntemleri ile konuldu. Kan kültürlerinin 4'ünde gram pozitif, 3'ünda gram negatif bakteriler izole edildi. Gram pozitif bakterilerden en sık etkenin koagülaz-negatif stafilokoklar (4/13), gram negatif bakterilerden ise en sık etkenin Escherichia coli (4/13) olduğu görüldü. Ateş nedeni araştırıldığında; 40 atakta (%47.6) olası infeksiyon odağı klinik bulgulara dayanarak saptanırken, 31 atakta (%36.9) infeksiyon odağı saptanamadı. Başlangıç tedavisi olarak 44 (%52.4) atakta sefepim + amikasin, 25 (%29.8) atakta seftazidim+ amikasin, 15 (%17.8) atakta imipenem + amikasin kullanıldı. 37 atakta (%44) tedaviye vankomisin, llatakta (%13.1) teikoplanin, 11 atakta (%13.1) amfoterisin-B eklendi. Başlangıç tedavisine cevap oranları sırasıyla; %41, %40 ve %33.3 iken, modifiye tedavilere cevap oranları, sırasıyla %75, %72 ve %71.4 olarak gerçekleşti. Sonuç: Akut lösemili hastalarda gelişen nötropenik ateş ataklarında, uygun ampirik tedavi başlanması ve sonrasında yakın klinik takip ile uygun modifikasyonların yapılması, tedaviye cevabı büyük oranda arttırmaktadır.
Altered Serum Levels of Elements in Acute Leukemia Cases in Turkey
(Asian Pacific Organization Cancer Prevention, 2011) Demir, Cengiz; Demir, Halit; Esen, Ramazan; Sehitogullari, Abidin; Atmaca, Murat; Alay, Murat
Objective: The purpose of the study was to compare serum concentrations of some elements [zinc (Zn), copper (Cu), manganese (Mn), magnesium (Mg), lead (Pb), iron (Fe), cadmium (Cd) and cobalt (Co)] in acute leukemia patients with those of healthy subjects. Methods: The study group consisted of newly diagnosed acute leukemia patients and the controls were matched for socioeconomic stauts and eating habits. The elements levels in the patient group were measured before treatment with an atomic absorption spectrophotometer. The selection criteria for the patients and controls were the lack of recent blood transfusion history and taking any medication with mineral supplement. Results: The acute leukemia group composed of 42 patients and there were 40 persons in the control group. There was no difference between the age of the two groups (p=0.239). Serum levels of Zn, Mg and Mn were significantly lower with acute leukemia than in controls (p<0.001, p=0.011, p<0.001, respectively), while Cu, Pb and Cd were significantly elevated (p=0.003, p<0.001, p<0.001, respectively). There were no significant differences regarding Co and Fe (p=0.323 and p=0.508, respectively) Conclusion: In this study, we found levels of Zn, Mg and Mn to be lowered and of Cu, Pb and Cd to be elevated in patients with leukemia. Further studies are needed to clarify the role of these elements in pathogenesis of acute leukemia.
Aspirin Resistance in Patients With Type Ii Diabetes Mellitus
(Taylor & Francis Ltd, 2014) Tasdemir, Eyyup; Toptas, Tayfur; Demir, Cengiz; Esen, Ramazan; Atmaca, Murat
Background. Diabetic patients exhibit platelet hyperreactivity, which renders them resistant to antithrombotic treatments. We aimed to investigate the prevalence and predictors of aspirin resistance in diabetic patients. Material and methods. A total of 93 diabetic and 37 non-diabetic participants were included into the study. Aspirin resistance was measured with a whole-blood desktop platelet function analyzer (PFA-100) with an epinephrine agonist. Results. Altogether 41.9% patients with DM were aspirin non-responders. Aspirin resistance was observed in 43.2% of nondiabetic patients (p = 0.89). Presence of diabetes mellitus had no effect on aspirin response (RR 0.95 (95% CI 0.44-2.05), p = 0.89) in the whole study population. Hypercholesterolemia was the only predictor of aspirin resistance in multivariate analysis in diabetic patients (RR 3.09 (95% CI 1.17-8.16), p = 0.023). Conclusion. The prevalence of aspirin resistance is comparable in diabetic and non-diabetic patients. Hypercholesterolemia is the only independent predictor of aspirin resistance in diabetic patients.
Assessment of Malnutrition in Adult Acute Leukemia Cases
(Asian Pacific Organization Cancer Prevention, 2010) Turedi, Ali; Demir, Cengiz; Dilek, Imdat
Introduction: This study examined malnutrition in acute leukemia cases, and its association to the treatment. Methods: 54 cases, consisting of 40 patients with acute myeloblastic leukemia (AML) and 14 patients with acute lymphoblastic leukemia (ALL) were included to the study, where further 34 healthy subjects were also recruited. Body mass index (BMI), triceps skin-fold thickness (TST), mid-arm circumference (MAC) and biochemistry tests were used for the assessment tools of malnutrition. Results: When classified according to BMI, prevalence of malnutrition was 18.5% in all cases, 18% in newly-diagnosed cases, 20% in patients with remission and 16% without remission, and 5.8% in control group. No statistically significant difference was found between groups (p=0.47). Prevalence of malnutrition according to TST and MAC was not difference in patient and control group (p=0.048), (p=0.37). Patients with malnutrition according to BMI had also significant malnutrition according to TST and MAC measurements (p < 0.001). Conclusions: Prevalence of malnutrition was seen at higher percentage in adult acute leukemia cases, which was increased during the course of treatment, and TST measurement was better in establishing malnutrition.
Association of Multiple Myeloma and Gastric Adenocarcinoma
(2011) Atmaca, Murat; Demir, Cengiz; Efe, Servet; Taşdemir, Eyüp
Multipl miyeloma ile solid tümör birlikteliği gösterilmiştir. Ancak multipl miyelomanın ikincil bir tümör gelişiminde bir risk faktörü olup olmadığı tartışmalı bir konudur. Biz burada multipl myeloma ve mide adenokarsinomu tanılı bir olgu sunduk. Olgumuz 77 yaşında erkek hasta kemik ağrısı, sol bacakta güçsüzlük, kilo kaybı ve epigastrik ağrı şikayetleri ile başvurdu. Hastada monoklonal gammapati, kemiklerde litik lezyonlar ve kemik iliğinde plazma hücre infiltrasyonu tespit edildi. Endoskopik incelemede midenin kardiya proksimalinde kitle tespit edildi, ülsere kitleden alınan biyopsi örneklerinde adenokarsinom saptandı.Sonuç olarak, bu iki hastalık birlikte görülebilir. Bu iki hastalığın birlikte görülmesinin açıklaması ileri geniş çaplı araştırmaların yapılmasını gerektirmektedir
Atropa Belladonna ile Zehirlenme: Bir Olgu Sunumu
(2006) Mete, Rafet; Dilek, İmdat; Demir, Cengiz; Dülger, Cumhur; Arslan, Şevket
Antikolinerjik zehirlenme zamanında tanınmadığında ölümcül klinik tablo oluşturabilmektedir. Atropa belladonna Linnaeus (L.), antikolinerjik etkiyle zehirlenme yapar. Bu yazıda bu bitkinin alımı sonucu zehirlenme gelişen bir olgu sunulmuştur. Altmış dört yaşında erkek hasta, bulantı, kusma, baş ağrısı, anlamsız konuşma, çarpıntı, vücudunda ve yüzünde kızarma ve idrar yapamama şikayetleriyle acil servisimize getirildi. Fizik muayenesinde hipertansiyon, ateş, taşikardi, midriazis, yüzünde kızarıklık ve ağız mukozasında kuruluk olduğu tespit edildi. Lökositoz dışında laboratuar bulgularında herhangi bir anormallik yoktu. Hastada antikolinerjik semptom ve bulguların varlığı ve hikayesinde de şikayetlerinin bir bitki alımından sonra başlamış olması nedeniyle zehirlenme düşünüldü. Daha sonra getirtilen bitkinin Atropa belladonna L. olduğu anlaşıldı. Fizostigmin olmadığından hastanın tedavisine konservatif olarak yaklaşıldı. Gastrik lavaj uygulandıktan sonra, aktif kömür başlandı. Hasta monitorize edildi ve ajitasyonu benzodiazepin ile kontrol altına alındı. Hipertermisi için de periferik soğutma uygulandı. Üriner retansiyonu idrar sondası ile giderildi. Sonuç olarak, ajitasyonu veya konfüzyonu olup zor konuşan ve dilate pupiller ile birlikte ateşi, antikolinerjik zehirlenme bulguları olan hastalarda Atropa belladonna L. ile zehirlenmenin de düşünülmesi ve zamanında müdahalenin hayati önem taşıyacağı bilinmelidir.
Author's Reply: Predictors of Aspirin Resistance
(informa Healthcare, 2014) Toptas, Tayfur; Tasdemir, Eyyup; Demir, Cengiz; Esen, Ramazan; Atmaca, Murat
Bone Marrow Biopsy Findings in Brucellosis Patients With Hematologic Abnormalities
(Lippincott Williams & Wilkins, 2012) Demir, Cengiz; Karahocagil, Mustafa Kasim; Esen, Ramazan; Atmaca, Murat; Gonullu, Hayriye; Akdeniz, Hayrettin
Background Brucellosis can mimic various multisytem diseases, showing wide clinical polymorphism that frequently leads to misdiagnosis and treatment delay, further increasing the complication rates. In this study, we aimed to examine bone marrow biopsy findings in brucellosis cases presenting with hematologic abnormalities. Methods Forty-eight brucellosis cases were prospectively investigated. Complaints and physical examination findings of patients were recorded. Patients' complete blood count, routine biochemical tests, erythrocyte sedimentation rate, C-reactive protein and serological screenings were performed. Bone marrow biopsy and aspiration was performed in patients with cytopenia, for bone marrow examination and brucella culture, in accordance with the standard procedures from spina iliaca posterior superior region of pelvic bone. Results Of the 48 patients, 35 (73%) were female and 13 (27%) were male. Mean age was (34.8 15.4) years (age range: 15-70 years). Anemia, leukopenia, thrombocytopenia and pancytopenia were found in 39 (81%), 28 (58%), 22 (46%) and 10 patients (21%), respectively. In the examination of bone marrow, hypercellularity was found in 35 (73%) patients. Increased megacariocytic, erythroid and granulocytic series were found in 28 (58%), 15 (31%) and 5 (10%) patients, respectively. In addition, hemophagocytosis was observed in 15 (31%) patients, granuloma observed in 12 (25%) and increased eosinophil and plasma cells observed in 9 (19%) patients. Conclusion According to the results of our series, hemophagocytosis, microgranuloma formation and hypersplenism may be responsible for hematologic complications of brucellosis. Chin Med J 2012;125(11):1871-1876
Bone Marrow Metastasis of Alveolar Rhabdomyosarcoma Mimicking Burkitt’s Lymphoma
(2018) Demircioğlu, Sinan; Dogan, Ali; Bayram, İrfan; Demir, Cengiz; Ekinci, Ömer
Some rare malignant diseases exhibit clinical features and bone marrow aspirate morphology similar to that of acute leukemia. For instance, rhabdomyosarcoma, neuroblastoma, medulloblastoma, anaplastic oligodendroglioma, small cell carcinoma, Ewing’s sarcoma and neuroendocrine tumors have been reported to display an acute leukemia-like morphology in bone marrow aspirates after metastasizing to the bone marrow. Rhabdomyosarcoma (RMS), a malignant tumour of mesenchymal origin which can occur at various sites in the body, is one of the most common soft tissue sarcomas in both children and adolescents, but is rare in adults with a prevalence of less than 1 %. Bone marrow metastases associated with this condition may be readily confused with acute leukemia or lymphoma. Diagnostic confirmation requires immunohistochemical and flowcytometric examinations. In patients with positive CD56 and negative CD45, rhabdomyosarcoma should be included in the differential diagnosis. Here, we report an unusual case of RMS confined to the bone marrow in an older adult.
Clinical and Laboratory Features of Cd5-Negative Chronic Lymphocytic Leukemia
(int Scientific Literature, inc, 2017) Demir, Cengiz; Kara, Erdal; Ekinci, Omer; Ebinc, Senar
Background: Chronic lymphocytic leukemia (CLL) usually expresses CD5 antigen. However, 7-20% of patients are CD5 negative. We report here a series of 19 CD5-negative B-CLL cases. Material/Methods: We reviewed 19 consecutive CD5-negative B-CLL cases seen in our medical center from 2009 to 2015 and compared them with 105 CD5-positive B-CLL cases. The two groups were compared in terms of clinical parameters, laboratory parameters, and survival characteristics. Results: Lymphadenopathy was present in 31.5% of the CD5-negative group and 51.4% of the CD5-positive group (p=0.029). Splenomegaly was present in 42.1% of the CD5-negative group and 16.1% of the CD5-positive group (p=0.029). There was no difference between the groups in terms of Binet A, B, and C stages (p=0.118, p=0.051, and p=0.882, respectively). The median thrombocyte count was 144x10(9)/L and 160x10(9)/L in the CD5- negative and CD5- positive groups, respectively (p=0.044).There was no difference between the two groups in terms of median neutrophil count (p=0.169). The mean lymphocyte count was 43.2 +/- 4.0x10(9)/L and 36.7 +/- 3.2x10(9)/L in the CD5-negative and CD5-positive groups, respectively (p=0.001). There was no difference between the groups in terms of autoimmune hemolytic anemia and autoimmune thrombocytopenia. In five-year follow-up, 84.2% of CD5-negative patients and 90.5% of CD5-positive patients were alive (p=0.393). Conclusions: We found more isolated splenomegaly, less lymphadenopathy, a higher lymphocyte count, and a lower thrombocyte count in the CD5-negative group. There was no difference between the groups in terms of clinical stage, autoimmune phenomena, hemoglobin and neutrophil count, and survival.
Clinical and Serological Autoimmune Complications in Chronic Lymphocytic Leukemia
(Springer Wien, 2017) Demir, Cengiz; Ekinci, Omer
Autoimmune disorders often develop during the course of chronic lymphocytic leukemia (CLL). The aim of our study was to investigate the incidence of autoimmune complications (AIC) and serological autoantibodies, and to assess the relationship of these to patient characteristics. We prospectively collected screenings of AIC and serological markers from a total of 192 patients. AIC was observed in 18 (9.4%) patients. Autoimmune hemolytic anemia (AIHA) was observed in 8 patients. Autoimmune thrombocytopenia (AITP) was observed in 3 patients. Other various types of AIC were observed in the remaining 7 patients. Serological autoantibodies were positive in 17.2% of patients with CLL. The mean age of patients with AIC was higher than the control group (p = 0.036). Patients with AIC were mostly in advanced disease stage (p = 0.004), and they had received more first-line treatments than the control group (p = 0.003). Patients with AIC had a higher mean age and more advanced disease stage than patients with positive serological autoantibodies (p = 0.020 and p = 0.009; respectively). In addition, patients with AIC had also received more first-line treatment than the patients with positive serological autoantibodies (p = 0.015). Hematologic AIC was associated with older age, advanced disease stage, and treatment. Conversely, non-hematological AIC and serological autoantibodies are generally observed in early stages. Our study has established a coexistence of CLL and autoimmune complications. Hematologists are usually familiar with AIHA and AITP, but less so with non-hematologic AIC. The latter complications should be carefully searched for, particularly in patients with early CLL.
Clinical Features and Responses To Eculizumab of Paroxysmal Nocturnal Hemoglobinuria Patients: a Single-Center Experience
(2019) Sonmez, Gulcin Miyase; Demir, Cengiz; Demircioğlu, Sinan; Ekinci, Omer
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal hematopoietic stem cell disease classically characterized by chronic intravascular hemolysis, bone marrow failure, and thrombosis. Eculizumab is an anti-C5 monoclonal antibody proven to reduce hemolysis and thrombotic attacks in the treatment of PNH. We aimed to present our data on PNH, a rare disease, and to share our experiences treating PNH with eculizumab. Demographic data, clinical features, history of thrombosis, responses to eculizumab treatment, and survival rates of 9 patients diagnosed with PNH at our hematology center were retrospectively analyzed. The median follow-up period was 46 months (range: 25-62). Five of the patients were female (55.5%), and 4 were male (44.5%), with a median age of 33.5±12.3 years. The mean hemoglobin level was 8.2 g/dL (5.7–10.1 g/dL), mean leukocyte count was 5.80x103/μL (1.72x103/μL–8.30x103/μL), mean platelet count was 96.6x103/L (42x103/μL–214x103/μL), mean lactate dehydrogenase level was 1312 U/L (423–2690 U/L), and mean reticulocyte level was 3.76% (1.1–6.3%). In our study, all cases received eculizumab therapy, of which 8 exhibited full or partial responses, while one was unresponsive to treatment. All patients were alive after the follow-up period. In 8 of the nine patients treated with eculizumab, hemolysis decreased following treatment and blood transfusion was not necessary. The quality of life experienced by all patients was improved. Following determination of the pathogenesis of the PNH, besides the classical treatment methods, eculizumab is a popular treatment option.
Çocukluk Çağı Akut Lenfoblastik Lösemi Olgularında L-asparajinaz'a Bağlı Toksisite
(2005) Mukul, Yurdagül; Öner, Ahmet Faik; Acikgoz, Mehmet; Demir, Cengiz; Cesur, Yaşar; Bay, Ali
L-Asparajinaz yüksek oranda toksisiteye sahip olmakla birlikte çocukluk çağı akut lenfoblastik lösemi (ALL) tedavisinde vinkristin ve prednizon ile başlama tedavisinin standart bileşenidir ve başarıyı önemli oranda artırır. Bu çalışmada indüksiyon kemoterapisinde L-asparaginaz kullandığımız 85 ALL'Ii olguda gelişen yan etkiler ye tedavileri incelendi. Olgularımızın 28 (%32.9) tanesinde L-aşparaginaza bağlı yan etki gelişti. Olgularımızda en sık görülen yan etkiler allerji, hiperglisemi ve hipertrigliseridemi idi. Daha az görülen yan etkiler ise pankreatit, parotitis ve trombozdu. Sonuç olarak, olgularımızdaki L-asparaginaza bağlı toksisite görülme sıklığı ve tipi ülkemizde diğer merkezlerden bildirilen oranlara benzer olarak izlendi.
Comparison of the Effects of Oral Iron Treatment Every Day and Every Other Day in Female Patients With Iron Deficiency Anaemia
(Wiley, 2020) Oflas, Nur Duzen; Demircioglu, Sinan; Dogan, Narin Yildirim; Eker, Elife; Kutlucan, Ali; Dogan, Ali; Demir, Cengiz
Background: It is known that daily divided doses and high doses of iron increase hepcidin and reduce iron absorption. Aim: To compare treatments of iron replacement every other day at low doses, once a day and twice a day in terms of their effectiveness and frequencies of side-effects. Methods: For 1 month, Group I received 270 mg ferrous sulphate twice a day (total elemental iron dose: 160 mg/day), Group II received 270 mg ferrous sulphate once a day (total elemental iron dose: 80 mg/day), and Group III received 270 mg ferrous sulphate every other day (total elemental iron dose: 80 mg/every other day). Intragroup and intergroup statistical analyses were carried out. Results: Haemoglobin (Hb) increased significantly in all three groups (P = 0.00). The increase in Hb levels was similar among the groups (P = 0.09). Ferritin significantly increased in all three groups after the treatment (P = 0.00). The increase in ferritin in Group I was significantly higher than those in Groups II and III (P < 0.05). Gastrointestinal tract (GIS) side-effects were also significantly higher in Group I in comparison to the others (P = 0.001). Conclusions: A low dosage of iron treatment every other day may be used in the place of providing iron once or twice every day with similar effectiveness and lower rates of GIS side-effects.
Decreased Bone Mineral Density and Associated Factors in Severe Haemophilia a Patients: a Case-Control Study
(Wiley, 2019) Ekinci, Omer; Demircioglu, Sinan; Dogan, Ali; Merter, Mustafa; Yildiz, Saliha; Demir, Cengiz
Introduction Haemophilia patients may exhibit lower levels of bone mineral density (BMD) than the general population for a variety of reasons. Aim We aimed to investigate decreased BMD in people with severe adult haemophilia A (PWH) living in eastern Turkey, and to evaluate the related potential risk factors. Methods The study included 41 PWH and 40 healthy volunteers. Dual-energy x-ray absorptiometry (DXA) was used to measure the BMD. Blood tests and body mass index (BMI) were recorded. The Functional Independence Score in Hemophilia (FISH) test was used to measure functional ability status. Results There was a significant difference between the PWH and control groups with respect to femoral neck and total hip BMD (in g/cm(2)), but the difference for lumbar spine was not significant (P = .017, P < .001, P = .071, respectively). In PWH, patients under 50 years of age, 19.4% were found to have "lower than expected" BMD levels for their age, while 27.8% showed "low normal" levels. In PWH, osteoporosis was found in 60% of the patients over 50 and osteopenia in 20%. Vitamin D insufficiency and deficiency were present in 63.4% of the PWH, significantly higher than the control group (37.5%; P < .001). Conclusion The results indicated that the decrease in BMD was significantly greater in patients with severe haemophilia A than in the normal healthy population. This reduction was correlated with BMI, vitamin D and low functional ability status. However, in multivariate analysis, none of these was a strong independent risk factor.
Delayed Diagnosed Subclinic Von Willebrand Disease Case Report
(derman Medical Publ, 2013) Ceylan, Mehmet Fethi; Guner, Savap; Turktas, Ugur; Goktas, Ugur; Demir, Cengiz
The evaluation of the patients who will be operated in terms of preoperative bleeding diathesis is an obligation. This evaluation contains history, physical examination and tests of haemostasis. That are as a routin used among these tests are the number of platelet, PT, aPTT and the values of INR. Despite these assessments, all of the bleeding-clotting disorders have not been able to be determined. Therefore, due to omitted diagnosis of bleeding diathesis, in orthopedic procedures, hemartroz hemarthrosis, intramuscular hematoma, and abandoned bleeding may develop in the postoperative period. These complications are the causes of morbidity and mortality. In one of our cases, who had osteochondroma in his femur diaphysis and also whose preoperative history, examination and mentioned tests were normal, developed recurrent bleeding and hematoma in the operative area in the postoperative period. Von Willebrand disease was determined in the examination which was carried out by being considered bleeding diathesis. As a result, seen at the rate of 1% in community screening and the most common inherited bleeding diathesis, in the cases of Von Willebrand disease's subclinical a good patient history should be taken in order to be able to be early dianosed diagnosed and to be able to be prevent the complications and also the necessary tests for diagnosis should be performed.
Demir Eksikliği Anemisi ve Tedavisinin P Dalga Süreleri ve Diyastolik Fonksiyon Parametreleri Üzerine Etkileri
(2010) Kaya, Yüksel; Gunes, Yilmaz; Demir, Cengiz; Şahin, Musa; Gümrükcüoğlu, Hasan Ali; Tuncer, Mustafa; Şimşek, Hakkı
Amaç: Bu makalenin amacı kronik demir eksikliği anemisinin (DEA) hastaların sol ventrikül (SV) diyastolik fonksiyon parametreleri ile P dalga sürelerine etkisi ve anemi tedavisinin bu parametreler üzerinde yapabileceği değişiklikleri araştırmaktır.Gereç ve yöntem: Çalışmaya kalp-damar hastalığı olmayan 56 kronik DEA hastası ve 50 sağlıklı birey alındı. Vakalar başlangıçta ve anemi tedavi edildikten sonra anamnez, fizik muayene, elektrokardiyografi (EKG) ve transtorasik ekokardiyografi (TTE) ile değerlendirildi. TTE ile konvansiyonel parametrelerin yanı sıra doku doppler yapıldı. 12 derivasyonlu EKG de en uzun P dalga süresinden (Pmaks) en kısa P dalga süresi (Pmin) çıkarılarak P dalga dispersiyonu (PDD) hesaplandı.Bulgular: Kontrol grubuna göre, DEA hastalarında sol atriyum (SA) çapı (p=0.02), sol ventrikül diastol sonu çapı (LVDÇ) (p=0.001), diastolik disfonksiyon sıklığı (p=0.02), Pmaks (p=0.002) ve PDD (p=0.001) anlamlı derecede artmıştı. Korelasyon analizi ile diastolik disfonksiyon sıklığının (r=0.231, p=0.02) ve PDD’nin (r=0.367, p=0.001) anemi derinliğiyle anlamlı derecede ilişkili olduğu saptandı. Tedavi öncesiyle kıyaslandığında tedavi sonrasında SA çapı (p=0.001), LVDÇ (p=0.001), diastolik disfonksiyon sıklığı (p=0.001), Pmaks (p=0.001), Pmin ( p=0.001) ve PDD (p=0.001) anlamlı derecede azalmıştı.Sonuç: DEA’nin şiddetine paralel olarak PDD, sol kalp boyutları ve SV diyastolik disfonksiyon sıklığının arttığı gözlendi. Aneminin tedavisiyle bozulan bu değişkenlerde düzelme sağlandı.