The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in ...this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 × 10
/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.
Background
Tuberculosis (TB) is a systemic infectious disease that is caused by Mycobacterium tuberculosis and which can affect many tissues and organs. Despite the development of curative and ...preventive therapies in recent years, TB continues to be a serious health problem, in the developing countries in particular.
Case presentation
In this case report, an extraordinary case of miliary tuberculosis with unexplained fever, joint pain, weight loss, pancytopenia, lymphadenopathy and splenomegaly, who was clinically suspected of lymphoma and successfully treated with a multidisciplinary approach without any complications, was presented. This case has been reported not because it is a rare case, but to raise awareness. It is a case, where early diagnosis and initiation of treatment early, as well as an individualized and multidisciplinary treatment approach emerged as the most important factors resulting in an improvement prognosis.
Conclusion
Extrapulmonary TB, if with lymph node involvement in particular, can easily mimic lymphoma. Imaging methods and clinical findings may be insufficient to distinguish these two conditions at the time of diagnosis. In such a case, it will be beneficial for the patient to proceed with an experienced team in the management of the patient.
Although bone marrow metastases can be found commonly in some malignant tumors, diagnosing a nonhematologic malignancy from marrow is not a usual event.
To underscore the value of bone marrow ...aspiration and biopsy as a short cut in establishing a diagnosis for disseminated tumors, we reviewed 19 patients with nonhematologic malignancies who initially had diagnosis from bone marrow.
The main indications for bone marrow examination were microangiopathic hemolytic anemia (MAHA), leukoerythroblastosis (LEB) and unexplained cytopenias. Bone marrow aspiration was not diagnostic due to dry tap or inadequate material in 6 cases. Biopsy results were parallel to the cytological ones in all cases except one; however a meticulous second examination of the biopsy confirmed the cytologic diagnosis in this patient too. The most common histologic subtype was adenocarcinoma, and after all the clinical and laboratory evaluations, the primary focus was disclosed definitively in ten patients (5 stomach, 3 prostate, 1 lung, 1 muscle) and probably in four patients (3 gastrointestinal tract, 1 lung). All work up failed in five patients and these cases were classified as tumor of unknown origin (TUO).
Our series showed that anemia, thrombocytopenia, elevated red cell distribution width (RDW) and hypoproteinemia formed a uniform tetrad in patients with disseminated tumors that were diagnosed via bone marrow examination. The prognosis of patients was very poor and survivals were only a few days or weeks (except for 4 patients whose survivals were longer). We concluded that MAHA, LEB and unexplained cytopenias are strong indicators of the necessity of bone marrow examination. Because of the very short survival of many patients, all investigational procedures should be judged in view of their rationality, and should be focused on treatable primary tumors.
This study aimed to evaluate real-life data on patterns of hydroxyurea prescription/use in polycythemia vera (PV).
This retrospective chart review study included PV patients who had received ...hydroxyurea therapy for at least 2 months after PV diagnosis. Data were collected from 10 representative academic medical centers.
Of 657 patients, 50.9% were in the high-risk group (age ≥60 years and/or history of thromboembolic event). The median duration of hydroxyurea therapy was 43.40 months for all patients; 70.2% of the patients had ongoing hydroxyurea therapy at last follow-up. Hydroxyurea was discontinued in 22.4% of the patients; the most common reason was death (38.5%). The predicted time until hydroxyurea discontinuation was 187.8 months (standard error: ±21.7) for all patients. This duration was shorter in females (140.3±37.7 vs. 187.8±29.7) (p=0.08). This trend was also observed in surviving patients aged ≥50 years at hydroxyurea initiation (122.2±12.4 vs. 187.8±30.7, p=0.03). Among the patients who were still on hydroxyurea therapy, 40.3% had a hematocrit concentration of ≥45% at their last follow-up visit, and the rate of patients with at least one elevated blood cell count was 67.8%.
Hydroxyurea prescription patterns and treatment aims are frequently not in accordance with the guideline recommendations. Its discontinuation rate is higher in females.
We aimed to assess the effectiveness, benefits, and reliability of percutaneous vertebroplasty (PV) in patients with vertebral involvement of multiple myeloma.
PV procedures performed on 166 ...vertebrae of 41 patients with multiple myeloma were retrospectively evaluated. Most of our patients were using level 3 (moderate to severe pain) analgesics. Magnetic resonance imaging was performed before the procedure to assess vertebral involvement of multiple myeloma. The following variables were evaluated: affected vertebral levels, loss of vertebral body height, polymethylmethacrylate (PMMA) cement amount applied to the vertebral body during PV, PMMA cement leakages, and pain before and after PV as assessed by a visual analogue scale (VAS).
Median VAS scores of patients decreased from 9 one day before PV, to 6 one day after the procedure, to 3 one week after the procedure, and eventually to 1 three months after the procedure (P < 0.001). During the PV procedure, cement leakage was observed at 68 vertebral levels (41%). The median value of PMMA applied to the vertebral body was 6 mL.
Being a minimally invasive and easily performed procedure with low complication rates, PV should be preferred for serious back pain of multiple myeloma patients.
While autoimmune hemolytic anemia (AIHA) is expected in non-Hodgkin’s lymphomas, it is less common in marginal zone lymphoma. Sixty-year-old male patient was followed up with hemolytic anemia in our ...clinic and while the etiology was investigated, scattered nodes in the mediastinum and abdomen compatible with lymphoproliferative disease were observed on CT, and positive detection of CD5, CD19, CD20, CD22, CD45, HLA-DR, FMC-7 on flow cytometry sent from peripheral blood and a diagnosis of low grade B cell lymphoma (MZL) was made with the result of bone marrow pathology. We found it appropriate to present our MZL case because of its response to steroid treatment and its rare presentation with AIHA.
Although splenectomy is markedly effective treatment modality at early period in adult chronic immune thrombocytopenia (ITP), long-term outcomes are still controversial. The aim of this study was to ...determine long-term effectiveness and reliability of splenectomy in ITP and to identify factors influencing on long-term response.
The study included 100 ITP patients who underwent splenectomy in our General Surgery Department between 1980 and 2004. Parameters including gender, age, platelet count, comorbid diseases, antiplatelet antibody positivity and long-term effect of medical treatment on response to splenectomy were considered.
Owing to advances in treatment protocols, ITP has become a more benign disease and need for splenectomy has been decreased. However, splenectomy is a highly effective in second-line treatment. Based on our results, it was seen that open or laparoscopic splenectomy with low morbidity and mortality rates is an appropriate treatment modality for long-term control of chronic ITP in cases requiring splenectomy. Age and postoperative platelet count were identified as significant prognostic and predictive factors for long-term response to splenectomy.
Abstract Myelodysplastic syndrome (MDS) is a heterogeneous spectrum of clonal hematopoietic disorders with varying degrees of cytopenia and morphologic dysplasia. The hemoglobin, albumin, lymphocyte, ...and platelet (HALP) score is a prognostic marker in several types of malignant tumors. Prognostic value of HALP score remains unclear for MDS. To determine the prognostic value of baseline HALP score in MDS. We retrospectively analyzed data from 130 newly diagnosed MDS patients evaluated and classified under HALP score. By the receiver operating characteristic (ROC) analysis, the optimal cut-off value of HALP was > 67.5 in predicting mortality. Patients were divided into two groups: with low and high HALP scores, and the characteristics were compared between both groups. Patients’ median age was 68 (19–84) years, and 79 (60.8%) were male. Higher HALP score was detected in MDS patients with intermediate-risk under IPSS score, and at high and very high risks under IPSS-R score, and those receiving azacitidine (AZA) treatment. The survival rates of those with a HALP score > 67.5 were significantly lower than those with low HALP score at 17.77 ± 3.98 (median ± SE) ( p < 0.001). The 3-, 5- and 10-years survival rates of individuals with HALP scores > 67.5 were found as 25, 18, and 11%, respectively. Median overall survival (OS) was also determined as 33.10 (95% CI 16.34–49.88) months by the Kaplan–Meier method. HALP score has shown an ability to be a useful prognostic biomarker in various cancers, including MDS. The meaningful cut-off value of HALP is disease-specific and largely study-specific. High HALP score is associated with unfavorable clinicopathological characteristics. Also, it may be useful in predicting OS and mortality of MDS.
•Vancomycin-resistant enterococcus infections increase morbidity and mortality especially in neutropenic patients.•Pay attention for VRE infection in VRE colonized patients who are coinfected and ...have >15 days of colonization.•Invasive procedures should be postpone if possible in VRE colonized patients.•Be aware in terms of increased mortality in patients who are older, female, neutropenic and coinfected.
Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality.
We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files.
There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and >15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival.
Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid.
Background/Purpose: Most community-acquired urinary tract infections (UTIs) are usually treated empirically. The knowledge of antibiotic resistance patterns of the microorganisms causing UTI is ...essential for defining the empirical treatment. Objective: The aim of the present study is to determine the distribution of bacterial strains isolated from lower UTIs and their resistance patterns against commonly used antimicrobial agents and treatment results in female patients. Subjects and Methods: This is a retrospective analysis of medical case records of 90 female patients with lower UTI for a period of 4 years from January 2013 to December 2016 in a tertiary care hospital in the Trakya region of Turkey. Results: The most common causative agent was Escherichia coli (66.6% of cases) followed by Klebsiella pneumoniae (16.6%). Fosfomycin was the most active agent against E. coli (resistant isolates: 5.5%), followed by nitrofurantoin (resistant isolates: 7.4%). Extended-spectrum beta-lactamases (ESBLs) production was observed in 29 (32.2%) isolates (22 in E. coli, 6 in K. pneumoniae, and 1 in Enterobacter spp.). The antimicrobial resistance rates among ESBL-producing E. coli isolates for trimethoprim-sulfamethoxazole, ciprofloxacin, fosfomycin, and nitrofurantoin were 77.7%, 72.7%, 13.6%, and 18.2%, respectively (P < 0.05). The estimated microbiological eradication rates for nitrofurantoin and fosfomycin were 89.7% and 83.8%, respectively. Conclusions: The results of the present study indicate that nitrofurantoin and fosfomycin may be considered for empirical therapy of lower UTIs in Trakya region of Turkey.
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