Evaluation of febrile neutropenic patients hospitalized in a hematology clinic

Objective: To evaluate the febrile neutropenic patients with hematological malignancies hospitalized in hematology clinic with poor hygiene standards. Methods: A total of 124 patients with hematological malignancies (69 male, 55 female) hospitalized in hematology clinic with poor hygiene conditions depending on hospital conditions, between January 2007 and December 2010, were evaluated, retrospectively. Results: In this study, 250 febrile neutropenia episodes developing in 124 hospitalized patients were evaluated. Of the patients, 69 were men (56%) and 55 women (44%). A total of 40 patients (32%) had acute myeloid leukemia, 25 (20%) acute lymphoblastic leukemia, 19 (15%) non-Hodgkin's lymphoma, 10 (8%) multiple myeloma, and 8 (8%) chronic myeloid leukemia. In our study, 56 patients (22%) were diagnosed as pneumonia, 38 (15%) invasive aspergillosis, 38 (15%) sepsis, 16 (6%) typhlitis, 9 (4%) mucormycosis, and 4 (2%) urinary tract infection. Gram-positive cocci were isolated from 52% (n = 20), while Gram-negative bacilli 42% (n = 16) and yeasts from 6% (n = 2) of the sepsis patients, respectively. The most frequently isolated Gram-positive bacteria were methicillin-resistant coagulase-negative staphylococci (n = 18), while the most frequently isolated Gram-negative bacteria was Escherichia coli (n = 10). Conclusions: Febrile neutropenia is still a problem in patients with hematological malignancies. The documentation of the flora and detection of causative agents of infections in each unit would help to decide appropriate empirical therapy. Infection control procedures should be applied for preventing infections and transmissions.

Gender differences in severity of sickle cell diseases in non-smokers

To find out gender differences in severity of sickle cell diseases [SCDs] in non-smokers. Three groups of SCDs patients on the basis of red blood cell [RBC] transfusions were included. Less than 10 units in their lives were kept in Group-1, Ten units of higher in Group-2 and 50 units or higher as the Third Group. Patients with a history of using one pack of cigarettes -year or above were excluded. The study included 269 patients. Mean ages of the groups were similar [28.4, 28.5, and 28.9 years, respectively]. Prevalences of cases without any RBC transfusion in their lives were 7.2% and 3.7% in females and males, respectively [p < 0.05]. Prevalences of cases without any painful crisis were 13.8% and 6.0% in females and males, respectively [p < 0.001]. There was progressive increase according to mean painful crises, clubbing, chronic obstructive pulmonary disease [COPD], leg ulcers, stroke, chronic renal disease [CRD], pulmonary hypertension, and male ratio from the first towards the third groups [p < 0.05, nearly for all]. Mean ages of mortal cases were 29.1 and 26.2 years in females and males, respectively [p > 0.05]. The higher painful crises per year, digital clubbing, COPD, leg ulcers, stroke, CRD, pulmonary hypertension, and male ratio of the third group, lower male ratio of patients without any RBC transfusion, lower male ratio of patients without any painful crisis, lower mean ages of male SCDs patients with mortality, and longer overall survival of females in the world could not be explained by well known strong atherosclerotic effects of smoking alone, instead it may be explained by the dominant role of male sex in life

Thrombophilia in young patients with acute myocardial infarction

To investigate the association of thrombophilia and coronary artery disease [CAD] in patients with myocardial infarction [MI]. Under the age of 45 years, 129 patients with MI and 107 control subjects were included into the study. Traditional risk factors of CAD and protein C, S, antithrombin III deficiencies, factor V Leiden [FV Leiden], prothrombin G20210A and methylenetetrahydrofolate reductase [MTHFR] C677T mutations were investigated. There were statistically significant differences in terms of obesity, smoking, triglyceride, total cholesterol, high-density lipoprotein, high-density lipoprotein, and very-low-density lipoprotein cholesterol, family history, hypertension, diabetes, and left ventricular hypertrophy between patients and controls. None of the patients and controls had protein C, protein S, and antithrombin III deficiencies. Ten patients [7.8%] and 4 controls [3.7%] had heterozygote FV Leiden mutation. Homozygous prothrombine G20210A gene mutation was detected in one patient [1.1%]. Homozygous MTHFR C677T mutation was observed in 7.8% [patients] and in 6.5% [controls]. Heterozygous MTHFR C677T mutation was detected 36.4% in patients and 31.7% in controls. The difference was not statistically significant in terms of carriage of thrombophilic mutations. We found that traditional risk factors increased the risk of CAD. Prothrombin G20210A, FV Leiden and MTHFR C677T mutations, protein C, S and AT-III deficiencies did not increase the risk of CAD in our young population

Intracranial myeloid metaplasia in idiopathic myelofibrosis

Extramedullary hematopoiesis is a common finding in idiopathic myelofibrosis and is generally found in the liver, spleen and lymph nodes, but meningeal extramedullary hematopoiesis is very rare. Some diseases may be causes of intracranial masses and diagnosis is difficult. We present a case diagnosed as intracranial and meningeal extramedullary hematopoiesis with idiopathic myelofibrosis inducing serious headache

unusual presentation of primary amyloidosis

A 65-year-old male patient presented with right upper-quadrant abdominal pain. Ultrasonography revealed hypoechoic lesion in the perihepatic and intraparenchymal area. Computed tomography CT showed hypodense lesion in the same localization. A fine needle biopsy specimen of the perihepatic lesion was hemorrhagic. On abdominal CT, the liver showed enhancement, but the spleen did not enhance. The spleen could not be detected by scintigraphic imaging using Tc99m sulfur dioxide. A diagnosis of primary amyloidosis was made by renal biopsy. Melphalan 10mg/day for 4 days/month was started. The clinical and radiological follow up demonstrated a resorption of the hematoma. The patient is still alive at the eighth month of therapy