The effect of HA330 hemoperfusion adsorbent method on inflammatory markers and end-organ damage levels in sepsis: a retrospective single center study.

OBJECTIVE: In this study, we aimed at evaluating the impact of HA330 hemoperfusion adsorbent application on inflammatory markers and end-organ damage markers in patients with sepsis/septic shock. PATIENTS AND METHODS: Patients who were diagnosed with sepsis/septic shock and treated with HA330 hemoperfusion adsorbent in addition to the standard treatment were included in this retrospective study conducted at Inonu University Turgut Ozal Medical Center between January 1, 2019 and January 1, 2021. RESULTS: A total of 150 patients were included in the study. The mean±SD age of the patients was 51.9±17.7 years. 102 patients (68%) were in septic shock. Mean±SD APACHE II scores were 15.3±4.8. The need for mechanical ventilation was noted in 64 patients (42.7%). WBC, neutrophil count, hemoglobin, platelet count, BUN, creatinine, AST, ALT, CRP and procalcitonin levels were measured before and after the procedure. Overall, 104 patients (69.3%) died median (min-max) 2.5 (1-114) days after the cytokine adsorption, while 46 patients (30.7%) recovered from sepsis and were discharged. The increase in BUN levels and decrease in platelet count after the procedure were statistically significant (p≤0.001, 0.041, respectively) in the overall study population. The laboratory findings in 46 survivors indicated significantly decreased AST and ALT levels after cytokine adsorption compared to baseline pre-treatment levels. WBC, neutrophil count, CRP, procalcitonin, BUN and creatinine values were also decreased after cytokine adsorption in survivors, whereas the change was not statistically significant. There was also a non-significant tendency for an increase in platelet count and hemoglobin levels after cytokine adsorption compared to pre-treatment values in these patients. CONCLUSIONS: Although no effect of HA330 hemoperfusion application on inflammatory markers and end-organ damage markers was demonstrated in our study, we used the HA330 hemoperfusion adsorbent method as a last resort in terminal patients with a mortality rate of approximately 90% and for whom antibiotic treatment did not benefit. Therefore, multicenter, prospective studies are needed to clarify the effect of early HA330 hemoperfusion use in the treatment of sepsis.

Effects of iloprost on bleomycin-induced pulmonary fibrosis in rats compared with methyl-prednisolone.

OBJECTIVE: Prostacyclin (PGI2) has been shown to inhibit the expression of pro-inflammatory and pro-fibrotic mediators in pulmonary fibrosis. In this study, we aimed to test the preventive effects of intraperitoneally administered iloprost, a stable PGI2 analog, on bleomycin-induced pulmonary fibrosis in rats and to compare the effects of iloprost with the effects of methyl-prednisolone, a traditional therapy. METHODS: Rats were randomly allocated into four groups: 1. Saline alone (n=6); 2. Bleomycin+placebo (n=7); 3. Bleomycin+methyl-prednisolone (n=7); 4. Bleomycin+iloprost (n=7). Fibrotic changes in the lungs were demonstrated by analyzing the cellular composition of bronchoalveolar lavage fluid, histological evaluation and lung hydroxyproline content. RESULTS: Fibrosis was made in the lungs of rats by bleomycin experimentally. Fibrosis scores in the methyl-prednisolone and the iloprost groups were significantly lower than in the placebo group (p<0.05). Furthermore, the score of the iloprost group was significantly lower than the score of the methyl-prednisolone group. The hydroxyproline content was significantly less in the methyl-prednisolone and the iloprost groups (p<0.05). In the placebo group, the neutrophil percentage in bronchoalveolar lavage was significantly higher than in the other groups, whereas the macrophage percentage in placebo group was significantly lower (p<0.05). CONCLUSION: Iloprost has protective effect on the pulmonary fibrosis induced by bleomycin and it may be more effective in decreasing fibrotic changes than methyl-prednisolone.

Clinical experience with three combination regimens for the treatment of high-risk febrile neutropenia.

INTRODUCTION: The objective of this study was to compare the safety and efficacy of ceftazidime (2 g every 8 h), piperacillin/tazobactam (4 g/500 mg every 6 h), and meropenem (1 g every 8 h), when combined with amikacin (15 mg/kg once daily), in the empirical treatment of high-risk febrile neutropenic episodes in patients with haematological malignancy. MATERIALS AND METHODS: A prospective, comparative study designed in the haematology unit of a university hospital in Turkey. RESULTS: A total of 89 febrile episodes in 60 neutropenic patients were treated; 29 febrile episodes in 23 patients with ceftazidime plus amikacin (group 1), 30 episodes in 25 patients with piperacillin/tazobactam plus amikacin (group 2), and 30 episodes in 25 patients with meropenem plus amikacin (group 3). The 3 groups were comparable in terms of age, sex, underlying malignancy, pretherapy neutrophil counts, duration of neutropenia and types of infections. Neutropenia, since the start of fever, persisted for > or =10 days in all of the episodes in the 3 study groups. Nearly all of the episodes were seen in patients with acute leukaemia. In 25.8% (23/89) of the febrile neutropenia episodes, an aetiologic organism was isolated, with gram-negative bacteria being the most commonly isolated. The success without modification rates were 34.5%, 30% and 36.7% for groups 1, 2 and 3, respectively (P >0.05). After modification with a different class of antimicrobial therapy, the response rates increased to 65.5%, 63.3% and 70% for groups 1, 2 and 3, respectively (P >0.05). The mean duration of treatment and the time to defervescence were also comparable in all groups. In all arms, side effects were minimal. CONCLUSIONS: It is concluded that the 3 regimens were equally effective and safe in the empirical treatment of high-risk febrile neutropenic episodes.

Oxidant/antioxidant parameters and their relationship with chemotherapy in Hodgkin's lymphoma.

This study investigated changing levels of serum oxidant/antioxidant with chemotherapy and their relation to treatment in 34 Hodgkin's lymphoma patients. The patient population consisted of 19 males and 15 females. Mean age was 30.41 +/- 12.08 years. All patients received the adriamycin, bleomycin, vincristine and dexamethasone (ABVD) treatment protocol. Blood samples were taken before treatment, and on days 1 and 7 during treatment for measurement of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT), malondialdehyde (MDA), nitric oxide (NO) and enzyme activities. After ABVD treatment, mean free radical levels were increased and antioxidant levels were significantly decreased in the serum. ABVD treatment results in an increase of free radical levels and a decrease of antioxidant levels in the serum of patients with Hodgkin's lymphoma.

Density of Demodex folliculorum in haematological malignancies.

We aimed to investigate the incidence and density of Demodex folliculorum in adults with leukaemia or lymphoma. Fifty patients with haematological malignancy and 50 healthy controls were studied. Patients had been diagnosed with acute lymphocytic leukaemia (12%), acute myelocytic leukaemia (32%), chronic lymphocytic leukaemia (4%), chronic myelocytic leukaemia (10%), Hodgkin's lymphoma (4%) or non-Hodgkin's lymphoma (38%). Standardized skin surface biopsies were taken and > or = 5 living parasites/cm2 of skin was defined as an infestation. The difference in infestation rates between patients and controls was statistically significant. The highest incidences of D. folliculorum were found in patients with acute myelocytic leukaemia (10%), non-Hodgkin's lymphoma (6%), acute lymphocytic leukaemia (4%), chronic lymphocytic leukaemia (4%) and chronic myelocytic leukaemia (4%). Demodicidosis should be included in the differential diagnosis of facial eruptions in patients with haematological malignancies who are receiving chemotherapy, and a standardized skin surface biopsy should be performed.

Blastic natural killer cell leukaemia with skin involvement: a case report.

Natural killer cell leukaemia is generally accompanied by extramedullary involvement. CD4+ natural killer cell leukaemia frequently manifests with cutaneous involvement. The disease pursues a very aggressive course with no long-term survivors reported. We present a patient with CD4+ natural killer cell leukaemia with skin, bone marrow and peripheral blood involvement who is still on remission at the end of 2 years.

Bilateral hearing loss during vincristine therapy: a case report.

Vincristine sulfate is a chemotherapeutic agent used in different cancer therapies. It is also the first choice of treatment for peripheral T-cell lymphoma with cyclophosphamide and adriamycin. Sudden hearing loss during vincristine therapy is a very rare event. This is a case of a 16-year old girl who developed sudden bilateral hearing loss related to vincristine therapy.

Isolated thrombocytopenia: the presenting finding of typhoid fever.

Thrombocytopenia is generally seen as a complication in typhoid fever. However, it can also be encountered as a presenting sign on admission. A 29-year-old man with complaints of fever and diarrhoea was hospitalized because of isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when Salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. Possible mechanisms of thrombocytopenia were discussed.

Gemcitabine-induced erysipeloid skin lesions in a patient with malignant mesothelioma.

Gemcitabine is a nucleoside analogue that has shown to have antineoplastic activity in different solid tumours (lung, pancreas, bladder, colon, ovarian, and breast cancer) and malignant mesothelioma. The toxic effects of gemcitabine include myelosuppression, flu-like syndrome, altered liver function tests, bronchospasm, rash, itching, and fever. However, gemcitabine-induced erysipeloid skin reaction was reported in a small number of patients with previous history of radiotherapy or lymphedema. We reported a male patient who developed erysipeloid skin reaction following gemcitabine treatment in the absence of radiotherapy and lymphedema.

Bilateral transient hearing loss associated with vincristine therapy: case report.

Vincristine, adriamycin, and dexamethasone (VAD) chemotherapy protocol is first-choice treatment in newly diagnosed multiple myeloma patients in many centers. Sudden hearing loss associated with vincristine therapy is a rarely observed event in the VAD protocol. We describe a 69-year old male patient diagnosed with multiple myeloma 7 months ago who developed sudden bilateral hearing loss related to vincristine therapy. This uncommon adverse effect of vincristine is discussed and the literature reviewed.

Severe epistaxis in brucellosis-induced isolated thrombocytopenia: a report of two cases.

Brucellosis can present initially with its haematological findings including anaemia, leukopenia, and thrombocytopenia and may mimic primary haematological diseases. We present two patients with complaints of severe epistaxis and isolated thrombocytopenia which was initially diagnosed as idiopathic thrombocytopenic purpura but which was finally attributed to brucellosis. Their platelet count reverted to normal within 2-3 weeks of initiating antibrucellosis treatment with recovery from the disease.

Paroxysmal Nocturnal Haemoglobinuria in the Differential Diagnosis of Unresponsive Iron Deficiency Anemia: A Case Report.

A 16-year-old male patient who was on oral iron treatment for iron deficiency anemia for the last one year was seen at the Haematology clinic with complaints of weakness, pallor, and jaundice. A complete blood count revealed Hb of 4.2 mmol/L, Hct of 0.14, and MCV of 76 fl. A blood smear showed 50% neutrophils, 40% lymphocytes, and 10% monocytes with anisocytosis, poikilocytosis, polichromasia in erythrocytes and normoblasts. Reticulocyte count was under 1%. There was a slight erythroid hyperplasia in the bone marrow aspiration. Biochemical examinations showed total bilirubin of 3.9 mg/dL, indirect bilirubin of 3.4 mg/dL, and lactate dehydrogenase (LDH) of 6085 U/L (220-450). In re-evaluating the history of the patient, he was seen to be complaining of dark discoloration of morning urine. Perl's reaction was found to be positive for hemosiderin in the urine sediment. Because Ham's test was positive, the levels of CD55, 58, and 59 proteins on erythrocyte membranes were found to be lower. The patient was started 32 mg of methylprednisolone and his anaemia was improved by the 14th day of treatment. When evaluating iron deficiency anemia resistant to iron supplementation, PNH should be kept in mind.

Prevalence of serum HGV-RNA among hemodialysis patients in Turkey.

A possible agent for human non-A-E hepatitis has been identified and named hepatitis G virus (HGV). The aim of this study is to evaluate the prevalence of serum HGV-RNA among hemodialysis patients in our country and the possible correlations of serum HGV-RNA with antibody to hepatitis C virus (anti-HCV), chronic liver dysfunction, number of blood transfusions, serum hepatitis B surface antigen (HBs Ag), duration of hemodialysis therapy, history of renal transplantation and patients' age and sex. Seventy-eight hemodialysis patients and 59 healthy controls were included in the study. Twenty-seven of 78 hemodialysis patients (34.6%) and two of the 59 healthy controls were serum HGV-RNA positive (p < 0.01, x2 = 17.8). There was no significant difference between the HGV-RNA positive and HGV-RNA negative groups regarding mean duration of dialysis therapy, anti-HCV, chronic liver dysfunction, number of blood transfusions, serum HBs Ag, duration of hemodialysis therapy, history of renal transplantation and patients' age and sex. In conclusion, hemodialysis patients carry the risk for HGV infection and transmission routes and clinical significance of HGV infection in these patients remain to be defined.