The Prognostic Impact of Pretreatment Geriatric Nutritional Risk Index in Patients with Diffuse Large B-Cell Lymphoma.

The prognostic value of the geriatric nutritional risk index (GNRI) is not clear in patients with diffuse large B-cell lymphoma (DLBCL). This study was designed to analyze the GNRI in DLBCL patients and to investigate its prognostic value in DLBCL. The archive records of DLBCL patients between 2008 and 2020 at the Akdeniz University Hospital were retrospectively analyzed. A total of 206 patients with DLBCL were recruited and classified into two GNRI-based groups based on nutrition status. The GNRI cut off value was determined by ROC analysis. In the univariate Cox regression analysis for overall survival (OS), age, lactate dehydrogenase, B symptoms, infiltration of bone marrow, and the GNRI were determined as prognostic factors for mortality. The OS of patients with a GNRI ≤104.238 was significantly lower than that of patients with a GNRI >104.238 (p = 0.001). The progression-free survival (PFS) of patients with GNRI ≤104.238 was significantly lower compared to the patients with GNRI >104.238 (p = 0.010). Based on the results of the present study with a relatively large hospital-based cohort, the GNRI can be recommended for use as an independent prognostic marker for OS and PFS in patients with DLBCL.

TAFRO Syndrome Treated Effectively with Corticosteroids: A Case Report and Review of the Literature.

TAFRO (thrombocytopenia, anasarca, fever, renal dysfunction, and organomegaly) syndrome is a subtype of Castleman's disease and has been described in recent years. In this case, a middle-aged woman was admitted to our clinic with a 2-week history of fever, weakness, cough, shortness of breath and edema all over the body. Physical examination on admission revealed pale conjunctiva, tachycardia, coarse crackles over left lower lung fields, pitting edema in the extremities, tense ascites, axillar, and bilateral inguinal lymph nodes measuring less than 2 cm. Inguinal lymph node excisional biopsy was compatible with TAFRO syndrome. We started corticosteroid treatment. The patient's general condition and physical findings improved. Laboratory values returned to normal limits. This case will help understand the clinical course and treatment strategy in TAFRO syndrome.

The prevalence of temporomandibular disorders in chronic hemodialysis patients: a cross-sectional study.

Objective: This study aimed to investigate the prevalence of temporomandibular disorders (TMD) in patients with chronic hemodialysis and evaluate the risk factors of developing TMD.Methods: One hundred forty-six subjects were included in the study. The examination for TMD was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders. Axis I protocol was used to evaluate the prevalence of TMD sub-diagnoses.Results: The prevalence of TMD was 41.5% in hemodialysis patients and significantly higher than in the control group. The most common symptom was TMJ pain, and the most common TMD subtype was muscular type. Female patients had significantly higher TMD than males. C-reactive protein, hemoglobin, parathyroid hormone, and albumin were significantly associated with TMD.Conclusion: There was an elevated prevalence of TMD in hemodialysis patients.

Frequency of masked hypertension in patients with nonfunctioning adrenal incidentalomas with normal and high normal blood pressure.

OBJECTIVES: Nonfunctioning adrenal incidentalomas (NFAIs) are associated with increased cardiovascular risk, but the frequency of masked hypertension (MH) is uncertain in these patients. This study aimed to evaluate the prevalence of MH by ambulatory blood pressure monitoring in patients with NFAIs. METHODS: The study included a total of 85 individuals: 43 patients with NFAIs and 42 controls of similar age, gender, BMI, smoking, and diabetes. The office BP and ABPM parameters of the NFAI and controls were measured. Biochemical, hormonal, and radiological data were obtained retrospectively in the NFAI group. RESULTS: There were no statistically significant difference between the NFAI and control groups in relation to the office SBP (134.4 ± 37.2 mmHg vs 133.1 ± 35.8 mmHg, p = 0.273) and office DBP (87.4 ± 14.5 mmHg vs 86.8 ± 13.7 mmHg, p = 0.318). Besides, normal (28% vs 28.6%, p = 0.176) and high normal blood pressure (72% vs 71.4%, p = 0.332) rates were similar. The prevalence of MH was significantly higher in patients with NFAI than in controls (25.5% vs 9.5%, p = 0.037). MH was significantly associated with diabetes odds ratio (OR) = 2.07, p = 0.044, office SBP (OR = 1.41, p = 0.046), smoking (OR = 1.46, p = 0.031), BMI (OR = 1.17, p = 0.037), and morning cortisol (OR = 1.21, p = 0.039). CONCLUSION: The prevalence of MH in the NFAI patient's was higher than in the control group. Patients with NFAI with high normal blood pressure should be evaluated for MH.

Recurrent arthritis as an unexpected side effect associated with azacitidine in a patient with myelodysplastic syndrome.

INTRODUCTION: Hypomethylating agents have confirmed efficacy for myelodysplastic syndrome and acute myeloid leukemia and are widely used. Although arthralgia is common side effect associated with hypomethylating agents, arthritis has not been reported previously. CASE REPORT: We present the first recorded patient with arthritis after azacitidine treatment. The patient we presented here had severe cytopenias requiring transfusion with erythrocyte and platelet suspensions, and a complete hematological response was obtained for myelodysplastic syndrome after three cycles of azacitidine (AZA) treatment. However, interestingly, after each AZA treatment cycle, the patient had recurrent attacks of arthritis. MANAGEMENT AND OUTCOMES: The episodes of arthritis were possibly acute flares of pre-existing crystal-induced arthritis, as exhibited with azacitidine treatments and were managed effectively with nonsteroidal anti-inflammatory drugs. DISCUSSION: Because it is a rare condition, clinicians should not overlook AZA as a possible cause of arthritis exacerbations when arthritis of unknown etiology develops in patients treated with AZA.

Prognostic impact of the psoas muscle index, a parameter of sarcopenia, in patients with diffuse large B-cell lymphoma treated with rituximab-based chemoimmunotherapy.

Muscle mass, defined as the psoas muscle index (PMI), is an important parameter of sarcopenia and it has been shown to be a prognostic factor of non-hematological cancers. This study aimed to investigate the prognostic impact of sarcopenia defined using PMI measurement in patients with diffuse large B-cell lymphoma treated with R-CHOP. We retrospectively investigated the impact of pretreatment PMI on survival and response to treatment. One hundred and twenty patients with DLBCL were included in the study, of whom 65 had baseline sarcopenia according to the defined PMI cutoffs. Sarcopenic patients displayed a worse response to treatment compared with non-sarcopenic patients. In a multivariate analysis, sarcopenia remained predictive of outcomes for overall survival (p = .009), progression free survival (p = .028), and response to treatment (p = .006). Sarcopenia defined by evaluating PMI is a simple and routinely applicable method that can predict poor outcomes in patients with DLBCL.

Symptomatic hypocalcemia following a single dose of zoledronic acid in a patient with bone metastases secondary to breast cancer.

INTRODUCTION: The use of bisphosphonates is increasing, for treatment of hypercalcemia and pain in cancer, and post-menopausal osteoporosis and also to decrease the risk of skeletal morbidity in multiple myeloma and metastatic breast cancer. CASE REPORT: A single dose of zoledronic acid was administered for hypercalcemia in a 54-year-old woman breast cancer patient with extensive bone metastasis. After the first dose, the patient developed symptomatic hypocalcemia.Management and outcome: Simultaneous hypocalcemia, hypophosphatemia, and vitamin D deficiency were detected in the patient. In the symptomatic process, intravenous, then oral replacement was performed. DISCUSSION: There is a need for taking precautionary measures such as vitamin D, serum phosphorus and, calcium monitoring and supplementation to prevent life-threatening complications, such as symptomatic hypocalcemia, especially in populations with vitamin D deficiency like ours.

Relationship between 25-hydroxyvitamin D and microalbuminuria in patients with newly diagnosed essential hypertension.

Purpose: Vitamin D deficiency is known that associated with hypertension. Microalbuminuria (MAU) is associated with increased cardiovascular morbidity and mortality. This study aimed to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) and MAU in newly diagnosed essential hypertension (NDEH) patients. Methods: A total of 116 patients with a diagnosis of NDEH were enrolled in the study. The diagnosis of hypertension was based on ABPM. Patients were divided into 2 groups according to 25(OH)D levels: Group 1: (25(OH)D)>20 ng/mL was defined as Vitamin D sufficiently (VDS), while Group 2: (25(OH)D)<20 ng/mL was defined Vitamin D deficiently (VDD). The relationship between 25(OH)D and MAU was analyzed. The results were analyzed using the SPSS program version 21. Results: The mean age of the patients was 58.4 ± 14.7 years and 60 (51.7%) of them were female. The prevalence of MAU was 18.9% and Vitamin D deficiency was 61.2% in NDEH. Linear regression analysis showed that 25(OH)D was independently related to MAU [ß 0.643, 95% confidence interval 1.173-1.631, p = .011]. Besides, male gender, C-reactive protein, non-dipper hypertension, and diastolic blood pressure were independent risk factors associated with MAU in the multivariate analysis (p < .05). Conclusion: Vitamin D deficiency is highly prevalent in NDEH patients. This study showed that the level of microalbuminuria was significantly higher in patients with 25(OH)D deficiency compared to patients with normal 25(OH)D levels. Vitamin D deficiency is independently related to microalbuminuria in NDEH.

Lymphocyte and monocyte vitamin D receptor expression during paricalcitol or calcitriol treatments in patients with stage 5 chronic kidney disease.

PURPOSE: In this study, we aimed to investigate the effect of paricalcitol and calcitriol usage on vitamin D receptor (VDR) contents of CD8+ , CD4+ lymphocytes and monocytes in stage 5d chronic kidney disease (CKD) patients. METHODS: Thirty-six hemodialysis patients older than 18 years of age and 19 healthy controls (group HC) without any known acute or chronic diseases were included in the study. The group of patients undergoing scheduled hemodialysis comprised three subgroups: group CL: patients on calcitriol (n: 10), group PC: patients on paricalcitol (n: 13), and group NT: patients not taking any vitamin D or VDR activating medications (n: 13). CD8+/VDR, CD4+/VDR and MONO/VDR values were representing the ratio of VDR representing cells among related cell group. On the other hand, values of CD8+/MFI, CD4+/MFI and MONO/MFI have shown the total amount of cellular VDR content per cell which has been given as of mean fluorescence intensity in the flow cytometric process. Main CKD mineral bone disorder parameters such as a hemogram, serum BUN, creatinine, albumin, Ca, iP, iPTH, 25(OH)D3 levels were also measured. RESULTS: Average VDR contents in CD8+, CD4+ and monocytes were not different among three patient groups on hemodialysis. But in all hemodialysis subgroups, CD8+/VDR, CD4+/VDR, MONO/VDR, CD8+/MFI, CD4+/MFI and MONO/MFI levels were found to be higher compared with the healthy control subjects (p < 0.001). Among hemodialysis groups, no significant CD8+/VDR, CD4+/VDR, and MONO/VDR content differences were found with regard to the type of VDR activator agent used. There was no difference in serum levels of 25(OH)D3 and CRP among groups participating in the study. CONCLUSION: There was no difference between CD8+/VDR, CD4+/VDR, and MONO/VDR levels in hemodialysis patients using calcitriol or paricalcitol, suggesting that both treatment agents may have a similar effect on VDR contents in lymphocytes and monocytes in that patient population. But in all hemodialysis subgroups, CD8+/VDR, CD4+/VDR, and MONO/VDR levels were found to be higher compared with the healthy control subjects, suggesting an overexpression of VDR through a non CRP and/or 25(OH)D3 dependent mechanism.