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    Öğe
    Clinical characteristics and therapeutic outcomes of paroxysmal nocturnal hemoglobinuria patients in Turkey: a multicenter experience
    (Springer, 2021) Şahin, Deniz Gören; Akay, Olga Meltem; Keklik, Muzaffer; Okan, Vahap; Karakuş, Abdullah; Demir, Cengiz; Erkurt, Mehmet Ali; İlkkılıç, Kadir; Yıldırım, Rahşan; Çağlıyan, Gülsüm Akgün; Aksu, Salih; Doğu, Mehmet Hilmi; Dal, Mehmet Sinan; Karakuş, Volkan; Gemici, Ali İhsan; Terzi, Hatice; Kelkitli, Engin; Şıvgn, Serdar; Ünal, Ali; Yılmaz, Mehmet; Ayyıldız, Orhan; Korkmaz, Serdal; Eser, Bülent; Altuntaş, Fevzi
    The aim of this study is to collect paroxysmal nocturnal hemoglobinuria (PNH) patient data from hematology centers all over Turkey in order to identify clinical features and management of PNH patients. Patients with PNH were evaluated by a retrospective review of medical records from 19 different institutions around Turkey. Patient demographics, medical history, laboratory findings, and PNH-specific information, including symptoms at the diagnosis, complications, erythrocyte, and granulocyte clone size, treatment, and causes of death were recorded. Sixty patients (28 males, 32 females) were identified. The median age was 33 (range; 17-77) years. Forty-six patients were diagnosed as classic PNH and 14 as secondary PNH. Fatigue and abdominal pain were the most frequent presenting symptoms. After eculizumab became available in Turkey, most of the patients (n = 31/46, 67.4%) were switched to eculizumab. Three patients with classic PNH underwent stem cell transplantation. The median survival time was 42 (range; 7-183 months) months. This study is the first and most comprehensive review of PNH cases in Turkey. It provided us useful information to find out the differences between our patients and literature, which may help us understand the disease.
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    Öğe
    Effects of Different Doses of Oral Iron on Hepcidin and Treatment Response in Iron Deficiency Anemia
    (Springer India, 2024) Beyler, Ozlem; Demir, Cengiz; Demircan, Vehbi; Kacmaz, Murat
    IntroductionIron deficiency anemia (IDA) is a common health problem. The hepcidin hormone is the main regulator of systemic iron balance. The body responds to IDA by decreasing hepcidin. This study investigated how different iron supplementation regimens affect hepcidin levels in women with IDA. 87 female participants aged 18-45 years with hemoglobin < 10 g/dL and serum ferritin < 20 ng/ml were assigned to receive iron therapy every other day, once daily, or twice daily. Hemogram, serum iron, serum iron binding capacity, ferritin, hepcidin, and C-reactive protein values were measured at baseline and on the 15th and 90th days of treatment in all groups. On the seventh day, no significant difference was found between the once-daily and twice-daily groups (p = 0.42) in reticulocyte counts. By the 15th day, hemoglobin and MCV levels showed significant improvement in the twice-daily group compared to the other groups (p < 0.01). At the third month, ferritin levels were significantly higher in the twice-daily group compared to the every-other-day and once-daily groups (p = 0.03). No significant differences were observed in hepcidin levels at three months across all groups. The study concludes that twice-daily iron supplementation results in the most significant hematological improvements but with increased gastrointestinal side effects. These findings underscore the importance of tailoring iron dosing schedules to individual patient needs. In cases where rapid haemoglobin response is required, twice-daily dosing may provide superior results. Conversely, once-daily dosing may be preferred if tolerable anemia can be maintained. Every other day dosing, although associated with fewer side effects and better tolerability, may not provide adequate support for erythropoiesis.
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    Öğe
    Pulse Methylprednisolone-Induced Sinus Bradycardia: A Case Report
    (Baskent Univ, 2023) Beyler, Ozlem; Demir, Cengiz
    Corticosteroids have a wide range of uses. The most common adverse side effects of high-dose pulse steroids are hyperglycemia, gastrointestinal intolerance, and psychiatric symptoms. Cardiac arrhythmias have been reported in patients who receive high- dose steroid therapy. Bradycardia is a rare adverse side effect of pulse steroid therapy. We present the case of a 57-year-old male patient who developed symptomatic sinus bradycardia after he received pulse methylprednisolone therapy as treatment for graft-versus-host disease. The patient's pulse steroid therapy was discontinued, and the dose of methylprednisolone was reduced to 100 mg/ day. He was treated conservatively and with close observation; the patient's heart rate increased to 68 beats/min after 1 day, and then to 78 beats/min. The diagnosis of methylprednisolone-induced bradycardia was made after exclusion of other common etiologies of sinus bradycardia. This case report demonstrates the importance of careful cardiovascular monitoring in patients who receive high-dose methylprednisolone because of dose-related cardiovascular risks.
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    Öğe
    Yineleyen ve inatçı akut lösemilerde Flag-İDAa kemoterapi sonuçları
    (2009) Gerekir., İg/Kg/Gün Dozda Uygulandı. All Ve Aml Olguları Arasında Cinsiyet, Yaş Ortalaması, Beyaz Küre Sayısı, Nötrofil Sayısı, Hemoglobin Düzeyi, Hematokrit Düzeyi, Trombosit Sayısı, Laktat Dehidrogenaz Düzeyi, Fibrinojen Düzeyi, Ptz Düzeyi, Inr Düzeyi Ve Aptt Düzeyi Açısından İstatistiksel Olarak Anlamlı Bir Farklılık Yoktu. Bulgular: Mayıs 2005 Ve Nisan 2008 Tarihleri Arasında, Yineleyen/İnatçı 10 All, 37 Aml Olgusu Flag-İda Protokolü İle Tedavi Edildi. All Grubunda 3 Hasta İnatçı, 7 Hasta Yineleyen All Olgusuydu. 3'ü Erken (%42), 4'ü (%58) Geç Yineleyen Olgulardı. Flag-İda Rejimi Sonrası All Hastalarının Hiçbirinde Tam Gerileme Elde Edilemedi, Tedavi Sonrası Toplam Yaşam Süresi 4,2 ± 1,6 Ay Bulundu. Aml Olgularının 20'si Yineleme, 17'si İnatçı Aml Hastalarıydı. İnatçı/Yineleyen Hasta Sayıları Gruplar Arasında Benzerdi (P=0,157). Olguların 15'inde (%40,5) Tam Gerileme Elde Edildi. Gerileyen Olgularda Flag-İda Sonrası Ortalama Yaşam Süresi 11,64 ± 9,6 Ay, Girmeyen Olgularda 6,36 ± 5,9 Ay Olarak Saptandı (P=0,003). 17 Primer İnatçı Aml'li Hastanın 5'i (%29,4) Geriledi. 20 Yinelemeli Aml Olgusunun 10'unda (%50) Tam Gerileme Oldu. 12'si Erken, 8'i Geç Yineleyen Olgulardı. Erken Yineleyen Olgularda Gerileme Oranı 4/12 (%33), Geç Yineleme Olgularda 6/8 (%75) Olarak Bulundu (P=0,157). Primer Dirençli Hastalar (5/17) İle Yinelemeli Hastalar (10/20) Arasında Flag-İda Protokolü İle Gerileme Oranlan Arasında İstatistiksel Olarak Anlamlı Farklılık Bulunmadı (P=0,09). Flag-İda Uygulaması Esnasında Hiçbir Hastada Kullanılan İlaçlara Bağlı Toksik Ölüm İzlenmedi. Sonuç: Aml Olgularında Gerileme Gözlenmesi Dikkate Değer Ölçüdeydi. Bu Bulgular Bize Yineleyen Veya İnatçı Aml Olgularında Flag-İda Tedavisinin İyi Bir Seçenek Olduğunu, Buna Karşın All Olgularında Yeterli Olmadığını Telkin Etmektedir. Etkinliğin Flag-İda Rejiminin Yineleyen/İnatçı All Olgularında Daha Geniş Hasta Gruplarında Değerlendirilmesi; Demir, Cengiz; Altıntaş, Abdullah; Küçükzeybek, Yüksel; Paşa, Semir; Ayyıldız, Orhan
    AMAÇ: Yineleyen ve inatçı akut lenfoblastik lösemi (ALL) ve akut miyeloblastik lösemi (AML) olgularımızda, FLAG-İDA (Fludarabin, cytarabin, idarubisin, G-CSF) kemoterapisi sonuçlarımızı inceledik. GEREÇ VE YÖNTEM: Fludarabine 30 mg/m2 tek doz, sitarabin 2 gr/m2 5 gün, idarubicin 10 mg/m2 3 gün verildi. Kemoterapi tamamlandıktan sonra nötrofil düzeyi yükselinceye kadar koloni uyarıcı faktör (G-CSF) 5