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Öğe A comparison of the mixed and sequential use of acetaminophen and dexketoprofen in painful vaso-occlusive crises(Springer Heidelberg, 2024) Kacmaz, Murat; Ilhan, GulPurpose Opioids are widely used to treat painful vaso-occlusive crises (VOC) in sickle cell disease (SCD). However, due to opioids' significant adverse effect profiles, the search for alternative therapies continues from the past to the present. The study aimed to investigate the efficacy of acetaminophen and dexketoprofen in the treatment of painful VOC.Methods This study is a single-center, prospective, non-randomized, single-blinded, controlled study. The study comprised two groups: the first administered acetaminophen and dexketoprofen mixed group, while the second received them sequential group. Opioids were used in patients with persistent pain despite these analgesics. Demographic and laboratory information, pain scores, opioid requirement, dose amount, side effects, and length of hospital stay of the patients were recorded.Results The study comprised 56 (100%) patients with painful VOC, 29 (51.8%) from the mixed group, and 27 (48.2%) from the sequential group. Opioid use was seen in 16 (55.2%) patients in the mixed group and 21 (77.8%) patients in the sequential group (p = 0.074). The median amount of opioid used was significantly lower in the mixed group than in the sequential group (p < 0.001). Also, the median length of hospital stay was significantly lower in the mixed group than in the sequential group (p < 0.001).Conclusion Our study suggests that administering acetaminophen and dexketoprofen in the mix for the treatment of painful VOC in patients with SCD may be a more efficient approach compared to sequential administration. This approach appears to reduce opioid usage and shorten hospital stays.Öğe The effect of pre-conditioning immunoglobulin and absolute lymphocyte count on the outcomes of allogeneic hematopoietic cell transplantation(Elsevier, 2023) Kacmaz, Murat; Basci, Semih; Ilhan, Gul; Yigenoglu, Tugce Nur; Cakar, Merih Kizil; Dal, Mehmet Sinan; Altuntas, FevziIntroduction: The prevention of mortality and morbidity related to the increasingly used allogeneic hematopoietic cell transplantation (allo-HCT), along with the effects of pre-and post-transplant immune status on transplant outcomes, have become the focus of the studies conducted on this subject in recent years. In parallel, this study was designed to investigate the effects of pre-conditioning immunoglobulin (pre-conditioning-Ig) and pre-conditioning absolute lymphocyte count (pre-conditioning-ALC) levels on transplant outcomes.Methods: This study was designed as a retrospective, observational and cross-sectional study. The objective of the study is to investigate the effects of pre-conditioning-Ig and ALC levels primarily on the rate of patients with febrile neutropenia (FEN) and the duration of FEN and length of hospital stay (LoS), and secondarily on acute graft-versus-host disease (aGVHD), cytomegalovirus (CMV) viremia, and mortality in the acute leukemia patients who underwent allo-HCT.Results: A total of 104 acute leukemia patients, of whom 55 had acute lymphoblastic leukemia (ALL) and 49 had acute myeloid leukemia (AML), were included in the study. Compared to the AML group, the median pre-conditioning-IgG, IgA, and IgM levels were found to be significantly lower in the ALL group (11.3 vs. 6.6, p < 0.001; 1.8 vs. 0.9, p < 0.001; and 0.7 vs. 0.4, p < 0.001; respectively). But, there was no significant difference between the groups in pre-conditioning-Ig and ALC levels and transplant outcomes. However, subgroup analysis revealed that high pre-conditioning-ALC levels were significantly correlated with aGVHD levels (Odds Ratio: 1.02; p = 0.034) and low pre-conditioning-IgM levels were significantly correlated with increased mortality rate (Hazard Ratio: 0.08; p = 0.042) in AML patients.Conclusion: The significant difference determined between the ALL and AML groups in pre-conditioning-Ig levels was not reflected on the effects of pre-conditioning-Ig and ALC levels on transplant outcomes. However, we observed that pre-conditioning-IgM and ALC levels have an impact on transplant outcomes in AML patients.Öğe Elastographic evaluation of the effect of sickle cell anemia on testicles: a prospective study(Wiley, 2022) Koras, Omer; Gorur, Sadik; Bayramogullari, Hanifi; Ilhan, Gul; Gokalp, Fatih; Kacmaz, Murat; Ilgezdi, AlicanTo quantitatively determine testicular tissue stiffness values using shear wave elastography (SWE) in males that have sickle cell anemia (SCA) and to evaluate the relationship between elastography results and semen analysis parameters and hormone levels. Fifty patients diagnosed with SCA and followed up in the hematology outpatient clinic were evaluated in the urology outpatient clinic as the study group. In addition, there were 88 patients without any SCA-related complaints in the control group. We compared these groups with respect to their values, spermiogram parameters, testicular volume, and SWE values. Among patients in the SCA group, 28% had impaired sperm parameters. When testicular elastography was assessed, the testicular volumes were materially lower in the SCA group in comparison to the control group [right testicular volume: 14.76 (12.77-18.12) and 19.68 (15.12-24.18), respectively, p < 0.001; left testicular volume: 14.11 (11.06-17.32) and 16.59 (13.38-20.13), respectively, p = 0.015]. Additionally, the left testis central stiffness and the left testis inferior stiffness were significantly higher in the SCA group (p < 0.001 and p = 0.014, respectively). The age and hydroxyurea use had a worse effect on sperm parameters in patients with SCA (odds ratio: -0.161 and -1.914, standard deviation: 0.071 and 0.921, and p = 0.024 and p = 0.038, respectively). We consider that the technique utilized in this study for SWE values is fast and can be adopted as a reliable diagnostic tool and follow-up practice in routine clinical practice to evaluate the acuteness of damage to the testicles in patients having SCA.Öğe Genotype-phenotype correlation and mutation spectrum of HBB gene in the Hatay province of Turkey(Cukurova Univ, Fac Medicine, 2024) Kacmaz, Murat; Asikovali, SemihPurpose: Thalassemia carriage and hemoglobinopathies are quite common disorders in Turkey, especially in the cukurova region, including Hatay province. Due to the high case population and genetic diversity in our region, this study aimed to investigate the genotype-phenotype correlation in the HBB gene. Materials and Methods: The data of patients who applied to Hatay Mustafa Kemal University Medical Genetics or Hematology Clinic between January 2010 and November 2022 were evaluated retrospectively. Results: A total of 40 (100%) cases, comprising 25 (62.5%) homozygous and 15 (37.5%) compound heterozygous genotypes, were included in the study based on the mutation profiles in the HBB gene. In the analysis of the cases, it was seen that there were 17 different variants and 22 distinct genotypes. The three most common variants identified in this study were IVS-I-6 (T>C), IVS-I-1 (G>A), and IVS-II-848 (C>A). Of the cases with homozygous genotypes, 13 (52%) had the IVSI-6 (T>C) variant. The most frequent genotypes observed in cases with compound heterozygous genotype were IVSI-6 (T>C)/IVS-I-110 (G>A), IVS-I-6 (T>C)/Hb Knossos, and IVS-I-110 (G>A)/-101 C>T, each in 2 (13%) cases. Conclusion: This study provides information on the phenotypic characteristics of very rare genotypes. We think that this information will be very beneficial, especially for clinicians interested in prenatal diagnosis, preimplantation genetic diagnosis, and postnatal genetic counseling.Öğe The leucine-rich-2-glycoprotein-1 levels in patients with multiple myeloma(Karger, 2023) Kacmaz, Murat; Oguzman, HamdiIntroduction: Angiogenesis is considered important in the pathogenesis of multiple myeloma (MM), as well as in the targeted treatment of the disease. Leucine-rich-alpha 2-glycoprotein 1 (LRG1) is a protein that participates in angiogenesis and its effect on solid organ tumors has been investigated recently. This study aimed to investigate the relationship between MM and LRG1. Methods: The MM patients who admitted to Hatay Mustafa Kemal University Hematology Clinic between September 2021 and October 2022 were included in the study. The study consists of a total of 4 groups: newly diagnosed MM (NDMM), relapsed refractory MM (RRMM), MM in remission (Rem-MM), and control group. Demographic data were retrieved from hospital records. Blood samples of our study groups were centrifuged at 1500 x g for 10 minutes and serum were collected. LRG1, IL-6, IL-8, TGF-ss 1, HIF-1 alpha, FGF-2, and VEGF levels were analyzed in all groups by ELISA method and statistical analysis was performed. Results: A total of 112 individuals, including NDMM (n:27), RRMM (n:18), Rem-MM (n:42), and control group (n:25), were enrolled in the study. Based on the analyses, the NDMM group exhibited significantly elevated levels of LRG1 (p<0.001), TGF-1 (p<0.001), and HIF-1 alpha (p=0.046, p<0.001, and p=0.003 compared to the RRMM, Rem-MM, and Control groups, respectively) compared to the other groups. LRG1 levels were positively correlated with creatinine (r:0.363, p=0.001), calcium (r:0.344, p=0.001), total protein (r:0.473, p<0.001), erythrocyte sedimentation rate (r:0.547, p<0.001), lactate dehydrogenase (r: 0.321, p=0.003), beta-2-microglobulin (r:0.312, p=0.017), IL-6 (r:0.478, p<0.001), IL-8 (r:0.240, p=0.03), TGF-ss 1 (r:0.521, p<0.001), and HIF-1a (r:0.321, p=0.003) levels, and were negatively correlated with hemoglobin (r:-0.512, p<0.001) and albumin (r:-0.549, p<0.001) levels. Receiver Operating Characteristics (ROC) analysis revealed the association of LRG1 with the highest AUC value of 0.959 (95% CI: 0.904-1, p<0.001) and the optimal cut-off value of 534.95 ng/mL (sensitivity: 93% and specificity: 99%) in the NDMM group compared to the control group. Discussion/Conclusion: In this study, providing data for the first time on LRG1 levels in the setting of MM. LRG1 levels were found to be significantly higher in NDMM patients and in our study discriminate this patient population from significant difference in FGF-2 and VEGF levels was observed in any group. While the results of TGF-ss 1, HIF-1 alpha, IL-6, and IL-8 analysis in our study's NDMM group were similar to previous studies [44-47], the results of FGF-2 and VEGF analysis appear to be conflicting [48-50]. Another result that contradicted previous studies was observed in the RRMM group. It is puzzling that only IL-6 levels were found to be higher than the control group in the results of cytokine analysis in the RRMM group, where a more aggressive disease course was expected compared to the NDMM group. We think the main reason for the differences is because the samples were analyzed from peripheral blood samples, and the study group numbers were not entirely uniform. There are certain limitations of our study. Analyses based on peripheral blood samples can be considered as a limitation. However, there are contradicting studies on the matter. A randomized controlled study of cytokines in MM found no difference between bone marrow and peripheral blood results [50], nevertheless, another comparative study found that bone marrow cytokine levels were higher than peripheral blood [51]. Another limitation of our study can be considered that bone marrow (BM) microvascular density measurements were not performed for the evaluation of angiogenesis. Another limitation of our study is the small sample size in the control group. However, we conducted a pilot study with 7 healthy individuals before the main study, and the mean LRG1 value we obtained was 188.9 +/- 50.8. Subsequently, when the control group was expanded to include 25 individuals, the calculated mean LRG1 value was 189.4 +/- 50.2. Based on these findings, we believe that increasing the sample size in the control group will not result in statistically significant changes in the observed results. Although the lack of data on survival analysis can be considered as a final limitation, the aim of this study was to reveal the descriptive features of MM within the study period, rather than evaluating the effect of LRG1 and other cytokines on survival in MM. Conclusion To our knowledge, this study was the first to analyze LRG1 in MM patients. In this way, we found that the LRG1 level was significantly increased in NDMM. In addition, we found that increase in LRG1 levels was correlated with laboratory parameters which are of considerable importance in the diagnosis, treatment, and prognosis of myeloma. In ROC curves analysis, we found that LRG1 showed a reasonable ability with high sensitivity and specificity in NDMM. These results suggested that LRG1 may play an important role in MM. Therefore, we consider that LRG1 should be evaluated in terms of diagnosis, stage, follow-up, prognosis, and treatment goal in future studies.Öğe Predictive Role of Blood Cellular Indices and Their Relationship with Endogenous Glycosaminoglycans as Determinants of Inflammatory Biomarkers in Pulmonary Embolism(Sage Publications Inc, 2022) Kantarcioglu, Bulent; Darki, Amir; Siddiqui, Fakiha; Krupa, Emily; Vural, Mehmet; Kacmaz, Murat; Hoppensteadt, DebraIntroduction In this study, we profiled the levels of blood cellular indices, endogenous glycosaminoglycans (GAGs) and inflammatory biomarkers in a cohort comprised of pulmonary embolism (PE) patients, to determine their inter-relationships. Identification of this relationship may provide insight to the complex pathophysiology of PE and the predictive role of blood cellular indices in acute PE patients. Materials and Methods Plasma samples from PE patients and healthy controls were analyzed for thrombo-inflammatory biomarkers (IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFN-gamma, TNF-alpha, IL-1 alpha, IL-1 beta, MCP-1, EGF, D-dimer, CRP and MMP-9) using biochip array and ELISA methods. The endogenous GAG levels were quantified using a fluorescence quenching method. The data regarding the blood cellular indices were collected through the review of patient medical records and analyzed to demonstrate their relationship. Results The levels of inflammatory biomarkers and endogenous GAGs were elevated in acute PE patients compared to controls (P < .05). Most of the blood cellular indices have shown significant differences in acute PE patients compared to controls (P < .05). The levels of inflammatory biomarkers, endogenous GAGs and the blood cellular indices have shown significant associations in correlation and multivariable analysis. While NLR, PLR and SII were significantly predicting the 30-day mortality, PNR, ELR and EMR were not sufficient to predict 30-day mortality in acute PE. Conclusion Our results show that the increased thrombo-inflammatory response is associated with the release of GAGs and the changes in blood cellular indices. The predictive role of the blood cellular indices for mortality is dependent on their relationship with the inflammatory response.Öğe The role of pentraxin 3 and oxidative status in the prognosis of multiple myeloma(Sage Publications Ltd, 2024) Oguzman, Hamdi; Kacmaz, MuratMultiple myeloma (MM) is a bone marrow malignancy characterized by plasma cell proliferation. It was aimed to investigate pentraxin 3 (PTX3) levels, oxidative/antioxidative status, and their correlation in MM. In the study, four groups were established, including newly diagnosed MM (NDMM), MM in remission (Rem-MM), relapsed/refractory MM (RRMM) patients, and a healthy control group. PTX3 levels were measured using enzyme-linked immunosorbent assay, and the total antioxidant status (TAS) and total oxidant status (TOS) were assessed with an autoanalyzer. The oxidative stress index (OSI) was calculated using the formula: OSI (arbitrary unit) = TOS (mu mol H2O2 Eq/L)/TAS (mmol Trolox Eq/L) x 100. The study involved comparing PTX3, TAS, TOS, and OSI levels among these four groups. PTX3 levels were significantly elevated in NDMM and RRMM groups compared to controls and the Rem-MM group (NDMM vs control; p < 0.001, NDMM vs Rem-MM; p < 0.001, RRMM vs control; p < 0.001, and RRMM vs Rem-MM; p = 0.006). TAS was higher in NDMM and RRMM groups versus controls (p = 0.009 and p < 0.001, respectively), and TOS was higher in rem-MM group versus NDMM and control groups (p < 0.001 and p = 0.016, respectively). OSI was higher in the Rem-MM group than in NDMM and RRMM groups (p < 0.001 and p = 0.009, respectively). Multivariate analysis confirmed associations between MM groups and PTX3 levels. Receiver operating characteristic analysis revealed high specificity (90%) and sensitivity (79%) for PTX3 in NDMM at a >0.56 ng/mL cut-off value. This study suggests that PTX3 levels may have diagnostic and prognostic potential in MM and its relationship with oxidative stress requires further exploration.Öğe Sickle Cell Leg Ulcer Extending to the Achilles Tendon(Galenos Publ House, 2023) Asma, Suheyl; Boga, Bircan; Kacmaz, Murat[Abstract Not Available]
