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    A Case of Pulmonary and Central Nervous System Invasive Aspergillosis with Characteristic Radiological Findings
    (Soc Turkish Intensivists - Sti, 2024) Akbas, Turkay; Karahan, Fatih; Ogul, Hayri; Onec, Birgul; Onmez, Attila; Unlu, Nisa; Balbay, Ege Gulec
    Central nervous system invasive aspergillosis is a rare fatal infection responsible for the majority of brain lesions in immunocompromised patients. A 56-year-old man with diabetes mellitus and non-Hodgkin's lymphoma was admitted to the emergency department with a diagnosis of pneumonia-related sepsis. At presentation, cranial computed tomography (CT) and magnetic resonance imaging were normal, but thoracic CT revealed right lung pneumonia, and antibiotic therapy was initiated. Control CT scans performed on the 13th day of admission because the patient had subsequently become hypotensive and somnolent revealed halo signs in the lungs and multiple hypodense lesions within the cerebrum, consistent with invasive aspergillosis. A post-contrast cranial CT scan also revealed vascular enhancement within the hypodense lesions, known as the central vascular sign. In conclusion, central nervous system aspergillosis can be diagnosed by means of tubular enhanced focuses in hypodense lesions on contrast-enhanced CT scans.
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    A Case of Pulmonary and Central Nervous System Invasive Aspergillosis With Characteristic Radiological Findings
    (Soc Turkish Intensivists - Sti, 2024) Akbas, Turkay; Karahan, Fatih; Ogul, Hayri; Onec, Birgul; Onmez, Attila; Unlu, Nisa; Balbay, Ege Gulec
    Central nervous system invasive aspergillosis is a rare and fatal infection that accounts for the majority of brain lesions in immunocompromised patients. A 56-year-old man with diabetes mellitus and non-Hodgkin's lymphoma was admitted to the emergency department with a diagnosis of pneumonia-related sepsis. At presentation, cranial computed tomography (CT) and magnetic resonance imaging were normal. However, thoracic CT revealed right lung pneumonia, and antibiotic therapy was initiated. Control CT scans performed on the 13(th) day of admission-because the patient had subsequently become hypotensive and somnolent- revealed halo signs in the lungs and multiple hypodense lesions within the cerebrum, consistent with invasive aspergillosis. A post-contrast cranial CT scan also revealed vascular enhancement within these hypodense lesions, known as the central vascular sign. In conclusion, central nervous system aspergillosis can be diagnosed by means of tubular enhanced foci in hypodense lesions on contrast-enhanced CT scans.
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    Clonal CD4+Cytotoxic T Lymphocytosis Concomitant With POEMS Syndrome: A Co-Existence of Key Findings for Relevance in the Pathogenesis
    (Cig Media Group, Lp, 2023) Gultekin, Burak; Kaya, Berker; Goksoy, Yagmur; Altinkaynak, Mustafa; Onec, Birgul; Altay, Yilmaz; Yegen, Gulcin
    [No abstract available]
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    The Effect of Treatment on Weight Gain in Iron Deficiency Anemia and Its Association with Ghrelin and Hepcidin Levels
    (Duzce Univ, Fac Medicine, 2023) Kilinc, Halil Cansun; Onec, Birgul; Onec, Kursad; Ankarali, Handan
    Aim: Although loss of appetite in iron deficiency anemia (IDA) and weight gain during treatment are common complaints, there are very few studies in adults. This study aimed to determine the levels of ghrelin, one of the appetite-related hormones, and hepcidin, one of the main regulators of iron metabolism, in IDA, and to examine the effects of treatment on weight gain and the levels of these hormones. Material and Methods: Eighty-seven adult patients with IDA and a control group of 50 healthy volunteers were included in the study. Anthropometric measurements and blood samples were obtained from the patient and control groups before treatment, and repeated after treatment in the IDA group. Results: No significant difference was found in terms of weight, body mass index (BMI), and waist-to-hip ratio between groups but there was a significant increase in weight and BMI, in the patient group after treatment (both p<0.001). Pre-treatment hepcidin and ghrelin levels of the patient group were significantly lower than the control group (p<0.001, and p=0.026, respectively), and hepcidin levels increased significantly after treatment (p<0.001). The increase in ghrelin was not statistically significant but showed a positive weak correlation with both weight (r=0.254, p=0.018) and BMI (r=0.231, p=0.031) increase. Hepcidin levels were not correlated with weight and BMI changes. Conclusion: These findings revealed low levels of ghrelin and hepcidin in adults with IDA and an increase in weight and BMI with treatment. Hepcidin increased with treatment but was not correlated with weight gain, ghrelin was weakly correlated.
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    The Relationship of Hepcidin, Soluble Transferrin Receptor, Growth Differentiation Factor-15 And Anemia in Multipl Myeloma
    (Duzce Univ, Fac Medicine, 2023) Onec, Birgul; Kos, Durdu Mehmet; Altun, Gulsah; Sungur, Mehmet Ali
    Objective: Multiple myeloma (MM) is a malignant hematological disease and anemia is observed in the majority of patients. Hepcidin, Growth differentiation factor-15 (GDF-15), soluble transferrin receptor (sTfR) have been investigated in many forms of anemia, especially in chronic diseases and cancers. However, there are few studies investigating their role in MM. We aimed to determine the relationship between hepcidin, sTfR and GDF-15 levels in MM patients and their clinical features such as anemia parameters, disease stage and overall survival.Methods: Hepcidin, sTfR and GDF-15 levels, as well as clinical and anemia-related parameters, were analyzed in newly diagnosed MM patients and healthy volunteers.Results: Although MM patients had significantly lower Hb and Hct levels compared to the control group, none of the GDF-15, hepcidin and sTfR levels showed a significant difference between the groups. Among MM patients, we found that the anemic subgroup had significantly lower hepcidin levels than the non-anemic subgroup. GDF-15, hepcidin and sTfR levels showed weak or moderate, but statistically significant positive correlation with each other, while GDF15 was positively correlated with creatinine and sTfR levels were correlated with many parameters such as LDH, CRP, ferritin, albumin, creatinine, Hb and ISS, all of which weak. None of the levels of GDF-15, hepcidin and sTfR had a significant effect on survival.Conclusions: We suggested that these mediators may play a role in anemia of MM but there is not a clear relashionship as in chronic disease anemia, there may be different mechanisms according to the characteristics of the patient groups.
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    Type and Level of Anxiety Affects the Perception of Pain During Bone Marrow Biopsy
    (Duzce Univ, 2021) Onec, Birgul; Onec, Kursad; Esbah, Ali Umit; Esbah, Onur
    Objective: Bone marrow aspiration and biopsy (BMAB) is an essential tool for diagnosis of hematological disorders. The most frequent complaint after BMAB is pain but the severity of this pain is described very different among patients. We investigated factors predicting this pain focusing on the role of state and trait anxiety. Methods: One hundred and ten adult patients undergoing BMAB, were informed adequately and assessed with The State-Trait Anxiety Inventory (STAI) before the procedure. In this Likert-type inventory, State Anxiety Scale evaluates the current state of anxiety, asking how respondents feel at that moment. The Trait Anxiety Scale evaluates relatively stable aspects of anxiety proneness, including general states of confidence, calmness, and security. After the biopsy, pain was measured with visual analog scale. Results: Most of the patients (71.8%) described mild pain but moderate to severe pain were significantly more frequent in both high state and trait anxiety groups. Pain severity had a positive but weak correlation with trait anxiety but not with state anxiety. The described pain level was associated with older age but was not with indication of biopsy, performance status, comorbidities or previous BMAB experiences. Conclusions: Results of our study made us thought that a good communication with the patient and talking about possible outcomes days before procedure might play a role reducing his or her anxiety but because age and trait anxiety cannot be changed by using fast acting anxiolytic drugs, advantage of premedication with anxiolytics in order of reducing pain, would be limited.