Effect of galantamine on platelet functions in healthy elderly people.

BACKGROUND & OBJECTIVES: Galantamine, a centrally-acting cholinesterase inhibitor, has been used in the treatment of mild-to-moderate dementia of Alzheimer disease. Increased mortality, mainly due to cardiovascular events, was observed in placebo-controlled trials of galantamine. Several studies have evaluated the efficacy of galantamine in dementia, it is not clear whether it has an effect on platelet function. It is important to clarify this effect, because it may be related to thrombotic tendency or bleeding diathesis. This study was aimed to investigate the effect of galantamine on platelet aggregation in whole blood from healthy, elderly subjects. METHODS: Fifteen healthy (mean age 76.8 ± 7.2 yr) volunteers were included in the study. Three concentrations of galantamine solution (20, 40 and 80 ng/µl) were prepared. Each concentration of galantamine solution and control diluent without galantamine were incubated with whole blood. After incubation, aggregation responses were evaluated with ADP (5 µM) and collagen (2 µg/ml) in platelet-rich plasma. RESULTS: Compared to control, pre-incubation with all dilutions of galantamine had no detectable effect on platelet aggregation response induced by ADP and collagen. Galantamine also had no detectable effect on platelet aggregation in a dose-dependent manner. INTERPRETATION & CONCLUSIONS: This in vitro study suggested that galantamine administration had no effect on platelet aggregation in the clinically relevant doses.

Treatment options in primary mediastinal B cell lymphoma patients, retrospective multicentric analysis; a Turkish oncology group study.

Introduction and Aim: Primary mediastinal B-cell lymphomas (PMBL) are aggressive B- cell lymphomas. Although the initial treatment models vary in PMBL, appropriate treatment methods are not known. We aim to show real-life data on health outcomes in adult patients with PMBL who received various type of chemoimmunotherapies in Turkey. Method: We analyzed the data of 61 patients who received treatments for PMBL from 2010 to 2020. The overall response rate (ORR), overall survival (OS) and progression-free survival (PFS) of the patients were evaluated. Results: 61 patients were observed in this study. The mean age of the study group was 38.4 ± 13.5 years. From among them, 49.2% of the patients were female (n = 30). For first-line therapy, 33 of them had received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen (54%). Twenty-five patients had received rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (DA-EPOCH-R) regimen. The ORR was 77%. The median OS and PFS were as follows: 25 months (95% CI: 20.4-29.4) and 13 months (95% CI: 8.6-17.3), respectively. The OS and PFS at 12 months were 91.3% and 50%, respectively. The OS and PFS at five years were 64.9% and 36.7%, respectively. Median follow-up time period was 20 months (IQR 8.5-38.5). Conclusion: R-CHOP and DA-EPOCH-R showed good results in PMBL. These remain one of the best determined systemic treatment options for first-line therapy. Also, the treatment was associated with good efficacy and tolerability.

A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey.

Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopus oryzae, Mucor circinelloides, and Lichtheimia corymbifera. Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.

Serum vitamin B12 and homocysteine levels in pregnant women with neural tube defect.

OBJECTIVE: The aim of the study is to investigate the importance of serum vitamin B12 levels in pregnant women with foetal neural tube defect (NTD). STUDY DESIGN: This study consists of 31 pregnant women having fetuses with NTD. The pregnant women in the study group were selected among cases with normal folate levels. Serum vitamin B12 levels were investigated. Additionally, complete blood count, serum iron level, iron binding capacity, ferritin, folate, free T(3), free T(4), thyroid stimulating hormone and plasma homocysteine levels were measured. Control group consisted of 32 pregnant women who did not have a history of NTD in previous pregnancies and did not have fetuses with NTD in present pregnancy. NTD was diagnosed between 14th and 20th gestational age. The mean gestational age of members of control group was the same as those of NTD group. RESULTS: There was no statistically significant difference between pregnants with NTD and control group according to number of cases with vitamin B12 deficiency. CONCLUSION: It seems that vitamin B12 deficiency does not play a causative role in the development of foetal NTD. Monitoring maternal homocystein levels might be important in understanding the aetiologies of foetal NTD.

Platelet-derived microparticle levels in women with recurrent spontaneous abortion.

OBJECTIVE: To investigate the significance of platelet-derived microparticles (PMPs) in women with recurrent spontaneous abortion. METHODS: We measured platelet P-selectin (CD62P) as a platelet activation marker and CD42b(+) microparticles as PMPs by flow cytometry in whole blood of 20 women with recurrent spontaneous abortion and 20 age-matched healthy controls with no previous history of spontaneous abortion. RESULTS: PMP levels in women with recurrent spontaneous abortion were higher than in women in the control group (4.79+/-1.18% vs 3.06+/-0.92%; P<0.000). CD62P levels were not significantly higher in the study group compared with the control group (13.78+/-8.62% vs 10.78+/-7.35%; P>0.05). CONCLUSION: Our findings suggest that PMPs may have a role in the pathogenesis of recurrent spontaneous abortion.

Platelet aggregation abnormalities in patients with recurrent fetal losses.

INTRODUCTION: There are some studies reporting that platelets might have a role in cases with recurrent fetal losses. The aim of this study is to evaluate the importance of platelet aggregation abnormalities in this patient group. MATERIALS AND METHODS: In this study, platelet aggregation abnormalities were compared in 56 cases with recurrent fetal losses (29 of these 56 patients have >or=3 losses) and in 33 healthy female controls with no previous history of fetal loss. Platelet aggregation studies were performed with optical turbidometric method by using ADP (5 microM), collagen (0.2 mg/ml) and epinephrine (10 microM). RESULTS: We did not find any statistically significant difference between patient (56 cases with >or=2 fetal losses and 29 of them with >or=3 fetal losses) and control groups for platelet aggregation abnormalities. CONCLUSIONS: The data we have obtained suggest that severe platelet aggregation abnormalities are not the rule in patients with recurrent fetal losses.

The effect of radiologic imaging studies on the risk of secondary malignancy development in patients with Hodgkin lymphoma.

PURPOSE: Recently, reports have been published, which suggest that diagnostic radiologic imaging studies could play a role in the risk of secondary malignancy development in patients with cancer. The aims of our study are to calculate the average amount of accumulated radiation dose gained by means of radiologic imaging studies performed intensively in diagnosis and follow-up of patients with Hodgkin lymphoma and to evaluate whether this amount of accumulation accounts for a real risk for secondary malignancies. PATIENTS AND METHODS: This study consists of 15 male patients, whose mean age was 23.67 years +/- 4.24 years. All radiologic imaging studies performed in patients with Hodgkin lymphoma were noted in detail, and average radiation dose accumulation was calculated. RESULTS: Median radiation doses to which patients were subjected during a median of 14.5 months of disease duration were 85.19 mSv and 161.08 mSv according to data of the National Radiological Protection Board and Biological Effects of Ionizing Radiation VII report, respectively. The cumulative radiation dose, because of radiologic imaging studies, is 8.5-16-times greater than that of the described dose having 1 in 1,000 chance of cancer development according to Biological Effects of Ionizing Radiation VII report. Approximately, this amount is equivalent to the dose of natural background radiation received during 35-70 years. CONCLUSION: Our study demonstrated that radiation dose accumulation because of radiologic imaging studies used in diagnosis, staging, and follow-up of patients with Hodgkin lymphoma was high enough to cause development of secondary malignancies. Finally, it is obvious that the radiologic imaging study policies used in follow-up of these patients should be overviewed.

The platelet count/mean corpuscular hemoglobin ratio distinguishes combined iron and vitamin B12 deficiency from uncomplicated iron deficiency.

Combined deficiencies of iron and cobalamin are common. The aims of this study were to investigate the significance of the parameters of the complete blood count (CBC) in differentiating microcytic anemia due to pure iron deficiency anemia (IDA) from anemia due to combined deficiencies of vitamin B(12) and iron (IDA-B12). The study was carried out with 122 patients (100 female) who had microcytic red blood cell indices with IDA-B12 and 105 patients (95 female) with IDA. Group IDA-B12 patients had decreased hemoglobin levels, mean corpuscular volumes, mean corpuscular hemoglobin (MCH) levels, and MCH concentrations but had increased platelet counts (PLT). Using these parameters, we developed a PLT/MCH ratio parameter that has high values when IDA is accompanied by cobalamin deficiency. The cutoff value of >12.00, with a 74.6% sensitivity and a 41.9% specificity, appears to be the most convenient value for screening. We advise measuring the levels of cobalamin in patients with IDA associated with a high PLT/MCH ratio.

Platelet apheresis affects prothrombin time and plasminogen levels in healthy donors.

There are few studies evaluating whether platelet apheresis has an effect on hemostasis parameters or not. The aim of this study was to define the effects of platelet apheresis on hemostasis screening tests and plasminogen levels. The study was performed on 40 healthy donors. We compared the values obtained before and after apheresis and observed that the prothombin time (PT) elongated, plasminogen levels decreased and the activated partial thromboplastin and thrombin times were not changed significantly. The differences were not high enough to cause any hemostasis problem. It can be hypothesized that platelet apheresis affects PT and plasminogen levels in healthy donors.

Evaluation of platelet parameters in healthy apheresis donors using the ADVIA 120.

Platelet apheresis is accepted as a safe procedure and no clinically important change is observed after apheresis. The ADVIA 120 provides both an accurate platelet count and parameters describing platelet morphology and function. We studied the changes in platelet parameters of 35 healthy apheresis donors using the ADVIA 120. The mean platelet component value did not change after apheresis but the value of the platelet count was low and this reduction could be due to activation of platelets. We conclude that no remarkable changes were noted except the reduction in platelet numbers and plateletcrit which were expected to return to normal values in a few days.

The effects of desflurane on human platelet aggregation in vitro.

In view of the possible antiplatelet effects of general anesthetics, we investigated the in vitro effects of desflurane, a new inhalation agent, on platelet aggregation. For 15 patients who underwent elective operations, blood was sampled with desflurane induction before and after anesthesia but prior to surgery so that platelet aggregation in the drawn blood could be tested before desflurane anesthesia and again after exposure to the anesthetic. Platelet aggregation was measured with a whole-blood aggregometer. Adenosine diphosphate (ADP), collagen, and ristocetin were used as aggregating agents. Our results showed that aggregation in response to ADP, collagen, or ristocetin was not inhibited in patients who received desflurane anesthesia. This study with an in vitro model showed that desflurane had no influence on platelets in clinically relevant doses.

Variant hairy cell leukemia following papillary urothelial neoplasm of bladder.

A 65 years old man was admitted with multiple lymphadenopathy, weight loss, night sweats and fatigue for 2 months. He had been treated for bladder cancer 2 years ago. Leukocyte count was 37.9 x10(9)/l. Peripheral blood smear had 91% lymphocytes. Lymphocytes had large nuclei with prominent nucleoli, heterogeneous appearance, and large cytoplasm with hairy projections. Flow cytometric immunophenotyping revealed CD20, CD22, CD24, CD45 and HLA-DR positivity. Atypical lymphocytes were stained with tartrate resistant acid phosphatase. Increased metabolic activity was detected in multiple lymph nodes, bone marrow and extremely enlarged spleen with positron emission tomography-computed tomography. Excisional biopsy of the left axillary lymph node revealed infiltration with diffuse B-cell leukemia/lymphoma. Immunohistochemistry showed CD20 positive atypical cells with weak expression of CD11c. The patient was diagnosed as a case of variant hairy cell leukemia and cladribine was administered. A probable second primary malignancy should be kept in mind in cases with a defined malignancy in the presence of unusual symptoms.