ÖZET
GİRİŞ ve AMAÇ:Bu çalışmanın amacı, hematolojik kanser tanısı almış ve kemoterapi tedavisi görmekte olan hastalarda distres, anksiyete ve depresyon yaşama durumlarını belirlemektir. YÖNTEM ve GEREÇLER: Tanımlayıcı kesitsel tipte yapılan çalışmanın örneklemini, hematolojik kanser tanısı almış, hematoloji servisine yatışı yapılan veya ayaktan kemoterapi tedavisi görmekte olan 75 bireyden oluşmaktadır. Hastalara kişisel bilgi formu, Distres Termometresi (DT) ve Hastane Anksiyete ve Depresyon Skalası (HADS) testleri uygulandı. BULGULAR: DT'ye göre 52 hastanın (%69,3) yüksek stres (≥4) yaşadığı, 23 hastanın (%30,7) düşük stres (<4) yaşadığı belirlenmiştir. HAD ölçeğine göre, HAD-Anksiyete alt boyutu açısından 17 hastanın (%22,7) 10 ve üzeri olduğu belirlenmiştir. HAD-Depresyon alt boyutu açısından 47 hastanın (%62,7) 7 ve üzeri olduğu belirlenmiştir. DT ve HAD skalaları arasında pozitif yönlü korelasyon vardır. Bayanların anksiyete puan ortalamasının, erkeklerin anksiyete puan ortalamasından istatistiksel olarak anlamlı düzeyde daha yüksek olduğu belirlenmiştir. TARTIŞMA ve SONUÇ: Hastaların büyük çoğunluğu tanı anından itibaren tedavi süreci boyunca distres yaşamaktadır. Hastaların distresi artıkça anksiyete ve depresyon seviyeleri de artmaktadır. Böylece hastaların fiziksel ve emosyonel yakınmaları artarken, tedaviye uyum zorlaşmakta, hastane yatış süreleri artmakta ve hastanın yaşam kalitesi azalmaktadır. Psikolojik sıkıntı yaşayan hastaların gözden kaçmaması, tespit edilmesi ve yönlendirilmesi için ve nicel olarak ölçüm yapan, zaman almayan tarama ölçekleriyle hastaların rutin olarak değerlendirilmesi literatür ışığında önerilmektedir.
Objective:
Significant developments occurred in the clinical management of acute lymphoblastic leukemia (ALL) in adults in recent decades. However, treatment results are still not satisfactory, especially in routine practice. The objective of this study was to evaluate the general clinical features, treatment details, and outcomes of a large group of patients followed in multiple centers in Turkey with a diagnosis of ALL.
Materials and Methods:
A retrospective analysis of the data of patients with ALL was made, the patients having been diagnosed and treated between January 2003 and June 2017 by different protocols in the hematology clinics of ten different centers. A total of 288 patients, aged between 17 and 76 years old, were included in the study. In this retrospective multicenter analysis of patients with ALL, classification of patients was performed based on treatment period, Philadelphia chromosome positivity, treatment regimen, and administration of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Results:
The majority of cases were B-cell in origin, while 224 patients had B-ALL and 64 of the patients had T-ALL. Median follow-up duration for all patients was 18.2 months (range: 0.03-161 months). Philadelphia chromosome positivity was determined in 49 patients (21.9%), and 54 patients (18.8%) were receiving allo-HSCT. After induction chemotherapy, 219 patients (76.0%) achieved complete remission, 32 patients (11.2%) were evaluated as treatment refractory, and 37 patients (12.8%) were deceased. Median overall survival was 47.7 months (95% confidence interval: 36.1-59.2) and median disease-free survival was 23.4 months (95% confidence interval: 6.7-40.0) for all patients.
Conclusion:
Multicenter studies are extremely important for defining the specific clinical features of a particular disease. The results of this study will make a significant contribution to the literature as they reflect real-life data providing valuable information about the Turkish ALL patient profile.
Objective: To evaluate vessel involvement and the role of multidetector computed tomography (MDCT) in the earlydiagnosis of invasive pulmonary aspergillosis (IPA) in patients with febrile neutropenia and antibiotic-resistant feverundergoing autologous bone morrow transplantation.Material and Methods: In all, 74 pulmonary MDCT examinations in 37 consecutive hematopoietic stem celltransplantation patients with febrile neutropenia and clinically suspected IPA were retrospectively evaluated.Results: Diagnosis of IPA was based on Fungal Infections Cooperative Group, and National Institute of Allergy andInfectious Diseases Mycoses Study Consensus Group criteria. In all, 0, 14, and 11 patients were diagnosed as proven,probable, and possible IPA, respectively. Among the 25 patients accepted as probable and possible IPA, all had pulmonaryMDCT findings consistent with IPA. The remaining 12 patients were accepted as having fever of unknown origin (FUO)and had patent vessels based on MDCT findings.In the patients with probable and possible IPA, 72 focal pulmonary lesions were observed; in 41 of the 72 (57%) lesionsvascular occlusion was noted and the CT halo sign was observed in 25 of these 41 (61%) lesions. Resolution of feveroccurred following antifungal therapy in 19 (76%) of the 25 patients with probable and possible IPA. In all, 6 (25%)of the patients diagnosed as IPA died during follow-up. Transplant-related mortality 100 d post transplant in patientswith IPA and FUO was 24% and 0%, respectively.Conclusion: In conclusion, MDCT has a potential role in the early diagnosis of IPA via detection of vessel occlusion.
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