Post-BMT subjects have an increased bone fracture risk. Additionally, several factors were associated with osteopenia and osteoporosis in these individuals. We aimed to identify other factors associated with osteopenia and osteoporosis in allogeneic post-BMT subjects. We conducted a cross-sectional study with 47 allogeneic post-BMT subjects. Serum 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, ferritin, vitamin B 12 , insulin, glucose, cholesterol and triglyceride levels were measured. Insulin resistance and secretion were estimated through the homeostatic model assessment for insulin resistance (HOMA-IR) and homeostatic model assessment for b-cell function (HOMA-B), respectively. A bone densitometry (BMD) was also obtained. The median time after BMT was 47.7 (12-115) months. Osteoporosis was identified in 17.0% of the subjects and osteopenia in 19.7%. The mean serum ferritin (P ¼ 0.002), insulin (Po0.0001), glucose (P ¼ 0.003) and triglyceride (P ¼ 0.018) levels were higher in individuals with osteopenia/osteoporosis. HOMA-IR (Po0.0001) and HOMA-B (Po0.0001) were increased in post-BMT subjects with osteopenia/osteoporosis. There was no other factor associated with the outcome. After adjustments ferritin, serum 25(OH)D and HOMA-IR remained independently associated with osteopenia/osteoporosis; however triglycerides no longer were. In conclusion, in the present study, low serum 25(OH)D levels, high serum ferritin levels and insulin resistance were associated with osteopenia/osteoporosis in post-BMT subjects.
New indications and conditioning regimens for hematopoietic stem cell transplantation (HSCT) have emerged in the last 10 years. Previous studies have shown the association of HSCT with late effects such as sleep disorders. The aim of this study was to determine the prevalence and factors associated with sleep disorders following HSCT in a population considering these new trends. Sixty-one individuals 1–10 years after allogeneic HSCT were surveyed using the DSM-IV-TR criteria for sleep disorders. Factors related to conditioning and graft-versus-host disease were collected from medical records. A prevalence of sleep disorders of 26.2% was found. Busulfan-cyclophosphamide conditioning was an independent risk factor in a multivariate analysis (relative risk, RR: 3.74, 95% CI: 1.1–12.6; p = 0.03), which also included sex (RR: 2.37, 95% CI: 1.0–5.7; p = 0.05) and age (RR: 1.03, 95% CI: 0.99–1.07; p = 0.11). Sleep disorders were frequent following HSCT. Patients who were treated with busulfan-cyclophosphamide had a higher risk of developing this complication. Female sex was also possibly a risk factor.
Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a rare late complication of brain irradiation. Patients commonly present recurrent attacks of headaches, seizures, and paroxysmal focal neurological deficits including aphasia, negligence, or hemianopsia. We report a 41-year-old male patient admitted to our emergency room with a reduced level of consciousness and global aphasia. One month prior to admission, he started with frequent headache attacks of moderate intensity and paroxysmal behavioral alterations, advancing to confusion, gait instability, language impairment, and somnolence. He had a history of medulloblastoma treated with surgical resection followed by craniospinal irradiation 21 years before symptom onset. After excluding more frequent causes for the patient’s symptoms along with a suggestive image pattern, we started treatment for SMART syndrome with high-dose corticosteroid and calcium channel blocker verapamil. The patient gradually improved his level of consciousness and recovered from aphasia and gait instability without new seizures or neuropsychiatric symptoms. Follow-up brain magnetic resonance imaging showed resolution of the typical findings. This case displays a successful clinical evolution of a patient treated for SMART syndrome in which identification of previous radiation treatment, exclusion of other etiologies, and prompt treatment institution were key for effectively tackling this disease.
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