Inappropriate prescription prevalence of ~40% by STOPP version 2 was similar to the global worldwide prevalence - yet at the upper end. STOPP version 2 was more successful than Beers 2012 to detect PIM. Patients with multiple drug use, multiple comorbidities and more dependency were more likely to have PIM requiring special attention during prescription. Geriatr Gerontol Int 2017; 17: 1245-1251.
Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP v2 identified potentially inappropriate-prescriptions by implicit evaluation in a significant percent of geriatric patients signifying need for comprehensive geriatric evaluation in practice.
Chronic lymphocytic leukemia (CLL) is a malignancy characterized by clonal proliferation and accumulation of B lymphocytes. Although leukaemic infiltration of the kidney is well recognized in CLL, acute renal failure (ARF) due to leukaemic infiltration is extremely rare. Here we present a case of ARF as the initial manifestation of CLL. The diagnosis was made by a kidney biopsy. Treatment with cyclophosphamide and prednisolone resulted in a completely improved renal function.
Visseral leishmaniasis (VL, Kala-azar) tatarcık sinekleri (sandflies) ile bulaşan Leishmania donovani ve Leishmania infantum'un neden olduğu bir hastalıktır. VL; Türkiye'de sporadik olarak görülmektedir. Üç aydır devam eden halsizlik, yorgunluk ve kilo kaybı şikayetleriyle hematoloji polikliniğimize başvuran altmış sekiz yaşında kadın hasta tetkik edildi. Hasta; pemfigus vulgaris nedeniyle iki aydır immünsüpresif tedavi almaktaydı. Yapılan tetkiklerde pansitopeni ve hepatosplenomegaliyi açıklayacak bir patolojiye rastlanmadı. Hastaya tanı için kemik iliği biyopsisi yapıldı. Hastanın kemik iliği aspirasyon ve biyopsisinde Leishmania parazitleri görüldü. Hastaya amfoterisin B tedavisi başlandı. Tedavi ile hastanın kliniği düzeldi. İmmünsüpresif tedavi alan, hepatosplenomegali ve pansitopenisi olan hastalarda VL'nin ayırıcı tanıda muhakkak akla gelmesi gerektiğini düşünüyoruz.
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