Friday, September 17, 2021

Milliyet, 10 Eylül 2021

Hafta başında Ankara Şehir Hastanesi yoğun bakım doktorlarının uyarılarını yazmıştım. Özellikle gebe olup da kovide yakalanan hastaların sayısının arttığı ve kayıpların olduğu vurgulanmıştı. Bir kaç gündür bazı illerden de benzer haberler geliyor.

Yoğun bakım doktoru Mehmet Eren Yüksel’in şu uyarıları çok önemli:

“Son günlerde gebe olup da kovide yakalanan çok hastamız var. 

Özellikle hamile olan hastalarımızda aşı olma yüzdesinin çok düşük olduğunu görüyoruz. 

Sezeryanla bebekleri almak gerekiyor. Birçoğu erken doğum olduğu için yaşamıyor.

Bu süreçte genç anne ve bebeklerinin ölümlerinin önüne geçmek için gebeler mutlaka aşı olmalı."

Abdullah Karakuş, Milliyet, 10 Eylül 2021

 https://www.milliyet.com.tr/yazarlar/abdullah-karakus/afganistandaki-hukumet-ve-kadinlar-ne-yapar-6594500

Prolonged SARS-CoV-2 RNA detection in nasopharyngeal RT-PCR test in COVID-19 patients with Myelodysplastic Syndrome: A case report

Prolonged SARS-CoV-2 RNA detection in nasopharyngeal RT-PCR test in COVID-19 patients with Myelodysplastic Syndrome: A case report

Dr. Hasan Dirik

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: hsndrk_38@hotmail.com

Dr. Şerife Bektaş

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: serifegbektas@gmail.com

Dr. Mehmet Eren Yüksel

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. e-mail: doctormehmeteren@yahoo.com

Prof. Dr. Seval İzdeş

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. E-mail: sevalizdes@yahoo.com

Introduction:The detection of viral ribonucleic acid using reverse transcription polymerase chain reaction (RT-PCR) within nasopharyngeal swabs is essential for the diagnosis of SARS-CoV-2 infection. Myelodysplastic syndrome (MDS) represents a heterogeneous group of myeloid neoplasms which are characterized by ineffective hematopoiesis, cytopenia, and risk of progression to acute myeloid leukemia. Hereby, we present a 62-year-old female patient with both MDS and Covid-19, who continued to have a positive nasopharyngeal RT-PCR test for 46 days until she passed away.

Case Report: The patient, who was diagnosed with MDS in August 2020, was complaining of high fever. She had had two doses of Sinovac vaccine. Past medical history was remarkable for chemotherapy which was ended 1 month before. Bone marrow transplantation was planned within a week. Despite the i.v. ertapenem treatment, high fever persisted, and neutropenia occurred. White blood cell count (Wbc) was 0.43 x109/L. Blood and urinary cultures revealed extended spectrum beta-lactamase (ESBL) producing Escherichia coli. In addition, SARS-CoV-2 RT-PCR test on nasopharyngeal swab was performed, which was revealed to be positive. Antibiotic treatment was initiated. The patient was admitted to the intensive care unit. Afterwards, serial nasopharyngeal swabs were collected from the patient for 46 days until she passed away, and all were positive for Covid-19.

Discussion: In the medical literature, long-term (longer than 3 weeks) SARS-CoV-2 RT-PCR positivity has been reported in mild or asymptomatic patients. There are a few number of publications dealing with MDS and Covid-19 in the English medical literature. Qing et al. reported MDS in a 30-year-old man with Covid-19, however, RT-PCR positive period was not mentioned. SARS-CoV-2 clearance period depends on immunity of the patients and Covid-19 infection may have  a prolonged course in patients with hematological disorders such as MDS.

References

1. Platzbecker U, Kubasch AS, Hom:er-Bouthiette C, Prebet T. Current challenges and unmet medical needs in myelodysplastic syndromes. Leukemia. 2021;35(8):2182-98.

2. Kim SM, Hwang YJ, Kwak Y. Prolonged SARS-CoV-2 detection and reversed RT-PCR results in mild or asymptomatic patients. Infect Dis (Lond). 2021;53(1):31-7.

3. Bhattacharya B, Kumar R, Meena VP, Soneja M, Singh A, Das R, et al. SARS-CoV-2 RT-PCR profile in 298 Indian COVID-19 patients: a retrospective observational study. Pathog Dis. 2021;79(1).

4. Xu W, Piper-Vallillo AJ, Bindal P, Wischhusen J, Patel JM, Costa DB, et al. Time to SARS-CoV-2 clearance among patients with cancer and COVID-19. Cancer Med. 2021;10(5):1545-9.

5. Qing X, Cai J, Rock A. Myelodysplastic syndrome in a 30-year-old man with coronavirus disease 2019 (COVID-19): a diagnostic challenge. Autops Case Rep. 2021;11:e2021274.

Conference: 2. International Cancer Days, Sivas Cumhuriyet University, 16-18 September 2021

https://kansergunleri.cumhuriyet.edu.tr/?page_id=589&lang=tr

Comparison Of Colorectal Cancer Screening Programmes Of Turkey and The European Union

Comparison Of Colorectal Cancer Screening Programmes Of Turkey and The European Union

Dr. Mehmet Eren Yuksel

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. e-mail: doctormehmeteren@yahoo.com

Dr. Hasan Dirik

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: hsndrk_38@hotmail.com

Introduction: Faecal immunochemical test (FIT), faecal occult blood test (FOBT), flexible sigmoidoscopy (FS), Guaiac faecal occult blood test (gFOBT) and total colonoscopy (TC) can be used for colorectal cancer screening. However, Turkey and other European countries have different practices for colorectal screening tests, beginning-stopping ages and screening intervals.

Method: World Cancer Report, which was published by World Health Organization (WHO) International Agency For Research on Cancer in 2020, has been throughly examined (1).

Results: Colorectal cancer screening starting age is 40 in Bulgaria and Austria, whereas it is 50 in Belgium, Croatia, Denmark, France, Germany, Greece, Italy, Latvia, Lithuania, Portugal, Slovenia, Spain, Scotland, Serbia, Switzerland and Turkey, and  it is 55 in Netherlands, Poland and Norway, whereas it is 60 in Estonia, Finland, Ireland, Sweden and United Kingdom. The stopping age for colorectal cancer screening is 60 in Bulgaria, 69 in Turkey, 80 in Austria and Switzerland. Interval period is 1 year in Bulgaria and Latvia, whereas it is 2 years in most of the European countries. Attendance to the colorectal screening programme is 1% in Hungary and Portugal, 2% in Poland, 8% in Greece and Spain,13% in Sweden, 30% in Turkey, 56% in United Kingdom and 61% in Austria.

Conclusion: WHO reported no definitive colorectal cancer screening interval period for Turkey, however, Turkish Ministry of Health recommends FOBT every 2 years and TC in every 10 years (2). For gFOBT, dietary restrictions are required before testing (1). However, FIT is based on human haemoglobin antibodies, and thus it does not require a special diet before testing. This might explain why FIT is the preferred colorectal cancer screening test in most of the European countries.

Keywords: cancer, colorectal, Europe, screening, Turkey

References:

1- Wild CP, Weiderpass E, Stewart BW, editors (2020). World Cancer Report: Cancer Research for Cancer Prevention. Lyon, France: International Agency for Research on Cancer. Available from: http://publications.iarc.fr/586. Licence: CC BY-NC-ND 3.0 IGO.

2- Turkish Ministry of Health. Colorectal Cancer Screening Programme National Standards. Available from: https://hsgm.saglik.gov.tr/tr/kanser-tarama-standartlari/listesi/kolorektal-kanser-tarama-program%C4%B1-ulusal-standartlar%C4%B1.html

Conference: 2. International Cancer Days, Sivas Cumhuriyet University, 16-18 September 2021

https://kansergunleri.cumhuriyet.edu.tr/?page_id=589&lang=tr

Thursday, September 16, 2021

Should Physicians Recommend Vitamins, Minerals and Micronutrients To Patients With Cancer?: An Analysis From The Perspective of ESPEN Guideline

Should Physicians Recommend Vitamins, Minerals and Micronutrients To Patients With Cancer?: An Analysis From The Perspective of ESPEN Guideline

Dr. Mehmet Eren Yuksel

Ankara Yıldırım Beyazıt University School of Medicine, Intensive Care Unit, Ankara, Turkey. e-mail: doctormehmeteren@yahoo.com

Dr. Hasan Dirik

Ankara City Hospital, Intensive Care Unit, Ankara, Turkey. e-mail: hsndrk_38@hotmail.com

Abstract

Background: The number of cancer patients using complementary and alternative medicine (CAM) is rapidly increasing in Turkey. However, it is a matter of debate if physicians should prescribe vitamins, minerals and micronutrients to patients with cancer.

Method: A Pubmed search, between the years 1990 and 2021, was performed to identify the prevalence of patients using CAM. Moreover, studies about vitamin C-D-E supplementation were examined according to the recommendations of European Society for Clinical Nutrition and Metabolism (ESPEN) guideline (1).

Results: Ernst et al. published the first systemic review regarding the prevalence of CAM use in cancer patients, which was 31.4%, in 1998 (2). Horneber et. al  reported in 2012 that their meta-analysis included 152 studies from 18 countries with 65.000 cancer patients and the prevalance of CAM usage was 40% (3). The CAM use was the highest in the United States (50%) and the lowest both in Italy and the Netherlands (22%). Turkey had the highest prevalence of CAM use with 48% in Europe (3). ESPEN guideline on clinical nutrition in cancer published in 2021 pointed out a few studies (1). Wang et al. reported that a total of 14,641 male physicians received 400 IU of vitamin E and 500 mg of vitamin C daily for 10 years. However, vitamin E and C supplementation had no immediate or long-term effects on the risk of total cancer and prostate cancer (4). Bolland et al. stated that vitamin D supplementation did not reduce skeletal or non-skeletal outcomes in individuals by more than 15% (5). Klein et al. revealed that dietary supplementation with vitamin E significantly increased the risk of prostate cancer (6).

Conclusion: Despite the fact that approximately 50% of all cancer patients consume CAM, ESPEN recommends that vitamins and minerals should be supplied in amounts equal to the recommended daily allowance, whereas high-dose micronutrients should be discouraged in the absence of specific deficiencies (1).

Keywords: Alternative, cancer, complementary, medicine, vitamin

References:

1. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-913.

2. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. 1998;83(4):777-82.

3. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther. 2012;11(3):187-203.

4. Wang L, Sesso HD, Glynn RJ, Christen WG, Bubes V, Manson JE, et al. Vitamin E and C supplementation and risk of cancer in men: posttrial follow-up in the Physicians' Health Study II randomized trial. Am J Clin Nutr. 2014;100(3):915-23.

5. Bolland MJ, Grey A, Gamble GD, Reid IR. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014;2(4):307-20.

6. Klein EA, Thompson IM, Jr., Tangen CM, Crowley JJ, Lucia MS, Goodman PJ, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). Jama. 2011;306(14):1549-56.

Conference: 2. International Cancer Days, Sivas Cumhuriyet University, 16-18 September 2021

https://kansergunleri.cumhuriyet.edu.tr/?page_id=589&lang=tr