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Bir fıkıh mezhebi olarak Zeydiyye hakkında da bilgi veren genel nitelikli bazı çağdaş yayınlarda Zeyd b. Ali’den (öl. 122/740) mezhebin kurucu imamı, ona nispet edilen el-Mecmûʿu’lfıḳhî’den de mezhebin en önemli kaynağı olarak söz edilmektedir. Buna karşın son zamanlarda yapılan Zeydiyye konulu müstakil çalışmalar, mezhebin Sünnî fıkıh mezhepleri gibi doktriner bir yapıya kavuştuğu müteaḫḫirûn dönem Zeydî literatüründe Zeyd b. Ali’nin hukuk doktrinine bağlılık anlamı içermeyen yaygın bir Zeydîlik anlayışının varlığını fark etmemizi sağlamıştır. Bu iki bakış arasındaki zıtlıktan yola çıkan çalışmamızda Zeydî fürû-i fıkıh literatürü açısından Zeyd b. Ali’nin hangi konumda görüldüğünü anlamak için onun Zeydî mezhep görüşünün oluşumundaki etkisinin açığa çıkarılması hedeflenmiştir. Yöntem olarak onun fıkhî görüşleri ile Zeydiyye’nin en güvenilir fıkıh metinlerinden Kitâbu’l-Ezhâr’daki müftâbih görüşler arasındaki farklılıklar mezhebin oluşum sürecindeki önemli fakihlerden el-Müeyyed-Billâh’ın (öl. 411/1020) Şerḥu’t-Tecrîd’i üzerinden yorumlanmıştır. Örneklem olarak istiftâḥ duasının zamanı, iftitâḥ tekbirinde ve kıraat sırasında ellerin durumu ve kunut dualarının okunuşu gibi namazın kılınış şeklinde öne çıkan ve her Müslümanın tanık olduğu ihtilaflı fıkhî meseleler incelenmiştir. In some contemporary publications of a general nature that also give information about Zaydiyya as a fiqh madhhab, Zayd b. ʿAlī (d. 122/740) is mentioned as the imam of the madhhab, and al-Majmūʿ al-fiqhī attributed to him is cited as the most crucial source of the madhhab. On the other hand, recent independent studies on Zaydiyya have made us realize the existence of a widespread understanding of Zaydiism, which does not mean adherence to Zayd b. ʿAlī’s legal doctrine in the Zaydī literature of the later period which the madhhab gained a doctrinal structure like the Sunnī fiqh madhhabs. Our study, which is based on the contrast between these two perspectives, aims to reveal the influence of Zayd b. ʿAlī in the formation of the Zaydī madhhab’s view to understand his position in terms of furūʿ al-fiqh literature. As a method, the differences between his opinions and the muftābih views of Kitāb al-Azhār, which is among the most reliable fiqh texts of Zaydiyyah have been interpreted through the Sharḥ al-Tajrīd by al-Muʾayyad bi-llāh (d. 411/1020) who is one of the essential faqīhs in the formation process of the madhhab. We examined, as examples, the controversial fiqh issues witnessed by every Muslim and attracting attention in the form of ritual prayer (ṣalāt), such as the introductory duʿā (al-istiftāḥ), the state of the hands during the takbīr al-iḥrām and recitation of the Qur’ān (al-qirāʾāt) at standing (qiyām), and the recitation of the duʿā l-qunūṭ.

Glanzmann thrombasthenia is an inherited disease causing bleeding episodes due to platelet dysfunction. The standard treatment for moderate-severe bleeding is platelet transfusion. Recombinant factor VIIa (rFVIIa) is successfully used in bleeding episodes and invasive procedures. Here, we present a patient with Glanzmann thrombasthenia, whose bleeding episodes could only be controlled by rFVIIa. The patient is a 28 years old male, who has had frequent bleeding episodes unresponsive to local hemostatic agents and tranexamic acid and had an anaphylactoid reaction to platelet transfusion. We started the patient on a low-dose (20 μg/kg) rFVIIa once a week. The patient has no spontaneous bleeding since then. This is the first case report of a Glanzmann thrombasthenia patient on routine prophylaxis with low-dose rFVIIa.

Background/aim: hyperparathyroidism is an endocrine disorder characterized by hypercalcemia. Because of calcium’s effects on parathyroid glands, bone, intestines, and kidneys, it has an important place in homeostasis. The results of studies regarding hyperparathyroidism hemostasis are conflicting. Thromboelastography helps to evaluate all steps of hemostatic system. Our aim in this study was to investigate the possible role of hemostatic mechanisms in the development of thrombosis in hyperparathyroid patients with the modified rotation thromboelastogram (ROTEM). Materials and methods: twenty-two patients with primary hyperparathyroidism (PHPT) and 20 healthy controls were involved. This study was conducted in Eskisehir Osmangazi University Faculty of Medicine, Endocrinology and Hematology clinics for 2 years. The complete blood count, fibrinogen, D-dimer levels, prothrombin time, activated prothrombin time, and ROTEM parameters [clot formation time (CFT), clotting time (CT), and maximum clot formation (MCF)] were determined by two activated tests, INTEM and EXTEM analyses. A thromboelastographic evaluation was performed in the preoperative and postoperative (3 months after surgery) periods. Results: in INTEM assay, the CT (p = 0.012) and CFT (p = 0.07) values were increased in preoperative PHPT patients compared with the control group. Although there was a decrease in the postoperative CT and CFT values, no statistical difference was found. Conclusion: the prolongation of the CT and CFT values were consistent with a hypocoagulable state in patients with PHPT. Hyperparathyroidism causes a hypocoagulable state that can be successfully assessed by ROTEM. Hemostatic changes, do not seem to have an effect on increased cardiovascular mortality., NA

Otolog kök hücre nakli, immünokemoterapi sonrası relaps Hodgkin ve non-Hodgkin lenfomada uzun süreli sağkalımı arttıran standart bir tedavi şeklidir. Başarıyı etkileyen en önemli faktör hastalığın kemosensitif ya da kemorezistan olmasıdır. Ancak transplant ilişkili morbidite/mortalite işlem başarısını halen önemli ölçüde etkilemektedir. Transplant ilişkili morbidite/mortalite açısından minimal kalıntı hastalığın yok edilmesi ile toksisite arasında bir denge sağlanması önemlidir. Bu amaçla yüksek doz rejimlerin terapötik penceresini arttırmaya yönelik çabalar devam etmektedir. Bununla birlikte bir yüksek doz tedavinin diğerine üstünlüğünden bahsetmek için kesin kanıtlar mevcut değildir. Farklı rejim arayışları devam etmekle birlikte özellikle karmustin temininde bir dönem yaşanan sıkıntı rejim değişikliğini zorunlu kılmıştır. Bu süreçte merkezimizde BEAM yerine BuCyE protokolü tercih edilmiştir. Çalışmamızda BuCyE’nin BEAM’a kalıcı bir alternatif olma potansiyelinin değerlendirilmesi amaçlanmıştır. Çalışmaya otolog nakil işlemleri 2006-2017 yılları arasında gerçekleştirilen 20 hasta dahil edildi.Hastalar 2 gruba ayrılarak demografik, klinik ve laboratuvar özellikleri açısından değerlendirildi. BuCyE uygulanan hasta sayısı 10 idi. Karşılaştırma amacıyla kullanılan BEAM grubuna seçilen hastalar verilerine ulaşılması mümkün olan hastalara ait isim listesinden rastgele seçildi. Sağkalım süresi; kaybedilen hastalar için nakil günü ile ölüm tarihi arası, yaşayan hastalar için nakil günü ile değerlendirme tarihi arası olarak hesaplandı. Çalışmamızda birçok parametre için veriler 2 grupta da benzer olmakla birlikte sağkalım BEAM lehine bulundu (55.25±15.29 vs 12.12±4.02 ay, p=0.02). Hasta sayısı ve takip süresi kesin sonuçlar çıkarmak için yetersiz olmakla birlikte verilerimiz sağkalım süresi ve merkezimizin mevcut tecrübesi itibariyle BEAM protokolünün lenfoma için BuCyE’ye tercih edilecek hazırlama rejimi olduğunu düşündürmüştür. Ancak prospektif karşılaştırmalı çalışmaların yokluğunda bir hazırlama rejimini tavsiye etmek mevcut kanıt düzeyleri düşük olduğundan güçtür. Devam eden klinik çalışmalara katılım önemlidir., Autologous stem cell transplantation is a type of standard therapy which increases the long term survival in post immunochemotherapy relapsed Hodgkin and non-Hodgkin lymphoma. Success is most commonly affected by the presence of chemosensitive or chemoresistant disease. However, transplant related morbidity/mortality still affects the success of the procedure. In the era of transplant related morbidity/mortality it is important to provide a balance between minimal residual disease and toxicity. To manage this goal trials on increasing the therapeutic window of high dose regimens are continuing. Unfortunately, we do not have conclusive evidence to say that one high dose regimen is better than the other. Different regimen trials are still going on but lack of carmustine for a while led to a compulsory change in regimen preference. During this period BuCyE was preferred instead of BEAM in our center. In this study, our aim was to decide whether BuCyE can be a permanent alternative to BEAM. Twenty patients who underwent autologous transplantation between 2006-2017 were included in the study. Patients were divided into 2 groups demographic, clinical and laboratory characteristics were evaluated. The number of patients in BuCyE group was 10. BEAM group which is used for comparison was chosen randomly from the list of patients with accessible data. Survival was calculated as the time between day of transplantation and data collection or exitus. Many of the parameters were similar between 2 groups in our study but survival was longer in favor of BEAM group (55.25±15.29 vs 12.12±4.02 months, p=0.02). Despite number of patients and follow up period is not enough to make definitive conclusions our data suggested that BEAM was superior to BuCyE in lymphoma in terms of survival and center experience. In the absence of prospective trials it is difficult to suggest a conditioning regimen due to low level of evidence. It is important to participate in ongoing clinical trials.

Chronic myeloproliferative neoplasms (MPN) are clonal disorders of hematopoietic stem/progenitor cell characterized by thrombohemorrhagic complications and a tendency to transform into acute leukemia. The pathogenesis of thrombosis in MPN is complex and results from a multifaceted interplay of clinical and disease-related factors. Rotational thromboelastometry (ROTEM) provides the complete and rapid information about all stages of the coagulation process. Here, we assess ROTEM parameters as a screening of coagulation profile in patients with MPNs. In particular, higher mean maximum clot firmness values were found in Essential thrombocythemia and Polycythemia vera patients when compared to healthy controls. Rotational thromboelastometry may be able to detect MPN patients who are susceptible to thrombotic and/or hemorrhagic complications. The predictive value of ROTEM for thrombosis remains to be established to classify subsets of patients at prominent risk who may benefit from prophylaxis with antithrombotic drugs.

Aim: The most seen complication of multiple myeloma (MM) is renal insufficiency (RI). Although MM is known as one of the causesof reversible end-stage renal disease, these patients are usually not suitable for autologous stem cell transplantation (ASCT). We aimed in this study to reveal the clinical course of MM patients with renal insufficiency that underwent ASCT. Materials and Methods: We included 25 MM patients with RI who has undergone ASCT in this study. Creatinine levels more than 2 mg/dL was defined as renal insufficiency at the time of diagnosis. For survival analysis, we included patients with a minimum 100 days post-transplantation follow-up.Results: Median age was 56.6±7.9 (42-65) years. Melphalan was given 140 mg/m 2 . Nine patients (36%) required dialysis at the time of diagnosis. Six patients became dialysis-free with induction therapy. After ASCT, none of the patients needed dialysis. Cox regression analysis showed a significant increase in disease-free survival (DFS) and overall survival (OS) times compared to patients with very good partial response in patients with complete response on the 100 th day of ASCT (for DFS; 15.7 months vs 63.7 months, p=0.009 and for OS; 37.9 months vs 97.3 months p=0.01, respectively). Conclusion: There are studies showing that ASCT performed with reduced dose of melphalan is a renal protective and effective method in patients with renal impairment. Our study confirms this thesis, as well as emphasizing the significant effect of CR on DFS and OS on the 100 th day after transplantation in these patients.

Rapid diagnosis and early treatment of invasive aspergillosis is crucial for the management of the patients with haematological malignancy. We evaluated 358 sera from 78 febrile neutropenic episodes in patient with invasive aspergillosis (IA) (one proven, 17 probable, and 60 possible) and 83 episodes in patients with no IA according to the EORTC/MSG criteria. Patient's specimens were tested by Mycassay Aspergillus PCR (first commercial real-time PCR test) and in house real-time PCR to investigate the presence of Aspergillus DNA, and by ELISA for detect the galactomannan (GM) antigen. We systematically investigated the medical background that can be effective on the test results. The hospitalisation period was longer in proven/probable episodes when compared with no IA (P = 0.001) and possible episodes. With regard to duration of neutropenia, the differences between both proven/probable with no IA (P = 0.023) and possible with no IA (P = 0.002) were highly significant. Similarly, the rates of T cell suppressant therapy in group proven/probable and possible episodes were significantly higher than in no IA (P = 0.005). There are significant differences in the performance of GM and PCR-based tests among studies, and standardisation is required. Therefore, it can be useful to determine the effective factors on these tests. The use of larger volume of sera improved the performance of real-time PCR for detection of Aspergillus DNA in high-risk adult patients in the present study. Some host factors such as duration of neutropenia and administration of T cell suppressants related to the development of IA.

Immune thrombocytopenia (ITP) is a disorder characterised by immune-mediated accelerated platelet destruction and suppressed platelet production. In the bone marrow examinations of patients with ITP, some investigators found megakaryocyte numbers to be increased while others have found them to be normal. Although recent guidelines recommend against bone marrow examinations in typical ITP patients, the recent introduction of thrombopoietin receptor agonists as an effective treatment for ITP has refocused attention on abnormalities of bone marrow megakaryocytes. In this study, we retrospectively analysed the bone marrow aspiration, flow cytometry-CD45 side scatter (SSC) and biopsy results of our patients with ITP by dividing them into two groups according to age (

Primer immunologic defect in patients with idiopathic thrombocytopaenic purpura (ITP) result from autoreactive B-lymphocytes secreting antiplatelet antibodies. Dysfunctional cellular immunity has also great importance in ITP pathogenesis. CD4(+)CD25(+) regulatory T-cells have immunoregulatory features and it is able to inhibit CD4(+)CD25(-) and CD8(+) responses. ITP is also an autoimmune disease; the CD4(+)CD25(+) T-cell levels of the patients decrease during the active state. According to our findings, immunosuppressive treatments increase the CD4(+)CD25(+) Treg cell levels in the non-remission ITP patients. However, this level is not enough to overcome the resistance. CD4(+)CD25(-)Foxp3(+) and CD4(+)Foxp3(+) Treg cells are responsible for the pathogenesis of the non-remission ITP patients and other factors exist, which are responsible for the resistance of ITP treatment.

Thrombelastography (TEG) analyses the status of blood coagulation including abnormalities associated with low platelet count. The aim of this study was to investigate the changes in TEG parameters in idiopathic thrombocytopenic purpura (ITP) patients. Thirty nine patients with ITP (platelet count 100 × 103 µl⁻¹) were included in the study. Age-matched 17 patients with thrombocytopenia due to chemotherapy were selected as a control group. Platelet count was positively correlated with maximum clot formation (MCF) in INTEM (r = 0.716, p 0.001) and MCF in EXTEM (r = 0.679, p 0.001); negatively correlated with clot formation time (CFT) in INTEM (r = -0.755, p 0.001) and CFT in EXTEM (r = -0.585, p 0.001) in ITP patients. Platelet count was positively correlated with MCF in INTEM (r = 0.776, p 0.001) and MCF in EXTEM (r = 0.878, p 0.001); negatively correlated with CFT in INTEM (r = -0.627, p 0.001) in control group. Receiver operating characteristic curves to describe the critical platelet count and fibrinogen level that affect MCF revealed 31 × 103 µl⁻¹ and 375 mg dl⁻¹ as cut-off values, respectively. In conclusion, ROTEM determines the contribution of fibrinogen and platelets to clot strength in patients with ITP. MCF appears to be the most important TEG parameter in predicting bleeding in ITP patients that makes TEG superior to other hemostatic tests.

Pleural effusion, as a side effect of tyrosine kinases, may be seen as most commonly associated with dasatinib and very rarely seen with nilotinib. In this report we present a chronic phase of CML case that was treated with nilotinib due to imatinib (Gleevec) allergy and had pleural effusion with nilotinib at 5th year of treatment. If pleural effusion develops in patients taking nilotinib and if this effusion is exudative and lymphocyte predominant, after ruling out pulmonary and cardiac etiologies, it must be associated with nilotinib; according to stage of effusion drug should be discontinued and/or steroid should be started and/or surgery should be performed.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a very rare subtype of AML characterized by the clonal proliferation of precursors of plasmacytoid dendritic cells. It presents with an aggressive behavior. The clinical findings include cytopenia, particularly thrombocytopenia. Although it responds well to chemotherapy initially, the relapse is a rule and prognosis is very poor. There is limited data published in the literature, making it very problematic to define the biological and clinical features, hence, the appropriate therapeutic approach. There are various treatment methods such as multiagent chemotherapy based on ALL or AML and/or hematopoietic stem cell transplantation. However, none of them is approved as a standard therapy. From this point of view, we herein report a 20-year-old case at onset of a leukemic form of BPDCN who survived 48 months after autologous hematopoietic stem cell transplantation.

Cytomegalovirus (CMV) infections continue to cause significant morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Successful pre-emptive therapy in transplant patients depends on the availability of reliable diagnostic tests for CMV infections. The purpose of this retrospective study was to evaluate CMV DNA viral load, incidence of CMV disease and CMV seropositivity, risk factors and correlation between CMV DNA positivity and clinical course in HSCT patients.Two hundred and twenty-five patients who underwent peripheral blood stem cell or bone marrow transplantation between June 2003 and April 2010 were included. A real-time polymerase chain reaction (RT-PCR) assay was used for CMV monitoring.Recipient median age was 42.5 years. CMV seropositivity was 95.6%. CMV DNA positivity determined by RT-PCR was 24.9% among the entire patient group. CMV DNA positivity with RT-PCR was found to be significantly higher in allogeneic transplant recipients than autologous transplant recipients (46.7% vs 14.0%; P0.0001). Gender, age, conditioning regimen, stem cell source, underlying disease and recipient and donor seropositivity (alone or paired) were not significant risk factors for CMV DNAemia. We did not observe any CMV end-organ disease.CMV DNAemia was significantly higher in allogeneic transplant recipients than in autologous transplant patients. End-organ disease could be prevented with appropriate pre-emptive therapy.

Acute myelogenous leukemia (AML) develops as the consequence of a series of genetic changes in a hematopoietic precursor cell. Specific cytogenetic abnormalities have been identified by karyotype analysis in AML. One of the rare chromosomal abnormalities is a dicentric chromosome, which is defined as an aberrant chromosome having two centromeres. In the literature, a limited number of cases have been reported with dic(1;15) in myeloid disorders, but only one case has been reported with in acute megakaryoblastic leukemia. Herein, we report a case of acute myelogenous leukemia without maturation with a dic(1;15)(p11;p11), resulting in trisomy of the long arm of chromosome 1. To date, this is the second case of dic(1;15) in acute myelogenous leukemia and the first case in acute myeloblastic leukemia without maturation.

Glucocorticosteroids, intravenous immunoglobulins, vincristine, danazol, and eltrombopag are used in refractory chronic idiopathic thrombocytopenic purpura (ITP). All those treatment modalities are susceptible for thrombosis generation. There is an increased risk of thrombosis in the diseases' natural course. The case we present is a resistant chronic ITP patient who developed pulmonary and intracardiac thrombosis during multidrug treatment. Risk of concomitant usage of drugs and rapid increase in platelet count are discussed.

Extramedullary relapse is an uncommon complication of acute promyelocytic leukaemia (APL). The most common site of extramedullary relapse is the central nervous system (CNS), and the majority of CNS relapses occur in patients with high-risk disease in which white blood cell count at presentation is greater than 10×10(3)/μL. The best management of such patients is still controversial. We describe a 47-year-old man with APL who developed two CNS relapses which were diagnosed through the presence of t(15;17)(q22;q21) on PCR of the cerebrospinal fluid (CSF), despite presenting initially with intermediate-risk disease. We conclude that the intermediate risk group is very heterogeneous and these patients sometimes may behave like high-risk patients. Also, clinicians should take into account symptoms that can be related to CNS relapse in patients with APL and consider lumbar puncture even if radiological imaging does not reveal anything.