The Injector

Infection management in hematological malignancies

Fatma Yılmaz — 2024-12-26

Dear Editor,

Hematological malignancies encompass a group of diseases that often require intensive cytotoxic chemotherapy. These chemotherapy protocols can lead to prolonged neutropenia, increasing the risk of hospitalization and potentially fatal infections (1). The risk of infection varies among patients due to factors such as diagnosis, risk status, relapse/refractory condition, comorbidities (e.g., renal or liver failure), chemotherapy intensity, and the severity and duration of neutropenia. Severe and prolonged neutropenia is particularly common following myeloablative regimens in stem cell transplantation, induction protocols in acute leukemia, and salvage therapies in refractory/relapsed patients. In addition to neutropenia, chemotherapy also predisposes patients to infections by disrupting the mucosal barrier and causing disease-related immunosuppression. The disruption of the mucosal barrier allows colonizing microorganisms to invade, increasing the risk of invasive infections (2).

Managing infections in patients with hematological malignancies presents several challenges, including shifting epidemiology, limited availability of rapid and reliable diagnostic methods, the effectiveness of prophylaxis, appropriate selection of empirical antibiotic therapy, drug interactions, and antibiotic resistance. Due to their compromised immune response, patients with severe neutropenia are highly susceptible to serious infections, even from typically mild pathogens. Febrile neutropenia (FN) is defined as an oral temperature exceeding 38.3°C or >38.0°C on two consecutive occasions within two hours, accompanied by an absolute neutrophil count (ANC) of <0.5 × 10⁹/L or expected to fall below this threshold within 48 hours (2). Sometimes, fever may be the only symptom. The disease can progress rapidly, leading to hypotension, end-organ damage, and an increased risk of serious morbidity and mortality.

Accurate risk assessment in patients with hematological malignancies facilitates the timely initiation of appropriate antibiotic prophylaxis and granulocyte-colony stimulating factor (G-CSF) in high-risk individuals, as well as empirical antibiotic and G-CSF therapy in patients with febrile neutropenia (3). The selection of broad-spectrum empirical antibiotics should be based on local hospital flora, the pathogens commonly isolated in immunocompromised febrile neutropenic patients, and their antibiotic resistance patterns, including extended-spectrum beta-lactamase (ESBL) positivity and carbapenem resistance (4). Studies investigating isolated pathogens and their resistance patterns in this patient population provide critical guidance for clinicians. Historically, the primary causes of infection have evolved over the decades. In the 1970s, gram-negative bacteria were predominant, whereas gram-positive bacteria, particularly coagulase-negative staphylococci, became more prevalent in the 1980s. In the 1990s, both gram-negative and gram-positive bacteria were isolated at similar rates, but gram-negative agents re-emerged as the dominant pathogens in the early 2000s (5).

A study by Arabacı et al. demonstrated that bloodstream infections were more common in immunosuppressed patients with hematological malignancies, consistent with previous findings. Among bloodstream infection pathogens, 51% were gram-negative bacteria and 32% were gram-positive bacteria. The two most frequently isolated pathogens were coagulase-negative staphylococci (20%) and Escherichia coli (19%). Antibiotic resistance analysis revealed a 47% ESBL positivity rate in E. coli isolates and a concerning 92% carbapenem resistance rate in Acinetobacter species (6). These findings provide valuable insights into the management of febrile neutropenia. Given the dynamic nature of pathogens and their resistance profiles in patients with hematological malignancies, regular monitoring and updates in treatment guidelines are essential. Additionally, future research should include subgroup analyses based on patient diagnosis, chemotherapy protocol, relapse/refractory status, and neutropenia duration to improve febrile neutropenia management. More effective and tailored febrile neutropenia management could help reduce prolonged hospital stays, antibiotic resistance, and healthcare costs.

Exploring the potential of artificial intelligence and Kaspa Health in transforming healthcare

Engin Şenel — 2024-12-27

Dear Editor,

The healthcare industry faces a wide range of challenges, from data security concerns to inefficiencies in administration and limited access to personalized care. Emerging technologies such as blockchain, BlockDAG (Directed Acyclic Graph), and artificial intelligence (AI) offer significant potential to address these issues. Among these innovations, the Kaspa blockchain, powered by its unique BlockDAG architecture, presents an opportunity to overcome many of the limitations associated with traditional blockchain systems.

This letter outlines the possibilities that Kaspa’s infrastructure, combined with AI, could bring to the healthcare sector and highlights how these advancements might help create a more secure, efficient, and inclusive healthcare ecosystem.

The Kaspa blockchain is built on a BlockDAG architecture, which enhances scalability, transaction speed, and security. These features make it particularly well-suited for applications in healthcare, a field that demands the handling of vast amounts of sensitive data and real-time information exchange (1).

Kaspa’s infrastructure could enable secure and decentralized storage of patient health records. This would empower patients with full control over their data while ensuring that healthcare providers can access accurate, tamper-proof records when needed (2). BlockDAG technology could support seamless data sharing across hospitals, research institutions, and patients, even on a global scale. This might enhance collaboration while addressing issues of interoperability among healthcare systems (3). Using Kaspa’s secure and energy-efficient protocol, sensitive healthcare data could be protected against unauthorized access and tampering. The immutability of blockchain might offer a reliable mechanism for compliance with data protection regulations (4).

Kaspa’s blockchain could improve transparency and traceability in the pharmaceutical and medical device supply chains, potentially reducing fraud and ensuring the authenticity of healthcare products. Smart contracts on Kaspa’s infrastructure could automate insurance claims, billing, and patient consent management processes, reducing administrative burdens and lowering costs (2).

AI has shown great promise in improving diagnostics, treatment, and patient outcomes. However, its full potential relies on access to high-quality data and robust computational systems. Kaspa’s blockchain might support AI applications by providing secure and reliable access to datasets, facilitating advanced applications. Decentralized and anonymized data sharing through Kaspa could enhance the training and performance of AI models, leading to more accurate and personalized diagnostic tools (5). Additionally, AI systems deployed on a blockchain-enabled platform might enable healthcare providers to predict patient outcomes and recommend preventative measures based on real-time data analysis (5). Moreover, secure and instant data verification via Kaspa could support AI tools in providing real-time decision-making assistance to clinicians, ultimately improving patient care (5).

KASPAI is a decentralized platform designed to support the integration of blockchain technologies across various sectors, with a particular focus on scalability, secure transactions, and community-driven innovations (6). Kaspa HEALTH and KASPAI are intrinsically connected, with KASPAI serving as the foundational platform for launching the HEALTH token (7). As a decentralized platform, KASPAI enables the seamless integration of blockchain technologies into healthcare systems, facilitating innovation and efficiency. KASPAI not only facilitates token distribution but also provides a robust infrastructure that supports secure transactions, decentralized governance, and community-driven initiatives. Through this platform, Kaspa HEALTH leverages blockchain and BlockDAG technologies to drive innovation in the healthcare sector. By distributing 1 billion HEALTH tokens to KASPAI token holders, the project fosters community engagement and incentivizes participation in its growing ecosystem. This collaboration underscores the potential of integrating decentralized systems with healthcare to achieve scalable and secure solutions.

The Kaspa HEALTH project is designed to explore and implement these possibilities within the healthcare sector. The HEALTH token economy aims to fund healthcare innovations and incentivize community participation, while also allowing tokens to be used for access to products or services at reduced costs or free of charge. Additionally, Kaspa HEALTH seeks to enable the secure sharing of anonymized health data to foster collaboration between researchers and institutions worldwide. By leveraging Kaspa’s BlockDAG technology, the project aims to build a scalable ecosystem that meets the growing demands of healthcare data and operations without compromising speed or security. Furthermore, in the future, Kaspa HEALTH may explore patent applications for proprietary innovations to ensure the protection of intellectual property and its utilization for the benefit of the broader healthcare community (4).

The Kaspa blockchain and its BlockDAG architecture hold immense potential to revolutionize healthcare. By combining this with the power of artificial intelligence, we might create systems that are secure, efficient, scalable, and patient-centered. Kaspa HEALTH is committed to exploring these possibilities and invites the academic and healthcare communities to join us in realizing this vision.

Investigation of the chronic pelvic pain developing after bening and malignant caused hysterectomy surgery

Belma Gözde Özdemir — 2024-12-20

Objective: Chronic pelvic pain is a condition that typically persists for a minimum of three to six months and is not associated with pregnancy. However, it is not an organic pathology or laboratory abnormality. This study aimed to evaluate the development of chronic pelvic pain in individuals who underwent hysterectomy for benign and malignant indications, and to examine the correlation between pain scores and the development of depression.

Methods: A survey method was used in this study, which was conducted on 163 hysterectomized patients at the Department of Gynecology and Obstetrics of Selçuk University Faculty of Medicine. Patients were categorized according to benign and malignant causes. The Visual Analog Scale was used for pelvic pain, and the Short Beck depression inventory was used for pain-related depression.

Results: A total of 163 patients were examined in terms of indication, of whom 52 (31.9%) were operated on for benign reasons and 111 (68.1%) for malignant reasons. No significant difference was observed in pain levels at the third and ninth months, irrespective of the indication. (p<0.05). However, there was a significant difference in pain levels in the third month depending on the age of the patients (p<0.05). In total, the pain levels of patients aged 45 and under in the third month are lower than those of patients over 45 years of age. Pain scores in the benign and malignant groups were higher in the ninth month, but it was determined that there was no significant difference in pain scores between these two groups. Beck depression levels were evaluated at the 3rd and 9th months in relation to pain across different ages, with and without comorbidities, and for pain associated with various indications. No significant differences were observed among these groups (p>0.05).

Conclusion: Each patient should receive personalized care, including a thorough evaluation of their complete pain constellation and a careful assessment of potential diagnoses. Evaluations should also consider the individual's surgical, psychological, and medical conditions.

Breastfeeding status of Syrian infants at a tertiary hospital in Turkey: a single-center study

Eren Güzeloğlu — 2024-12-20

Objective: Turkey is home to the largest refugee population in the world, with approximately half of all refugees being children who are at high risk of developmental issues due to the disruption and lack of resources they have experienced. Syrian refugee children in Turkey face various risks to their health and well-being, including communicable and non-communicable diseases, post-traumatic stress disorder, depression, domestic violence, child labor, and child marriage. This study aimed to investigate the breastfeeding status of Syrian mothers, who are a disadvantaged group in Turkey due to migration. The study also aimed to contribute to the literature.

Methods: This was a retrospective observational study using data from medical records of Syrian infants who were followed in our hospital at the neonatal intensive care unit, delivery room, and puerperal service between January 1, 2020, and January 1, 2022. The breastfeeding status of Syrian women who gave birth in our hospital and their babies were followed for a year.

Results: A total of 10,312 births occurred at our hospital between January 1, 2020, and January 1, 2022. Of these, 17% (n=1,754) were Syrian children. Of the Syrian infants, 52.6% were female (n=922) and 47.4% were male (n=832). A total of 2% (n=212) of all infants and 2% (n=37) of Syrian infants were born prematurely. The majority of preterm cases, specifically 72% of all cases and 84% of Syrian cases, were followed in the neonatal intensive care unit. A total of 40.1% (n=705) of Syrian infants are classified as low birthweight (LBW), 6.7% (n=119) as very low birthweight (VLBW), and 1.8% (n=33) as extremely low birthweight (ELBW). The proportion of infants who were breastfed within one hour of birth was 68% (n=1193), while 20.9% (n=368) received prelacteal food. The proportion of infants who were exclusively breastfed for the first six months was 48.2% (n=845), while 44.7% (n=784) were bottle-fed. The proportion of infants who were breastfed for one year was 53.6% (n=940).

Conclusion: There have been very few studies on migrant children in our country, and what we know about breastfeeding is limited. Increasing studies and raising awareness on this issue will be more beneficial for refugee children. We should provide refugee mothers with regular breastfeeding training and psychological and social support. In our study, we observed that Syrian mothers benefited from breastfeeding training during the outpatient clinic monitoring process.

The negative influence of Trichomonas vaginalis on pregnancy and treatment strategies.

Cezary Dawid Zieliński — 2024-12-21

Trichomonas vaginalis (TV) is a parasite that invades the urogenital tract, causing numerous pathologies. Two main genotypes can be distinguished, which differ in their response to treatment.
Trichomoniasis is the second most prevalent curable sexually transmitted infection worldwide, with an
estimated annual incidence ranging from 170 to 256 million cases, including approximately 25 million
cases among pregnant women. This patient group is highly susceptible due to hormonal changes
occurring during pregnancy. A rise in estrogen concentration causes a change in the pH of vaginal
secretions, and increased epithelial exfoliation favors parasite colonization. In addition to causing
pelvic inflammatory disease (PID), infertility, and cervical cancer, TV infection may also contribute to
low birth weight, preterm rupture of membranes (PROM), and preterm birth (PTB). Moreover, TV is a
risk factor for HIV infection. The treatment of trichomoniasis in pregnant women remains a subject of
debate. Although the WHO recommends metronidazole, its use is often substituted due to concerns
regarding its transplacental transport and the potential for TV resistance. This paper aims to analyze the available literature concerning the diagnosis, symptoms, complications, and treatment of Trichomonas vaginalis invasion during pregnancy.

Is diabetes a risk factor in fungal infections?

Rabiye Altınbaş — 2024-12-21

Diabetes is a metabolic disease characterized by abnormally high blood glucose levels and associated with complications. In diabetes, with dysregulation and the loss of functions of immune system cells, phagocytic activity, which is necessary to control and kill pathogens and process them for antigen presentation, is reduced. Thus, individuals with diabetes are more prone to infections and more susceptible to certain complications related to infections. Diabetic patients are particularly susceptible to fungal infections because their vascular and immunological systems are compromised. Many different types of fungal infections occur in people with diabetes, but one type with a particularly serious risk of death is mucormycosis. To obtain successful results from combined antifungal treatment and surgical interventions, it is necessary to address the underlying predisposing factors.