CBs levels seem to be changed in different proteinuric patients. This condition should be kept in mind when evaluating CBs levels in proteinuric patients.
Background:Immune thrombocytopenia (ITP) is an autoimmune disorder. It is characterized by thrombocytopenia due to thrombocyte destruction mediated by autoantibodies; however, cytotoxic and defective regulatory T-lymphocytes play an important role in its pathogenesis. While childhood ITP is usually acute, self-limiting and generally seasonal in nature, ITP in adults is usually chronic; its relation with seasons has not been studied. Aims: We investigated whether months and/or seasons have triggering roles in adults with ITP. Study Design: Descriptive study. Methods: A retrospective case review of adult patients with primary ITP diagnosed at various University Hospitals in cities where Mediterranean climate is seen was performed. Demographic data, date of referral and treatments were recorded. Corticosteroid-resistant, chronic and refractory cases were determined. Relation between sex, corticosteroid-resistant, chronic and refractory ITP with the seasons was also investigated. Results: The study included 165 patients (124 female, mean age=42.8±16.6). Most cases of primary ITP were diagnosed in the spring (p=0.015). Rates of patients diagnosed according to the seasons were as follows: 35.8% in spring, 23% in summer, 20.6% in fall, and 20.6% in winter. With respect to months, the majority of cases occurred in May (18.2%). Time of diagnosis according to the seasons did not differ between genders (p=0.699). First-line treatment was corticosteroids in 97.3%, but 35% of the cases were corticosteroid-resistant. Steroid-resistant patients were mostly diagnosed in the spring (52.1%) (p=0.001). ITP was chronic in 52.7% of the patients and they were also diagnosed mostly in the spring (62.7%) (p=0.149). Conclusion: This is the first study showing seasonal association of ITP in adults and we have observed that ITP in adults is mostly diagnosed in the spring. The reason why more patients are diagnosed in the spring may be due to the existence of atmospheric pollens reaching maximum levels in the spring in places where a Mediterranean climate is seen.
air. The extraocular muscles were intact; without nystagmus. His pupils were symmetric and equally reactive to light, and the optic discs appeared normal. His abdomen was nontender, without masses, and there was no appreciable costovertebral angle tenderness. His lungs were clear to auscultation with a normal respiratory effort. The heart rate was regular but bradycardic, with normal S1 and S2 heart sounds. There was no edema in extremities. The skin was clear without any rash, petechiae, or ecchymoses. Otherwise, the neurologic examination revealed 3/5 muscle strength throughout bilateral upper and lower extremities, including deep tendon reflexes, and cerebellar tests, were all within normal range. The patient's laboratory results are reported in Table 1. ECG showed bradycardia and significant ST depression with bifasic and negative T waves, and significant positive U waves, as well, in most derivations. The patient hospitalized with the diagonosis of acute hypokalemic and hypophosphatemic paralysis. Because of bradycardia he was monitored. 20 mmol of potassium chloride per 100 ml of normal saline and izolyte fluid was infused hourly through a central venous line. By the day 3, serum potassium and phosphorus had improved (3.1 mmol/ l and 3.5 mg/dL) and the patient explained improvement in muscle weakness.
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