SummaryBackgroundThe purpose of this study is to investigate whether or not reticulocyte hemoglobin equivalent (RET-He) is a superior indicator of blood count and other iron parameters in terms of diagnosing iron deficiency (ID) and iron deficiency anemia (IDA), and thus evaluating a patient’s response to oral iron treatment.MethodsThe research population consisted of 217 participants in total: 54 control, 53 ID, 58 non-ID anemia, and 52 IDA patients. A hemoglobin (Hb) value of < 130.0 g/L was defined as indicating anemia for men, while an Hb value of < 120.0 g/L was defined as indicating anemia for women. All patients were administered 270 mg oral elemental iron sulphate daily.ResultsThe RET-He was significantly lower in the IDA group, compared to other groups (IDA: 21.0 ± 4.1, ID: 26.0 ± 4.9, non-ID anemia: 32.1 ± 6.8, control: 36.6 ± 7.0; < 0.001). The ID group had a lower RET-He compared to the non-ID anemia group and the control group. On the 5th day of treatment, the ID and IDA group showed no significant differences in terms of Hb while the RET-He level demonstrated a significant increase. The increase in the RET-He level observed in the IDA group on the 5th day was significantly higher compared to the increase observed in the ID group. A RET-He value of 25.4 pg and below predicted ID diagnosis with 90.4% sensitivity and 49.1% specificity in IDA patients, compared to the ID group.ConclusionsThe results of our study, therefore, suggest that RET-He may be a clinically useful marker in the diagnosis of ID and IDA.

Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome ( = 22), myasthenia gravis ( = 21), chronic inflammatory demyelinating polyneuropathy ( = 7), polymyositis ( = 3), multifocal motor neuropathy ( = 2), acute disseminated encephalomyelitis ( = 2), neuromyelitis optica ( = 2), multiple sclerosis ( = 2), limbic encephalitis ( = 1) and transverse myelitis ( = 1). TPE was frontline therapy in 57 % of the patients ( = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.

No abstract

No abstract

This study revealed that pectus excavatum leads to cardiac and pulmonary problems, and functions of the left ventricle may be affected by the deformity. Furthermore, the relation between the severity of the deformity and cardiovascular function is evident.

Genel popülasyonla karşılaştırıldığında hemodiyaliz hastalarında latent tüberküloz infeksiyonu (LTBİ) riski artmıştır. Hemodiyaliz hastalarında LTBİ araştırılmasında QuantiFERON-TB Gold (QFT-G) test tüberküloz cilt testi (TCT)'nden daha umut vericidir. Çalışmanın amacı hemodiyaliz hastalarındaki LTBİ tanısında QFT-G'nin TCT'den daha hassas olup olmadığını belirlemektir. LTBİ için TCT ve QFT-G ile 89 hemodiyaliz hastası değerlendirildi. Tüm hastalarda QFT-G için kan alındıktan sonra TCT uygulandı. Demografik veriler, laboratuvar testleri, göğüs radyogramı sonuçları ve BCG aşılama durumu standart hasta dosyalarından sağlandı. Kırk hastada QFT-G pozitifti. Elli altı hastanın TCT indürasyonu 5 mm'nin, 28 hastanın 10 mm'nin üzerindeydi. Altmış bir hastada BCG skarı vardı. TCT ve QFT-G arasında anlamlı istatistiksel korelasyon saptandı (p< 0.05). BCG aşısız subgrupta TCT 8 (%29) hastada pozitif, hastada pozitifti. Yirmi bir aşısız hastada her iki test sonuçlarındaki uyum %82 κ= 0.61, p= 0.001 idi. BCG aşısız hemodiyaliz hastalarında LTBİ için TCT ve QFT-G test arasındaki uyum iyi iken, aşılı hastalardaki uyum kötü olarak bulundu. BCG aşılaması ülkemizde yaygın olarak kullanıldığından QFT-G test, LTBİ şüphe edilen hemodiyaliz hastalarında TCT'den daha kullanışlı bir test olabilir.

MicroRNAs (miRNA) are small non-coding RNA molecules that play critical roles in cell differentiation, proliferation and apoptosis and thus regulate haematopoietic stem cells and committed progenitor cells. We analyzed expressions of miRNAs associated with hematopoietic transformation of myeloid, erythroid and megakaryocytic progenitor cells during haematopoiesis (mir155, mir181a, mir221, mir222, mir223, mir451), in patients with primary myelofibrosis (PMF) (n = 22), polycythemia vera (PV) (n = 33), essential thrombocythemia (ET) (n = 49) and in healthy controls (n = 40) by quantitate/real time polymerase chain reaction. RT-PCR testing was negative for BCR-ABL1 fusion gene in all the patients. Mir155 was expressed in higher levels in all 3 disorders (p < 0.05). Mir221 was higher especially in ET and PMF group (p < 0.05). Mir222 expression was lower in PV patients (p < 0.05) and higher in ET and PMF patients compared to control group. Mir223 expression was higher in ET and PMF group than control group (p > 0.05). Mir451 levels were lower in all three groups compared to control group (p < 0.05). There was no difference in expression levels of mir181a between groups. JAK2V617F positivity, co-morbidities, drugs, and gender did not affect miRNA expressions. This study holds promise for the future application of these molecules for differential diagnosis and as therapeutic targets in Philadelphia chromosome negative myeloproliferative neoplasms.

Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP/HUS) is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal function abnormalities, and fever. Coexistence of TTP/HUS and adult onset Still's disease (ASD) is extremely rare. We report the case of a 46-year-old woman who presented with fever, arthritis, myalgias, petechia on skin and confusion five years after the onset of ASD. Thrombocytopenia, renal failure, marked elevation lactate dehydrogenase, and red cell fragmentation on peripheral blood smear were observed. We made a diagnosis of TTP/HUS associated with ASD, according to physical examination and characteristic laboratory data. She recovered from the TTP/HUS following daily sessions of therapeutic plasma exchange with fresh frozen plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP/HUS in ASD is important for early diagnosis and treatment.