Objective Copper deficiency has been reported to cause hematological disorders. However, its clinical and hematological characteristics are not fully understood. Therefore, we investigated bedridden patients suffering from copper deficiency and tried to clarify the clinical features of hematological disorders caused by this condition.Patients and Methods Five patients with typical copper deficiency who had been dependent upon enteral nutrition for a long period of time due to various diseases were investigated. We measured hematological parameters and observed the response to copper supplementation therapy and the recovery process of hematological disorders.Results Their mean age was 82.6±10.4 years and the mean duration of enteral nutrition was 16.4±5.2 months. Their serum copper concentration was extremely decreased (range, 3 to 8 g/dl). All five patients had anemia and neutropenia. On the other hand, platelet count remained within the normal range. After copper supplementation therapy, hemoglobin concentration increased from 6.8±0.7 g/dl to 9.9±0.7 g/dl within a few months (p<0.01). Neutrophil count also increased from 750±370/ l to 3,690±1,210/ l in a few weeks (p<0.01). Mean corpuscular volume (MCV) decreased from 94.3±7.3 fl to 86.0±4.8 fl (p<0.05). Elevated serum ferritin and erythropoietin (EPO) levels were normalized after the improvement of anemia.Conclusion Bicytopenia (anemia and neutropenia) with normal platelet count is a feature of hematological disorders caused by copper deficiency. MCV tends to indicate macrocytic anemia. Serum ferritin and EPO levels are elevated. These hematological abnormalities are improved within a few months after copper supplementation therapy.
BackgroundA published study demonstrating that listening to Rakugo (a comic story) alleviated the pain experienced by patients with rheumatoid arthritis (RA), accompanied by reduction in serum IL-6 and cortisol levels [1]. Overall physical condition improvement and pain alleviation with music therapy have also been reported [2]. However, only few studies have assessed the efficacy of occupational therapy (particularly handcraft work) in outpatients with RA.ObjectivesThe present study evaluated the usefulness of handcraft work (particularly ceramic art) for both physical and mental rehabilitation for outpatients with RA.MethodsThe study involved 10 outpatients with RA managed at our hospital (all females, all right-handed persons, mean age 63.1 years, the average duration of disease was 10.7 years). For physical and mental evaluation, grip, pinching power, VAS score for systemic pain, 20-level FACE scale score, self-rating depression scale (SDS) score were measured before and after participation in ceramic art craft and compared. In addition, a questionnaire survey was administered to assess patient perception of ceramic art.ResultsThe range of annual changes among the participants was 0.4±0.3 for Modified Health Assessment Questionnaire (m-HAQ) and 0.9±1.6 for C-reactive protein (CRP).Right hand grip was 14.3±7.2 kgw before participation and 14.8 ±7.1 after participation in ceramic art craft. Left hand grip was 12.1±7.1 and 13.4±7.1 before and after participation, respectively.Right pinching power was 8.2±4.1 and 10.8±4.0 and left pinching power was 8.7±4.0 and 10.8±3.8 before and after participation, respectively.VAS score for systemic pain was 38.0±29.2 and 22.4±21.5, and FACE scale scores was 4.7±3.6 and 2.9±3.3 before and after participation, respectively.SDS score was 41.2±11.8 and 37.1±9.4 before and after participation, respectively. Thus, all parameters except right hand grip and left pinching power differed significantly between the pre-participation and post-participation periods.In the questionnaire survey, many patients answered “having pleasure/joy in creation and use of ceramic products.” This indicates that ceramic art can serve as a continued activity for patients with RA, useful not only during treatment but also during daily living. In addition, ceramic art was shown to be useful in functional training, e.g., in “maintaining and reinforcing grip and finger function” and “maintaining and checking skilled movements.” These results suggest that ceramic art is an activity effective as a means of rehabilitation, with both physical and mental effects perceptible to the patients.ConclusionsCeramic art is an activity capable of improving the physical condition and mental state (alleviation of depression, etc.) of patients with RA and improving physical functions such as grip of opposite hand and dominant pinching power. It is useful in the treatment of RA, similar to listening to Rakugo and music therapy.ReferencesInfluence of laugh on patients with rheumatoid arthritis. Japanese Journal of Psychosomatic...
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