Epidemiology of Vitamin B12 Deficiency

Vitamin B12 is only synthesized by microorganisms in nature and thus, is obtained by human beings through their diet. Since the most important source of vitamin B12 is animal proteins, vegetarians may lack sufficient quantities of this vitamin in their diets. Vitamin B12 deficiency may stem from a lower dietary intake, an autoimmune issue related to intrinsic factors or gastrointestinal system diseases resulting in vitamin B12 malabsorption. The most important symptoms and findings of severe vitamin B12 deficiency are anemia and neurological problems. If it is not treated, anemia symptoms and neurological disturbances resulting in spinal cord and cerebral cortex demyelination may emerge. Vitamin B12 deficiency is one of the most frequent vitamin deficiencies worldwide. This deficiency is a highly important public health issue because of its serious complications if it is not detected and treated appropriately, although its treatment is very simple. Epidemiological studies in this field are, therefore, of great value. Most of the studies on this subject have been examined vitamin status of the general population. The research generally contains to the national or provincial populations data. Nevertheless, the few data are not fully representative in the general population. Determining risk factors and at‐risk groups, and educating them about vitamin B12 deficiency and proper diet would prevent the irreversible complications of this type of deficiency. The goal of this study is to review epidemiological studies related to vitamin B12 deficiency and to point out the importance of identifying and treating it

Oral iron absorption test: myth or reality?

Introduction: Anemia is a serious health problem affecting one-third of the world's population. The most common etiology is iron deficiency anemia (IDA). The oral iron absorption test (OIAT) is a method that has been used for a long time to demonstrate the level of iron absorption in patients, but it has not reached widespread use in clinical practice. The study aims to analyze predictive factors of iron absorption in patients with IDA. Material and methods: A total of 108 patients between the ages of 18–65 who were diagnosed with IDA were included and patients with concomitant inflammatory bowel disease, celiac disease, history of gastrointestinal surgery, malignancy, using iron therapy, and patients with unavailable data were excluded from the study. OIAT applied to 108 patients. Results: Female patients form the majority of the cohort (n = 100, 92.6%). OIAT was administered to 54 patients in tablet form and 54 patients in capsule form. The following study compared 88 patients with adequate oral iron absorption and 20 patients with insufficient oral iron absorption. Less iron absorption was found in male patients (p = 0.04) with increasing age, and it was statistically significant (p = 0.02). Conclusion: The result of the current study demonstrated that male gender and older age have a significant impact on iron absorption. OIAT is recommended at the time of diagnosis in elderly patients and male patients so that the underlying cause can be identified without delay in the insufficient iron absorption group. Additionally, patients with oral iron absorption disorders can be diagnosed at an early stage by applying the OIAT.

Kronik myeloid lösemide moleküler yanıtı öngörücü faktörler: BCR::ABL1 is transkript seviyelerinin azalma oranı ve yarılanma zamanı

Objective: Achieving an early molecular response (EMR) is crucial for improving the prognosis of patients with chronic myeloid leukemia (CML). The halving time (HT) and reduction ratio (RR) of BCR::ABL1 transcript levels have recently emerged as additional prognostic indexes besides the BCR::ABL1 International Scale (IS). We aimed to investigate the prognostic role of BCR::ABL1 transcript levels, HT, and RR on molecular response kinetics at 3 months in patients with newly diagnosed chronic-phase (CP)-CML. Materials and Methods: Forty patients with CP-CML who received first-line imatinib treatment were included in this study. BCR::ABL1 transcript levels and molecular responses at baseline and at 3, 6, 12, and 24 months of treatment were evaluated retrospectively. Major molecular response (MMR) at 12 months and event-free survival (EFS) were determined as primary endpoints and the effects of treatment kinetics on these parameters were examined. Results: Of the 40 patients, BCR::ABL1 IS was ≤10% at 3 months in 72.5%, representing EMR. The rate of event occurrence was 45.5% in patients with BCR::ABL1 IS of >10%, whereas it was 6.9% in those with BCR::ABL1 IS of ≤10% (p=0.004). MMR was detected in 62.1% of the patients with EMR and in 9.1% of those without EMR (p=0.003). The cut-off value for achieving MMR was 24 days for HT and 0.04 for RR. Deep molecular response (DMR) at 24 months was associated with HT of ≤24 days and RR of ≤0.04. EFS was found to be significantly better in the group with BCR::ABL1 IS of ≤10% and HT of ≤24 days (p=0.001) and in the group with BCR::ABL1 IS of ≤10% and RR of ≤0.04 (p=0.007) compared to others. Conclusion: Our findings revealed that MMR could be predicted via EMR as well as by HT and RR. Additionally, HT of ≤24 days and RR of ≤0.04 were more important than BCR::ABL1 IS of ≤10% in achieving DMR at 24 months, and the combination of BCR::ABL1 IS of ≤10% with both HT of ≤24 days and RR of ≤0.04 has the best predictive value for EFS.Amaç: Kronik myeloid lösemili (KML) hastaların prognozunu iyileştirmek için erken moleküler yanıtın (EMR) elde edilmesi çok önemlidir. Son zamanlarda BCR::ABL1 IS değerinin yanı sıra yarılanma zamanı (HT) ve azalma oranı (RR) gibi kavramlar ek prognostik göstergeler olarak ortaya çıkmıştır. Bu çalışmada yeni tanı kronik faz (KF)-KML hastalarında 3 ayda BCR::ABL1 IS transkript düzeyi, HT ve RR ile moleküler yanıt kinetiklerinin prognostik rolünü araştırmayı amaçladık. Gereç ve Yöntemler: Birinci basamak imatinib tedavisi alan KF-KML’li kırk hasta bu çalışmaya dahil edildi. Bazal, 3, 6, 12 ve 24 aylardaki BCR::ABL1 transkript seviyeleri ve moleküler yanıtlar retrospektif olarak değerlendirildi. On ikinci ay majör moleküler yanıt (MMR) ve olaysız sağkalım (EFS) sonlanım noktaları olarak belirlendi ve bu parametreler üzerindeki tedavi kinetiklerinin etkileri incelendi. Bulgular: Kırk KF-KML hastasının %72,5’inde 3. ayda BCR::ABL1 IS ≤ %10’du (EMR). Üçüncü ayda BCR::ABL1 IS>%10 olanların %45,5 inde olay varken, ≤%10 olanların %6,9’u olaya sahipti (p=0,004). EMR elde edilen hastaların %62,1’inde, elde edilemeyenlerin %9,1’inde MMR saptandı (p=0,003). Bu çalışmada MMR sağlanmasında eşik değeri HT için 24 gün ve RR için 0,04 olarak saptandı. Yirmi dördüncü ay derin moleküler yanıt (DMR), HT ≤24 gün ve RR ≤0,04 olmasıyla ilişkiliydi. BCR::ABL1 IS ≤%10 ve HT ≤24 gün olan grupta (p=0,001) ve BCR::ABL1 IS ≤%10 ve RR ≤0,04 olan grupta (p=0,007) diğer gruplara göre EFS belirgin olarak daha iyi bulundu. Sonuç: Bulgularımız, MMR’nin, EMR’nin yanı sıra HT ve RR ile de tahmin edilebileceğini gösterdi. Ayrıca, HT ≤24 gün ve RR ≤0,04 olması 24. ay DMR elde edilmesinde BCR::ABL1 IS ≤%10 olmasından daha önemliydi ve BCR::ABL1 IS ≤%10 olmasının hem HT ≤24 gün hem de RR ≤0,04 ile kombinasyonu, EFS için en iyi belirleyici değere sahipti

Short Communication Nutritional Status and Immune Functions in Maintenance Hemodialysis Patients

Epidemiological studies suggest various kinds of immune dysregulation in hemodialysis (HD) patients. The aim of this study was to investigate the relationship between immune functions and nutritional status of HD patients. We studied 54 patients with ESRD on chronic HD, included 34 females and 20 males with mean age 46.6 ± 16.3 (18-77) years. We measured the height and dry weight of all patients. The BMI was calculated by dividing weight (kg) by height squared (m 2 ). In all patients serum urea, creatinine, albumin, iron, cholesterol, triglyceride, CRP, IgG, IgM, IgA, CD4, CD8, CD19, CD16-56 lymphocytes were measured. Kt/V values were calculated according to DOQI guideline. In this study, a positive correlation between albumin, cholesterol, and triglyceride levels as nutritional parameters and immune functions in terms of total and subtype lymphocyte counts was observed. Further prospective studies are needed to determine the clinical importance of this finding and the appropriate means of measurement and effects of nutrition on immune function in hemodialysis patients

Natural coagulation inhibitors and active protein c resistance in preeclampsia

INTRODUCTION: The etiology of preeclampsia is not fully established. A few studies have shown a relationship between natural coagulation inhibitors and preeclampsia. OBJECTIVES: The purpose of this study was to investigate the status of natural coagulation inhibitors and active protein C resistance (APC-R) in preeclampsia. PATIENTS AND METHODS: We studied 70 women with preeclampsia recruited consecutively and 70 healthy pregnant and 70 nonpregnant women as controls. Plasma protein C (PC), free protein S (fPS), antithrombin III (ATIII) and APC-R were evaluated. RESULTS: ATIII values were found to be significantly lower in preeclamptic patients than in the control groups (p< 0.001). Nevertheless, there was no significant difference between the healthy pregnant and nonpregnant women groups (p=0.141). The fPS values of the preeclamptic and healthy pregnant groups were lower than that of the nonpregnant group (p< 0.001), and the fPS value of the preeclamptic pregnant women was lower than that of healthy pregnant women (p<0.001). The PC value of the preeclamptic pregnant women was lower than that of the control groups (p< 0.001). The PC value of the healthy pregnant women was lower than that of the nonpregnant women (p< 0.001). The mean APC activity values were lower in the preeclamptic patients than that of the control groups (p< 0.001, p< 0.001). The APC-R positivity rates of the preeclamptic groups were higher than that of the control groups (p<0.001). CONCLUSIONS: This study demonstrated that ATIII, fPS, PC values and APC resistance were lower and APC-R positivity was higher in preeclamptic women than in normal pregnant and nonpregnant women

The effects of iron deficiency anemia on the thyroid functions

Objectives: The aim of the present study was to investigate the effect of iron deficiency anemia and iron treatment on the thyroid functions.Materials and methods: In this study, 42 patients and 38 healthy individuals were studied. Iron deficiency anemia was diagnosed by measurement of serum ferritin and complete blood counts. Free Triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine, total thyroxine, thyroid stimulating hormone (TSH) and cortisol levels were measured in blood samples before treatment and after two months of treatment with iron in patients group and after 12 hours of starvation in healthy controls.Results: Before iron treatment, secondary hypothyroidism (35.7%) and subclinical hypothyroidism (16.6%) were found in patient group. Before the treatment TSH levels in the patient group were higher than the control group (p=0.001). FT3 values were not different between patient and the control groups (p>0.05). Before the treatment FT4 levels were significantly lower than the control group (p<0.001) and FT4 values significantly increased after treatment (p=0.001). Cortisol levels before treatment were significantly higher than the control group (p=0.001). Cortisol levels were significantly decreased after iron treatment in the patient group (p<0.001).Conclusions: Secondary and subclinical hypothyroidism were found in iron deficiency anemia. Hormonal changes returned to normal values with iron supplementation. J Clin Exp Invest 2010; 1(3): 156-16

Head and Neck Granulocytic Sarcoma with Acute Myeloid Leukemia: Three Rare Cases

We conducted a retrospective review of pathology files and hospital records and identified three unusual presentations of granulocytic sarcoma associated with acute myeloid leukemia (AML) of the head and neck. At least one mass was observed on the skin of all three patients. A 17-year-old boy had masses in each temporal region that were accompanied by bilateral facial paralysis. He was administered chemotherapy and radiotherapy, but he died of infection secondary to a second relapse 29 months after the initial diagnosis. A 17-year-old girl had a tumor in the right parotid area. She received chemotherapy, but she died of infection and bleeding 2 months after the initial diagnosis. A 33-year-old man had numerous tumors widely disseminated over his skin. He received chemotherapy and was in remission 12 months after the initial diagnosis, but he eventually relapsed and died. Granulocytic sarcoma can be localized in unexpected regions, including the head and neck. This tumor is very often misdiagnosed as a malignant lymphoma, which leads to delayed treatment and a poor outcome. Therefore, clinical and histopathologic findings should be evaluated before any diagnosis of malignant lymphoma is pronounced. Immunohistochemical stains should also be performed on patients with suspected granulocytic sarcoma, and aggressive chemotherapy or immunotherapy should be administered. We believe that high-dose chemotherapy can improve survival rates in granulocytic sarcoma associated with AML. </jats:p

Assessment of Malnutrition in Adult Acute Leukemia Cases

Introduction: This study examined malnutrition in acute leukemia cases, and its association to the treatment. Methods: 54 cases, consisting of 40 patients with acute myeloblastic leukemia (AML) and 14 patients with acute lymphoblastic leukemia (ALL) were included to the study, where further 34 healthy subjects were also recruited. Body mass index (BMI), triceps skin-fold thickness (TST), mid-arm circumference (MAC) and biochemistry tests were used for the assessment tools of malnutrition. Results: When classified according to BMI, prevalence of malnutrition was 18.5% in all cases, 18% in newly-diagnosed cases, 20% in patients with remission and 16% without remission, and 5.8% in control group. No statistically significant difference was found between groups (p=0.47). Prevalence of malnutrition according to TST and MAC was not difference in patient and control group (p=0.048), (p=0.37). Patients with malnutrition according to BMI had also significant malnutrition according to TST and MAC measurements (p < 0.001). Conclusions: Prevalence of malnutrition was seen at higher percentage in adult acute leukemia cases, which was increased during the course of treatment, and TST measurement was better in establishing malnutrition