Diagnose und Behandlung von Eisenmangel ohne Anämie

Eisenmangel ohne Anämie bleibt oft undiagnostiziert, da die Symptome einem Eisenmangel mit Anämie zugeschrieben werden. Serumferritin ist der beste diagnostische Parameter, wobei <10 μg/l eine erschöpfte Eisenreserve widerspiegeln, 10-30 μg/l einen Eisenmangel ohne Anämie bestätigen können und bei 30-50 μg/l ein funktioneller Eisenmangel möglich ist. Sind CRP oder ALT erhöht, ist normales/erhöhtes Ferritin mit Vorsicht zu interpretieren. Parenterale Eisenbehandlung ist indiziert, falls die primäre orale Eisentherapie nicht erfolgreich ist oder nicht toleriert wird. Bei Ferritin <10 μg/l ist eine kumulative Gesamtdosis von 1000 mg Eisen vorzusehen, bei 10-30 μg/l ist eine kumulative Gesamtdosis von 500 mg empfohlen, und bei 30-50 μg/l kann eine erste Dosis von 200 mg verabreicht werden. Ferritin soll frühestens zwei Wochen nach der letzten oralen bzw. 8-12 Wochen nach der letzten parenteralen Verabreichung nachkontrolliert werden. = Iron deficiency (ID) without anaemia frequently remains undiagnosed when symptoms are attributed to ID with anaemia. Serum ferritin is the primary diagnostic parameter, whereas <10 μg/l represent depleted iron stores, 10-30 μg/l can confirm ID without anaemia and 30-50 μg/l might indicate functional ID. In case of increased CRP or ALT, normal/elevated ferritin should be interpreted with caution. Intravenous iron is indicated if oral iron is not effective or tolerated. At ferritin <10 μg/l, a cumulative dose of 1000 mg iron and at ferritin 10-30 μg/l, a cumulative dose of 500 mg is advised. At ferritin 30-50 μg/l a first dose of 200 mg might be considered. Ferritin shall be reassessed not sooner than 2 weeks after the last oral or 8-12 weeks after the last iv iron administration. = La carence en fer (CF) sans anémie reste souvent non diagnostiquée car les symptômes sont attribués à l’anémie ferriprive. La ferritine en est le marqueur le plus spécifique: <10 μg/l représente des réserves épuisées, 10-30 μg/l peuvent confirmer une CF, 30-50 μg/l peuvent indiquer une CF fonctionnelle. Si les valeurs de CRP et d’ALAT sont élevées, il faut interpréter une valeur de ferritine élevée/normale avec précaution. Si un traitement oral n’apporte pas le succès escompté ou n’est pas toléré par le patient, un traitement intraveineux est justifié. Chez les patients présentant une ferritine <10 μg/l, l’administration d’une dose cumulative totale de 1000 mg de fer doit être envisage. Pour une ferritine de 10-30 μg/l, on préconise une dose cumulative totale de 500 mg de fer. Pour une ferritine de 30-50 μg/l, on peut administrer une première dose de 200 mg de fer. La ferritine doit être contrôlée au plus tôt 2 semaines après le dernier traitement par voie orale ou 8-12 semaines après la dernière injection par voie intraveineuse

Maltreatment during childhood: a risk factor for the development of endometriosis?

STUDY QUESTION: Is maltreatment during childhood (MC), e.g. sexual abuse, physical abuse, emotional abuse and neglect, associated with diagnosis of endometriosis? SUMMARY ANSWER: Childhood sexual abuse, emotional abuse/neglect and inconsistency experiences were associated with the diagnosis of endometriosis while no such association was found for physical abuse/neglect and other forms of maltreatment. WHAT IS KNOWN ALREADY: Symptoms of endometriosis such as chronic pelvic pain, fatigue and depression, are correlated with MC, as are immune reactions linked to endometriosis. These factors support a case for a potential role of MC in the development of endometriosis. STUDY DESIGN, SIZE, DURATION: The study was designed as a multicentre retrospective case-control study. Women with a diagnosis of endometriosis were matched to control women from the same clinic/doctor's office with regard to age (±3 years) and ethnic background. A total of 421 matched pairs were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometriosis and control women were recruited in university hospitals, district hospitals, and doctors' offices in Germany, Switzerland and Austria. A German-language version of the Childhood Trauma Questionnaire (CTQ) was used to evaluate MC. Diagnosis of endometriosis was confirmed histologically and classified according to ASRM criteria. MAIN RESULTS AND THE ROLE OF CHANCE: Women with endometriosis reported significantly more often than control women a history of sexual abuse (20%/14%, P = 0.0197), emotional abuse (44%/28%, P < 0.0001), emotional neglect (50%/42%, P = 0.0123) and inconsistency experiences (53%/41%, P = 0.0007). No statistically significant differences could be demonstrated for physical abuse/neglect (31%/26%, P = 0.1738). Combinations of different abuse/neglect experiences were described significantly more often in women with endometriosis. Frequencies of other MC, i.e. violence against the mother (8%/7%, P = 0.8222), drug abuse in the family (5%/3%, P = 0.0943), mentally handicapped family members (1%/1%, P = 0.7271), suicidal intentions in the family (6%/4%, P = 0.2879) and family members in prison (1%/1%, P = 0.1597) were not statistically different in women with endometriosis and control women. LIMITATIONS, REASONS FOR CAUTION: Some control women might present asymptomatic endometriosis, which would lead to underestimation of our findings. The exclusion of pregnant women may have biased the results. Statistical power for sub-analyses of physical abuse/neglect and sexual abuse was limited. WIDER IMPLICATIONS OF THE FINDINGS: A link to MC needs to be considered in women with endometriosis. As there are effective strategies to avoid long-term consequences of MC, healthcare professionals should inquire about such experiences in order to be able to provide treatment for the consequences as early as possible. STUDY FUNDING/COMPETING INTEREST(S): None. TRIAL REGISTRATION NUMBER: Endo_QoL NCT 02511626

Maltreatment during childhood: a risk factor for the development of endometriosis?

Abstract STUDY QUESTION Is maltreatment during childhood (MC), e.g. sexual abuse, physical abuse, emotional abuse and neglect, associated with diagnosis of endometriosis? SUMMARY ANSWER Childhood sexual abuse, emotional abuse/neglect and inconsistency experiences were associated with the diagnosis of endometriosis while no such association was found for physical abuse/neglect and other forms of maltreatment. WHAT IS KNOWN ALREADY Symptoms of endometriosis such as chronic pelvic pain, fatigue and depression, are correlated with MC, as are immune reactions linked to endometriosis. These factors support a case for a potential role of MC in the development of endometriosis. STUDY DESIGN, SIZE, DURATION The study was designed as a multicentre retrospective case-control study. Women with a diagnosis of endometriosis were matched to control women from the same clinic/doctor's office with regard to age (±3 years) and ethnic background. A total of 421 matched pairs were included in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with endometriosis and control women were recruited in university hospitals, district hospitals, and doctors' offices in Germany, Switzerland and Austria. A German-language version of the Childhood Trauma Questionnaire (CTQ) was used to evaluate MC. Diagnosis of endometriosis was confirmed histologically and classified according to ASRM criteria. MAIN RESULTS AND THE ROLE OF CHANCE Women with endometriosis reported significantly more often than control women a history of sexual abuse (20%/14%, P = 0.0197), emotional abuse (44%/28%, P < 0.0001), emotional neglect (50%/42%, P = 0.0123) and inconsistency experiences (53%/41%, P = 0.0007). No statistically significant differences could be demonstrated for physical abuse/neglect (31%/26%, P = 0.1738). Combinations of different abuse/neglect experiences were described significantly more often in women with endometriosis. Frequencies of other MC, i.e. violence against the mother (8%/7%, P = 0.8222), drug abuse in the family (5%/3%, P = 0.0943), mentally handicapped family members (1%/1%, P = 0.7271), suicidal intentions in the family (6%/4%, P = 0.2879) and family members in prison (1%/1%, P = 0.1597) were not statistically different in women with endometriosis and control women. LIMITATIONS, REASONS FOR CAUTION Some control women might present asymptomatic endometriosis, which would lead to underestimation of our findings. The exclusion of pregnant women may have biased the results. Statistical power for sub-analyses of physical abuse/neglect and sexual abuse was limited. WIDER IMPLICATIONS OF THE FINDINGS A link to MC needs to be considered in women with endometriosis. As there are effective strategies to avoid long-term consequences of MC, healthcare professionals should inquire about such experiences in order to be able to provide treatment for the consequences as early as possible. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER Endo_QoL NCT 02511626

Patient satisfaction of primary care for musculoskeletal diseases: A comparison between Neural Therapy and conventional medicine

<p>Abstract</p> <p>Background</p> <p>The main objective of this study was to assess and compare patient satisfaction with Neural Therapy (NT) and conventional medicine (COM) in primary care for musculoskeletal diseases.</p> <p>Methods</p> <p>A cross-sectional study in primary care for musculoskeletal disorders covering 77 conventional primary care providers and 18 physicians certified in NT with 241 and 164 patients respectively. Patients and physicians documented consultations and patients completed questionnaires at a one-month follow-up. Physicians documented duration and severity of symptoms, diagnosis, and procedures. The main outcomes in the evaluation of patients were: fulfillment of expectations, perceived treatment effects, and patient satisfaction.</p> <p>Results</p> <p>The most frequent diagnoses belonged to the group of dorsopathies (39% in COM, 46% in NT). We found significant differences between NT and COM with regard to patient evaluations. NT patients documented better fulfilment of treatment expectations and higher overall treatment satisfaction. More patients in NT reported positive side effects and less frequent negative effects than patients in COM. Also, significant differences between NT and COM patients were seen in the quality of the patient-physician interaction (relation and communication, medical care, information and support, continuity and cooperation, facilities availability, and accessibility), where NT patients showed higher satisfaction. Differences were also found with regard to the physicians' management of disease, with fewer work incapacity attestations issued and longer consultation times in NT.</p> <p>Conclusion</p> <p>Our findings show a significantly higher treatment and care-related patient satisfaction with primary care for musculoskeletal diseases provided by physicians practising Neural Therapy.</p