Demir Eksikliği Anemisi Tedavisinde RDW’nin Dalgalı Seyri ve Klinik Önemi

Giriş: RDW, kan sayımının rutin bir parametresidir. Bu parametrenin kullanımı genel olarak mikrositer anemilerin ayırıcı tanısıyla kısıtlıdır. Bununla birlikte literatürde demir eksikliği anemisinin tedavisinde RDW’ nin seyri ve klinik önemiyle ilgili yeteri kadar bilgi bulunmamaktadır. Bundan dolayı bu çalışmada RDW’ nin demir eksikliği anemisinin tedavisindeki seyri ve hemoglobin artışı ile ilişkisinin araştırılması amaçlanmıştır. Method: Demir eksikliği anemisi tanısı konulan 105 hasta bu çalışmaya alınmıştır. Bulgular: Tanı anındaki ve tedavi başlandıktan sonraki 1, 2 ve 3. aydaki ortalama hemoglobin değerleri sırasıyla 9.2±1.5, 11.7±1.0, 12.7±0.8 ve 13.1±0.8 g/dL, RDW değerleri sırasıyla %18.4±2.6, %26.4±6.5, %17.8±4.3 ve %14.7±1.7 bulundu. Tanı anında ve 1. aydaki RDW değerleri arasında istatistiksel olarak belirgin artış (p<0.0001), 1, 2 ve 3. aydaki RDW değerleri arasında belirgin azalma (p<0.0001) tespit edildi. Regresyon analizinde 1. aydaki RDW artışı ile 1, 2 ve 3. aylardaki hemoglobin artışları arasında doğrusal bir bağlantı olduğu görüldü (sırasıyla p<0.0001, r=0.461; p<0.0001, r=0.51; p<0.0001, r=0.472). Sonuç: Bu çalışmanın sonuçlarına göre, RDW’ de meydana gelen artışın demir tedavisi yanıtını öngördürmek için kullanılabileceğini düşünmekteyiz.Background: Red cell distribution width (RDW) is a routine parameter of blood count. The use of this parameter is generally restricted to the differential diagnosis of microcytic anemia. However, there is insufficient published data on the course of RDW in the treatment of iron deficiency anemia and on its clinical importance. Therefore, this study investigated the course of RDW in the treatment of iron deficiency anemia and its association with increased hemoglobin values. Methods: One hundred five patients diagnosed with iron deficiency anemia were enrolled in this study. Results: The mean hemoglobin values of patients at diagnosis and at 1, 2 and 3 months after initiation of treatment were 9.2±1.5, 11.7±1.0, 12.7±0.8, and 13.1±0.8 g/dL, respectively. The mean RDW values of patients at diagnosis and 1, 2 and 3 months after initiation of treatment were 18.4±2.6, 26.4±6.5, 17.8±4.3, and 14.7±1.7%, respectively. Between baseline and 1 month of treatment there was a significant increase in RDW values (<0.0001), and between 1, 2 and 3 months there was a significant decrease in RDW values (<0.0001). Regression analysis revealed a linear correlation between the increase in RDW at month 1 and increase in hemoglobin level at months 1, 2 and 3 (<0.0001, r=0.461; <0.0001, r=0.51; <0.0001, r=0.472, respectively). Conclusion: We suggest that an increase in RDW may be used to predict the response to iron treatment

Intracranial Involvement Of Multiple Myeloma

OBJECTIVE: Multiple myeloma is usually restricted to the bone marrow. Central nervous system involvement is uncommon and can be observed in approximately 1% of the multiple myeloma patients. OBJECTIVES: We aimed to demonstrate brain magnetic resonance patterns in patients with multiple myeloma with neurologic symptoms and the literature is reviewed. METHODS: We retrospectively studied 39 patients with multiple myeloma with neurologic symptoms. All the patients underwent classic and contrast enhanced brain MR examination. RESULTS: Patients presented with the following symptoms: impaired consciousness (n=8, 20.5%), headache (n=6, 15.3%), hemiparesis (n=2, 5.1%), aphasia (n=6, 15.3%), scalp swelling (n=2, 5.1%), visual loss (n=1, 2.5%), seizure (n=2, 5.1%), vertigo (n=4, 10.2%), ophthalmoplegia (n=4, 10.2%), meningeal irritation findings (n=2, 5.1%), and orientation disorder (n=2, 5.1%). Among 39 patients with multiple myeloma, 14 (35.8%) had ischemic lesions, 14 (35.8%) had calvarial diploic metastases, 5 (12.8%) had dura mater mass, 4 (10.2%) had dura mater involvement, 2 (5.1%) had sinonasal mass, 1 had cavernous sinus and orbital apex mass, 1 (2.5%) had leptomeningeal involvement, 1 (2.5%) had intraorbital mass, 3 (7.6%) had clivus mass, 1 (2.5%) had optic neuritis, 1 (2.5%) had central pontine myelinolysis and 2 (5.1%) had meningitis. Examination of the cerebrospinal fluid was performed in 6 patients. Cerebrospinal fluid studies showed malignant plasma cells in 1 patient with leptomeningeal contrast enhancement. Despite serial cerebrospinal fluid examination, plasma cells in cerebrospinal fluid were not showed in 2 patients with dura mater involvement. Two patients had menengitis. CONCLUSION: Involvement of the central nervous system in multiple myeloma is very uncommon. The occurrence of neurological symptoms in a patient with myeloma requires an accurate evaluation with MR and lumbar puncture to detect a possible meningeal or cerebral involvement, when metabolic factors (hypercalcemia,drug toxicity, uremia), hyperviscosity, or medullary compression can be exclude

Factors effecting influenza vaccination uptake among health care workers: a multi-center cross-sectional study

Background: The present study aimed to identify factors affecting vaccination against influenza among health professionals. Methods: We used a multi-centre cross-sectional design to conduct an online self-administered questionnaire with physicians and nurses at state and foundation university hospitals in the south-east of Turkey, between 1 January 2015 and 1 February 2015. The five participating hospitals provided staff email address lists filtered for physicians and nurses. The questionnaire comprised multiple choice questions covering demographic data, knowledge sources, and Likert-type items on factors affecting vaccination against influenza. The target response rate was 20 %. Results: In total, 642 (22 %) of 2870 health professionals (1220 physicians and 1650 nurses) responded to the questionnaire. Participants' mean age was 29.6 +/- 9.2 years (range 17-62 years); 177 (28.2 %) were physicians and 448 (71.3 %) were nurses. The rate of regular vaccination was 9.2 % (15.2 % for physicians and 8.2 % for nurses). Increasing age, longer work duration in health services, being male, being a physician, working in an internal medicine department, having a chronic disease, and living with a person over 65 years old significantly increased vaccination compliance (p < 0.05). We found differences between vaccine compliant and non-compliant groups for expected benefit from vaccination, social influences, and personal efficacy (p < 0.05). Univariate analysis showed differences between the groups in perceptions of personal risks, side effects, and efficacy of the vaccine (p < 0.05). Multivariate analysis found that important factors influencing vaccination behavior were work place, colleagues' opinions, having a chronic disease, belief that vaccination was effective, and belief that flu can be prevented by natural ways. Conclusion: Numerous factors influence health professionals' decisions about influenza vaccination. Strategies to increase the ratio of vaccination among physicians and nurses should consider all of these factors to increase the likelihood of success