Variant clinical courses in children with immune thrombocytopenic purpura: Sixteen year experience of a single medical center

Objective: Immune thrombocytopenic purpura (ITP) is the most common cause of acquired thrombocytopenia in children. The objective of this study was to evaluate the presenting features, variation in the clinical courses, initial response rate to therapy, and long-term outcome in patients with ITP. Materials and Methods: Three hundred and fifty out of 491 newly diagnosed patients with ITP between the initial diagnosis ages of 6 months to 16 years were included in this retrospective, descriptive study. Patients with acute vs chronic ITP, acute vs recurrent ITP and chronic vs recurrent ITP were compared in terms of age at diagnosis, gender, initial platelet count, response rate to initial therapy, long-term outcome, and total duration of follow-up. Results: The clinical courses of the patients were determined as acute, chronic and recurrent in 63.8%, 29.1%, and 7.1%, respectively. Platelet count >20x109/L and initial diagnosis age >10 years were found to increase the probability of chronic outcome by at least two-fold. Conclusion: It is concluded that ITP in childhood is a common disease with low morbidity and mortality. In addition to the acute and chronic form, a rare recurrent form, which accounts for about 4-7% of all ITP patients, should be considered

Gebelerdeki demir eksikliği tanısında serum transferin reseptörünün yeri

Aim: Iron deficiency anemia (IDA) is an important public health problem in pregnancy, especially in developing countries. However, conventional markers for assessing iron status tend to be less reliable in pregnancy. Our aim was to study whether soluble serum transferrin receptor (sTfR) could be effectively used or not as a marker for iron deficiency in pregnancy. Methods: One-hundred and sixty-four relatively low- income healthy pregnant women, accepted for term delivery at Ege Gynecology and Obstetrics Hospital, were studied for iron status. the women with thalassemia trait, anemia of other causes, multiple pregnancies and a history of blood transfusion for any reason were excluded. One-hundred and thirty-two subjects were included in the study in the final analysis. Erythrocyte indices were studied with an automatic coulter (Symex SE, 9000). Serum ferritin and sTfR levels were measured by an immunoturbidimetric and nephelometric method (Dade Behring, Dutch) respectively. A serum ferritin level of less than 15 ng/dl was accepted as iron deficiency (ID). in addition to tow ferritin level, a hemoglobin (Hb) level less than 11 g/dl were considered as IDA. the pregnant women with normal Hb and ferritin levels were evaluated as control group. the data were analyzed on SPSS for Windows (version 10.0). Chi square, Pearson correlation test and one-way ANOVA were used for statistical analysis. Results: the mean age and the gestational age of pregnant women were 26.4±4.7 years and 39.4±1 weeks, respectively. the median number of parity was 2. Seventy-two (52.3%) women had IDA and 15 (13.6 %) had ID. All of the hematological parameters showed statistical difference between the IDA, ID and the control groups, except MCHC (p;lt;0.05). the levels of serum ferritin, sTfR and sTfR index showed statistically significant differences both in IDA and ID groups as compared to control group. Calculated sensitivity, specifity, positive and negative predictive values for sTfR (>1.8 mg/dl) were 70%, 72%, 83% and 55% respectively. Thirty percent of the subjects were not given iron supplementation during pregnancy, and 35% of them did not receive routine prenatal care. Conclusion: From the data in this study, it can be said that because of the low sensitivity, the measurement of serum sTfR level for the evaluation of iron deficiency in the pregnancy does not provide additional benefit to the conventional serum ferritin measurement. Also, the prevalence of ID and IDA among pregnant women in low socio-economic population in Izmir is very high.Amaç: Gebelikte demir eksikliği anemisi gelişmekte olan ülkelerde önemli bir halk sağlığı sorunudur. Ancak, gebelikteki demir durumunun değerlendirilmesinde optimal laboratuvar tetkiki konusunda halen fikir birliği yoktur. Bu çalışmadaki amacımız gebelerdeki demir durumunun değerlendirilmesinde serum soluble transferin reseptörünün (sTfR) kullanılıp kullanılamayacağını araştırmaktır. Yöntem: Çalışmaya SB Kadın Hastalıkları ve Doğumevi Eğitim ve Araştırma Hastanesinde miadında normal doğum yapan 164 gebe alınmıştır. Demir durumu değerlendirilen ve talasemi taşıyıcılığı, sınıflandırılamayan anemi, transfüzyon öyküsü, çoğul gebelikler ve enfeksiyonlu olanlar çalışma dışı tutularak 132 gebe ile çalışmaya devam edilmiştir. Gebelerden, doğumdan önceki gün içinde 2 mi EDTA'lı ve 2 adet 2 ml düz kan alınmıştır. Eritrosit indeksleri tam otomatik kan sayım cihazında (Symex-SE, 9000), ferritin otoanalizörede immunoturbidimetrik (Hitachi 911), sTfR düzeyleri ise nefelometrik yöntemle (Dade Behring) çalışılmıştır. Demir durumunun değerlendirilmesinde altın standart olarak serum ferritin düzeyi alınmıştır. Ferritin 15 mg/dl olması demir eksikliği (DE), ek olarak Hb 11 g/dl olması demir eksikliği anemisi (DEA) olarak tanımlanmıştır. Hb $\geq$11 g/dl ve ferritin $\geq$15 ng/dl blan gebelerin demir durumu normal olarak kabul edilmiş ve kontrol grubunu oluşturmuştur. İstatistiksel değerlendirmede SPSS 10.0 for Windows programında, ki-kare, Pearson korelasyon analizi ve tek yönlü varyans analizi (ANOVA) kullanılmıştır. Bulgular: Ortalama gebe yaşı 26.4±4.7 yıl, ortalama gebelik haftası 39.4±1, medyan gebelik sayısı 2 olup, gebelerin %52.3'inde DEA, %13.6'inde DE saptanmıştır. Kontrol grup ile DE ve DEA grubu arasında ferritin, sTfR, sTfR indeks ortalama değerleri arasında istatistiksel anlamlı fark bulunmuştur( p0.05). Serum sTfR ve sTfR indeksinin duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri sırası ile %70, %72, %83, %55 ve %88, %79, %89, %77 olarak saptanmıştır. Gebelerin %30'unun demir kullanmadığı ve %35'inin gebelikte hiç kontrole gitmediği saptanmıştır. Sonuç: İzmir'de SB Ege Doğum Hastanesine doğum için başvuran gebelerde DE ve DEA sıklığı oldukça yüksektir. Bu çalışmadan elde edilen verilere dayanarak gebelerde demir eksikliğinin saptanmasında serum sTfR,düzeyinin duyarlılığının %70 civarında olması nedeniyle beklendiği ölçüde yarar sağlamadığı söylenebilir

Retinopathy of Prematurity in Very Low Birth Weight Infants: Effects of Serum Vitamin A and Clinical Parameters

Pur po se: Retinopathy of prematurity (ROP) is a proliferative vascular disease which affects premature newborns and occurs during vessel development. The pathogenesis of ROP is complex and includes oxidative damage to the developing retina. The aim of this study was to evaluate the relationship of ROP with serum vitamin A levels and clinical parameters in infants with a gestational age of ≤32 weeks and birth weight of ≤1500 grams. Ma te ri al and Met hod: Newborns admitted to Newborn Intensive Care Unit within the first 24 hours of life, with gestational age ≤ 32 weeks, birth weight ≤1500 grams, without any major congenital anomalies, inborn error of metabolism or prior history of blood/blood products transfusion were included in the study. The patients were divided into two groups, ROP (+) and ROP (-), according to the presence of ROP at any stage. Serum vitamin A levels and gender, type of delivery, birth weight, gestational age, duration of hospitalization and oxygen supply, multiple gestation, preeclampsia, PDA, sepsis and intraventricular hemorrhage of the groups were compared with Mann-Whitney U and chi-square tests. Re sults: The mean gestational age of these infants was 29.2±2.0 weeks and the mean birth weight was 1287±197 grams. ROP was diagnosed in 48% of infants and the mean serum vitamin A level was 0.56±0.45 μmol/L. In 44 cases (84%), vitamin A level was determined low (<0.7 μmol/L) and was extremely low (<0.35 μmol/L) in 17 cases (32.7%). There was no significant difference between the ROP (+) and ROP (-) groups in terms of vitamin A levels. There was a statistically significant difference between the groups in terms of birth weight, gestational age, multiple gestation, duration of hospitalization and oxygen supply. Dis cus si on: Our results suggest that low birth weight, small gestational age, duration of hospitalization, oxygen exposure time and multiple gestation may increase the risk of ROP, while serum vitamin A level was not found to be associated with ROP in the present study. (Turk J Ophthalmol 2011; 41: 309-1

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1–84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0–18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4–9.6; p = .007).IMPACT STATEMENT What is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential. What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival. What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings