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We investigated depression and anxiety levels and related psychological disorders in adolescents with transfusion-dependent thalassemia (TDT) in this study. The study was conducted in two pediatric hematology outpatient clinics and included adolescents with TDT (14.8 ± 2.4 years, n = 40) in the study and compared them with the healthy age-matched control group (14.3 ± 2.3 years, n = 62). The Turkish version of the Revised Child Anxiety and Depression Scale (RCADS) was used to determine depression, anxiety, and related psychologic disorders (obsession, panic disorder, social phobia). Depression, anxiety, obsession, panic disorder, and social phobia scores were significantly higher in the patient group compared with the control (all p < 0.05). Ferritin levels were positively correlated with total depression, general anxiety, separation anxiety, and social phobia scores, but transfusion frequency and young age were the confounding factors. Patients in early adolescence and those who require more frequent blood transfusions are at higher risk of developing psychological disorders; routine screening for mood disorders should be warranted. Serum ferritin level may be a good warning indicator for early recognition of psychologic disorders in TDT patients. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim: This study examines patients diagnosed with vitamin B12 deficiency in our department. Although rare, vitamin B12 deficiency is one of the causes of megaloblastic anemia, which can lead to negative outcomes in patients. We aim to promote earlier diagnosis to protect patients from these negative effects. Therefore, this study will contribute to raising awareness in the literature. Methods: Retrospectively, we included a total of 127 outpatient children, aged 0-18 years (0-215 months), who were diagnosed and treated for vitamin B12 deficiency at the Bagcilar Training and Research Hospital Child Health and Disease Clinic between October 2014 and February 2015. Results: Among the patients, 67 (53%) with vitamin B12 deficiency were female, while 60 (47%) were male, indicating a higher occurrence in girls. Vitamin B12 deficiency was most commonly observed in the age groups of 0-2 years and 12-17 years (adolescents). The mean vitamin B12 level was 168.1 (34.1) pg/mL, the mean hemoglobin level was 12 (1.9) g/dL, and the mean MCV (mean corpuscular volume) was 78.4 (8.1) fl. Anemia was observed in 38% of the patients, bicytopenia in 4%, neutropenia in 6%, thrombocytopenia in 9%, pancytopenia in 3%, and macrocytosis in 2%. Non-iron-deficient patients showed no difference in mean hemoglobin and RDW (red cell distribution width) when compared to irondeficient patients. However, their B12 levels were lower. The prevalence of iron deficiency did not differ between girls and boys. Comparing patients with vitamin B12 levels lower than 150 pg/mL to those with higher levels, there were no significant differences in average Hb, MCV, and RDW. Conclusion: It should be noted that macrocytic anemia is not exclusive to vitamin B12 deficiency. Vitamin B12 deficiency can manifest as normocytic anemia and should not be overlooked in biochemical assessments. It is recommended to conduct nationwide and regional prevalence studies to evaluate vitamin B12 deficiency as a public health issue and to develop new solutions accordingly. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Coronavirus disease 2019 (COVID-19) can cause hypoxic respiratory failure; long-term oxygen therapy (LTOT) duration is unknown. MATERIAL AND METHODS: The aim was to investigate which patients would need LTOT after COVID-19 pneumonia. This single-center, prospective study was conducted at the Ankara University Faculty of Medicine, Department of Chest Diseases, between May 2021 and December 2021. The 70 patients hospitalized for COVID-19 pneumonia and discharged with LTOT due to hypoxemic respiratory failure were included. Patients were divided into 2 groups as group I (LTOT requirement <3 months) and group II (LTOT requirement continued =3 months). RESULTS: The mean age was 64.4 ± 13.5 years, and 44 (62.9%) of them were male. The most frequently encountered comorbidities were cardiovascular disease (57.1%) and lung disease (22.9%). While PaO2 levels increased in both groups during the follow-up period, this increment was significantly higher in group I (PaO2: 66.6 ± 9.9 mm Hg, P < .001). The factors affecting the LTOT requirement were evaluated using binary logistic regression. On multivariate analyses of lymphocytes, ferritin, C-reactive protein, PaO2, SaO2, subpleural reticulation, and number of lobes affected (=3 lobes), the SaO2 level and presence of subpleural reticulation were significantly different between the 2 groups [odds ratio (OR) (95% CI): 0.853 (0.749-0.971), P = .016] and [OR (95% CI): 0.171 (0.042-0.733), P = .017], respectively. CONCLUSION: A significant proportion of patients who develop respiratory failure due to COVID-19 recover within the first 3 months. Factors determining the LTOT requirement for more than 3 months were SaO2 and the presence of subpleural reticulation. [ABSTRACT FROM AUTHOR]

Biological variation (BV) plays a crucial role in determining analytical performance specifications, assessing serial measurements of individuals, and establishing the use of population-based reference intervals. Our study aimed to calculate the BV and BV-based quality goals of 25-hydroxyvitamin D3 (25-OH D3), ferritin, folate and vitamin B12 tests. We included a total of 22 apparently healthy volunteers (9 women and 13 men) aged 18-55 years in the study that we conducted in Turkey. Blood samples were collected from the participants once a week for five weeks. Serum ferritin, folate and vitamin B12 levels were measured using immunochemical method, while plasma 25-OH D3 levels were determined using the high-performance liquid chromatography method. Analysis of variance (ANOVA) was used to estimate analytical variation(CVA), within-subject BV(CVI) and between-subject BV(CVG). The individuality index (II) and reference change value (RCV) were calculated based on these data. The CVI of 25-OH D3, ferritin, folate, and vitamin B12 were found to be 1.8% (0.6%-2.5%), 16.9% (14.4%-20.2%), 10.7% (9.2%-12.7%), and 8.6% (6.8%-10.5%), respectively. CVG were 44.2% (34.3%-69.9%), 132% (87.7%-238%), 19.4% (14.4%-28.8%), and 39.6% (29.8%-59.0%) for the same biomarkers, while CVA were 3.2% (2.81%-3.71%), 3.5% (3.1%-4.1%), 4.0% (3.5%-4.6%), and 7.5% (6.6%-8.6%), respectively. The II values for 25-OH D3, ferritin, folate, and vitamin B12 were calculated as 0.04, 0.13, 0.55, and 0.22, respectively. The RCV were 10.2%, 47.8%, 31.7%, and 31.6%, respectively. Because the tests analyzed in this study exhibit high individuality, RCV should be preferred rather than population-based reference ranges in clinical interpretation of results. [ABSTRACT FROM AUTHOR]

Objective: There are limited studies regarding endocrine complications in Turkish adult thalassemic patients. Data regarding newly emerging endocrine complications in the long-term monitoring of adult patients with beta-thalassemia are also quite limited. Methods: The study was a single-center cohort study involving 103 adult patients with betathalassemia. Results: The most frequent endocrine disorder was vitamin D insufficiency (69%), whereas the most common endocrine complications were hypogonadism (56%) and osteoporosis (37%) in thalassemic patients. Three or more endocrine disorders were present in 42% of the patients. Patients with hypogonadism had higher ferritin levels (P = .014), lower hemoglobin concentrations (P = .028), and increased myocardial iron deposition (P = .002) compared to those without hypogonadism. There was also a link between 5-year calculated mean ferritin levels and fasting plasma glucose (r = 0.29, P = .004) and 75 g oral glucose tolerance test second-hour glucose levels (r = 0.46, P = .001). Osteoporosis was more common in patients with hypogonadism (51% vs. 21%, P = .003) and diabetes (75% vs. 35%, P = .027). The remaining endocrine problems, on the other hand, were not linked to thalassemia-related characteristics or each other. In 3 and 5 years of follow-up, 16% and 12% of patients developed a new endocrine-metabolic complication, respectively, with osteoporosis and prediabetes/diabetes being the most common. Conclusion: A significant proportion of adult thalassemic patients have multiple endocrine-metabolic complications. All patients with thalassemia major, regardless of their ferritin levels, should be evaluated for the occurrence of endocrine complications. Endocrinologists should be especially vigilant during long-term follow-up for the development of glucose metabolism disorders and osteoporosis in adult thalassemic patients. [ABSTRACT FROM AUTHOR]

Background: Vitamin B12 is a water-soluble vitamin with important cellular functions; it is an essential vitamin. The aim of this study is to determine the B12 levels of children in the period from the 6th month when they start taking additional foods to the age of seven (preschool children) and the risk factors affecting them. Methods: One hundred pediatric patients aged 6–72 months who were diagnosed with vitamin B12 deficiency and their parents who agreed to attend Istanbul Atlas University, Medical Faculty, "Medicine Hospital" Pediatric Clinic between September 2022 and June 2023 were prospectively included in this study. Results: B12 deficiency was significantly higher in the 6–11 (25%)-month group than in the 12–23 (5.8%)- and 24–47 (2.8%)-month groups. Homocysteine levels were highest in those with insufficient B12 levels compared to the other groups. There was no statistically significant difference in weekly dairy and meat consumption levels between age groups. B12 levels were lower in the 6–11-month group than in the other groups. Homocysteine levels were highest in those with insufficient B12 levels (<200 pg/mL (148 pmol/L)). Folic acid levels were lower in the 24–47-month and 48–72-month groups than in the 6–11-month and 12–23-month groups. Conclusions: The results obtained in this study showed that low vitamin B12 and increased homocysteine levels seem to be important risk factors in preschool children, especially from the 6th month when they start consuming additional foods. The diagnosis of B12 deficiency can be confirmed by elevated serum total homocysteine levels, which are evidence of functional cobalamin deficiency. [ABSTRACT FROM AUTHOR]

Background/Aim: Prolonged fever in children presents a diagnostic challenge due to its diverse underlying causes. While infectious diseases historically played a primary role, recent shifts in disease patterns and the emergence of conditions such as multisystem inflammatory syndrome in children (MIS-C) have added complexity. Understanding factors contributing to prolonged fever, particularly the rise in MIS-C and Kawasaki Disease (KD), is vital for accurate diagnosis and timely intervention. This study aimed to identify the etiologies causing prolonged fever in children with temperatures exceeding 38°C for a minimum of 5 days and to examine its relationship with conditions like MIS-C and KD following the coronavirus disease 2019 (COVID-19) pandemic. Methods: We conducted a retrospective cohort study at a pediatric hospital in Istanbul, Turkey, involving 243 children aged 3 months to 17 years with prolonged fever (>38°C for =5 days) between April 2020 and October 2022. We collected data on patient demographics, clinical characteristics, laboratory results, and final diagnoses. The study categorized patients into Group 1 (KD and MIS-C) and Group 2 (other causes). We performed logistic regression analysis to identify factors associated with KD and MIS-C, using hospitalization days and levels of C-reactive protein (CRP), ferritin, and D-dimer. We calculated sensitivity, specificity, and likelihood ratio values and generated ROC (Receiver operating characteristic) curves. The threshold for statistical significance was set at P<0.05. Results: This study encompassed 243 patients with prolonged fever. The primary causes of admission included infection-related illnesses (60.91%, n=148), MIS-C (18.52%, n=45), and KD (10.70%, n=26). Significant differences were observed in lymphocyte count (P<0.001), CRP level (P<0.001), ferritin level (P<0.001), D-dimer level (P<0.001), hospitalization days (P<0.001), and echocardiographic findings (P<0.001) between the groups. Logistic regression analysis revealed noteworthy associations between the presence of KD and MIS-C and hospitalization days (P=0.001), elevated CRP levels (P=0.018), elevated ferritin levels (P=0.009), and elevated D-dimer levels (P=0.001). Ferritin exhibited an AUC (Area under curve) of 0.737 (P<0.001), and D-dimer demonstrated an AUC of 0.782 (P<0.001) in differentiating between the presence of KD and MIS-C. Conclusion: The prevalence of infectious and inflammatory conditions remains high in cases of prolonged fever, with a noticeable increase in the occurrence of KD and MIS-C since the onset of the COVID-19 pandemic. Notably, ferritin, CRP, and D-dimer levels are valuable indicators for identifying children at elevated risk of developing KD and MIS-C. While data were collected during the epidemic, additional data collection beyond this period would be necessary. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Archives of Lung is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim: Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increasing incidence worldwide and its effects are being seen in many countries. Insulin resistance is the main factor in the pathophysiology. T2DM leads to an increase in mortality and morbidity due to macrovascular and microvascular complications. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are effective parameters in monitoring the inflammatory response. The primary aim of this study was to investigate glycemic control in patients with type 2 diabetes by focusing on their correlation with inflammatory markers, such as NLR and PLR, glycated hemoglobin (HbA1c), and fasting blood glucose levels. Methods: The present study was carried out in 2022 within the purview of the Internal Medicine Clinic at Balikesir İvrindi State Hospital. Data from the initial annual consultations of patients with T2DM, either newly diagnosed or previously diagnosed and visiting for follow-up, were utilized. Our study excluded patients under the age of 18 and those diagnosed with cirrhosis, heart failure, type 1 diabetes mellitus, malignancy, epilepsy, acute infection, pregnancy, or chronic inflammatory disease. We further excluded those on medications including steroids, antivirals, anticonvulsants, antipsychotics, antithyroids, and chemotherapeutic drugs that impact the leukocyte count. Based on their HbA1c levels, patients were systematically categorized into two distinct cohorts: those with controlled blood sugar (HbA1c =7%) and those with uncontrolled blood sugar (HbA1c >7%). In the ambit of this study, we incorporated data from 205 patients. We employed a cross-sectional study that retrospectively examined the correlation between NLR, PLR, and glycemic regulation in T2DM patients. SPSS 22.0 software was used to perform statistical calculations. Results: It was observed that patients with poor glycemic control had longer disease durations and this disparity bore statistical significance (P=0.005). Patients exhibiting poor glycemic control demonstrated elevated levels of CRP (C-reactive protein), a difference that reached statistical significance (P=0.003). The group exhibiting poor glycemic control demonstrated a notable elevation in NLR, indicating statistical significance (P=0.001). Although it was not statistically significant, PLR was found to be higher in patients with uncontrolled T2DM (P=0.441). Conclusion: This research investigates the correlation between HbA1c levels and inflammatory markers, specifically NLR and TLR, in T2DM patients who exhibit poor control of glycemia. Our findings highlight the potential of these markers as indicators of glycemic control, thus emphasizing the need for integrated strategies for managing inflammation and improving glycemic control in T2DM patients. The novelty of this area of research contributes to the scarcity of available literature, underlining the importance and timeliness of this study. Based on our findings, we suggest an increased focus on regular monitoring of inflammatory markers, for instance NLR and PLR, to assess the glycemic control in T2DM patients. The significant correlation of these markers with HbA1c levels implies that they could potentially serve as useful tools in personalizing diabetes management strategies, leading to improved patient outcomes. Not only does our research contribute to filling this knowledge gap, but it also underscores the potential for utilizing inflammatory markers in tracking disease progression and optimizing treatment efficacy in T2DM. [ABSTRACT FROM AUTHOR]

Introduction: Secondary hemophagocytic syndrome (HPS) and systemic inflammatory response syndrome (SIRS) share similar clinical findings as a result of hyperinflammation. Due to high mortality rates in HPS; it is critical to diagnose promptly. Thus, this study aimed to evaluate the diagnostic and prognostic significance of inflammatory markers in these two increased inflammatory states. Methods: We conducted a prospective observational study including patients hospitalized in the intensive care unit of the Internal Medicine Department of Ege University Hospital. Results: Thirty‐three patients with HPS and 46 patients with SIRS were evaluated. Serum ferritin and sIL‐2r levels were significantly higher in the HPS group than in the SIRS group, as expected. Receiver operating curve (ROC) analysis showed that the optimal cutoff for ferritin to distinguish HPS from SIRS was 1703 μg/L (sensitivity: 75%, specificity: 94.1%, area under the curve (AUC): 0.871, p < 0.001), and that for sIL‐2r was 5888 U/ml (sensitivity: 45.5%, specificity: 89.1%, AUC: 0.698, and p = 0.001). Temporal changes (Δ) in ferritin were determined as a mortality predictor. When evaluated in terms of prognostic significance in ROC analysis, a decrease in ferritin of less than 38% was the cutoff value (sensitivity: 92.3%, specificity: 76.9%, AUC: 0.888, and p < 0.001), in mortality. Contrarily, neither baseline nor temporal change in sIL‐2r did not achieve prognostic significance as a mortality predictor. Conclusion: In this single‐center study, serum ferritin level was found to be a particularly more valuable diagnostic and prognostic marker than sIL‐2r in patients with HPS. [ABSTRACT FROM AUTHOR]

Copyright of Ümraniye Pediatri Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim: Convalescent plasma (CP) therapy, which includes processing and administering antibody-rich plasma from recovered patients to sick patients, is used for passive immunity in COVID-19 pneumonia patients in addition to antivirals and antibiotics. This study aimed to assess whether CP treatment significantly affects hyperviscosity and COVID-19 prognosis-related blood parameters. Methods: This study was a single-center retrospective cohort study. Ninety-seven patients with COVID-19 polymerase chain reaction (PCR)-positive results and pneumonia observed on thoracic computed tomography (CT) were included. Patients' ferritin, d-dimer, C-reactive protein (CRP), and complete blood count levels before and after CP administration were compared. Results: Ferritin, d-dimer, white blood cell (WBC), neutrophil, and plateletcrit (PCT) levels and the platelet distribution width (PDW) were significantly higher and there was a significant decrease in the CRP level after CP treatment compared to before CP (P < 0.05). Ferritin, d-dimer, and CRP values measured after CP were higher in deceased patients than in survivors (P = 0.001, P = 0.007, and P < 0.001, respectively). Conclusion: Ferritin, d-dimer, WBC, and neutrophil levels, which we expected to decrease on the basis of the COVID-19 prognosis, unfortunately increased, and only CRP levels decreased. However, we found that these increases were more pronounced in patients who died. Considering these prognostic factors, the findings of our study suggest that CP treatment has no effect on the COVID-19 disease course and may lead to a worse prognosis. [ABSTRACT FROM AUTHOR]

Objective: In the present study, the relationship between a poor prognosis and adropin levels in diabetic patients with coronavirus disease 2019 was investigated by measuring serum adropin levels and levels of D-dimer, C-reactive protein, and ferritin, which are considered prognostic factors for coronavirus disease 2019. Materials and Methods: Hundred volunteer participants treated in the Erzurum Regional Training and Research Hospital were included in this study. Serum adropin levels were measured by enzyme-linked immunosorbent assay. The relationship between serum adropin level and C-reactive protein, ferritin, and D-dimer levels was analyzed by correlation analysis. Results: The participants' serum adropin levels differed between the groups (P = .0007). The control group had the highest adropin levels among groups. The lowest adropin levels were in the COVID + diabetes mellitus group. Adropin levels of diabetes mellitus, COVID, and diabetes mellitus + COVID groups were significantly decreased when compared to the control (P < .05). There was a significant negative correlation between adropin and C-reactive protein, D-dimer, and ferritin. Conclusion: Adropin can be used as an auxiliary biomarker, a prognostic factor in the early management of coronavirus disease 2019 patients with diabetes mellitus. We think that our study will guide future studies conducted in this field. [ABSTRACT FROM AUTHOR]

Objective: Coronavirus disease (COVID-19) is a worldwide pandemic with a huge burden of illness, high economic costs, and mortality rates. This study sought to compare clinical signs and symptoms among adult COVID-19 patients admitted to triage outpatient clinics. Methods: In this observational retrospective study, clinical symptoms, biochemical parameters, and chest computed tomography (CT) of 1745 suspected patients admitted to COVID-19 triage outpatient clinic between 01 April 2020-01 September 2020 were analyzed. Results: A total of 650 (37.2%) of 1745 patients who were admitted to triage outpatient clinic were diagnosed as COVID-19 by PCR confirmation. Of the participants, 88.1% had at least one symptom, 11.9% were asymptomatic. Almost half of the patients (50.1%) had a history of exposure including contact with COVİD-19 confirmed cases. COVID-19 (+) patients were more diabetic and hypertensive than negative cases. In patients who underwent chest CT imaging, 40.6% (310) had pneumonic infiltrations compatible with COVID-19 pneumonia. Hemoglobin, leukocyte, neutrophil, lymphocyte, and platelet counts were lower, but CRP levels were higher in patients with COVID-19. Multivariate logistic regression analysis revealed that older age (OR=1.020; p=0.018), contact with confirmed COVID-19 patient (OR=1.907, p=0.009), fever (OR=1,588, p=0,001), fatigue (OR=2.075, p=0.009), cough (OR= 2.301, p<0.001) were significantly associated with increased odds of PCR (+) status. Conclusions: Predictive factors associated with PCR (+) test results were older age, history of contact with confirmed COVID-19 patient, high fever, fatigue, cough in our study. Some symptoms could have a significant relationship with PCR positivity, which requires a more careful approach during the first admission to healthcare facilities. [ABSTRACT FROM AUTHOR]

Objective: Sleep is important for metabolism and the immune system. Disturbed sleep may be a risk factor for poor recovery from diseases. Coronavirus disease-2019 (COVID-19) pneumonia has been the most common cause of hospitalization in the last year. This study aimed to evaluate the sleep quality of hospitalized patients with COVID-19 pneumonia and the factors that affect their sleep quality. Materials and Methods: This cross-sectional study included patients with COVID-19 pneumonia who were hospitalized at a pandemic clinic. The demographic data, symptoms, laboratory parameters, and hospitalization duration were evaluated. After the first night of admission, the patients completed Pittsburgh sleep quality index (PSQI) and hospital anxiety and depression scale (HADS). Results: This study included 105 patients, of whom 55 were with mild-moderate pneumonia and 50 with severe pneumonia. The mean value of the total PSQI score was 8.43±2.03 in the non-severe group and 12.64±2.24 in the severe group. Positive correlations were found between the total PSQI score and age, HAD-A score, HAD-D score, length of hospital stay, and ferritin. Negatively significant correlations were found between the PSQI score and leukocyte count, lymphocyte count, albumin, and oxygen saturation. Independent factors, such as disease severity, HADS scores, oxygen saturation, and dyspnea, were associated with the total PSQI score (R2=0.630). Conclusion: Patients who are hospitalized with COVID-19 pneumonia had poor sleep quality. Sleep quality was affected by disease severity. Anxiety and depression levels, oxygen saturation, and dyspnea are associated with sleep quality in these patients. [ABSTRACT FROM AUTHOR]

Background/aim: We aimed to analyze the usefulness of such a reserved area for the admission of the patients’ symptoms suggesting COVID-19 and compare the demographic and clinical characteristics of the patients with COVID-19 and without COVID-19 who were admitted to C1 during the first month of the COVID-19 outbreak in our hospital. Materials and methods: A new area was set up in Hacettepe University Adult Hospital to limit the contact of COVID-19 suspicious patients with other patients, which was named as COVID-19 First Evaluation Outpatient Clinic (C1). C1 had eight isolation rooms and two sampling rooms for SARS-CoV-2 polymerase-chain-reaction (PCR). All rooms were negative-pressurized. Patients who had symptoms that were compatible with COVID-19 were referred to C1 from pretriage areas. All staff received training for the appropriate use of personal protective equipment and were visited daily by the Infection Prevention and Control team. Results: One hundred and ninety-eight (29.4%) of 673 patients who were admitted to C1were diagnosed with COVID-19 between March 20, 2020, and April 19, 2020. SARS-CoV-2 PCR was positive in 142 out of 673 patients. Chest computerized tomography (CT) was performed in 421 patients and COVID-19 was diagnosed in 56 of them based on CT findings despite negative PCR. Four hundred and ninety-three patients were tested for other viral and bacterial infections with multiplex real-time reverse-transcriptase PCR (RTPCR). Blood tests that included complete blood count, renal and liver functions, d-dimer levels, ferritin, C- reactive protein, and procalcitonin were performed in 593 patients. Only one out of 44 healthcare workers who worked at C1 was infected by SARS-CoV-2. Conclusion: A well-planned outpatient care area and teamwork including internal medicine, microbiology, and radiology specialists under the supervision of infectious diseases specialists allowed adequate management of the mild-to-moderate patients with suspicion of COVID-19. [ABSTRACT FROM AUTHOR]

Aim: Viral wart is a common benign infectious dermatosis. It remains unclear why not everyone exposed to HPV develops warts. It is known that vitamin and mineral deficiencies can affect impair natural and acquired immunity and lead to a tendency to get more infections. This study aimed to determine the potential utility of evaluating vitamin B12, folic acid, and ferritin levels in patients with viral warts. Material and Methods: In this retrospective study, 70 patients who were diagnosed with viral warts in the dermatology outpatient clinic of Karabük University Training and Research Hospital between January 2018 and December 2019 were included. 70 healthy individuals matched with viral wart patients in terms of gender and age were included as the control group. Serum vitamin B12, folic acid, and ferritin levels of both groups were detected and compared from the hospital automation system. Results: Vitamin B12 level was detected statistically significantly lower in the viral wart group as compared to the control group (p=0.046). Although serum ferritin levels were found lower in the viral wart group, this difference was not statistically significant (p=0.677). No statistically significant difference was detected between the viral wart and control groups in terms of folate levels (p=0.879). Conclusion: In patients with viral warts with low serum vitamin B12 levels, replacement therapy could be considered. Also, the evaluation of serum ferritin level, an iron storage parameter in the body, is important in patients with viral warts infection. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Data about Turkish coronavirus disease 2019 patients are limited. We evaluated hospitalized coronavirus disease 2019 patients who were followed up in the first 3 months of the pandemic. MATERIAL AND METHODS: This retrospective, single-center, observational study included 415 confirmed hospitalized coronavirus disease 2019 patients. The patients were divided into groups, namely, mild, moderate, and critically ill patients. Symptoms at the time of admission, clinical, laboratory, and imaging findings were examined. RESULTS: In our study, 6.74% of coronavirus disease 2019 patients had severe disease, 59.5% were male, and the mortality rate was 11.3%. Diabetes mellitus and chronic obstructive pulmonary disease were more frequently seen in critically ill patient groups and hypertension in moderate patient groups. Anemia and aspartate aminotransferase levels were higher in non-survivors among mild coronavirus disease 2019 patients. In the moderate patients' group, aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, ferritin, and D-dimer levels were higher and lymphocyte, hemoglobin levels were lower; in the critically ill patients' group, platelets were lower and uric acid levels were higher in non-survivor patients. CONCLUSION: In mild patients, anemia, lymphopenia, and increased aspartate aminotransferase levels; in moderate patients, leukopenia, anemia, and increased aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, ferritin, and D-dimer levels; in the critically ill patient group, lower platelet and increased uric acid levels should be followed closely as they are mortality predictors. [ABSTRACT FROM AUTHOR]

Objective: Uric acid (UA), a known danger signal released from injured cells, is a valuable sign of inflammation. We aimed to evaluate the association of serum UA levels before the start of conditioning regimens with the risk of hepatic sinusoidal obstruction syndrome (SOS) development after hematopoietic stem cell transplantation (HSCT). Materials and Methods: Two hundred and twenty-two children who underwent allogeneic HSCT at the Pediatric BMT Unit of Hacettepe University between 2000 and 2014 were included in this retrospective study. Serum UA levels were measured before conditioning as an indicator of the pre-transplant inflammatory status of the patients. Patients with and without a diagnosis of SOS were compared regarding primary diagnosis, previously described risk factors for SOS, and preconditioning serum UA. Results: SOS was diagnosed in 42 patients who had higher pre-conditioning serum UA levels compared to those who did not. Pre-transplant serum creatinine, gamma-glutamyl transferase, bilirubin, ferritin, and C-reactive protein levels did not differ significantly among patients with and without SOS; however, serum albumin was lower in the patients who developed SOS. Receiver operating characteristic analysis revealed that a pre-conditioning UA level higher than 3.32 mg/dL was predictive of SOS. When applied to a multivariate model, only pre-conditioning UA and albumin levels remained significant risk factors for SOS (UA: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.26-5.12, p=0.009; albumin: OR, 0.45, 95% CI, 0.22-0.95, p=0.037). Conclusion: Our results suggest that pre-conditioning serum UA is an independent risk factor for SOS, and it might be used as an early predictor of hepatic SOS together with previously described clinical and laboratory parameters. [ABSTRACT FROM AUTHOR]

Objectives: Coronavirus disease 2019 (Covid-19) is an emerging, fast-spreading and worldwide infectious disease that would be deteriorated with the precipitation of systemic or local thrombosis. The aim of current study was evaluating the effects of early anticoagulant treatment in hospitalized Covid-19 patients. Method: The present retrospective and comparative cohort study investigated 413 hospitalized Covid-19 patients treated with or without Low Molecular Weight Heparin (LMWH) (n = 187 and 226, respectively) in the Covid Clinics of Gulhane Education and Research Hospital in Ankara, Turkey, between March 18 and May 03, 2020. The treatment groups were consisted of the patients evaluated before and after The Covid-19 Treatment Guide update on April 12, 2020 that included the anticoagulant treatment thereafter. Results: The mean age of all 413 patients (204 male and 209 female) at disease onset was 50.6 ± 16.7 years. The LMWH-treated patients had significantly higher coagulation markers such as d-dimer and platelet count than LMWH-untreated patients (p values < 0.05). The inflammatory markers, ferritin, interleukin-6 and procalcitonin were significantly increased in LMWH-untreated patients (p values < 0.05). The presence of any comorbidity was significantly more common in LMWH-treated patients compared to LMWH-untreated group (39.6% vs 19.9%, respectively; p < 0.001). Hypertension and diabetes mellitus were the most frequent comorbidities in both groups. The number of intensive care unit (ICU) transfer and longer length of hospital stay were more commonly observed in LMWH-untreated patients (p values <0.05). Conclusions: Early anticoagulant treatment with relatively higher doses of LMWH may improve the clinical outcome of Covid-19 patients and shorten the length of hospital stay. [ABSTRACT FROM AUTHOR]

The most common reason of anemia is iron deficiency. Oral iron preparations are the first and most preferred method of treatment of iron deficiency anemia (IDA). In cases where Hb levels need to be increased rapidly, intravenous iron treatment gives more favorable results. Ferric carboxymaltose (FCM) is the most recent formulation developed to reduce the problem of anaphylaxis and has reached a very wide usage rate in a short time. In this study, we wanted to show the efficacy and safety of this treatment in patients diagnosed with IDA and treated with FCM in our clinic. In this study, 103 patients older than 18 years old who were diagnosed with IDA and treated with FCM, in our clinic, between January 2020 and December 2020 were included in the study. A total of 103 patients were evaluated. In the tests performed one month and two months after FCM use, an increase was seen as the following; the median of hemoglobin (Hb) level was 2.6 and 3.7 gr/dL, the median of hematocrit (Hct) level was 6% and 10%, the median of transferrin saturation (TS) was 17% and 18%, and the median of ferritin level was 85 and 48 ng/mL, respectively. When the Hb, Hct, TS and ferritin values were compared basal and after FCM treatment, statistically significant increase was found (p<0.05). Various side effects occurred as the following; allergic reaction in the form of itching in three of the patients (2.9%), bone and joint pain in two of the patients (1.9%), nausea in two of the patients (1.9%), dizziness in one of the patients (0.9%), and headache in three of the patients (2.9%). None of the patients complained about anaphylactic reaction, vomiting, constipation, diarrhea or abdominal pain. FCM is an effective and safe drug in iron deficiency anemia. [ABSTRACT FROM AUTHOR]

Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes in patients admitted to the intensive care unit with the diagnosis of COVID-19. Method: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/QlinICU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Query Language (SQL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model. Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 ± 15.41 years. The mean intensive care hospitalization period was 12.5 ± 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively). Conclusion: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit. [ABSTRACT FROM AUTHOR]

Objective: Iron deficiency anemia (IDA) is a common disease of childhood encountered in pediatric clinics. Its diagnosis and treatment are quite important in childhood when the growth and development are fast and the requirements are increased. In this study, our objective was to investigate the incidence of iron deficiency anemia, which might be overlooked in children hospitalized in the pediatric clinic. Methods: The incidence was prospectively determined with the help of whole blood count, which was evaluated according to the age of patients. The hemoglobin, iron and MCV levels of patients were evaluated and low levels according to the age and increased iron-binding capacity were considered as significant regarding IDA. The Mentzer index was used for differential diagnosis. Since ferritin is also an acute-phase reactant, it is taken into consideration as an adjuvant parameter for the diagnosis. The patients with iron deficiency anemia were determined while other anemia causes were excluded. Results: A total of 103 patients 40 females (38.8%) and 63 males (61.2%), who were hospitalized between January 2018 and April 2018 in the Pediatric Clinic of Bahçelievler State Hospital, were included in the study. The ages of children were between 1 and 166 months with an average of 24.2±34.7 months. A total of 17 patients (16.5%) were diagnosed with IDA considering the low hemoglobin, iron and MCV levels and increased iron-binding capacity. Conclusion: Iron deficiency anemia is still an important health problem for our country. The nutrition should be properly regulated and the importance of the education of mothers should be emphasized in the 0-14 age group, in which there are rapid growth and development and the requirements are increased. Patients hospitalized for any reason should be evaluated for anemia and iron replacement therapy should be initiated in cases diagnosed with iron deficiency anemia. [ABSTRACT FROM AUTHOR]

Objective: In recent years, the rates of marriage and pregnancy are increasing in patients with thalassemia major. The aim of the present study was to investigate the fertility rate of thalassemic patients and the course of pregnancies in terms of mother and infant health. Materials and Methods: In this observational study patients with major hemoglobinopathy were evaluated regarding marital status, the need for assisted reproductive techniques, fertility rate, iron status, and pregnancy complications. Results: Seventeen female patients gave birth to 21 healthy infants. About one-third of the patients needed assisted reproductive techniques. Thalassemia major patients showed increased serum ferritin levels from 1203±1206 µg/L at baseline to 1880±1174 µg/L at the end of pregnancy. All babies are still alive and healthy. Conclusion: Pregnancy in patients with thalassemia can be safe for the mother and newborn with close monitoring and a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background and Design: Pernio is an inflammatory disease that occurs in the acral regions of the body after exposure to cold. The study aimed to investigate the demographic findings of patients diagnosed with pernio and to determine the role of vitamin B12, folate and ferritin values in the pathogenesis of pernio. Materials and Methods: This study was conducted in pernio patients diagnosed at the Ağrı State Hospital, Dermatology Outpatient Clinic (Ağrı, Turkey) between September 2015 and April 2016. The healthy control group participants were of similar age and gender. Vitamin B12, folate and ferritin levels were compared between the groups. Results: The patient and control groups were similar in age and gender. Vitamin B12 and ferritin levels were significantly lower in the patient group (p<0.05). Folate levels did not differ significantly between the groups (p>0.05). Conclusion: According to the data obtained from our study, when the demographic findings of the pernio patients were compared with those in the literature, the results were found to be similar. In the patients with pernio, it is likely that low Vitamin B12 was involved in the pernio etiology via the mechanism of vasoconstriction/vasodilatation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To estimate Helicobacter Pylori (H.Pylori) prevalence, coincidence of iron deficiency anemia (IDA) and related hematological parameters in children of North Central Turkey. METHODS: Hemoglobin, hematocrit, mean corpuscular volume (n=852); serum iron level (n=175), iron binding capacity (n=175), ferritin (n=197), transferrin saturation (n=254) and 14C urea breath test results (n=1006) were reviewed in children with nonspecific gastrointestinal symptoms. H.Pylori prevalence was determined; hematological parameters were compared in H.Pylori positive and negative patients. RESULTS: Overall H.Pylori prevalence was 46,8%. Hemoglobin and hematocrit values were significantly lower in H. Pylori positive patients (T: 4,014 P: 0,000 for hemoglobin; T: 3,486 P: 0,001 for hematocrit). Although MCV values were lower in H. Pylori positive patients, the difference was not statistically significant.Serum iron levels (T: 2,297 P: 0,023), ferritin levels (T: 2,19 P: 0,03) and transferrin saturations (T: 2,541 P: 0,012) were significantly lower in H.Pylori positive patients. Iron binding capacity was higher in H.Pylori positive patients but this was also not significant. H.Pylori positivity is significantly higher in anemic patients (x²: 23,533 P: 0,000), in patients with low transferrin (x²: 4,948 P: 0,026), low ferritin (x²: 6,96 P: 0,008) and in patients with low ferritin and anemia together (x²: 13,74 P: 0,00). In females and males, anemia was significantly higher in H.Pylori positive patients (x²: 9,033 P: 0,003 and x²: 15,016 P: 0,000 in females and males respectively). DISCUSSION and CONCLUSION: H.Pylori positivity rate in the pediatric population of North Central Turkey seems to be a median value within the range of yet reported Turkish prevalence. There is an association between H.Pylori and IDA according to the results of a large pediatric population. [ABSTRACT FROM AUTHOR]

Objective: Hyperferritinemia cataract syndrome (HFCS) is an autosomal dominantly inherited disease characterized by increased serum ferritin levels and bilateral cataract formation in the early period of life. Heterozygote mutations in the 5' untranslated region of the L-ferritin gene (FTL) have been reported to cause this disease. In this study, our purpose was to research the FTL gene mutations that cause HFCS in Central Anatolia and the clinical effects of these mutations. Materials and Methods: Seventeen patients from 6 families with high ferritin levels in performed serum measurements, those who were found to have cataracts in eye examinations, and families with vertical inheritance, since the disease is autosomal dominant, were included in the study. Exons, exon-intron boundaries, and 5' and 3' untranslated regions of FTL (NM_000146) were sequenced using the Sanger sequencing method. Results: The female/male ratio of the patients was 7/10. All of the patients were found to have c.-160A>G heterozygous mutation in the FTL gene. Conclusion: In the Turkish population, the prevalence of HFCS is about 1/100,000 and the commonly observed mutation is c.-160A>G mutation. [ABSTRACT FROM AUTHOR]

Biological variation (BV) plays a crucial role in determining analytical performance specifications, assessing serial measurements of individuals, and establishing the use of population-based reference intervals. Our study aimed to calculate the BV and BV-based quality goals of 25-hydroxyvitamin D 3 (25-OH D 3 ), ferritin, folate and vitamin B12 tests. We included a total of 22 apparently healthy volunteers (9 women and 13 men) aged 18-55 years in the study that we conducted in Turkey. Blood samples were collected from the participants once a week for five weeks. Serum ferritin, folate and vitamin B12 levels were measured using immunochemical method, while plasma 25-OH D 3 levels were determined using the high-performance liquid chromatography method. Analysis of variance (ANOVA) was used to estimate analytical variation(CV A ), within-subject BV(CV I ) and between-subject BV(CV G ). The individuality index (II) and reference change value (RCV) were calculated based on these data. The CV I of 25-OH D 3 , ferritin, folate, and vitamin B12 were found to be 1.8% (0.6%-2.5%), 16.9% (14.4%-20.2%), 10.7% (9.2%-12.7%), and 8.6% (6.8%-10.5%), respectively. CV G were 44.2% (34.3%-69.9%), 132% (87.7%-238%), 19.4% (14.4%-28.8%), and 39.6% (29.8%-59.0%) for the same biomarkers, while CV A were 3.2% (2.81%-3.71%), 3.5% (3.1%-4.1%), 4.0% (3.5%-4.6%), and 7.5% (6.6%-8.6%), respectively. The II values for 25-OH D 3 , ferritin, folate, and vitamin B12 were calculated as 0.04, 0.13, 0.55, and 0.22, respectively. The RCV were 10.2%, 47.8%, 31.7%, and 31.6%, respectively. Because the tests analyzed in this study exhibit high individuality, RCV should be preferred rather than population-based reference ranges in clinical interpretation of results.

Abstract: Background: Zinc deficiency is thought to be common in children, but its predictive capacity for anemia is unclear. Thus, this study identified zinc deficiency in school children, and investigated the association between zinc status and hemoglobin, together with other estimates of anemia. Methods: For this case–control study, 349 of 483 children between 6.5 and 14.8 years old were included from primary schools in Bolu, Turkey. We measured weight, length, body mass index, and complete blood count with serum zinc, ferritin, vitamin B12 and folate. We investigated the differences between the groups and the effects of independent predictors such as age, gender, ferritin, zinc, vitamin B12 and folate on hemoglobin, on hierarchical multiple regression analysis. Results: Thirty‐eight (10.9%) of 349 children had low serum zinc concentration, and 21 (6.0%) were anemic. There were 12 anemic children in the zinc‐deficient group and nine in the zinc‐sufficient control group (31.5% vs 2.9%) with similar ferritin levels. On regression analysis, zinc had the strongest association with hemoglobin. On receiver operating characteristic analysis, the cut‐off for serum zinc for prediction of anemia was 71.5 μg/dL. Conclusions: The strongest association of zinc with hemoglobin suggests that low zinc contributed the most to the observed anemia in children. [ABSTRACT FROM AUTHOR]

Background/Aim: We aimed to analyze serum hepcidin level in children with chronic liver disease (CLD) and its relationship with serum cytokines level, liver function tests, hepatic iron content, and liver fibrosis. Patients and Methods: The study included 34 children with CLD, and 15 age‑ and gender‑matched healthy children. Serum hepcidin, ferritin, iron level, interleukin‑6 (IL‑6), transforming growth factor‑β (TGF‑β), total oxidant status (TOS), and antioxidant status (TAS) were studied in all patients and in the control group. Liver iron content (LIC) was measured from the liver biopsy specimen. Results: Serum ferritin levels were higher in patients with CLD than control group (100.1 ± 98.2 ng/mL vs 50.5 ± 32.2 ng/mL, P = 0.016). No significant difference was found in hepcidin levels. Hepcidin levels in children with CLD was positively correlated with ferritin (r = 0.75, P = 0.001), pediatric end‑stage liver disease (PELD) score (r = 0.56, P = 0.001), TAS (r = 0.42, P = 0.02), but negatively correlated with albumin level (r = −0.45, P = 0.008). Transferrin saturation and hepcidin:ferritin ratio were significantly low in patients with severe fibrosis compared with patients with mild/without fibrosis (15.5 ± 5.5 vs 34.3 ± 30.1, P = 0.017 and 1 ± 0.5 vs 1.9 ± 1.4, P = 0.04, respectively). Conclusion: Serum hepcidin levels in children with CLD reflect both liver functions and TAS, and severe fibrosis is associated with low hepcidin:ferritin ratio in children with CLD. [ABSTRACT FROM AUTHOR]

Yesilipek MA, Ertem M, Cetin M, Öniz H, Kansoy S, Tanyeli A, Anak S, Kurekci E, Hazar V. HLA-matched family hematopoetic stem cell transplantation in children with beta thalassemia major: The experience of the Turkish Pediatric Bone Marrow Transplantation Group. Abstract: From January 1991 to June 2009, 245 children with beta thalassemia major who underwent their first allogeneic HSCT in Turkey and who were followed for a minimum of one yr post-transplantation were enrolled this study. The median age of the patients was 6.6 yr old (range, 1-22 yr). The distribution of Pesaro risk class I, II, and III categories was 41, 130, and 63 children, respectively. The median serum ferritin level was 2203 ng/mL. Eighty-eight patients received bone marrow (BM) stem cells; 137, peripheral blood (PB) stem cells; and 20, cord blood (CB) stem cells. The donors were HLA-matched siblings or parents. Median engraftment times were shorter in PBSCT patients compared with the BMT group (p < 0.001). Grade II-IV acute GvHD was observed in 33 children (13.5%), while cGvHD was observed in 28 patients (12.5%), eight of whom had the extensive form. Thalassemic reconstitution was observed in 43 (17%) of the transplant patients. Post-transplant aplasia occurred in three patients, and the TRM rate was 7.75%. Seventeen patients were lost after 100 days. The thalassemia-free survival and OS rates were 68% (95% CI, 61.8-74.2) and 85.0% (95% CI, 80.2-89.8), respectively. We believe that this study is important because it is the first multicenter national data for children with beta thalassemia major receiving HSCT. [ABSTRACT FROM AUTHOR]

Abstract: The RLS is an underdiagnosed condition, characterized by unpleasant sensations in the legs. Pathophysiological mechanisms may include iron deficiency as reflected by low serum ferritin levels and dopaminergic system dysfunction. The purpose of our study was to investigate the prevalence and characteristics of RLS in the elderly and the relation of serum ferritin levels with disease severity. Ambulatory 1012 (621 women, 391 men, mean age: 73.51±7.12 years) consecutive patients above 65 years who admitted to our clinic for any reason were evaluated according to the International RLS Study Group (IRLSSG) criteria: 103 patients (74 women, 29 men, mean age: 72.43±6.31) (10.18%) had RLS diagnosis. Only 9 of them had known RLS. The duration of symptoms was 4.80±4.65 years and 27 patients (26.2%) had positive family history. The average of serum ferritin levels was 39.13±23.74ng/ml and 71 patients (68.9%) had serum ferritin levels ≤50ng/ml. The disease severity was evaluated with IRLSSG rating scale. Patients were classified as severe–very severe group (n =49) and mild–moderate group (n =54). The ferritin levels of severe–very severe disease group were lower than those of mild–moderate disease group (26.01±15.82ng/ml versus 49.87±23.24ng/ml, p <0.001). Our data show that RLS is very common in the elderly and the disease is more severe in patients with lower ferritin levels. [Copyright &y& Elsevier]

Objective: The aim of this study was to evaluate the prevalence and risk factors of anemia among adolescents in Denizli where Mediterranean cuisine (fresh fruit and vegetables) is adopted. Methods: We accepted hemoglobin values below 12 g/dl for girls and 13 g/dl for boys as the criteria of anemia. We recorded a detailed history including nutritional habits, consumption of animal source foods especially red meat, consumption of fresh fruit and vegetables, presence of parasitic infestation, psychosocial status, school success and. any materials consumed except ordinary food. Findings; We investigated the prevalence of anemia in 1120 children (672 girls and 448 boys), aged 12 to 16 years. We found that the overall prevalence of anemia was 5.6%. 8.3% of the girls and 1.6% of the boys were anemic. We diagnosed iron deficiency anemia in 37(59%) anemic patients and combined iron deficiency and vitamin B12 deficiency anemia in 26 (41%) anemic patients. None of the patients had folic acid deficiency. Conclusion: Our results suggest that the socioeconomic status of the family, traditional eating habits of the region, the fear of gaining weight and irregular eating habits are of great importance in the development of adolescent anemia in Denizli. [ABSTRACT FROM AUTHOR]

Objective: Vitamin D deficiency is an important health problem in both developed and developing countries. Recent reports on the extraskeletal effects of vitamin D have led to increased interest in prevalence studies on states of deficiency/insufficiency of vitamin D. The aim of this study was to determine the frequency of vitamin D deficiency and insufficiency in children and adolescents residing in Ankara, Turkey and to investigate the factors associated with low vitamin D status. Methods: A total of 440 children and adolescents aged between 0 and 16 years were enrolled in this study. The subjects were divided into three groups according to their vitamin D status (deficiency ≤15 ng/mL; insufficiency: 15-20 ng/mL; sufficiency ≥20 ng/mL) and also according to their age (preschool<5 years; middle childhood: 5-10 years; adolescence: 11-16 years). Results: Overall, 40% of the subjects were found to have 25 hydroxy vitamin D [25(OH)D] levels of less than 20 ng/mL. The levels indicated a deficiency state in 110 subjects (25%) and insufficiency - in 66 (15%). The rate of vitamin D deficiency was higher in girls, regardless of age. 25(OH)D levels correlated negatively with age (r=-0.48, p<0.001), body mass index (BMI) (r=-0.20, p=0.001) and intact parathyroid hormone (iPTH) level (r=-0.31, p=0.001). A positive correlation was observed between 25(OH)D and serum ferritin levels (r=0.15, p=0.004). Conclusions: The high frequency of vitamin D deficiency in childhood (especially among adolescent girls) indicates a need for supplementation and nutritional support. [ABSTRACT FROM AUTHOR]

Aim. We assessed the bone mineral density and related parameters in nine adults, thirty-eight pubertal, prepubertal totally fortyseven patients with thalassemia major living in Antalya, Turkey. Materials and Methods.We measured height and pubertal staging in last five years by six-month intervals. Average ferritin and hemoglobin concentrations were calculated for last three years. The levels of hydroxyproline, calcium, phosphorus, and creatinine were measured in 24 h urine, and those of parathormone, IGF 1, osteocalcine, alkaline phosphatase, calcium, ionized calcium, magnesium, phosphorus, creatine, blood glucose, thyroid stimulating hormone, alanine transaminase, and aspartate transaminase were determined in serum, and also the bone mineral density was measured. Results. The average L1-L4 bone mass density was 27.1±10.1 g cm-2; the average bone mineral content was 0.65 ± 0.11 g. of the patients with a Z-score under 2.5. A moderate relationship was found between the bone mass density age and height. Subjects in low pubertal staging and short stature (<3% percentile) have significantly lower bone mass densities P < 0.001. Conclusion. he prevalence of osteoporosis is high in patients with thalassemia major, possibly related to delayed puberty. [ABSTRACT FROM AUTHOR]

Objective: Iron, folate and vitamin B12 play important roles in the healthy development of the fetus in pregnancy. Preconceptional levels of these micronutrients is influenced by dietary habits. The purpose of this study was to investigate the status of iron, vitamin B12 and folate in first trimester pregnancies in the southwest region of Turkey where the Mediterranean Cuisine, rich in fresh fruit and vegetables is commonly consumed. Material and Methods: Two hundred and one low-middle income pregnant women were recruited during their first prenatal visit. Hemoglobin, ferritin, folate and vitamin B12 levels were evaluated and a structured questionnaire was given to gather information including age, gravida, parity, frequency of pregnancy, history of abortion, and intrauterine device usage. Based on WHO and international guidelines, anemia was defined as hemoglobin <11 g/dl, and iron deficiency as ferritin <15 μg/L. Serum folate and vitamin B12 deficiencies were defined as levels below 3 ng/ml and 200 pg/ml respectively. Results: The mean age and gestational week were 26.4±5.3 years and 9±3 weeks respectively. Mean plasma concentrations were 12.8±9.7 g/dl for hemoglobin, 22.7±17.2 μg/L for ferritin, 12.2±5.6 ng/ ml for folate and 266.6±100.2 pg/ml for vitamin B12. Anemia was detected in 4.5% of pregnant women, iron deficiency in 40.3%, vitamin B12 deficiency in 29.8% and folate deficiency in 0.5% of patients. In 10.9% of patients, both vitamin B12 and iron iron deficiency was detected. There was no significant difference for age, body mass index, gravida, parity, frequency of pregnancy, history of abortion, and intrauterine device usage between women with low and normal levels of vitamin B12 and Ferritin (p>0.05). Conclusion: Iron and vitamin B12 deficiencies were relatively common in the pregnant population consuming vegetable based diets. Iron and vitamin B12 supplementation in addition to folate must be considered for the wellbeing of the fetus in pregnant women living in areas where dietary patterns are mainly vegetable based. [ABSTRACT FROM AUTHOR]

Aim: Iron deficiency anemia is the most frequent cause of nutritional anemia in the first two years of life. The aim of this study was to evaluate iron status of pregnant women and their infants in Eastern Turkey and to determine their effects on iron deficiency anemia in the first year of life. Material and Method: This study was realized on 92 pregnant women classified in four groups according to their iron status and iron prophylaxis. This study was approved by The Local Ethic Committee (Fırat Üniversitesi Tıp Fakültesi Etik Kurulu 25.03.2004, 4. Session). Pregnant women were followed from the 14th week of gestation and blood samples of her were got at onset and of women were olatained infants at birth and on the third month, sixth month and twelfth month of life. Total blood count, serum ferritin and iron levels and total iron-binding capacity were evaluated. One way analysis of variance (ANOVA) and Pearson's and Spearman's rank test were used for statistical methods. Results: At birth, serum iron and ferritin levels were not significantly different between the four groups (p<0.05). At the third month of life; serum iron levels were diminished according to the physiologic changes and at the sixth month of life; iron deficiency anemia developed in 40% of the first group, in 57.1% of the second group, in 50% of the third group and in 69.2% of the fourth group. Conclusions: Iron status of infants is not defined only by iron stores at birth, the nutrition during the first year of life is also effective. In this study, iron deficiency anemia developed in approximately 50% of infants at the sixth month of life; despite the iron storage was sufficient at birth. Supplementation of iron in infants living in Eastern Turkey is necessary from the third month of life. [ABSTRACT FROM AUTHOR]

Objective: Symptoms of attention deficit hyperactivity disorder (ADHD) have been previously shown to be related with dopamine and noradrenaline dysfunction. Iron is the main cofactor of the tyrosine hydroxylase enzyme, the rate-limiting protein in dopamine synthesis. We aimed to investigate the association between iron/ferritin serum levels/subtypes and behavioral symptoms of ADHD. Methods: Fifty-eight children diagnosed with ADHD according to DSM-IV criteria in Samsun Ondokuz Mayis University Medical Faculty, Child Psychiatry outpatient clinic, were included in this study. Serum iron and ferritin levels in the participants were measured. The parents of the participants completed the Disruptive Behaviors Rating Scale-Parent Version (DBRS-PV). Results: There was no significant difference in serum iron and ferritin levels between the ADHD subtypes (p<0.05). We found a statistically significant negative correlation between the scores of DBRS-PV conduct problems and ferritin levels (r=-0.38, p<0.05). In further analysis, when participants age, gender, parental education level, ferritin and iron levels were taken into consideration, ferritin level was found the most powerful predictor of conduct score. Conclusion: This study revealed that serum ferritin level is significantly correlated with severity of conduct problems in children with ADHD. Especially in children with ADHD with low serum iron and ferritin levels, iron treatment would have beneficial effects on conduct problems comorbid with ADHD. [ABSTRACT FROM AUTHOR]

Objective: It has been reported that disability due to migraine may be reduced with homocysteine-lowering treatment including folic acid and vitamin B12. In addition, periaqueductal gray matter iron deposits have been found recently to be increased in migraine patients. There are few studies regarding vitamin B12, folic acid, ferritin, and transferrin levels in patients with migraine. The aim of this study was to measure vitamin B12, folic acid, ferritin, and transferrin levels in patients with migraine and to compare them with the control group. Patients and Methods: Fifty-one consecutive newly diagnosed migraine patients who did not receive any vitamin supplement medication were enrolled. The study group consisted of 51 patients suffering from migraine with aura (n= 23) and migraine without aura (n= 28). The control group consisted of 28 healthy participants without history of headache, anemia or vitamin supplement. Serum vitamin B12, folic acid, ferritin, and transferrin levels were measured using a chemiluminescence method. Results: Migraine patients had significantly lower concentrations of vitamin B12 and folic acid compared with the healthy controls (for vitamin B12: 215.6 ± 133.7 pg/mL vs. 289.9 ± 12 pg/mL, respectively, p= 0.005; for folic acid: 6.74 ± 4.31 pg/mL vs. 8.47 ± 1.85 pg/mL, respectively, p= 0.048). The vitamin B12 levels were found to be significantly lower during attacks in migraine patients than in interictal periods (177.3 ± 139.2 pg/mL vs. 252.5 ± 119.5 pg/mL, p= 0.043). There were no differences in folic acid, and transferrin levels during attacks versus in the interictal period in patients with migraine (p> 0.05). The ferritin levels were found to be significantly lower during attacks in migraine patients than in interictal periods (43.4 ± 41.1 mg/mL vs. 75.4 ± 51.7 mg/mL, respectively, p= 0.018). Conclusion: Migraine patients had lower serum vitamin B12 and folic acid levels than healthy subjects. These findings support that vitamin B12 and folic acid may have a role in migraine pathogenesis and may be included in migraine prophylaxis. Further, this study indicated that iron homeostasis is disturbed in migraine attacks. [ABSTRACT FROM AUTHOR]

A 33 weeks' gestation, a baby with rhesus hemolytic disease (RHD), who had received intrauterine transfusions twice, developed cholestatic hepatic disease and late hyporegenerative anemia. Her serum ferritin and bilirubin levels increased to 8842 ng/ml and 17.9 mg/dl, respectively. Liver biopsy showed cholestasis and severe iron overload. Treatment with recombinant erythropoietin (rHuEPO) decreased the transfusion need, and intravenous deferoxamine resulted in a marked decreased in serum ferritin levels and normalization of liver function. In patients who have undergone intrauterine transfusions due to RHD, hyperferritinemia and late hyporegenerative anemia should be kept in mind. Chelation therapy in cases with symptomatic hyperferritinemia and rHuEPO treatment in cases with severe hyporegenerative anemia should be considered. [ABSTRACT FROM AUTHOR]

Abstract: Purpose : To determine the prevalence of anaemia and iron-deficiency anaemia (IDA) in Kahramanmaras, a province in the south-eastern Anatolia. Methods : The study was performed on 1491 persons of both sexes aged 2–69. All were volunteers. Haematological parameters were determined and haemoglobin (Hb) electrophoresis was carried out in all subjects, and only for those with haemoglobin levels below normal were subsequent measurements of ferritin and Hb A 2 made to detect iron deficiency and rule out β-thalassaemia. Results : The means of all the haematological parameters for all age groups and sexes were found to be lower than the reference values given in the literature. Anaemia was found to be present in all age groups, especially in children aged 2–5 yr and women aged 19–40 yr (34.5% and 40.0%, respectively). IDA in the same age groups was 15.5% and 23.8%, respectively. Conclusion : The high rate of IDA raises serious concern about nutritional disease risks in the region. An inexpensive oral iron therapy and education as to the importance of iron for their health would help to provide optimal health for the population concerned, especially for mothers-to-be and children. [ABSTRACT FROM AUTHOR]

Risk factors for lactational failure in puerperium were investigated. Sixty mothers with inadequate daily milk supply for their babies were the lactational failure group, and 60 mothers with similar age having babies with similar age and weight were chosen as the control group. Low prolactin levels, low serum iron and low serum ferritin levels and low aldosterone values and birth in community hospitals were associated with significantly increased risk of deficient lactation. High income of the family, increase osmolality of breastmilk, high systolic blood pressure of the mother, birth by cesarean section were some of the variables that increased the risk that could not reach the level of significance. Prematurity of the baby was not among the risk factors if the gestational ages were more than 30 weeks. It is concluded that physicians awareness of the factors that may adversely effect the initiation and continuation of lactation is vital. Correcting iron deficiency even if it is not overt, sparing more time for the mothers discussing the benefits of breastmilk to their babies, and avoiding cesarean section if possible may help increase the incidence of breastmilk feeding. [ABSTRACT FROM AUTHOR]

We present a case of gastroschisis managed with serial amnioexchanges. Marked decreases were detected in both ferritin and bile acid levels following the procedure. The bowels were not severely affected, as expected. After delivery, single primary closure of the defect was performed. Early enteral feeding and shorter hospital stay were the main outcome measures. Intrauterine pre-treatment of gastroschisis by serial amnioexchange may provide benefits by decreasing the levels of inflammatory products in the amniotic fluid in order to lower the possible risk of bowel damage, and this may help to achieve better surgical and postnatal outcomes. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic disease caused by a kind of Brucella bacteria, which commonly appears in humans and rarely causes mortality. In our study, five cases, who were diagnosed by evaluation of clinical findings and serological tests, they also had very high ferritin levels, were reported. Ages of the patients were 16, 12, 10, 16 and 8 years, respectively. Serum ferritin levels were 1200, 985, 886, 748 and 435 ng/ml, respectively. We observed that complaints of the patients reduced after the treatment and ferritin levels returned to its normal range. In the situations of extremely evaluated serum ferritin which is an acute-phase reactant, its levels are able to raise in brucellosis, without existing hemochromatosis and Still’s disease [ABSTRACT FROM AUTHOR]

Introduction: Patients diagnosed with COVID-19 have presented to emergency departments (EDs) worldwide with a wide range of symptoms. In this study we reported the clinical, laboratory and radiological features of the cases diagnosed with COVID-19., Methods: This is a single-center, retrospective, descriptive, and observational study. The patients who have admitted to ED between March 11 and May 31, 2020 and diagnosed COVID-19 infection., Results: 130 (73 male and 57 female) patients with COVID-19 polymerase chain reaction (PCR) positive test were included in the study. The average age of the study group was calculated as 52.63 ± 17.95 year. While 15.4% of the patients were asymptomatic, the most common symptom was identified as cough (46.2%), followed by dyspnea (23.1%), fever (17.7%). The computed tomography (CT) severity scores proved significantly higher in the patients with hypertension and coronary artery disease (CAD) than in those without these diseases (p = 0.010 and p = 0.042, respectively). The moderate positive correlation between serum ferritin level and CT severity score is another finding worth noting (rho = 0.530 and p = 0.0001). In a similar vein, the high level of D-dimer in the CT-positive group and its positive moderate correlation with CT severity (rho = 0.375 and p = 0.0001)., Conclusion: In our study, serum ferritin and D-dimer levels were observed to be high in the CT-positive group and have moderate positive correlation with CT severity. We thus argue that D-dimer and ferritin levels measured at the time of admission to the ED can be taken into consideration to predict radiological severity., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interests., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The article presents a study that aims to evaluate the correlations among liver, pancreas, spleen, vertebral bone marrow, among them in patients with transfusion-related iron overload. The study included nine students who were reported of suspicion of hepatic iron overload and underwent T1-independent volumetric multi-echo gradient-echo imaging. The study showed that all the patients under the study were found to have hepatic iron overload.

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral hemorrhagic disease. In this study, an evaluation was made of the potential use of iron metabolism and liver function biomarkers to estimate the bleeding status in CCHF patients. This prospective study was conducted in Cumhuriyet University, Turkey. Only patients with confirmed CCHF were enrolled in the study. The study subjects comprised 40 CCHF patients and 37 healthy control subjects. Serum iron, unsaturated iron binding capacity (UIBC), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined using the colorimetric method. Serum ferritin levels were measured using the electrochemiluminescent method. The serum ferritin (p = 0.037), AST (p = 0.0002), ALT (p = 0.002), LDH (p = 0.0005) and aPTT (p = 0.001) values were higher in patients with bleeding than in patients without bleeding. Receiving operating characteristic analyses were applied for the area under the curve (AUC) values for ferritin, aPTT, and AST to discriminate the bleeding status in patients, an these were determined as 0.717, 0.819, and 0.882, respectively. A cut-off value of 149 U/L for AST was obtained to discriminate the bleeding condition in CCHF patients. Higher ferritin (p < 0.0001) levels were determined in patients compared to the control group. The iron (p = 0.180) and UIBC (p = 0.0017) values were lower in patients than in the control group. Cytokine storm due to an increase in ferritin levels may contribute to the increased inflammation and coagulation abnormalities in CCHF patients. It was concluded that routine screening of the AST level would be helpful to estimate the bleeding status in addition to screening liver damage in CCHF patients., (Copyright © 2019 Elsevier GmbH. All rights reserved.)