Updated threshold, renewed problems: should the diagnostic criteria of polycythemia vera be reconsidered? A retrospective cross-sectional cohort study.

OBJECTIVE: This aim of this study was to evaluate hemoglobin and hematocrit values of polycythemia vera and secondary polycythemia patients with updated World Health Organization thresholds. In addition, by determining our own threshold values, we aimed to demonstrate the necessity of bone marrow biopsy and genetic analysis to be used for further diagnosis in patients with high-normal hematocrit and hemoglobin values. METHODS: A cross-sectional and retrospective study was performed with the medical records of patients from Eskisehir City Hospital hematology clinics and outpatient clinics between July 1, 2019 and July 1, 2020. The study included patients with polycythemia, divided into two groups according to polycythemia vera and secondary polycythemia. A bone marrow biopsy was performed on patients with either Janus kinase mutation positivity and/or subnormal erythropoietin levels. Receiver operating characteristics analysis was used to find threshold values, and the diagnostic efficiency of these values in differentiating World Health Organization thresholds in 2008 and 2016 was evaluated. RESULTS: A total of 73 patients were included. The median age was 43.5 years (min: 18; max: 84). The hematocrit value of 54.1 was predicted to diagnose polycythemia vera with a sensitivity of 45% and a specificity of 80%. Subsequent analysis revealed that an hemoglobin value of 17.7 was indicative of diagnosing polycythemia vera with a sensitivity of 60% and a specificity of 63%. The mean follow-up length was 6.4 months (2-12). CONCLUSION: Our study demonstrated that modified World Health Organization criteria might lead to unnecessary additional tests for polycythemia vera patients with high-normal hemoglobin and hematocrit values.

Investigation of cardiac adverse effects in COVID-19 ARDS patients treated with intravenous immunoglobulin.

OBJECTIVE: The popularity of intravenous immunoglobulin (IVIG) therapy in Acute Respiratory Distress Syndrome (CARDS) secondary to COVID-19 infection is increasing day by day. In this study, we aimed to retrospectively evaluate the possible cardiac effects in our CARDS patients treated with IVIG. METHODS: Demographic and clinical characteristics, mortality, sequential electrocardiography (ECG), echocardiography, cardiac markers, and other laboratory parameters of CARDS patients who received IVIG treatment were recorded. RESULTS: The mean age of the patients was 68.7±13.6%, and 70.5% were female. The mean number of days of hospitalization in the intensive care unit was 18.2±9.7, and the mortality rate was recorded as 35.2%. No pathological rhythm or ischemic change was observed in sequential ECG follow-ups. However, in consecutive ECO follow-ups, the sPAP values at the treatment end were numerically lower, although not statistically significant. CONCLUSION: Our study suggests that IVIG therapy may be used safely in COVID-19 patients with cardiovascular side effects. However, due to the high risk of coagulopathy in these patients, the use of IVIG therapy in COVID-19 infection should be monitored with close monitoring, as it may increase the potential for cardiovascular risk. Furthermore, monitoring cardiac parameters are also essential as it may predict high cardiovascular risk in patients. For this reason, patients need lower infusion rates, steroid combination, adequate hydration, and effective anticoagulation therapy to avoid these side effects.

Comparing therapeutic effects of alternate day versus daily oral iron in women with iron deficiency anemia: A retrospective cohort study.

In order to replenish iron stores and bring hemoglobin (Hb) levels back to normal, oral iron is the primary treatment option for women with iron deficiency anemia (IDA). This study investigated the efficacy and side effects of daily versus alternate-day, given single doses versus double doses oral iron supplementation for treating IDA. A retrospective cohort study was performed between 2021 and 2022, including 120 patients. Study group were divided into 4 age-sex-matched groups; Group I (n = 30) and Group II (n = 30) which were received ferrous sulphate tablets daily in single or double doses, respectively, containing 60 mg of elemental iron each. Groups III (n = 30) and IV (n = 30) were received a single and double dose on alternate days, respectively. The primary outcome was the mean difference in Hb from baseline at week 4. Gastrointestinal (GI) side effects were accepted as a secondary outcome. The daily single dose and alternate day double dose groups had median Hb changes of 2.3 (2.1) and 2.6 (1.8) g/dL. The differences in Hb between Groups I and II, I and III, and Groups IV and II, IV and III were significant (P < .001, P = .001, P < .001, and P < .001, respectively). There is no significant difference between groups regarding improving iron parameters such as serum iron, total iron binding capacity, transferrin saturation, and ferritin. The incidence of GI side effects were greater in double doses than in single doses of daily or alternate-day therapies (43.3% and 30% vs 10% and 3.3%). Daily or alternate-day double dose resulted in more side effects but less therapeutic efficacy in women with IDA. To find the best supplementation method, randomized controlled trials with a larger sample of participants, longer study lengths, and various iron doses may be helpful.

Predictors of 3-month mortality with muscle ultrasound and palliative prognostic tools among patients admitted to palliative care units.

BACKGROUND/AIMS: Prognostic factors are an important issue in progressive and life-limiting diseases. This study evaluate 3-month mortality in patients admitted to the palliative care unit (PCU). METHODS: In this study, the patient's demographics, comorbidities, nutritional status, and laboratory values were recorded. The palliative performance scale (PPS), the palliative prognostic index (PPI), and the palliative prognostic (PaP) score were calculated. The rectus femoris (RF) cross-sectional area (CSA), RF muscle thickness, gastrocnemius (GC) medialis muscle thickness, pennation angle and fascicle length of the GC were measured by ultrasound for survival prediction. RESULTS: A total of 88 patients enrolled during the study period, with a mean age of 73.6 ± 13.3 years and a 3-month mortality rate of 59.1%. The findings of a multivariable Cox proportional hazards regression model based on age, gender, C-reactive protein level and Nutrition Risk Screening 2002 scores as covariates revealed the PPI and the PaP score to be significant predictors of 3-month mortality. In addition, in the unadjusted Cox proportional hazard regression analysis, the CSA of the RF muscle was also found to be a significant predictor of 3-month mortality. CONCLUSION: Findings revealed that the combined use of the CSA of the RF, the PPI, and the PaP score are reliable predictors of mortality in patients admitted to the PCU.

Musculoskeletal symptoms and related factors in postacute COVID-19 patients.

AIM: There is a lack of an overview of the factors associated with postacute COVID-19 musculoskeletal symptoms. The aims of this study were as follows: 1- to evaluate the most frequent admission symptoms and the frequency of musculoskeletal symptoms in postacute COVID-19 patients; and 2- to determine the related factors with the postacute COVID-19 musculoskeletal symptoms. METHODS: A total of 280 postacute COVID-19 patients (183 females, 97 males) were enrolled and divided into two groups: 1- patients whose musculoskeletal symptoms initiated with or were aggravated by COVID-19 (n = 240); and 2- patients whose musculoskeletal symptoms did not change with COVID-19 (n = 40). The variables were demographic and treatment data, symptoms on admission, postacute COVID-19 symptoms, laboratory results (complete blood count, erythrocyte sedimentation rate, C-reactive protein, ferritin and d-dimer), chest computed tomography findings and symptoms during acute COVID-19. RESULTS: Most of the patients have fatigue (71.8%), spine pain (70.7%) and myalgia (60.7%). The most common pain region was the back (30.4%). The frequency of dyspnoea was 30%, cough 18.5% and chest pain 10.7%. Having any chronic disease (P = .031), the duration of hospital stay (P = .016), frequency of back pain during acute COVID-19 (P = .018), tomography findings and d-dimer (P = .035) levels were significantly higher, and lymphocyte (P = .024) levels were significantly lower in the patients whose symptoms began with or were aggravated by COVID-19. CONCLUSION: Back pain was the most frequent symptom on admission. The most common postacute COVID-19 musculoskeletal symptoms were fatigue, spine pain and myalgia. Lower lymphocyte and higher d-dimer levels, the presence of COVID-19 findings in tomography and back pain during acute COVID-19 infection, higher duration of hospital stay and having chronic diseases were related to post-COVID-19 musculoskeletal symptoms.

Benefits of treatment with favipiravir in hospitalized patients for COVID-19: a retrospective observational case-control study.

BACKGROUND: Although more than a year past since COVID-19 was defined, there is no specific treatment yet. Since COVID-19 management differs over time, it is hard to determine which therapy is more efficacious. In this study, we aimed to evaluate the efficacy of the regimen with Favipiravir (FPV) and determine if the timing of FPV addition offers any improvement. METHODS: A retrospective observational case-controlled cohort study was performed between March and September 2020, including adults with COVID-19 in a single-center in Turkey. We categorized patients into age-sex matched three groups, group 1 (n = 48) and group 2 (n = 48) included patients treated with the combination of FPV plus Hydroxychloroquine (HQ) early and late, respectively. Group 3 (n = 48) consisted of patients on HQ monotherapy. In Group 2, if the respiratory or clinic condition had not improved sufficiently, FPV was added on or after day 3. RESULTS: We found that starting FPV early had an impact on PCR negativity and the progression of the disease. 'No progression' was defined as the absence of a new finding in the control radiological examination and the absence of accompanying clinical deterioration. Also, the decrease in C-reactive protein (CRP) was greater in Group 1 than Group 3 (p < 0.001). However, we found that early initiation of FPV treatment did not have a positive effect on the estimated survival time. CONCLUSIONS: According to this retrospective study results, we believe that for better clinical outcomes, FPV treatment should be started promptly to enhance antiviral effects and improve clinical outcomes.