Measurement of the major ignored burden of multiple myeloma, pernicious anaemia and of other haematological conditions on partners and family members: A cross-sectional study.

BACKGROUND: Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. OBJECTIVE: To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure-16 (FROM-16). METHODS: A cross-sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM-16. RESULTS: 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM-16. The FROM-16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM-16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non-malignant conditions (mean = 11, SD = 7.4, n = 56, p < .01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM-16 score>16) on their quality of life. CONCLUSIONS: Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM-16, identify those most affected and should consider how to provide appropriate holistic support within routine practice.

Quality of Life, Burden of Disease, Co-morbidities, and Systemic Effects in Vitiligo Patients.

Vitiligo is a complex, systemic disease associated with many autoimmune and autoinflammatory conditions. Additionally, the cutaneous changes of vitiligo have significant effects on quality of life and self-esteem. Further efforts are needed to increase our understanding of vitiligo comorbidities as well as to increase awareness of the psychological effects of vitiligo.

Cost of detecting gastric neoplasia by surveillance endoscopy in atrophic gastritis in Italy: A low risk country.

BACKGROUND: Atrophic gastritis (AG) is at increased risk of gastric neoplasia, thus surveillance gastroscopy has been proposed. AIMS: To assess cost of detecting gastric neoplasias by surveillance endoscopy according to identified risk factors in Italy. METHODS: Post-hoc analysis of a cohort study including 200 AG-patients from Italy followed up for a mean of 7.5 (4-23.4) years was done. Considered risk factors were: age >50years, extensive atrophy, pernicious anaemia, OLGA-OLGIM scores 3-4 at diagnosis. The number of 4-year-surveillance endoscopies needed to be performed to detect one gastric neoplasia (NNS) was calculated. RESULTS: In 19 patients neoplasias (4 gastric cancers, 8 type 1 gastric carcinoids, 7 dysplasias) were detected at the 361 surveillance gastroscopies, corresponding to NNS of 19 and a cost per gastric neoplastic lesion of €2945. By restricting surveillance to pernicious anaemia patients, reduction of NNS and cost per neoplasia to 13.8 and €2139 may be obtained still detecting 74% of neoplasias. By limiting the surveillance to pernicious anaemia patients and OLGA 3-4, 5 (26.3%) neoplasias would have been detected with a corresponding NNS of 5.4 and a cost per lesion of €837. CONCLUSION: Risk factors may allow an efficient allocation of financial and medical resources for endoscopic surveillance in AG in a low risk country.

Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354).

BACKGROUND: Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM: To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS: A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 µg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS: Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION: Our findings suggest that foods fortified with 1.4 µg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs.

Anemia secondary to combined deficiencies of iron and cobalamin.

The focus of attention on combined-deficiency anemia is often on concurrent deficiencies of cobalamin (vitamin B12) and folate, emphasizing the correction of megaloblastic changes with folate alone and risking neurologic sequelae of uncorrected simultaneous cobalamin deficiency. Simultaneous deficiencies of cobalamin and iron, however, may be a more common cause of combined-deficiency anemia. Variability in red blood cell morphologic characteristics in this setting reflects the relative degree of deficiency of each of these substrates. A patient with combined cobalamin and iron deficiency anemia with microcytic, hypochromic indices and the absence of hypersegmented neutrophils was treated. This case and the literature reviewed emphasize the need to consider combined-deficiency states in all cases of anemia.

[The assessment of the proliferative activity of bone marrow cells by flow cytofluorometry]. / Otsenka proliferativnoi aktivnosti kletok kostnogo mozga metodom protochnoi tsitofliuorometrii.

The distribution of bone marrow cells by the stages of cellular cycle (G1/0, S, G2 + M) was studied in 56 hematologically normal subjects and in 30 anemic patients by flow cytofluorometry. In health the analyzed parameters were found rather stable, well reproducible, this permitting their use as reference values. In pernicious anemia the S-phase fraction of bone marrow cells was found increased; a lesser increase was observed in the counts of myelokaryocytes in the postsynthetic phase of the mitotic cycle; in iron deficiency anemia these parameters virtually did not differ from the reference values, whereas in autoimmune anemia the pool of proliferating cells was increased. The author discusses the problems of the pathogenesis of anemias and the diagnostic value of his results.

Vitamin B12 deficiency. Important new concepts in recognition.

Vitamin B12 deficiency develops over a slowly progressive continuum. Early manifestations may be generalized weakness or fatigue, indigestion, diarrhea, or depression. Pernicious anemia is considered the classic cause, but others include malabsorption because of achlorhydria or other gastric dysfunction, fish tapeworm infection, and strict vegetarianism. Iron deficiency often coexists. Because presentation is often atypical, vitamin B12 deficiency is a diagnostic consideration whenever neuropsychiatric signs or symptoms are unexplained.

Epidemiologic, clinicopathologic, and economic aspects of gastroscopic screening of patients with pernicious anemia.

In a well-defined population with a known prevalence of pernicious anemia (PA), gastroscopic screening was performed in 123 patients with PA, of whom 61 were rescreened after a mean time interval of 32 months. At the primary screening the prevalence of gastric neoplasia was 8.1% and that of gastric malignancy 4.1%. No neoplasias or malignancies were diagnosed at re-screening. The estimated cost per gastric neoplasia diagnosed during primary screening was USD 850 and that per diagnosed malignancy USD 1700. Adenoma, one with early adenocarcinoma, was diagnosed in two patients, primary early adenocarcinoma in two patients, and advanced adenocarcinoma in one patient. Five patients had gastric fundic mucosal carcinoid, of which one was multicentric with a regional metastasis. Gastric carcinoids most probably are underdiagnosed in atrophic gastritis, and, when small and solitary, their clinical relevance is uncertain. Fundic mucosal endocrine cell hyperplasia and hypergastrinemia seem to be important factors in their development.

Serum pepsinogen I levels: assessment of gastric acid secretion?

We measured serum PG I levels by an Elisa technique before and after stimulation with pentagastrin in 260 patients (161 males and 99 females). The serum levels were correlated to basic acid output (BAO), maximum acid output (MAO) and peak acid output (PAO). The correlation coefficient between serum PG I and PAO varied between -0.482 and 0.744 depending on the diagnosis. This indicates that a simple measurement of PG I cannot replace the pentagastrin test in estimating gastric acid secreting capacity. However, since all patients who were achlorhydric had a serum PG I level of less than 50 micrograms/l the measurement of serum PG I can be recommended as a screening test for achlorhydria.

Prevalence and incidence of pernicious anemia. An evaluation for gastric screening.

To evaluate the feasibility of gastroscopic screening for gastric malignancy in patients with pernicious anemia, all individuals treated with vitamin B12 in a well-defined population were identified. Individuals treated for an uncertain diagnosis were submitted to supplementary examinations. Of all individuals treated with vitamin B12 41% had unequivocal pernicious anemia, 13% possible pernicious anemia, 26% vitamin B12 malabsorption other than pernicious anemia, and 20% no verified vitamin B12 deficiency. The maximum crude prevalence of pernicious anemia was 1.98 per mile and the crude maximum incidence 16.7 x 10(-5) x year-1. The estimated annual cost of endoscopic gastric screening at 3-year intervals in patients with pernicious anemia younger than 75 years of age would be SEK 15,000/100,000 inhabitants, a cost that to a great extent could be financed by a more adequate prescription of vitamin B12 treatment.

Quality of diagnoses and cost of managing anemia in four countries.

An earlier study of non-hospitalized Swedish patients suggested frequent overprescribing of iron tablets and frequently uncertain diagnoses of iron deficiency. For this reason, a record audit was performed of 202 patients hospitalized because of iron deficiency anaemia or pernicious anemia in an English, a French, three Swedish, and a US teaching hospitals. Results are difficult to interpret because of the limited extent of this study and because differences between hospitals are as great as those between countries. Nevertheless, the Swedish hospital seemed to have 37% longer duration of stays (p less than 0.05), it spent only 16% of the total hospitalization cost for diagnostic studies as compared to 22-35% for the other hospitals, and it had numerically, but not significantly increased percentages both of uncertain diagnoses and of unidentified causes of the iron deficiency. For comparable time periods the hospitals with the longest length of stay also had the highest percentage of uncertain diagnoses (p less than 0.001). After the local publication of the first reports in 1978-1981, an improvement in the percentage of uncertain diagnoses was found in the Swedish hospital, which suggests that quality evaluation can lead to quality assurance.

A simple in vitro method for the assessment of ineffective erythropoiesis.

A simple in vitro method has been developed for the assessment of ineffective erythropoiesis by measuring the release of heme from a labeled cohort of erythroblasts in short-term suspension culture. The release of labeled heme was shown to correlate with the death of erythroblasts in culture determined by cell counting. Heme release was markedly increased in conditions where there is known to be excessive ineffective erythropoiesis, while in hematologic disorders where ineffective erythropoiesis is thought to be normal, heme release was within the normal range.

[A safe alternative for the diagnosis of pernicious anemia--a contribution to medical economics (proceedings)]. / Sichere Alternative für die Perniziosa-Diagnostik--ein Beitrag zur Kostensenkung.

Mucosal biopsies of corpus and antrum were performed in 17 patients with pernicious anemia. In all patients the corpus mucosa showed atrophic gastritis, while in 16 the antrum was normal or showed only superficial gastritis. This combination is conclusive for pernicious anemia. Over 80% of megaloblastic anemias are caused by pernicious anemia. It is therefore proposed that endoscopy and biopsy be performed as the first examination in these patients. In this way the diagnosis is simple, rapid and economical.