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Amaç: Vitamin B12 tüm vitaminleriçindeki en karmaşık kimyasal yapıya sahip olanı olup, hematolojik ve sinirselsistemin normal fonksiyon görebilmesi için gereklidir. Dolayısıyla, vitamin B12 eksikliği tedaviedilmediğinde depresyon gibi psikiyatrik belirtilere yol açabilir. Bu çalışmadaamacımız, majör depresyon tanılı hastalarda vitamin B12 eksikliği sıklığınıtespit etmekti.Metod: Çalışmada Kayseri Eğitim ve Araştırma Hastanesi’nde DSM-5 kriterleri bazalınarak majör depresyon tanısı konan 425 erişkin hastaya ait verilerdeğerlendirildi. Tüm hastaların CBC, serum vitamin B12 ve folat düzeyleri ilerutin biyokimyasal tetkikleri incelendi. Bulgular: Toplam 425 depresif hastanınverileri incelendi. Hastaların%74.6’sı kadındı. Vitamin B12 eksikliği 93 hastada tespit edildi (% 21.9).Kadınlarda vitamin B12 eksikliği % 22.7 iken, erkeklerde bu oran % 19.4 olaraksaptandı. Her iki cinsiyet grubunda da folik asit, Hb, PLT ve WBC sayılarındaanlamlı farklılık yoktu.Sonuç: : Bu çalışmanın sonuçları, majördepresyon hastalarında vitamin B12 eksikliğinin nadir olmadığını göstermiştir.Depresif semptomları olan hastalarda fizikbulgularıdeğerlendirmek ve vitamin B12 eksikliğini saptamaya yönelik gerekli testleriyapmak faydalı olabilir. Aim: Vitamin B12 has the most complex chemical structure of all vitamins and it is necessary for normal functioning of hematological and nervoussystem. Thus, vitamin B12 deficiency could cause psychiatric symptoms such asdepression when it is untreated. Our aim was to determine vitamin B12deficiency frequency of patients diagnosed with major depression.Method: The present study included 425adult patients with major depression based on Diagnostic and Statistical Manualof Mental Disorders, fifth edition (DSM-5) criteria at Kayseri Education and Research Hospital.In all patients, laboratory evaluations were performed: complete blood count(CBC), serum vitamin B12 andfolate levels, and routine biochemical tests.Results: Theresults of 425 depressive patients were analyzed. Depression was prevelant among females (74.6%). Also, total 93patients (21.9%) were vitamin B12 deficient. While in female patients vitaminB12 deficiency was 22.7%, in male patients, the rate was 19.4%. There wereno significant differences between folate and hemoglobin(Hb) levels, platelet (PLT) and white blood cell (WBC) counts.Conclusion: The results of this study shownthat, the frequency of vitamin B12 deficiency among people is major depressionnot uncommon. It would be beneficial to consider the physical symptoms and toconduct the required examinations to determine vitamin B12 deficiency among this patients.

Aim: Polycythemia is a disease state in which the proportion of blood volumethat is occupied by red blood cells increases. Flow-mediatedvasodilation (FMD) is a non-invasive ultrasound method of evaluatingendothelial function. Theaim of this prospective study was to compare the systemic endothelial functionsby FMD method in patients with polycythemia withcontrol group.Method: Thepresent study included 50 patients with polycytemia (hemoglobin (Hb) ≥16.5 g/dl) and 61 healthy control group aged ≥ 18 years at KayseriEducation and Research Hospital were included. In allindividuals, the following laboratory evaluations were performed: completeblood count (CBC), serum iron indices, and routine biochemical tests. Also, all participants underwent the FMDstudy at Cardiology department with Doppler ultrasound. Results: The results of 111 participantswere analyzed. On the other hand, the rate ofsmoking was 76% in the polycythemia group, while it was 36.1% in the controlgroup (p< 0.005). Likewise, Hb, hematocrit andserum lipid parameters were significantly increased in polycythemia groupexcept high density lipoprotein (HDL) cholesterol (p < 0.001). Also, FMD was significantlyreduced in polycythemiagroup compared with control group (7.78 ± 4.83% vs. 10.98 ± 7.86%,respectively) (p= 0.010).Conclusion: Theresults of the study indicate that polycythemia is associated with endothelialdysfunction and hyperlipidemia. As the noninvasive ultrasound method forperipheral endothelial testing is generally accurate and reproducible, and canbe performed serially, FMD can be used safely in patients with polycythemia toevaluation of endothelial functions.Amaç: Polisitemi, kan volümünün bir parçasını teşkil eden eritrositmiktarındaki artışla karakaterize bir patolojik durumdur. Akış aracılı genişletme (FMD) yöntemi, sistemikvasküler fonksiyonların değerlendirilmesinde giderek önemi artan birnon-invaziv tetkik olup, çeşitli hastalıklarda bu yöntem ile vasküler endotelhakkında önemli bilgiler edinilmiştir. Bu prospektif çalışmada amacımız,polisitemik bireylerde FMD yöntemi ile vasküler fonksiyonları değerlendirmek vesağlıklı kontrol grubu ile karşılaştırmaktı. Metod: Bu çalışmaya; Kayseri Eğitim veAraştırma Hastanesi’ne başvuran 18 yaş ve üzeri, 61 sağlıklı ve Hb değerinormal sınırlarda olan gönüllü ile, 50 polisitemi olgusu alındı. Polisitemitanısı için Hb > 16.5 g/dL baz alındı. Bireylerin tam kan sayımları, demir parametreleri ve rutin biyokimyasaltetkikleri istendi. Katılımcılara Kardiyoloji kliniğinde Doppler ultrasonografieşliğinde FMD işlemi uygulandı.Bulgular: Toplam 111 olgunundeğerlendirildiği çalışmada, gruplar arasında yaş, cinsiyet, vücut kitleindeksi, hipertansiyon ve diabet oranları bakımından fark yoktu. Buna karşın,sigara içim oranı polisitemi grubunda kontrol grubuna göre anlamlı şekildeyüksekti (%76 ve %36.1, sırasıyla) (p< 0.005). Hb, hematokrit ve serum lipidparametreleri de yüksek densiteli lipoprotein (HDL) kolesterol dışındapolisitemi grubunda anlamlı şekilde yüksekti (p < 0.001). Ayrıca, FMD oranıpolisitemik grupta kontrol grubuna göre anlamlı şekilde düşük bulundu (% 7.78 ±4.83 ve %10.98 ± 7.86, sırasıyla)(p= 0.010). Sonuçlar: Bulgularımızla, polisitemik bireylerde vaskülerendotelyal fonksiyonların olumsuz etkilendiği ve hiperlipidemi birlikteliğiortaya konmuştur. Non invaziv ve kolay uygulanabilen FMD yöntemi ile,polisiteminin muhtemel endotelyal disfonksiyon gelişimindeki rolüöngörülebilir.

WOS: 000321403400017, PubMed ID: 23602056, Thrombotic thrombocytopenic purpura (TIT) is a particular form of thrombotic microangiopathy typically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. UP requires a rapid diagnosis and an adapted management in emergency. Daily sessions of therapeutic plasma exchange (TPE) remain the basis of management of UP. Also, UP is a rare disease that is fatal if it is not treated. TPE has resulted in excellent remission and survival rates in UP patients. Aim: We aimed to present our experience in 163 patients with UP treated with TPE during the past 5 years from 10 centers of Turkey. Patients and methods: One hundered and sixty-three patients with UP treated with TPE during the past 5 years from 10 centers of Turkey were retrospectively evaluated. TPE was carried out 1-1.5 times plasma volume. Fresh frozen plasma (FFP) was used as the replacement fluid. TPE was performed daily until normalization of serum lactate dehydrogenase (LDH) and recovery of the platelet count to >150 x 10(9)/dL. TPE was then slowly tapered. Clinical data, the number of TPE, other given therapy modalities, treatment outcomes, and TPE complications were recorded. Results: Fifty-eight percent (95/163) of the patients were females. The median age of the patients was 42 years (range; 16-82). The median age of male patients was significantly higher than female (53 vs. 34 years; p < 0.001). All patients had thrombocytopenia and microangiopathic hemolytic anemia. At the same time, 82.8% (135/163) of patients had neurological abnormalities, 78.5% (128/163) of patients had renal dysfunction, and 89% (145/163) of patients had fever. Also, 10.4% (17/163) of patients had three of the five criteria, 10.4% (17/163) of patients had four of the five criteria, and 6.1% (10/163) of patients had all of the five criteria. Primary UP comprised of 85.9% (140/163) of the patients and secondary UP comprised of 14.1% (23/163) of the patients. Malignancy was the most common cause in secondary UP. The median number of TPE was 13 (range; 1-80). The number of TPE was significantly higher in complete response (CR) patients (median 15.0 vs. 3.5; p < 0.001). CR was achieved in 85.3% (139/163) of the patients. Similar results were achieved with TPE in both primary and secondary UP (85% vs. 87%, respectively; p = 0.806). There was no advantage of TPE + prednisolone compared to TPE alone in terms of CR rates (82.1% vs. 76.7%; p = 0.746). CR was not achieved in 14.7% (24/163) of the patients and these patients died of TTP related causes. There were no statistical differences in terms of mortality rate between patients with secondary and primary TIT [15% (21/140) vs. 13% (3/23); p = 0.8061. But, we obtained significant statistical differences in terms of mortality rate between patients on TPE alone and TPE + prednisolone [14% (12/86) vs. 3% (2/67), p < 0.001]. Conclusions: TPE is an effective treatment for UP and is associated with high CR rate in both primary and secondary UP. Thrombocytopenia together with microangiopathic hemolytic anemia is mandatory for the diagnosis of UP and if these two criteria met in a patient, TPE should be performed immediately. (C) 2013 Elsevier Ltd. All rights reserved.