Iron Succinate Increased Ferritin and Transferrin Saturation in Non-Anaemic Patients with Heart Failure and Iron Deficiency—A Pilot Study

Introduction: Iron deficiency (ID) is often present (32% - 65%) in patients with heart failure (HF). Oral iron absorption in patients with HF is generally poor. This is the reason why oral treatment is not recommended. Aim: To test whether oral iron succinate significantly increases iron deposits in non-anaaemic patients with HF. Methods: ID was defined as ferritin < 100 μg/L or 100 - 299 μg/L with transferrin saturation (TSAT) < 20%. Forty-two patients were screened. Ferrous succinate was administered as one tablet (100 mg, including 32.48 mg Fe2+ plus 100 mg succinate) in the morning and one tablet at bedtime for at least 3 months. Hemoglobin, CRP, ferritin, iron, TSAT, and hepcidin were analyzed before starting treatment, at 6 weeks, and at 3 months end of study (EOS). Results: Five women and 15 men were included in the study. The level of ferritin increased significantly from baseline to 6 weeks (47 to 78 μg/L, p = 0.009) and baseline to EOS (47 to 85 μg/L, p = 0.001). TSAT increased significantly from baseline to 6 weeks (20% to 27%, p = 0.046) and baseline to EOS (20% to 25%, p = 0.043). Hepcidin increased significantly from baseline to 6 weeks (2.5 nmol/L to 4.8 nmol/L, p = 0.006) and baseline to EOS (2.5 to 4.2 nmol/L, p = 0.02). Conclusion: Oral iron succinate significantly increased iron uptake, almost doubling the ferritin levels and increasing the TSAT, in patients with HF. Our findings challenge the opinion that oral iron treatment cannot significantly increase iron deposits in non-anemic patients with ID and HF.

Disentanglement of a Singlet Spin State in a Coincidence Stern-Gerlach Device

We analyze the spin coincidence experiment considered by Bell in the derivation of Bells theorem. We solve the equation of motion for the spin system with a spin Hamiltonian, Hz, where the magnetic field is only in the z-direction. For the specific case of the coincidence experiment where the two magnets have the same orientation the Hamiltonian Hz commutes with the total spin Iz, which thus emerges as a constant of the motion. Bells argument is then that an observation of spin up at one magnet A necessarily implies spin down at the other B. For an isolated spin system A-B with classical translational degrees of freedom and an initial spin singlet state there is no force on the spin particles A and B. The spins are fully entangled but none of the spin particles A or B are deflected by the Stern-Gerlach magnets. This result is not compatible with Bells assumption that spin 1/2 particles are deected in a Stern-Gerlach device. Assuming a more realistic Hamiltonian Hz + Hx including a gradient in x direction the total Iz is not conserved and fully entanglement is not expected in this case. The conclusion is that Bells theorem is not applicable to spin coincidence measurement originally discussed by Bell.

You Need to Know More to Understand My Scoring on the Survey: Free-Text Comments as Part of a PROM-Survey of Men with Prostate Cancer

Prostate cancer and its treatment have long-term implications for men’s lives. We aimed to describe the content, extent, and frequency of written comments to the open-ended question, “Further comments?” in the patient-reported outcome measures questionnaire. During the study period, 897 men participated;372 wrote 747 free-text comments in the questionnaire. These comments were analysed using qualitative content analysis and were grouped into four categories: 1) prostate cancer’s influence on health;2) clarifications of answers to the survey;3) descriptions of well-being despite the cancer;and 4) experiences of care and the need for contact with health care. The distribution of the comments shifted over time. The open-ended question not only allowed the participants to explain their other responses and describe important aspects of their lives during and after treatment, something not normally covered by a questionnaire, but it also indicated their experiences of health care services along the patients’ PC-trajectory. This further raises the issue of including an open-ended item in a forced-choice survey into the ethical realm to ensure that proper care is taken of participants’ answers and thoughts.

Corticosteroid Injection by Palpation Guide versus Palpation Guide and Needling Method for Coccydynia

Background: Coccydynia is a painful condition with tenderness and ache in sacrococcygeal area which may radiate to the buttocks and lower back. Coccydynia is a multifactorial disorder and the most common cause of it is trauma. The initial treatment of the disease is conservative methods. One of the most common conservative treatments of chronic coccydynia is the local corticosteroid injection, which performed usually by palpation-guided method. This study was conducted to compare the effectiveness of local corticosteroid injection using palpation and needling method with palpation method alone. Patients and Methods: In this prospective study, 50 patients with the diagnosis of coccydynia were enrolled between 2010 and 2017. All patients had chronic coccydynia which did not respond to conservative therapy for at least three months. Participants were divided into two groups and each group consisted of 25 individuals. Patients who underwent local corticosteroid injection using palpation guide technique alone were assigned as group A and others who underwent palpation guiding injection with needling technique were considered as group B. Results: There was a statistically significant difference between the mean VAS scores in preinjection and final follow up visit in each groups (P value < 0.001). Moreover, the difference between the mean VAS scores of the final visit in groups A and B was statistically significant (P value < 0.001). Conclusion: Local corticosteroid injection using palpation guiding technique with needling is an uncomplicated, inexpensive, and effective invasive conservative treatment for refractory chronic coccydynia.