Background: Megaloblastic anemia is a hyperchromic macrocytic anemia caused by impaired DNA synthesis and delayed cell division, most commonly resulting from deficiencies of cobalamin and folic acid. Vitamin B12 is obtained from animal-derived foods such as meat, fish, eggs, and dairy products. In the stomach, it is released from dietary proteins by gastric acid and subsequently binds to an intrinsic factor, after which it is absorbed in the distal ileum. Therefore, vitamin B12 deficiency may occur following gastric or intestinal resection surgery. Another common cause of vitamin B12 deficiency is pernicious anemia, which results from autoimmune atrophic gastritis leading to decreased secretion of intrinsic factor. Vitamin B12 deficiency is most frequently observed in individuals over 60 years of age, and its clinical manifestations vary depending on the severity of deficiency. Patients with mild to moderate deficiency commonly present with fatigue, general symptoms of anemia, glossitis, and neurological disturbances. In cases of severe deficiency, profound hematological abnormalities, severe neurological manifestations, and cardiac involvement such as cardiomyopathy may be observed. In this report, we present a clinical case of a 46-year-old male who developed severe vitamin B12 deficiency anemia following total gastrectomy, complicated by anemia-induced mild hypokinesia of the anterior and inferior walls of the heart. Conclusion If vitamin B12 deficiency–related anemia is accurately diagnosed, appropriately treated, prevented, and monitored starting from the primary health care level, it can have a positive impact on patients’ quality of life. Given that this condition may present with diverse clinical manifestations, a multidisciplinary team approach involving specialists in hematology, neurology, psychiatry, gastroenterology, cardiology, and nutrition enables early identification and prevention of potential complications, thereby improving overall clinical outcomes.

Background: Sjögren’s syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, particularly the lacrimal and salivary glands, as a result of genetic and environmental factors, and it is mainly manifested by mucosal dryness. Sjögren’s syndrome is a rare disorder with a prevalence of approximately 6 cases per 1,000 population and shows a marked female predominance. It is most commonly diagnosed between the ages of 40 and 60 years. Anemia is observed in about 70% of patients diagnosed with Sjögren’s syndrome; however, autoimmune hemolytic anemia occurs in only approximately 3% of cases. In this report, we present a rare case of Sjögren’s syndrome that manifested with warm autoimmune hemolytic anemia. Conclusion In cases of autoimmune hemolytic anemia of unknown etiology, it is crucial to investigate the underlying causes leading to hemolysis in order to establish the differential diagnosis and to confirm or exclude the condition. Sjögren’s syndrome typically presents initially with sicca symptoms, with chronic anemia developing during the course of the disease and its treatment. In contrast, in our case, persistent manifestations of autoimmune hemolytic anemia over a prolonged period represented the initial clinical presentation that led to the diagnosis of Sjögren’s syndrome. Immunological markers play a key role in the diagnosis of this syndrome, as they are essential for early detection of Sjögren’s syndrome, timely diagnostic confirmation, monitoring of disease progression, and adjustment of therapeutic dosing.

Background: Aviation security work requires a high level of responsibility, sustained vigilance, and shift- and night-work schedules. However, studies evaluating the interrelationship between the psychosocial work environment, stress, and oral health indicators among aviation security personnel are limited, which was the rationale for this study. Aim: This study aimed to determine the relationship between oral health and some risk factors among aviation security personnel. Materials and Methods: An analytical cross-sectional study was conducted among 132 aviation security personnel. The psychosocial work environment was assessed using the Job Content Questionnaire (JCQ), perceived stress using the 10-item Perceived Stress Scale (PSS-10), and oral health-related quality of life using the 14-item Oral Health Impact Profile (OHIP-14). Self-rated oral health, oral health behaviors, and related risk factors were assessed using relevant items from the standard adult questionnaire provided in the World Health Organization’s Oral Health Surveys: Basic Methods (5th edition, 2013). Clinical oral examinations included the Decayed, Missing and Filled Teeth (DMFT) index, Simplified Oral Hygiene Index (OHI-S), Community Periodontal Index (CPI), and assessment of tooth wear. Statistical analysis was performed. Result: The mean age of the participants was 39.22±8.24 years. Psychological job demands were positively correlated with PSS-10 scores (r=0.248, p=0.004), PSS-10 scores with OHIP-14 scores (r=0.215, p=0.013), and OHI-S scores with CPI scores (r=0.568, p<0.001). Bruxism and tooth wear were identified in 67.4% and 91.7% of participants, respectively, and the number of teeth affected by wear was significantly greater among participants with bruxism (p<0.001). In multivariable analysis, higher PSS-10 scores (B=0.776; 95% CI: 0.337–1.214; p=0.001) and tobacco-use risk (B=4.679; 95% CI: 0.671–8.688; p=0.022) were associated with higher OHIP-14 scores. Conclusion Higher psychological job demands were associated with higher levels of perceived stress, while perceived stress was associated with poorer oral health-related quality of life. Oral hygiene status was associated with periodontal status, and bruxism was associated with tooth wear.

Objectives: Waldenstrom Macroglobulinemia (WM) is a malignant disease of the B lymphocytes. We report on a patient in Mongolia having WM complicated with hyperviscosity syndrome. Methods: A 28 year-old Mongolian woman had symptoms due to hyperviscosity syndrome such as vision loss, headache, dizziness and, epistaxis. Upon examination, her morphology, biochemistry, histology, flow cytometry and serum protein electrophoresis indicated WM complicated with hyperviscosity syndrome. Results: The patient was was successfully treated with a combination chemotherapy and plasmapheresis. Conclusion: Hyperviscosity syndrome manifestations should be treated with plasmapheresis.