Diagnostic utility of reticulocyte hemoglobin for iron-restricted anemia in patients with end-stage kidney disease on hemodialysis

BackgroundChronic kidney disease (CKD) is a serious, long-term illness that damages kidneys and lowers glomerular filtration rate. CKD often causes anemia. Iron deficiency (ID) is common in these patients and worsens illness symptoms. Modern hematology analysers can measure reticulocyte mean cell hemoglobin (MCHr), which directly measures iron integration into erythrocyte hemoglobin. MCHr can improve iron deficiency detection in CKD patients, who have aberrant iron indicators due to chronic inflammation. This research aims to evaluate the effectiveness of MCHr as a marker for ID in patients with CKD.MethodTo obtain data for this study, CBC, reticulocyte profile, and iron biomarkers were collected from King Khalid National Guard Hospital (Ref No. IRB/1861/23). Transferring saturation was calculated using (Serum iron/TIBC) × 100. GraphPad Prism 9 software was used to analyze the data, and Mann-Whitney, Spearman correlation, and ROC plots were used to determine MCHr's diagnostic performance. A p-value < 0.05 was considered significant.ResultThe study compared 190 individuals undergoing hemodialysis (HD) with 165 healthy blood donors. The HD group showed lower levels of RBC, Hb, MCHr, serum iron, and total iron-binding capacity (TIBC). Despite anemia, the HD group had higher levels of ferritin and transferrin saturation (TSAT). MCHr demonstrated excellent diagnostic performance in identifying iron deficiency anemia (IDA), particularly in functional iron deficiency. When TSAT was < 20%, MCHr showed an AUC of 0.98, with 100% specificity and 72.41% sensitivity, significantly outperforming ferritin and TSAT in inflammatory settings. In the HD group with ferritin levels < 200 ng/mL, the MCHr cut-off value of < 31.20 pg had a sensitivity and specificity of 89.47% and an AUC of 0.89. When TSAT was < 20%, the MCHr cut-off value of < 23.95 pg had a sensitivity of 72.41%, specificity of 100%, and AUC of 0.98.ConclusionsBased on the findings, MCHr is more effective than ferritin and TSAT in detecting iron deficiency in hemodialysis patients. Future research should use MCH to investigate the impact of iron therapy with or without rHuEPO

Improvement of comorbid anxiety and depression in patients with migraine treated with injectable preventive calcitonin gene-related peptide antagonists: Review of clinical evidence

Background: Migraine is often associated with depression and anxiety, leading to a diminished quality of life. Calcitonin gene‐related peptide (CGRP) antagonists have shown promise in treating migraines, but their effects on concurrent depression and anxiety have not been clarified. Methods: A literature review was conducted on ClinicalTrials.gov, PubMed, Ovid Medline, and EMBASE focusing on phase 3 clinical trials, post-hoc analysis studies, and real-world evidence (RWE) published in the past 5 years. The review primarily utilized patient-reported outcome tools, such as the Patient Health Questionnaire-9, Hamilton Depression Rating Scale, Beck Depression Inventory-II, generalized anxiety disorder (GAD)-7, and Hamilton Anxiety Rating Scale (HARS), to assess anxiety and depression in relation to CGRP-targeted monoclonal antibodies. Results: Out of 260 studies, 17 met the inclusion criteria. Eptinezumab lacked sufficient evidence regarding its impact on depression and anxiety. While sufficient evidence on its effect on comorbid anxiety was not available, fremanezumab was shown to significantly improve comorbid depression in one study while not achieving statistical significance in another. Erenumab and galcanezumab showed significant improvement in comorbid depression, implying possible benefits in patients with migraine. Galcanezumab showed faster relief from depressive symptoms than other injectable CGRP antagonists. Galcanezumab also exhibited improvements in GAD-7 scores for anxiety, although not statistically significant, whereas RWE showed promising HARS scores for both galcanezumab and erenumab. Conclusions: Galcanezumab and erenumab appear to be more effective in improving concurrent depressive and anxiety symptoms in migraine patients than fremanezumab. Notably, these psychometric questionnaires were not the primary outcome measures of the trials and were not specifically designed to investigate the effects of these medications on depression or anxiety. Further research is needed to fully understand the impact of CGRP antagonists on mental health disorders associated with migraines. These findings have implications for enhancing the overall well-being and quality of life in individuals with migraines and comorbid psychiatric conditions

Knowledge assessment for the management of patients with cleft lip and palate among dental and medical interns and practitioners in Medina, Saudi Arabia

Introduction: Cleft lip and palate (CLP) is a common developmental anomaly in the head-and-neck region that can be syndromic or nonsyndromic. Various therapeutic procedures can be addressed to manage patients with CLP; hence, awareness about CLP is warranted. Aims: This study aims to identify the level of knowledge among dental and medical health-care professionals regarding the management of patients with CLP in Medina. Materials and Methods: A cross-sectional study was conducted using an online-based self-administrated questionnaire. The sampling was convenient with snowball effect; the questionnaire was sent to eligible participants (n = 228). It was divided into four sections regarding demographic data and knowledge questions regarding the management of patients with cleft lip/palate. Results and Discussion: About 44.3% disagreed that CLP is always associated with syndromes, whereas only 34.65% and 36.4% were aware of a method to examine for the presence of transverse and/or anteroposterior restriction of maxillary growth, respectively. The responses highlighted moderate level of knowledge regarding the relationship between CLP, associated problems, and the treatment needed. The total knowledge score was 26.83 (7.65) and was significantly higher among participants in the dental field compared to other participants in the medical field (P < 0.001). Conclusion: The present study highlighted the need to enhance the level of knowledge regarding CLP among dental and medical health-care professionals. Early diagnosis is essential for better treatment outcomes and could influence good prognosis and enhance the quality of life of patients. Hence, improving the knowledge regarding CLP and its management is warranted

Clinical features and outcome of human Mpox (Monkeypox) in Saudi Arabia: An observational study of travel-related cases

Background: The 2022 Monkeypox virus (Mpox) outbreak had involved multiple countries around the globe. Here, we report clinical features and outcome of human Mpox of the first cases in Saudi Arabia. Methods: We obtained records of confirmed Mpox cases in Saudi Arabia from the public electronic health information system, Health Electronic Surveillance Network (HESN) and the healthcare providers completed a de-identified structured clinical data collection form. Results: The reported seven cases were travel-related and all were males between 24 and 41 years of age (mean age + SD) was 30.14 (+ 6.69) years. Of the cases, three (43 %) had heterosexual contact and the others had other intimate encounters while traveling abroad. They presented with skin lesions (100 %), fever (86 %), and lymphadenopathy (71 %). The illness was mild to moderate, did not require antiviral medications, and lasted 7–15 days. The mean duration of skin rash (+ SD) was 10 (+ 2.68) days. Routine laboratory tests (CBC, BUN, serum electrolytes, and liver enzymes) were within normal limits, and initial screening for HIV was negative. Expanded contact tracing did not reveal secondary cases of Mpox in the community or the healthcare setting. Conclusion: The current study showed heterosexual transmission of Mpox and the clinical course was mild and non-complicated. Therefore, clinicians and public health professionals should consider Mpox among individuals presenting with skin rash especially in the context of the investigation of HIV and other sexually transmitted diseases