Re-personalization and stratification of hemophilia care in an evolving treatment landscape.

Hemophilia therapeutics are evolving rapidly. Comprehensive care must also evolve to embrace this change. Online tools and guidelines are widely available to optimize prophylaxis with conventional clotting factor concentrates using an individual's predicted pharmacokinetic profile. Novel hemostatic agents (e.g. biphenotypic antibody) are also becoming widely available, with other agents with differing mechanisms of action in final stages of trial. Contemporary issues including challenges of prophylaxis; bleed treatment; laboratory monitoring and inhibitor risk/surveillance are summarized in this narrative review, focusing on how a re-personalization of education and treatment will be necessary to meet these challenges of the rapidly changing therapeutic landscape

The 5, 10 methylenetetrahydrofolate reductase C677T mutation and risk of fetal loss: a case series and review of the literature

<p>Abstract</p> <p>Background</p> <p>The true relationship between methylenetetrahydrofolate reductase C677T homozygosity and risk of recurrent spontaneous abortion is unknown, and it is unclear if women with these mutations should be anticoagulated during pregnancy.</p> <p>Objectives</p> <p>We report a series of 8 patients with this issue and review the current literature.</p> <p>Methods</p> <p>8 patients (3 of whom were actively pregnant) were referred with histories of spontaneous fetal loss; hypercoaguability work-ups revealed each were homozygous for the MTHFR C677T mutation without other thrombophilias.</p> <p>Results</p> <p>In the 3 women who have conceived, treatment with LMW heparin during pregnancy led to two full-term births and one additional pregnancy without complication. For the 5 who have not, we recommended treatment with LMW heparin upon conception.</p> <p>Conclusion</p> <p>We provide evidence to support the relationship between MTHFR C677T mutations and recurrent fetal loss, and to suggest that anticoagulation of these patients during pregnancy can lead to a successful pregnancy outcome.</p

REAL MEN Curriculum

This is the curriculum for a program known as REAL MEN, an acronym for Returning Educated African American and Latino Men to Enriched Neighborhoods. A collaborative effort, the REAL MEN program was a public health intervention based at Rikers Island and at a community-based organization, Friends of Island Academy, for young men, ages 15-19, who were leaving jail and returning to their home communities. The curriculum for this program was designed to reduce drug use, HIV risk, and rearrest by helping participants examine alternative paths to manhood and consider racial/ethnic pride as a source of strength

Healthcare resource utilization among haemophilia A patients in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91210/1/j.1365-2516.2011.02677.x.pd

Household Responses to Pandemic (H1N1) 2009–related School Closures, Perth, Western Australia

Results from closures will determine the appropriateness and efficacy of this mitigation measure

The history and evolution of the clinical effectiveness of haemophilia type a treatment: a systematic review.

First evidence of cases of haemophilia dates from ancient Egypt, but it was when Queen Victoria from England in the 19th century transmitted this illness to her descendants, when it became known as the "royal disease". Last decades of the 20th century account for major discoveries that improved the life expectancy and quality of life of these patients. The history and evolution of haemophilia healthcare counts ups and downs. The introduction of prophylactic schemes during the 1970s have proved to be more effective that the classic on-demand replacement of clotting factors, nevertheless many patients managed with frequent plasma transfusions or derived products became infected with the Human Immunodeficiency Virus (HIV) and Hepatitis C virus during the 1980s and 1990s. Recombinant factor VIII inception has decreased the risk of blood borne infections and restored back longer life expectancies. Main concerns for haemophilia healthcare are shifting from the pure clinical aspects to the economic considerations of long-term replacement therapy. Nowadays researchers' attention has been placed on the future costs and cost-effectiveness of costly long-term treatment. Equity considerations are relevant as well, and alternative options for less affluent countries are under the scope of further research. The aim of this review was to assess the evidence of different treatment options for haemophilia type A over the past four decades, focusing on the most important technological advances that have influenced the natural course of this "royal disease"

The hope and reality of long‐acting hemophilia products

Recombinant DNA technology and protein engineering are creating hope that we can address ongoing challenges in hemophilia care such as reducing the costs of therapy, increasing the availability to the developing world, and improving the functional properties of these proteins. Technological advances to improve the half‐life of recombinant clotting factors have brought long‐acting clotting factors for hemophilia replacement therapy closer to reality. Preclinical and clinical trial results are reviewed as well as the potential benefits and risks of these novel therapies. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91179/1/23146_ftp.pd

Immune tolerance induction in 31 children with haemophilia A: is ITI less successful in African Americans?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92102/1/j.1365-2516.2010.02429.x.pd