The Outcome of Withholding Pharmacologic Treatment in Children with Acute ITP

Background: ITP is a nonthreatening disorder disturbing children at any age but mostly below 5 years. Objective: To evaluate the outcome of children with acute ITP who were not specified with any pharmacologic action and linked with those who were treated. Patients and Methods: A prospective case- control   study was done between Jan.2002 to May 2016 at Mukalla children and Maternity Hospital and University Hospital for Children and Mother Health in Mukalla/ Hadhramout /Yemen,  where 20 children with acute ITP. the control group was 18 children given the conventional therapy. The identification and grouping of ITP were made according to the 2009 International Working Group criteria. Results: In group A there were 11( 55%) boys and 9(45%) girls, while control group B there were 18 children 10 (55.5%) boys and 8 (44.5%) girls.   the ages were from 2 to 12 years. The mean age is 4.7 years with the median age at identification was 4r years. There was no statistical significant difference between both groups regarding outcome. Conclusion: The recovery percentage has some relation with age at appearance and preliminary platelet count where younger children and those with platelet amount of <20000 /µL have better recovery percentage. There was no statistical significant difference between both groups regarding outcome

Osteolytic lesions in myelofibrosis

Abstract Bony pain in patients with a history of myelofibrosis warrants further investigation. Although skeletal involvement in myelofibrosis is more commonly osteosclerosis or periostitis, it can also cause osteolytic lesions

Cessation of Medication for People With Schizophrenia Already Stable on Chlorpromazine

Introduction People with schizophrenia are often encouraged to take medication for protracted periods of time in order to postpone or stop deterioration. It is, nevertheless, difficult for clinicians to provide a quantitative estimate of risk of relapse should medication be stopped. Because protracted use of any medication carries a risk of adverse effects, it seems reasonable to seek this evidence. Objectives To investigate the effects of stopping chlorpromazine for people with schizophrenia already stable on that drug, primarily for outcomes of global state, improvement, and relapse. Search Strategy We searched the Cochrane Schizophrenia Group Trials Register (March 2006). This is compiled by systematic searches of major

A systematic review and network meta-analysis comparing azacitidine and decitabine for the treatment of myelodysplastic syndrome

Abstract Background Hypomethylating agents (HMA), azacitidine, and decitabine are frequently used in the management of myelodysplastic syndromes (MDS). However, there are no clinical trials that have directly compared these agents. We conducted a systematic review and indirectly compared the efficacy of azacitidine to decitabine in MDS. Methods We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus) through June 28, 2018, without language or time restrictions. Studies were screened by two independent reviewers, and differences were resolved by consensus. The fixed effect model and adjusted indirect comparison methods were used to pool relative risks (RR) of major outcomes of interest (mortality, response rate, quality of life, hematologic improvement, hospitalization, leukemia transformation, transfusion independence). Results Only four trials met the eligibility criteria. Two trials compared azacitidine to the best supportive care (BSC) and included 549 patients, and the other two compared decitabine to BSC and included 403 patients. The risk of bias was unclear overall. Compared to BSC, azacitidine was significantly associated with lower mortality (RR = 0.83, 95% CI 0.74–0.94, I 2 = 89%) whereas decitabine did not significantly reduce mortality (RR = 0.88, 95% CI 0.77–1.00, I 2 = 53%). Both drugs were associated with higher partial and complete response compared to BSC. Indirect comparisons were not statistically significant for all the studied outcomes, except for complete response where azacitidine was less likely to induce complete response compared to decitabine (RR = 0.11, 95% CI = 0.01–0.86, very low-certainty evidence). Conclusions Azacitidine and decitabine are both associated with improved outcomes compared to BSC. The available indirect evidence comparing the two agents warrants very low certainty and cannot reliably confirm the superiority of either agent. Head-to-head trials are needed. In the meantime, the choice of agent should be driven by patient preferences, adverse effects, drug availability, and cost

Radial artery anomalies in patients undergoing transradial coronary procedures – An Egyptian multicenter experience

Objectives: We investigated the incidence of radial anomalies (RA) in patients undergoing transradial (TR) coronary procedure and their impact on procedural outcome in the Egyptian population. Background: Radial anomalies (RA) are considered an important factor for procedural failure. Information about anatomical variation is limited in our Egyptian population. Methods: We performed a multicentre prospective study in Egypt. A total of 650 consecutive patients undergoing their first TR coronary procedure were recruited from January 2013 till January 2015. By retrograde radial arteriography we assessed the frequency of RA and their impact on procedural outcome. Results: 650 consecutive patients were studied, 74% male, mean (SD) age 55 (10) years. The overall incidence of radial artery anomaly was 12.6% (n = 82). 40 (6.2%) patients had a high-bifurcating radial origin, 8 (1.2%) had a full radial loop, 14 (2.1%) had extreme radial artery tortuosity and 20 (3%) had other anomalies such as persistent left subclavian artery and extreme subclavian tortuosity. Overall transradial procedural success was 95%. Procedural failure was more common in patients with anomalous anatomy (39%) than in patients with normal anatomy (0.2%). Procedural failure was highest in patients with radial loop (87.5%), followed by those with subclavian tortuosity (45%), then high radial bifurcation (30%), and severe radial tortuosity (28.5%). 14 (2.1%) vascular complications occurred, all of which were treated conservatively. Conclusion: There is a relatively significant presence of radial anomalies, with different degrees of impact on procedural failure rate, in our Egyptian population. Further collaborative studies are recommended to increase our success rates