Intravenous Iron Supplementation for the Treatment of Chemotherapy-Induced Anemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: The pathophysiology of cancer-related anemia is multifactorial, including that of chemotherapy-induced anemia (CIA). The guidelines are not consistent in their approach to the use of intravenous (IV) iron in patients with cancer as part of the clinical practice. Materials and methods: All randomized controlled trials that compared IV iron with either no iron or iron taken orally for the treatment of CIA were included. We excluded trials if erythropoiesis-stimulating agents (ESAs) were used. The primary outcome was the percentage of patients requiring a red blood cell (RBC) transfusion during the study period. The secondary outcomes included the hematopoietic response (an increase in the Hb level by more than 1 g/dL or an increase above 11 g/dL), the iron parameters and adverse events. For the dichotomous data, risk ratios (RRs) with 95% confidence intervals (Cis) were estimated and pooled. For the continuous data, the mean differences were calculated. A fixed effect model was used, except in the event of significant heterogeneity between the trials (p < 0.10; I2 > 40%), in which we used a random effects model. Results: A total of 8 trials published between January 1990 and July 2021 that randomized 1015 patients fulfilled the inclusion criteria. Of these, 553 patients were randomized to IV iron and were compared with 271 patients randomized to oral iron and 191 to no iron. IV iron decreased the percentage of patients requiring a blood transfusion compared with oral iron (RR 0.72; 95% CI 0.55–0.95) with a number needed to treat of 20 (95% CI 11–100). IV iron increased the hematopoietic response (RR 1.23; 95% CI 1.01–1.5). There was no difference with respect to the risk of adverse events (RR 0.97; 95% CI 0.88–1.07; 8 trials) or severe adverse events (RR 1.09; 95% CI 0.76–1.57; 8 trials). Conclusions: IV iron resulted in a decrease in the need for RBC transfusions, with no difference in adverse events in patients with CIA. IV iron for the treatment of CIA should be considered in clinical practice

The Importance of Abnormal Platelet Count in Patients with Clostridioides difficile Infection

Background: Clostridium difficile infection (CDI) causes morbidity and mortality. Platelets have been increasingly recognized as an important component of innate and adaptive immunity. We aimed to assess the incidence of thrombocytopenia and thrombocytosis in CDI and the effect of an abnormal platelet count on clinical outcomes. Methods: This single-center, retrospective cohort study consisted of all adult patients hospitalized in Rabin Medical Center between 1 January 2013 and 31 December 2018 with laboratory confirmed CDI. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression. Results: A total of 527 patients with CDI were included. Among them 179 (34%) had an abnormal platelet count: 118 (22%) had thrombocytopenia and 61 (11.5%) had thrombocytosis. Patients with thrombocytosis were similar to control patients other than having a significantly higher white blood cell count at admission. Patients with thrombocytopenia were younger than control patients and were more likely to suffer from malignancies, immunosuppression, and hematological conditions. In a multivariable analysis, both thrombocytosis (OR 1.89, 95% CI 1.01–3.52) and thrombocytopenia (OR 1.70, 95% CI 1.01–2.89) were associated with 30-days mortality, as well as age, hypoalbuminemia, acute kidney injury, and dependency on activities of daily living. A sensitivity analysis restricted for patients without hematological malignancy or receiving chemotherapy revealed increased mortality with thrombocytosis but not with thrombocytopenia. Conclusions: In this retrospective study of hospitalized patients with CDI, we observed an association between thrombocytosis on admission and all-cause mortality, which might represent a marker for disease severity. Patients with CDI and thrombocytopenia also exhibited increased mortality, which might reflect their background conditions and not the severity of the CDI. Future studies should assess thrombocytosis as a severity marker with or without the inclusion of the WBC count

Representation of women in editorial boards of infectious disease and microbiology journals-cross-sectional study

Objectives: We aimed to assess whether there is an association between the proportion of female editors-in-chief and members of editorial boards in infectious disease (ID) and microbiology journals. Methods: Our cross-sectional observational study included ID or microbiology journals according to the 2019 Clarivate Journal Citation Reports. Journals' Q ranking, open-access status, and number and gender of editors-in-chief and editorial board members were collected from the journals' official websites. We conducted a binary gender assignment for each editor using names, pictures, and other online descriptors. Journals with over 100 editorial board members and those with over 25% of board members for whom we could not determine gender were excluded. Editorial teams with &gt;50% women were considered women dominant. Univariate and multivariable analyses for female editor dominance were performed. Results: Overall, 167 journals were included, with total 6057 editorial members, 1655 (27.3%) of whom were women. Of 214 editors-in-chief, 48 (22%) were women, and only 25% (40 of 162) of journals had female editor-in-chief dominance. Factors associated with female dominance in the editor-in-chief role in univariate analysis were higher quartile rank, higher impact factor, and open access. Open-access journals remined significant in multivariable analysis (odds ratio (OR) 2.521; 95% CI, 1.140-5.576, p = 0.022). Larger editorial boards were less likely to have female dominance. Female editor-in-chief dominance was significantly associated with women-dominant editorial boards. Discussion: ID and microbiology journals have significantly few women as editors-in-chief and editorial board members. Understanding the reasons for this inequality is required as an important step to confront and resolve it.</p