Pathophysiology, Diagnosis and Treatment of Immune Thrombocytopenia

Immune thrombocytopenia (ITP) is an acquired disorder characterized by isolated thrombocytopenia with a peripheral blood count < 100.000/ mm3 in the absence of any obvious initiating or underlying causes, by antibody mediated destruction of platelets and suppression of megakaryocyte and platelet production on the basis of immune deregulation. ITP is idiopathic (primary) in 80% of cases and secondary to several associated disorders in 20% of cases. A diagnosis of exclusion, based on patient history, physical examination, complete blood count and examination of the peripheral blood smear, is used for ITP. The treatment of ITP is indicated in adult patients with platelet counts below 20.000-30.000/ mm3, with bleedings or risk for bleeding. First line therapy is represented by corticosteroids, intravenous immunoglobulins and intravenous anti-RhD. Second-line treatment is represented by: splenectomy, inhibition of the monocytic phagocytic system therapy, immunosupressive therapy, anabolic steroids, anti-CD20 therapy, and thrombopoietin receptor agonists

Paroxysmal nocturnal hemoglobinuria: Pandora’s box?

Introduction. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired non-malignant hematological disorder which affects the pluripotent hematopoietic stem cell. The cause of PNH development is the occurrence of somatic mutations in the phosphatidylinositol glycan-A gene which encodes a protein necessary for the biosynthesis of glycosylphosphatidylinositol anchors. The diagnosis of PNH requires the presence of signs of intravascular hemolysis, thrombosis, and (or) bone marrow failure. Case Report. We report the case of a 42-year-old female, diagnosed with PNH at the age of 27, whose evolution was initially characterized predominantly by hemolytic attacks and whose disease pattern evolved towards thromboembolic episodes with the advancement of age. Conclusions. Establishing the diagnosis of PNH is a difficult task and its management requires teamwork. During the evolution of the disease, a PNH patient can acquire supplementary risk factors for thrombosis, in addition to the pro-coagulant potential of the disease itself. We reported this case to remind physicians that establishing the diagnosis of PNH is troublesome, and thus it is questionable whether PNH is a rare disease or just underdiagnosed. In this context, in the clinical practice of hematologists and other physicians as well, PNH remains a veritable Pandora\u27s box

The evaluation of oxidative stress in patients with essential thrombocythemia treated with risk-adapted therapy

Introduction. Essential thrombocythemia (ET) is a clonal disorder of the hematopoietic stem cells characterized by persistent thrombocytosis in the peripheral blood, excessive proliferation of megakaryocytes and minor reticulin fibrosis in the bone marrow. It seems that oxidative stress is involved in the development and progression of ET. Objective. To evaluate oxidative stress levels in ET patients treated with risk-adapted therapy. Material and methods. 62 ET patients and 20 controls (informed consent obtained) were enrolled. ET diagnosis was based on WHO criteria (2016 revised). Reactive oxygen species (ROS) levels and the total antioxidant capacity (TAC) were evaluated at time of diagnosis and after 6 months of risk-adapted therapy. ET patients were divided into 3 groups and treated with risk–adapted therapy: a low risk group, treated with low doses of aspirin 75 mg/day or watch-and-wait; an intermediate risk group treated with low doses of aspirin 100 mg/day or low-dose aspirin + cytoreductive treatment; a high-risk group, treated with low doses of aspirin and cytoreductive treatment (hydroxyurea) or platelet-lowering agents (anagrelide). Results. ET patients had at diagnosis higher ROS levels and a lower TAC vs. controls. After 6 months of risk-adapted therapy, ROS levels decreased and TAC increased. No significant differences were seen between the effect of hydroxyurea and the effect of anagrelide on oxidative stress levels. Conclusions. ROS levels are increased and TAC is decreased in ET patients vs. controls. These values depend on the risk group assigned to the patient. Risk-adapted therapy was useful to reduce ROS levels and increase TAC

Research Grant Proposal Writing Course for Students in Higher Institutions

Research grant proposals have become part of the everyday life of every scientist working in the field of life sciences. Although most early career researchers begin working on research grant proposals during their doctorate, laying the foundation of this complicated task should occur during their undergraduate training. This editorial serves as an introduction into research grant proposal writing for students enrolled in higher education and tackles subjects such as choosing a research topic and writing a successful grant application, as well as possible challenges and funding opportunities that we considered appropriate for students and early career researchers

War on Ukraine: Impact on Ukrainian Medical Students

The ongoing Russian invasion of Ukraine has taken a tremendous toll on the physical and mental wellbeing of the Ukrainian people. Accordingly, medical trainees and institutions must adapt to a high degree of uncertainty and turmoil. In 2022, Ukraine has 23 medical institutions filled with not only Ukrainian nationals but medical students from around the world. It is estimated that approximately 18,000 students from India alone study in Ukraine, many of whom are medical learners. Many of these national and foreign medical students are now displaced refugees looking to escape to Western Europe or their country of origin. Even by escaping the ongoing conflict, the question remains as to how many of these students will complete their medical education and cope with the trauma of political unrest. This is the first time that the International Journal of Medical Students Editorial Team has commented on a political conflict. We have learned in our tenure that medical students and their education worldwide is affected by many factors, including global warming and conflict. We have raised our voice before for actions to prevent climate change. We are adding our voice of support to those suffering from political unrest and acts of violence globally, with specific focus on the Ukraine. The path of war and vengeance is an easy one when compared to political dialogue and collaboration. We, the new generation of scientists of the world, claim for the use of reason over emotions to keep us all safe and promote progress worldwide

Medical Student Research Journals: The International Journal of Medical Students (IJMS) Legacy

The International Journal of Medical Students (IJMS) has emerged over the past decade as a critical platform for showcasing medical student innovation and experiences. Though the work of trainees has historically been undervalued and over scrutinized, the IJMS is committed to highlighting the immense capacity for novel and robust research in this cohort. Thus, supporting an upcoming generation of leaders in medicine and academia to gain confidence in their work and contribute positively to the scientific community. In this issue of the IJMS, we are proud to present 16 articles from the Americas, Europe, Asia, and Africa. Original research articles cover a breadth of topics, including medical training, impacts of the COVID-19 pandemic on teaching and communication, pediatric respiratory illness, gender equity in medicine, understudied illnesses, and cardiovascular disease. The IJMS is proud to feature first-hand experiences of medical trainees in each issue. Accordingly, in the present issue perspectives of six medical students are outlined following unique and career-altering experiences. From working in palliative care to international outreach program, local vaccination initiatives, and the creation of a student-oriented research and innovation council in India. The IJMs extends our gratitude to our contributors, team, and readers for another remarkable issue