Plenary survey on incidence of cardiac complications among transfusion-dependent thalassemia patients

Introduction: Cardiac complications are the leading cause of mortality amongst transfusion-dependent thalassemia (TDT) patients. The multifactorial etiology of cardiac disorders has made their management quite challenging. Therefore, in addition to evaluating the incidence of heart failure (HF) and pulmonary hypertension (PHT), the associated factors were assessed amongst 737 TDT patients, aiming to achieve a plenary perspective of their cardiac disorders and relative factors. Material and methods: In this cross-sectional, we evaluated the incidence of HF and PHT amongst 737 TDT patients while considering imperative factors such as endocrinopathies, iron status, and serum vitamin D level. Results: Incidence of total heart failure and pulmonary hypertension were estimated at 12.3% amongst participants, however, the rate of cardiac iron overload was about 40%. Splenectomy, serum vitamin D, low bone mass, age, gender, hypoparathyroidism, hypogonadism, and diabetes were significantly impairing the cardiac function of our patients. The latter results were concluded by univariate analysis and only the frequency of blood transfusion proved to have a risk effect on left ventricle ejection fraction. Conclusions: Cardiac iron overload has the highest impact on the incidence of cardiac disorders amongst TDT patients. Even though the significant statistical association between studied disorders and iron chelation regimen, endocrinopathies, splenectomy, serum vitamin D, and total body iron status were not observed, however about clinical practice, their effect could not be ignored and require further studies to achieve efficient management of thalassemia patients with cardiac disorders

Acute Progressive Visual Loss in a Case of Acute Myeloid Leukemia: Challenges in the Utility of Molecular Tests in Early Diagnose of Cytomegalovirus Retinitis

Cytomegalovirus (CMV) retinitis is one of the rare but debilitating presentations of the CMV infection in children with leukemia. Herein, we report a 12-year-old boy with acute myeloid leukemia complicated by rapid progressive visual loss during relapse of leukemia. The definite diagnosis of CMV retinitis was made after vitreous aspiration. Despite prompt treatment and ophthalmologic intervention, he died because of AML relapse. Viral infections, especially cytomegalovirus infection, may present with vague clinical pictures during any time of chemotherapy, which may not be easily distinguishable from bacterial or fungal retinitis and also chemotherapy-induced retinopathies. Clinician should consider CMV retinitis in seropositive patients especially those without detectable viremia

Parameters of tissue iron overload and cardiac function in patients with thalassemia major and intermedia

BackgroundNoninvasive T2* magnetic resonance imaging (MRI) assessment can stratify the risk of subsequent cardiac dysfunction in β-thalassemia major (TM) and β-thalassemia intermedia (TI) patients. The normal level of N-terminal pro B-type natriuretic peptides (NT-proBNP) can rule out acute heart failure. AimWe aim to investigate the relation of NT-proBNP level, T2* MRI, and echocardiographic findings in TM and TI patients. Materials and methodsIn this cross-sectional study, 41 TM patients, 41 TI patients, and 41 healthy individuals (HI) were enrolled. NT-proBNP level, T2* MRI, and two-dimensional echocardiography were assessed for all patients and controls. ResultsThere was statistically significant correlation between NT-proBNP levels and mitral inflow late diastolic velocity ( = −0.538; = 0.006) in TM group. There was statistically significant correlation between NT-proBNP levels and tricuspid annulus systolic velocity ( = −0.438; = 0.028), systolic velocity of septum ( = −0.472; = 0.020), and mitral inflow early-to-late diastolic wave ratio ( = 0.592; = 0.002) in TM group. ConclusionEarly diagnosis and treatment of myocardial iron overload are likely to prevent the mortality in patients with established ventricular dysfunction. Since NT-proBNP levels were not significantly increased in documented left ventricular (LV) diastolic dysfunction, this factor may not be sensitive for the detection of latent LV diastolic dysfunction in the early stages of disease progression

Excisional wound healing activity of Carboxymethyle cellulose in diabetic rat

Introduction:Wound healing is a complex process that occurs after injury and as a result of the cellular and biochemical interactions between various components in the wound area. Many new methods have been used to treat diabetic ulcers. In recent decades, a dramatic increase in the number and types of treatment for diabetic ulcers has been observed. Despite a new approach to the basic cellular and molecular therapy, diabetic wound healing remains one of the clinical problems.Material and Methods:In this experimental study, excisional wound healing activity of Carboxymethyle cellulose (CMC) was evaluated in 21 streptozotocin-induced diabetic Sprague dawley male rats that were randomly divided into three groups of seven rats (Group A, B and C with 4, 7 and 12 days of follow up, respectively). The animals were housed in standard environmental conditions with light/dark, temperature of 23 ± 20C, humidity of 50 ± 5%, and a 12h cycle. Healing process was evaluated using macroscopic (area mesurment) and histopathologic study.Results:The average area of wounds treated with CMC compared to the control wound was reduced with a statistically significant difference. The histopathologic study showed higher and lower inflammation on days 4 and 12, respectively. A lower level of tissue necrosis and hemorrhage and higher level of epithelialization were shown in wounds which were treated with CMC.Conclusion:Given the positive effects of CMC on wound healing of diabetic male rats, there is a need to conduct clinical trials on using this new Gel on diabetic and burn ulcers

Acquired Vitamin K Deficiency as Unusual Cause of Bleeding Tendency in Adults: A Case Report of a Nonhospitalized Student Presenting with Severe Menorrhagia

We report a rare case of acquired vitamin K deficiency presenting with severe menorrhagia and without any gynecological problem. Partial thromboplastin time (59.2 seconds) and prothrombin time (33.1 seconds, INR: 5.97) were considerably prolonged in laboratory evaluations. A complete coagulation factor assay test was performed for the patient: factor IX, 24%; factor II, 41%; factor VII, 3%; and factor X, 52%. She had been taking many high-energy drinks and she had inadequate dietary intake for the past 6 months. Given that she had vitamin K deficiency (VKD), a course of vitamin K therapy was started for her in the hospital. This case showed the potential for menorrhagia due to VKD with use of high-energy drinks and the value of a complete and detailed history in early diagnosis

Hypothyroidism in β-Thalassemia Intermedia Patients with and without Hydroxyurea

Hydroxyurea (HU) has been successfully used in patients with β-thalassemia intermedia (β-TI). We aimed to evaluate the effect of the long-term use of HU on thyroid function in patients with β-TI. Seventy-five patients with β-TI aged≥11 years and taking HU were randomly selected during 2010 in southern Iran. Thirty-one patients with β-TI without HU were considered as a control group. Serum levels of thyroid stimulating hormone (TSH) and T4 were measured. The mean age of the participants was 22.7±5.1 years (age range=12-41 years). Serum ferritin level had no significant correlation with HU consumption (P>0.05). Overall, we detected 10 (9.4%) patients with hypothyroidism. We found that the use of HU at a dose of 8-15 mg/kg/day has no significant association with thyroid function in β-TI patients. However, due to the small sample size in our study, documentation of this finding needs further studies with higher numbers of patients

Prevalence of hopelessness and suicidal ideation and their associated factors among pediatric patients with leukemia

Abstract Background With the increasing survival rate of pediatric patients with leukemia, improving their quality of life (QoL) is the new challenge. Psychiatric disorders are among the significant confounding factors of the aforementioned patients’ QoL. Ninety-seven pediatric patients with leukemia were evaluated based on the Beck Hopelessness and SI scale while considering associated factors. We assessed the prevalence of suicidal ideation (SI) and hopelessness, as two of the most prevalent psychiatric symptoms of pediatrics with malignancy while assessing some of the associated factors to provide a plenary insight. Results Prevalence of SI and hopelessness were 7.2% and 87.6% respectively. Gender, education, the abode of living, time from onset of disease, and parents’ education level and income states of many were significantly related to the prevalence of the two studied psychiatric disorders. Multiple logistic regression determined a significant confounding role of abode of living, parent’s education, onset, and type of leukemia in hopelessness. As for SI, the result of the latter test determined more confounding factors such as age and patients’ education. Conclusion Both SI and hopelessness are noticeable disorders among children with leukemia with multiple manageable associated factors; hence, it is advisable to recommend psychiatric assessment of leukemic children

Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence

Current strategies against invasive fungal infections in patients with aplastic anemia, strong power and weak weapon, a case report and review of literature

We report an 18 year old boy with Aplastic anemia complicated by serious fungal rhinosinusitis. Despite prompt treatment and early repeated surgical debridements, he died after about more than 6 weeks of hard challenges with fungal infections. Current strategies against invasive fungal infections (IFIs) in patients with Aplastic anemia may be inadequate for the management of serious complications. Antifungal prophylaxis is highly recommended in pre-transplant period for severe form of Aplastic anemia