Romiplostim use for thrombocytopenia following allogeneic hematopoietic stem cell transplantation: a case series from a single center in Qatar.

Thrombocytopenia is a common and serious complication that can occur following hematopoietic stem cell transplantation (HSCT), and it contributes to increased morbidity and mortality. The mechanisms of post-HSCT thrombocytopenia are multifactorial and complex. There are no clear consensus and guidelines for managing thrombocytopenia post-HSCT. Recently, there has been promising use of thrombopoietin receptor agonists (TPO-RAs), particularly eltrombopag and romiplostim, as treatments for post-HSCT thrombocytopenia. Notably, that this indication is considered off-label, and data in this use are limited. Based on the existing body of evidence, romiplostim emerges as a safe and effective option for individuals with transfusion-dependent thrombocytopenia after HSCT. In this context, we present a summary of our experience at a single center, where romiplostim was used in the management of post-HSCT thrombocytopenia due to poor graft function. Notably, all four cases responded positively to romiplostim treatment, and no significant adverse events were observed.

Short- and Long-term Outcomes of Percutaneous Coronary Interventions in Chronic and Non-chronic Total Occlusions: A Meta-analysis of 690,123 Patients.

The use of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still a subject of debate, with conflicting outcomes reported in different studies when compared to non-CTO lesions. This meta-analysis aims to clarify the clinical outcomes of PCI in CTO cases compared to non-CTO lesions, both in the short and long-term. PubMed, Scopus, Web of Science, Ovid, and Cochrane Central were searched until March 2023 for relevant studies addressing short- and long-term outcomes of PCI in CTO vs non-CTO lesions. Dichotomous data were pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random Der-Simonian lair effect model using STATA 17 MP. Eight studies with a total of 690,123 patients were included. In terms of short-term outcomes, CTO PCI was associated with higher rates of vessel perforation (OR = 2.16, 95% CI: 1.31-3.57) and cardiac tamponade (OR = 5.19, 95% CI: 4.29-6.28). Additionally, CTO PCI showed lower rates of procedural success (OR = 0.84, 95% CI: 0.73-0.96). Moreover, in the long-term, CTO PCI had higher rates of MACE (OR = 1.02, 95% CI: 1.01-1.04), however, it showed lower rates of cardiac death (OR = 0.61, 95% CI: 0.38-0.98), with no significant difference in other reported outcomes. Our findings underscore the challenges and adverse outcomes associated with using PCI to treat CTO lesions in the short term. This suggests that interventional cardiologists should carefully evaluate the risks and benefits before proceeding with PCI in CTO lesions.

Partial replacement of corn with chocolate byproducts or protected fat in diets of early lactating Holstein cows: feed utilization and lactational performance.

This study determined the effects of the partial replacement of corn with chocolate byproducts or protected fat on the performance of cows. Forty multiparous Holstein cows were assigned to four treatments in a completely randomized design for 90 d. The control diet was a complete diet containing 41.2% concentrate feed mixture, 41.2% corn silage, and 17.6% berseem hay. In the other experimental diets, each kg of crushed corn grain in the control diet (DM basis) was replaced with 600 g chocolate byproducts (CH), 400 g protected fat (PF), or 500 g of a mixture of chocolate byproducts and protected fat (1:1 DM basis) (CHPF). Both amounts of PF and CH had the same energy concentration as 1 kg of corn. The experimental treatments did not affect total intake; however, they increased (p < 0.001) daily production of milk, milk fat content, and feed efficiency. Moreover, treatments increased (p < 0.05) blood total protein, albumin, glucose, cholesterol, and triglyceride. The CH, PF, and CHPF treatments increased (p < 0.01) nutrient digestibility. It is concluded that replacing 1 kg of corn in the diet of lactating Holstein cows with PF at 400 g, followed by CHPF at 500 g, and CH at 600 g enhanced milk production and feed efficiency.

End-tidal carbon dioxide measurements as a surrogate to arterial carbon dioxide during pediatric laparoscopic surgeries: a prospective observational cohort study.

BACKGROUND: Maintaining normocapnia during mechanical ventilation in anesthetized children during laparoscopic surgeries is highly recommended. There is a debate regarding the use of capnography (ETCO2) as a trend monitor for evaluation of arterial carbon dioxide levels (PaCO2). We analyzed the relationship between ETCO2 and PaCO2 with time in elective pediatric laparoscopic surgeries. METHODS: This study was a prospective observational cohort analysis of 116 paired comparisons between PaCO2 and ETCO2 computed from 29 children (ASA I, 12-72 months). Arterial blood samples were withdrawn before, at 15 minutes and 30 minutes during pneumoperitoneum and 1 minute after deflation. ETCO2 value was recorded simultaneously, while arterial blood was withdrawn. PaCO2-ETCO2 relationship was evaluated by Pearson's correlation coefficients and Bland Altman Method of agreement. RESULTS: Out of the 116 comparisons analyzed, a PaCO2-ETCO2 difference beyond 0 to ≤ 5 mmHg was recorded in 71 comparisons (61.2%) with negative difference in 34 comparisons (29.3%). A positive significant correlation between PaCO2 and ETCO2 was recorded before (r = 0.617, p = 0.000) and at 15 minutes (r = 0.582, p = 0.001), with no significant correlation at 30 minutes (r = 0.142, p = 0.461), either after deflation (r = 0.108, p = 0.577). Bland-Altman plots showed agreement between ETCO2 and PaCO2 before inflation with mean PaCO2-ETCO2 difference 0.14 ± 5.6 mmHg (limits of 95% agreement -10.84-11.2, simple linear regression testing p-value 0.971), with no agreement at 15 minutes (0.51 ± 7.15, -13.5-14.5, p = 0.000), 30 minutes. (2.62 ± 7.83, -12.73-17.97, p = 0.000), or after deflation (1.81 ± 6.56, -10.93-14.55, p = 0.015). CONCLUSION: Usage of capnography as a trend monitor in pediatric laparoscopic surgeries may not be a reliable surrogate for PaCO2 levels. TRIAL REGISTRATION: Clinical Trials. gov (Identifier: NCT03361657).

Complete Substitution of Clover Hay and its Impact on Performance of Barki Sheep in Arid and Semi-arid Regions.

BACKGROUND AND OBJECTIVE: Barley straw is a farm by product that may be useful in animal feeding but its use is limited due to its low nutritional value and high fiber content. Therefore, this study aimed to improving the nutritive value of barley straw by bacterial treatment with Condensed Molasses Soluble (CMS) in the ration of Barki lambs. MATERIALS AND METHODS: In Experiment 1, 12 Barki rams, which were divided into 3 equal groups (4 each), were given rations which consisted of 50% CFM+50%, either clover hay (C) or bacterial treated barley straw (T1) or T1+ CMS (T2). In Experiment 2, 10 Barki lambs were divided into 2 groups, one (C) and T2 as descripted in Experiment 1. Data analyzed by using one way ANOVA model. RESULTS: Digestibility of Dry Matter (DM), Organic Matter (OM), Crude Fiber (CF) and Ether Extract (EE) were insignificantly affected among all rations, while Digestible Crude Protein (DCP) recorded a higher value in T2 compared to T1. Changes in Total Digestible Nutrients (TDN) values were insignificant. Values of DCP were higher for T2 compared to C and T1. The Body Weight Gain (BWG) and Feed Conversion Ratio (FCR) of growing lambs didn't statistically differ among the groups. CONCLUSION: Finally, complete replacement of clover hay by treated barley straw plus CMS may be considered good feeding strategies in the feeding of Barki lambs in Arid and semi-arid regions.

Emtricitabine.

Emtricitabine (Emtriva, FTC) is an antiviral medicine which decreases the body's amount of HIV. Emtricitabine on of Anti-HIV drugs slow down or protect the immune system against damage and reduce the risk of diseases related to developing of AIDS. Emtricitabine use also for treatment of hepatitis B virus. Emtricitabine is a drug class known as nucleoside reversing transcriptase inhibitors (NRTIs). In view of Emtricitabine's clinical significance, a thorough review of the physical and pharmaceutical characteristics and details of the multiple analytical techniques used to test the drug in pharmaceutical and biological systems was conducted. The methods investigated include identification test, Spectroscopy, chromatography, electrochemicals, and Thermal. Beside the analytical profile, the degradation and stability of Emtricitabine, its pharmacology and pharmacokinetics, Pharmaceutical Applications, Mechanism of Action, dosage forms and dose, ADME profile, and interactions have been debated.

Study of the risk factors and complications of diabetes mellitus after live kidney donation.

OBJECTIVES: Kidney donors, similar to the general population, are at risk for development of type 2 diabetes mellitus. The course of donors who develop type 2 diabetes mellitus has not been well studied. This work is aimed at estimating the incidence of diabetes after kidney donation, and study some risk factors and some complications of diabetes mellitus after donation. MATERIALS AND METHODS: The material of this record based work comprised the records 2267 donors who donated 1 of their kidneys between 1976 and 2014 in the Urology and Nephrology Center, Mansoura University, Egypt, and regularly followed-up at its outpatient clinic. There were 388 donors included in the study and their medical records were revised. RESULTS: Postdonation weight gain and family history of diabetes mellitus were statistically significant on both the development of diabetes mellitus, high, very high albuminuria, and/or decreased creatinine clearance. Metformin and insulin use seemed to significantly reduce the protein excretion, and creatinine clearance decline in the studied group. CONCLUSIONS: There is a significant effect of the family history of diabetes mellitus on the development of high, very high albuminuria, and/or decreased creatinine clearance.

Methotrexate-induced acute leukemia: report of three cases and review of the literature.

For many years, methotrexate has been used in the treatment of certain chronic medical disorders e.g. rheumatoid arthritis and psoriasis as well as a number of malignant disorders e.g. acute lymphoblastic leukemia, certain types of lymphoma and breast carcinoma. Its use has been associated with various systemic toxicities and complications. The association between methotrexate therapy and the development of lymphoma and pseudolymphoma is well established. In patients treated with methotrexate, the development of leukemia has been attributed to either the primary disorder e.g. rheumatoid arthritis or to other drugs used concomitantly e.g. cyclophosphamide. Reported here are two patients with rheumatoid arthritis and one patient with psoriasis treated with low dose methotrexate for variable periods of time. Two of these patients developed acute myeloid leukemia on myelodysplastic syndrome background, while the third patient developed pre-B acute lymphoblastic leukemia that expressed few myeloid markers and had a positive philadelphia chromosome. To our knowledge, these are the first reported cases of methotrexate-induced acute leukemia.

Clinicoepidemiologic study of posttransplant diabetes after living-donor renal transplant.

OBJECTIVES: We sought to evaluate posttransplant diabetes mellitus with regard to its incidence, risk factors for occurrence, complications, impact on graft function, and impact on patient and graft survival rates. MATERIALS AND METHODS: A total of 1,580 patients received living-donor renal allografts at Mansoura University, Egypt, between March 1976 and November 2004. Of these, 286 recipients developed diabetes after transplant (diabetic group). These patients were matched with 316 kidney transplant recipients who did not develop diabetes after transplant (control group). A complete clinical history was obtained and a clinical examination was done. Laboratory analyses including urine analysis, complete blood count, total serum cholesterol, fasting and 2-hour postprandial plasma glucose, Hb A1c, serum creatinine, and creatinine clearance were obtained in all patients. In each patient, presence of hepatitis B and C was determined with polymerase chain reaction, and a graft biopsy was obtained to diagnose renal allograft rejection. RESULTS: The onset of diabetes mellitus among our recipients occurred primarily during the first 6 months after transplant (in 52.4% of the patients). Significant correlations were found between posttransplant diabetes mellitus and the recipients' age (P = .0001), obesity (P = .001), positive family history of diabetes mellitus (P = .001), hepatitis C virus infection (P = .039), cumulative dose of steroids in the first 3 months (P = .047), and calcineurin inhibitor-based immunosuppressive therapy (P = .001). Moreover, posttransplant diabetes mellitus significantly affected rates of coronary heart disease (P = .001), hypertension (P = .02), and hypercholesterolemia (P = .001). Graft survival was similar in both groups until 15-year follow-up, at which time graft survival began to decrease in patients with diabetes mellitus compared with those without diabetes mellitus (43.5% vs 53.6%, P = .013). Similarly, patient survival was similar until 8-year follow-up, at which time survival rates began to decline in patients with diabetes as compared with patients without diabetes (79.9% vs 86.1%, P = .001); this trend continued to the 15-year follow-up (60.6% vs 77.8%, P = .001). CONCLUSIONS: Posttransplant diabetes mellitus is a major problem that endangers patient and graft survival. In our population, the incidence of posttransplant diabetes mellitus was 18.2%. Further studies are recommended to screen for patients with impaired fasting glucose and impaired glucose tolerance for prediction, early detection, and better management of posttransplant diabetes mellitus.