Adult-onset Still's disease (AOSD) is an inflammatory disorder with arthritis, quotidian fever, evanescent rash, elevated white cell count, elevated ferritin, and abnormal liver function tests. The ...diagnosis requires the exclusion of other inflammatory, infectious, and malignant conditions. Onset of AOSD, though rare, has been known to occur in pregnancy. We present a 28-year-old woman diagnosed with AOSD at 3 months gestation.
The present study aimed to evaluate the effect of dietary fermented extracts sourced from
(nucleotides, β-glucans and MOS) (Hilyses
) on the production and health of Nile tilapia (
) broodstock, as ...well as on seed survival and performance. The trial was performed in a hatchery along the spawning season and continued in the laboratory to monitor the performance in fry and fingerlings. The broodstock were divided into two groups, (C) fed a basal diet and (H) fed 0.4% Hilyses. Blood and histological parameters, antioxidant power, cortisol level and the expression of some immune-related (
,
and
) and growth-related genes (
and
) were measured. The obtained seeds were subdivided into four treatments: (C-C) fed a basal diet, (C-H) fed 0.4% Hilyses, (H-C) fed a basal diet and (H-H) fed 0.4% Hilyses. Results revealed that the dietary inclusion of Hilyses in the broodstock increased seed production, survival, hematological parameters, and antioxidant power. Moreover, it improved the intestinal microstructure and upregulated the immune- and growth-related genes. The growth indices of fry and fingerlings were significantly increased in all Hilyses-treated groups (
< 0.05). The performance in the (H-H) group significantly surpassed those of all groups. Therefore, dietary fermented yeast could be used as a strategic solution to sustain tilapia production.
يعتبر استئصال الطحال طريقة علاجية للعديد من أمراض الدم، على الرغم من احتمال حدوث المضاعفات. قيمت هذه الدراسة تأثير استئصال الطحال على اضطرابات الدم المختلفة ودور التدابير الوقائية على نتائج ما بعد ...الجراحة.
أجريت هذه الدراسة المقطعية في المملكة العربية السعودية على مرضى بالغين يعانون من اضطرابات الدم غير الخبيثة وخضعوا لاستئصال الطحال.
فحصت هذه الدراسة ۱٧٩مريضا يعانون من اضطرابات الدم المختلفة، وخضع ۳٨ منهم (21.1٪) لاستئصال الطحال. من بين هؤلاء المرضى، أكثر من الثلثين (73.7%) خضعوا لعملية استئصال الطحال المفتوح. كان معدل الإقامة في المستشفى يومين إلى سبعة أيام، مع عدم وجود فرق كبير بين المنهجين المفتوح أو بالمنظار. لاحظ حوالي ٩٥٪ من المرضى تحسنا عاما في حالتهم بعد استئصال الطحال. ومع ذلك، أبلغ (٢٦٫۳٪) من المرضى عن تكرار المرض أو الحاجة إلى المزيد من العلاج بعد عام أو أكثر من استئصال الطحال. حوالي ۱٦٪ كان لديهم زيادة في حدوث المضاعفات المعدية بعد الجراحة، خاصة في مرض فقر الدم المنجلي ومرضى بيتا الثلاسيميا. أكثر من نصف الذين أصيبوا بمضاعفات لم يتلقوا التطعيم قبل الجراحة، بالمقارنة مع ٤٤٫٤٪من المرضى الذين تم تطعيمهم والذين عانوا من مضاعفات.
يعتبر استئصال الطحال خط علاج شامل لمعظم أمراض الدم غير الخبيثة. على الرغم من كونه علاجا فعالا، إلا أنه لا يزال غير واضح لماذا يمكن أن يكون لدى المرضى الذين يعانون من نفس المرض استجابات مختلفة. تعد العدوى من المضاعفات الشائعة بعد الجراحة، واللقاحات غير مستخدمة. تؤكد هذه الدراسة على دور تثقيف المريض، التطعيمات المجدولة، والاختيار الصحيح للمرضى في استخدام استئصال الطحال لعلاج أمراض الدم غير الخبيثة.
Splenectomy is considered a therapeutic modality for several hematological diseases, although complications are possible. This study assessed the effects of splenectomy on various hematological disorders and the roles of prophylactic measures on postoperative outcomes.
This was a cross-sectional study performed in KSA on adult patients with underlying non-malignant hematological disorders who had undergone splenectomy.
This study examined 179 patients with various hematological disorders, 38 (21.1%) of whom had undergone a splenectomy. Of those 38 patients, more than two-thirds (73.7%) had an open splenectomy. The average hospital stay was 2–7 days, and no significant difference was observed between the open and laparoscopic approaches. Approximately 95% of the patients showed overall improvements in their condition after splenectomy. However, 26.3% of patients reported a recurrence or need for further treatment 1 year or more after splenectomy. Approximately 16% of patients had an increased incidence of postoperative infectious complications, particularly patients with sickle cell disease and beta thalassemia. More than half the patients who developed complications had not received vaccination preoperatively, whereas 44.4% of vaccinated patients experienced complications (p = 0.04).
Splenectomy is considered a universal line of treatment for most non-malignant hematological diseases. Although splenectomy is an effective treatment, the reasons why patients with the same disease can have different responses remains unclear. Infection is a common postoperative complication, and vaccinations are underused. This study emphasizes the roles of patient education, scheduled vaccinations and proper selection of patients in the use of splenectomy for the treatment of non-malignant hematological diseases.
Highlights • We calculated the costs of managing epilepsy in children and young people in the UK. • The direct medical costs of epilepsy were higher in the first year after diagnosis. • Costs of ...inpatient hospital admissions were the highest followed by costs of drugs. • Medical costs did not vary substantially by sex or socioeconomic deprivation.
Extraskeletal Ewing sarcoma (EES) is a rare tumor of the soft tissue that looks the same as skeletal Ewing sarcoma (ES). A male in his 50s was diagnosed with extraskeletal Ewing sarcoma (EES) of the ...right shoulder, which had infiltrated the muscles around the shoulder joints. Although uncommon, all members of the ES family of tumors, including EES, were treated following the same general protocol for sarcoma tumors. Due to the significant tumor size in this patient and local invasion, wide local excision and a latissimus dorsi flap were required. This case highlighted the management of EES, including the surgical removal of the mass on the right shoulder, followed by chemotherapy, which led to a successful outcome.
Background
There is limited real‐world data on the efficacy and safety of combination programmed cell death protein‐1 (PD‐1) inhibitor, nivolumab and the cytotoxic T‐lymphocyte antigen (CTLA‐4) ...inhibitor ipilimumab.
Method
We retrospectively identified patients (pts) with metastatic melanoma treated with three‐weekly nivolumab (1 mg/kg) in combination with ipilimumab (3 mg/kg) for four cycles followed by nivolumab monotherapy (3 mg/kg) fortnightly. Patient demographics and treatment parameters were collected and outcomes determined.
Results
A total of 45 pts received combination treatment with a median follow up of 8.7 months (range 0.33–25.9 months). A total of 67% were male, and BRAF V600 mutations detected in 38%. At treatment commencement, 14 (31%) pts had brain metastases, 51% had an elevated LDH and 18 (40%) were treatment‐naive. Almost a third (30%) required corticosteroids for symptom control or management of prior toxicities. Nineteen (42%) patients had prior anti‐PD‐1 therapy. The disease control rate (DCR) was 54% and objective response rate (ORR) was 29%. Of pts treated with prior immune checkpoint inhibitors, the DCR and ORR were 50% and 33%, respectively. Intracranial responses were observed in 18% (n = 2). The median progression‐free survival (PFS) was 5.8 months (95% Confidence interval (CI), 2.9–14.1 months). PFS was higher in treatment naïve patients compared to those who had prior immunotherapy (6.2 months vs 4.9 months, P = 0.59). The median OS was 17.4 months (95% CI, 7.1–NR). pts requiring corticosteroids had a shorter PFS (4.9 months vs 6.8 months) and OS (7.1 months vs NR, P = 0.01).Treatment‐related adverse events of any grade were experienced by 88% of pts, with 54% having grade 3–4 adverse events. Treatment discontinuation due to adverse events occurred in 44% of pts.
Conclusion
In this study, responses to combination immunotherapy were lower than reported. Patients treated with prior immunotherapy had similar responses as treatment‐naïve pts. The toxicity profile seen in this study is similar to those reported in clinical trials.
This work derives and analyzes an online learning strategy for tracking the average of time-varying distributed signals by relying on randomized coordinate-descent updates. During each iteration, ...each agent selects or observes a random entry of the observation vector, and different agents may select different entries of their observations before engaging in a consultation step. Careful coordination of the interactions among agents is necessary to avoid bias and ensure convergence. We provide a convergence analysis for the proposed methods, and illustrate the results by means of simulations.
Simeprevir (SPV) is a powerful antihepatitis C virus agent that was newly introduced into the pharmaceutical market. We here established and validated an easy, simple, and sensitive ...spectrofluorimetric method for its estimation at λem 427 nm (λex 337 nm). The suggested procedure was based on two times enhancement in the original emission of SPV through modifying its microenvironment in buffered aqueous solution by adding Triton X‐100. The relationship between the concentration of SPV and the observed fluorescence intensity was linear in the range 0.06–1.0 μg ml−1 with a correlation coefficient of 0.9997. The limits of detection and quantitation were 21 and 64 ng ml−1, respectively. The present method was effectively applied to quantify SPV content in pharmaceutical tablets and human plasma spiked with the drug with no interference from tablet excipients or plasma components.
Background: Minimally invasive heart valve surgery via anterolateral mini-thoracotomy with full endoscopic 3D visualization (MIS) has become the standard treatment of patients with valvular heart ...disease and low operative risk over the past two decades. It requires extracorporeal circulation and cardioplegic arrest. The most established form of arterial cannulation for MIS is through the femoral artery and is used by most surgeons, but it is suspected to increase the risk of stroke through retrograde blood flow. An alternative route of cannulation is the axillary artery, producing antegrade blood flow during extracorporeal circulation. Methods: Femoral or axillary cannulation for extracorporeal circulation during minimally invasive heart valve surgery (FAMI) is a multicenter randomized controlled trial designed to determine whether axillary cannulation is superior to femoral cannulation for the outcome of a manifest stroke within 7 days postoperatively. The target sample size was 848 participants. Patients ≥ 18 years of age, with valvular regurgitation or stenosis scheduled for minimally invasive surgery via anterolateral mini-thoracotomy, were randomized to axillary cannulation (treatment group) or to femoral cannulation (standard care). Patients were followed up for seven days postoperatively. A CT scan was performed pre-operatively to screen patients for vascular calcifications and to assess the safety of femoral cannulation. The standard of care is femoral artery cannulation, but is performed only in patients without significant vascular calcifications or severe kinking of the iliac arteries and in patients with sufficient vessel diameter. The cannulation is performed via Seldinger’s technique, and the vessel closed percutaneously using a plug-based vascular closure device. Only patients without significant vascular calcifications are considered for femoral cannulation, as an increased risk of stroke is assumed. In patients with vascular calcifications, axillary cannulation is the standard of care to avoid these risks. Retrospective studies have hinted that, even in patients without vascular calcifications, there may be a lower stroke risk with axillary cannulation compared to femoral cannulation. We present a protocol for a multi-center randomized trial to investigate this hypothesis. Discussion: To date, evidence on the best access for peripheral artery cannulation during minimally invasive heart valve surgery has been scarce. Patients may benefit from axillary cannulation for extracorporeal circulation in terms of stroke risk and other neurological and vascular complications, though femoral cannulation is the gold standard. The aim of this study is to determine the risks of peri-operative stroke in a prospective randomized comparison of femoral vs. axillary cannulation.
Obesity and iron deficiency (ID) are two forms of the most usual nutritional disorders worldwide. Some studies have discovered a correlation between ID and obesity although more investigation is ...required. This study was aimed to determine the association between obesity and ID anemia (IDA) in Iranian childbearing age women.
This cross-sectional study was done on 256 women of reproductive age in northern Iran. The anthropometric measurements including height and weight were measured, and body mass index (BMI) was calculated. Low blood index of the hemoglobin (Hb), mean cell volume (MCV), and mean corpuscular hemoglobin (MCH) were evaluated with ferritin, serum iron, and total iron-binding capacity. Baseline data were expressed as means ± standard deviations. Chi-square test was applied to compare the categorical variable. Differences between the two groups were evaluated with independent samples
-test. A value of
< 0.05 was considered as statistically significant.
Obesity was in urban women higher than rural women (55.1% vs. 44.9%), and this difference was significant (
< 0.021). There was found no association between hematological characteristics and BMI. The data showed that only 13.4% of obese women and 17.1% of the women with normal weight had IDA (odds ratio = 0.75; 95% confidence interval: 0.39-1.49,
> 0.05).
According to the results of this study, it seems that the relationship between obesity and IDA is controversial. Hence, further studies are needed to be done.
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