Abstract: BACKGROUND: Although the terms “aphthous ulcers” and “aphthous stomatitis” have been used interchangeably in the past, the latter is now preferable. It is a widespread illness that affects 20% of the general population and 9% of children, according to estimates. Due to the high prevalence, pediatric patients who complain of mouth ulcers frequently present to medical and dental specialists. OBJECTIVES: Hematological assessments of patients with oral aphthous ulcer and comparison with healthy control. MATERIALS AND METHODS: A case–control study of 120 kids was conducted. The study included 100 patients with oral aphthous ulcer (56 male and 44 female) and a group of 20 healthy controls (10 males and 10 females). Data were collected using questionnaires. The questionnaires had two sections. The first section involved personal information. The second section is related to hematological examinations, such as hemoglobin level, serum iron level, folic acid level, Vitamin B12 level, and mean corpuscular volume. Statistical analysis was carried out using the t-test, and the LSD was employed to significantly compare the means. RESULTS: The level of hemoglobin in the control group was statistically highly significantly increased when compared with patients with mean ± standard error (SE) (13.14 ± 0.20) versus mean ± SE (10.39 ± 0.19). Serum iron showed an increased level in the control group compared to patients with statistically showed highly significant correlation with mean ± SE (71.77 ± 5.14) versus mean ± SE (46.76 ± 2.79). A highly significant correlation existed when compared the control group and patients concerning Vitamin B12 levels with mean ± SE (517.02 ± 28.11) versus mean ± SE (367.32 ± 21.25). CONCLUSIONS: Hemoglobin, serum iron, and Vitamin B12 levels of patients are higher than that of controls. It is very important to observe the hemoglobin, folic acid, Vitamin B12, and serum iron levels in patients with oral ulcer before it starts to suggest treatments for oral ulcer.

Abstract: Mutations in the hydroxymethylbilane synthase (HMBS) gene can lead to a deficiency of the HMBS enzyme, allowing porphyrins to accumulate to toxic levels in the liver and other organs, leading to acute intermittent porphyria (AIP). This case report describes the medical journey of a 20-year-old female, previously in good health, who experienced multiple hospitalizations and clinic visits due to severe abdominal pain episodes and remained undiagnosed for over 6 years. Despite the nonspecific nature of these symptoms, a suspicion of acute porphyria confirmed by genetic analysis revealed a splice pathogenic variant (c.826-2A>T) in the HMBS gene in a heterozygous state. As the disease progressed, the patient developed a series of complications, including hyponatremia, autonomic instability, and motor neuropathy, culminating in complete paralysis (quadriplegia) and respiratory failure. The case highlights the importance of early recognition and differential diagnoses in managing AIP, with genetic testing playing a crucial role in confirming the diagnosis.

Plasmablastic lymphoma is a rare and aggressive variant of diffuse large B-cell lymphoma. It often develops in immunocompromised patients, particularly in human immunodeficiency virus-positive individuals. This report highlights the development of such a rare, aggressive malignancy in an immunocompetent adult male with negative Epstein–Barr virus serology. The patient was diagnosed 6 months after the onset of neck and submandibular swelling. A pan-computed tomography scan revealed nodal and extranodal involvement of the iliac bone and iliacus muscle. Chemotherapy was planned, but the patient’s condition deteriorated and he died. This case helps us to understand the clinicopathological features of this malignancy in the Saudi population and may help in early detection and better prognosis.

Iron-deficiency anemia (IDA) is a global health concern, and its widespread prevalence and multifaceted impact on various populations, particularly in developing countries, underscore the urgency for efficient diagnostic and management strategies. While traditional diagnostic methods such as ferritin and transferrin saturation are fundamental, their limitations in sensitivity and specificity lead to challenges in the early detection and effective management of IDA. This review provides a comprehensive analysis of IDA, focusing on the evolution of diagnostic methods culminating in the utilization of reticulocyte hemoglobin content (CHr) as a critical biomarker. The core of this review is the detailed examination of CHr as a biomarker. Its emergence has been pivotal due to its superior sensitivity and specificity in identifying iron deficiency and monitoring therapy efficacy. The review discusses the comparative advantages of CHr over conventional methods, including its ability to detect IDA at an earlier stage and its utility in varied demographic groups, such as children and pregnant women. Future research directions are proposed, including integration of CHr into routine clinical practice, cost-effectiveness analysis, and technological advancements for enhanced measurement and accessibility. In conclusion, CHr holds significant potential for revolutionizing IDA management, paving the way for more precise and personalized medical interventions, thereby improving patient outcomes in diverse populations.

Cancer-associated thrombosis (CAT) is a substantial burden and an emerging topic of great interest in Vietnam. The management of CAT is complex, with several challenges, including a high risk of bleeding and thrombosis, treatment burden, and low treatment motivation due to the short life expectancy of patients. Another challenge in CAT management is the low awareness among local physicians regarding CAT. The introduction of direct oral anticoagulants, which offer a better risk–benefit profile compared to conventional anticoagulation, has brought about a revolution in CAT management. To address these challenges, a group of 14 experts, including cardiologists and oncologists, convened in January 2023 to discuss and provide comprehensive information on CAT management in Vietnam, along with recommendations to optimize clinical outcomes. This review will encompass the available evidence in the medical literature and the expert opinions derived from the meeting.

CONTEXT: Postoperative Portomesenteric venous thrombosis (PMVT), is a rare but significant condition that occurs in colorectal surgery patients. PMVT involves thrombus formation in veins such as the portal, superior mesenteric, inferior mesenteric, or splenic vein, often following colon and rectum surgical resection. Recognized risk factors include cancer and inflammatory bowel disease. AIMS: The research aimed to evaluate the prevalence, associated risk factors, and treatment methods for PMVT in a large academic tertiary care hospital. SETTINGS AND DESIGN: Retrospective review METHODS: A retrospective review of 750 colorectal surgeries was conducted, examining patient medical histories, operative details, perioperative medications, and postoperative complications. STATISTICAL ANALYSIS USED: Categorical variables were presented as frequencies and percentages, whereas continuous variables were presented as a mean +/- Standard deviation. Comparative analysis used odds ratios to understand the association between categorical risk factors and PMVT, and independent samples t-tests for continuous variables RESULTS: PMVT was identified in 0.8% of the 621 patients meeting the inclusion criteria, all of whom had underlying cancer. These patients were successfully treated with anticoagulants, without the need for surgery or resulting in any mortality at 45 days postoperatively. No significant variables associated with PMVT were identified in this cohort. CONCLUSIONS: PMVT after colorectal surgery, while rare, is predominantly seen in patients with cancer. The outcomes in these cases were favorable with medical therapy alone. Larger, long-term studies are recommended to further investigate risk factors and effective management strategies for PMVT.

The most prevalent ticagrelor adverse effects are bleeding, dyspnea, bradycardia, and, in rare cases, thrombotic thrombocytopenic purpura. Although extremely rare, ticagrelor can cause absolute or profound thrombocytopenia. We present a case of total thrombocytopenia caused by ticagrelor after 4 days of treatment. A male in his 60 s with hypertension, type 2 diabetes mellitus, and dyslipidemia presented with chest pain. A 12-lead electrocardiogram showed sinus rhythm at 80 beats per min, ST-segment elevation, Q waves, and ST depression in V4-V6, indicating inferolateral myocardial infarction. Patient received thrombolytics with prompt administration of aspirin and ticagrelor. Baseline platelet count was 138 × 109/L. A subsequent angiography was performed 10 h later that revealed multivessel disease and the patient deemed a candidate for coronary artery bypass surgery. About 72 h after presentation, he had hematuria and his platelet count dropped to 23 109/L. On repeat testing, a complete blood count indicated platelet counts of 23 × 109 and 9 × 109/µL. A peripheral smear revealed no signs of platelet clumping or schistocytes. As a result, ticagrelor and aspirin were promptly stopped. Six platelet units were transfused. Prior to discharge, the platelet count hit the 50 s and then recovered to baseline. Clopidogrel and aspirin were prescribed for the patient. On outpatient follow-up, no thrombocytopenia was observed. In addition to our patient, we came across two patients in the literature who developed profound thrombocytopenia after being treated with ticagrelor. The timing of ticagrelor-induced thrombocytopenia varied and all patients were treated with platelets transfusion and discontinuation of ticagrelor. No thrombocytopenia was seen thereafter. In conclusion, thrombocytopenia with ticagrelor should be considered when other potential causes of thrombocytopenia have been ruled out.

BACKGROUND: β-thalassemia major (βTM) is a genetic disorder characterized by a deficiency in hemoglobin production, ineffective erythropoiesis, chronic hemolysis, lifelong blood transfusions, iron overload, and increased risk of cardiac complications. OBJECTIVE: The study aimed to evaluate the growth differentiation factor-15 (GDF-15) concentration in βTM patients and its correlation with cardiac complications. H63D refers to a specific mutation in the HFE gene, which is associated with hereditary hemochromatosis (HH), a genetic disorder characterized by excessive accumulation of iron in the body. This mutation involves a change of histidine (H) to aspartic acid (D) at position 63 in the HFE protein. This mutation is often only written abbreviated as (H63D). MATERIALS AND METHODS: This case–control study was done on 120 subjects. A total of 60 patient samples were randomly collected from the Genetic Hematology Center at the Babylon Hospital, with an age range of 10–26 years. In addition, 60 samples were collected from healthy children in the same age range as the control group; patients and controls were subdivided into (10–18) and (18–26) year groups. GDF-15 was measured by enzyme-linked immunosorbent assay, and the genotyping of mutation was done by amplification refractory mutation system-polymerase chain reaction technique. RESULTS: The study revealed a significant increase in ferritin (FER) and GDF-15 levels in the patients compared to controls (P < 0.001). GDF-15 showed a direct correlation with age (r = 0.244, P = 0.02) and FER (r = 0.215, P = 0.04). There was a significant difference in H63D mutations between controls and patients (P = 0.044), with a higher proportion of the C-G (heterozygous for the mutant allele) genotype observed in βTM patients (31.67%). Additionally, a notable effect of the H63D mutation on serum ferritin (higher) levels within the βTM group was observed. CONCLUSION: Elevations of the GDF-15 in βTM patients indicate a high risk of cardiovascular complications in patients with βTM. The H63D mutation of the hemostatic iron regulator (HFE) gene is frequently found in βTM. Although a significant effect of the mutation was obtained on serum FER levels, it did not act as a risk factor in βTM patients. However, the frequent presence of the H63D mutation in patients indicated a possible association between single-nucleotide polymorphism and the iron regulation pathway.

BACKGROUND: Volume indices and count of platelets through sickle cell anemia (SCA) steady state are modified by chronic hemolysis, red blood cell sickling, and vaso-occlusion induced by this structural hemoglobinopathy. The bone pain crises additionally change these parameters. The recognition of the modification in platelet indices has a significant impact on understanding the pathogenesis and outcome of sickle cell disease patients. OBJECTIVES: This study objective is to compare volume indices and count of platelets of SCA patients in steady and through bone pain crisis states. PATIENTS AND METHODS: This is a retrospective cohort study that included 82 SCA patients who received care between October 2022 and October 2023 at the Hereditary Blood Disease Center, Basra, Iraq Written consent was obtained from all the participants and legal guardians. The criteria of inclusion involved SCA patients of 13 years old and older who presented to the center at the period of the stdy. They had their platelet count and volume indices measured during the crises of bone pain and in the steady state later on. Platelet count, platelet distribution width (PDW), plateletcrit (PCT), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were measured by the automatic analyzer. RESULTS: Through bone pain crises as well as steady state, patients had a normal mean platelet count in comparison to the reference values of non-SCA population. It was found that MPV, PDW, PCT, and P-LCR were different in a significant way between the steady and bone pain crisis states, with P ≤ 0.001 with the mean values of 9.69 ± 1.25 versus 11.09 ± 0.99 for MPV, 13.27 ± 0.46 versus 15.78 ± 0.65 for PDW, 0.31 ± 0.03 versus 0.36 ± 0.01 for PCT, and 0.16 ± 0.01 versus 0.18 ± 0 for P-LCR, respectively. CONCLUSIONS: Through the steady state as well as bone pain crisis, the platelet count of SCA patients showed a normal value according to the range of reference for the normal population with no SCA. The P-LCR, MPV, PCT, and PDW were different significantly between SCA two clinical states as they became higher through the state of bone pain crises. This finding reflects the increment in the activation of platelets and the existence of large platelets in circulation at the time of vaso-occlusive crises.