Frequency Of Blood Transfusion Research Articles

Controlled CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis

ABSTRACT Feldmeier J, Kirby J, Gelly H, Robins M, Peters J, Gruhn P, Pal S. Controlled CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis. Undersea Hyperb Med. 2024 Second Quarter; 51(2):145-157. Introduction: Increasing cancer survivorship, in part due to new radiation treatments, has created a larger population at risk for delayed complications of treatment. Radiation cystitis continues to occur despite targeted radiation techniques. Materials and Methods: To investigate value-based care applying hyperbaric oxygen (HBO2) to treat delayed radiation cystitis, we reviewed public-access Medicare data from 3,309 patients from Oct 1, 2014, through Dec 31, 2019. Using novel statistical modeling, we compared cost and clinical effectiveness in a hyperbaric oxygen group to a control group receiving conventional therapies. Results: Treatment in the hyperbaric group provided a 36% reduction in urinary bleeding, a 78% reduced frequency of blood transfusion for hematuria, a 31% reduction in endoscopic procedures, and fewer hospitalizations when study patients were compared to control. There was a 53% reduction in mortality and reduced unadjusted Medicare costs of $5,059 per patient within the first year after completion of HBO2 treatment per patient. When at least 40 treatments were provided, cost savings per patient increased to $11,548 for the HBO2 study group compared to the control group. This represents a 37% reduction in Medicare spending for the HBO2-treated group. We also validate a dose-response curve effect with a complete course of 40 or more HBO2 treatments having better clinical outcomes than those treated with fewer treatments. Conclusion: These data support previous studies that demonstrate clinical benefits now with cost- effectiveness when adjunctive HBO2 treatments are added to routine interventions. The methodology provides a comparative group selected without bias. It also provides validation of statistical modeling techniques that may be valuable in future analysis, complementary to more traditional methods.

Evaluation of the level of liver enzymes and its relationship with ferritin and the frequency of blood transfusion in patients with thalassemia

Evaluation of the level of liver enzymes and its relationship with ferritin and the frequency of blood transfusion in patients with thalassemia

Relationship of hemoglobin levels with outcomes in deceased donor kidney transplant: a retrospective cohort study.

Anemia is frequent in patients undergoing replacement therapy for kidney failure. Anemia in the pre- and post-transplantation period might be related to kidney transplant outcomes. The current study therefore sought to assess the relationship between anemia, delayed allograft function (DGF), chronic kidney allograft dysfunction (CAD), and death from any cause following kidney transplantation from a deceased donor. This was a retrospective study with 206 kidney transplant patients of deceased donors. We analyzed deceased donors' and kidney transplant patients' demographic data. Moreover, we compared biochemical parameters, anemia status, and medicines between DGF and non-DGF groups. Afterward, we performed a multivariate analysis. We also evaluated outcomes, such as CAD within one year and death in ten years. We observed a lower frequency of pre-transplant hemoglobin concentration (Hb) but higher frequency of donor-serum creatinine and red blood transfusion within one week after transplantation in the group with DGF. In addition, there was an independent association between Hb concentration before transplantation and DGF [OR 0.252, 95%CI: 0.159-0.401; p < 0.001]. There was also an association between Hb concentration after six months of kidney transplantation and both CAD [OR 0.798, 95% CI: 0.687-0.926; p = 0.003] and death from any cause. An association was found between pre-transplantation anemia and DGF and between anemia six months after transplantation and both CAD and death by any cause. Thus, anemia before or after transplantation affects the outcomes for patients who have undergone kidney transplantation from a deceased donor.

Role of tranexamic acid in reducing peri-operative blood loss in open spine surgeries.

Spine surgeries are associated with significant blood loss due to the extensive soft tissue dissection, bony decompression, and prolonged surgical time. Excessive bleeding may require blood transfusions and thereby increase the risk of adverse transfusion reactions. Therefore, minimizing peri-operative bleeding is important for spine surgeons to reduce post-operative morbidity. Tranexamic acid (TXA) is a synthetic anti-fibrinolytic drug, which helps in reducing perioperative blood loss in major surgeries. The evidence on the efficacy of this agent in all manner of spine surgeries is not sufficient. Hence this study was conducted to determine the efficacy of TXA on perioperative blood loss in major spinal surgeries. In a prospective study, two groups of patients with similar surgical profiles who were posted for all manner of open spine surgeries were included. One group received one gram of intravenous TXA while the others did not. Intra- and post-operative assessments included noting levels of surgery, duration of surgery, assessment of blood loss, intra- and/or post- operative blood transfusion, and blood collected in surgical drain at the end of 24h. The intra-operative blood loss, frequency of intra-operative blood transfusion, post-operative Hemoglobin drop, and surgical drain output were found to be significantly lower in patients who received TXA. In spine surgeries, TXA was found to be effective in reducing intra-operative blood loss, need for intra-operative blood transfusion and post-operative Hb drop. Also, TXA had reduced surgical drain output significantly between the two groups.

Support for Thrombolytic Therapy for Acute Stroke Patients on Direct Oral Anticoagulants: Mortality and Bleeding Complications.

Alteplase (tPA) is the initial treatment for acute ischemic stroke. Current tPA guidelines exclude patients who took direct oral anticoagulants (DOAC) within the prior 48 hours. In this propensity-matched retrospective study we compared acute ischemic stroke patients treated with tPA who had received DOACs within 48 hours of thrombolysis to those not previously treated with DOACs, regarding three outcomes: mortality; intracranial hemorrhage (ICH); and need for acute blood transfusions (as a marker of significant blood loss). Using the United States cohort of 54 healthcare organizations in the TriNetx database, we identified 8,582 stroke patients treated with tPA on DOACs within 48 hours of thrombolysis and 46,703 stroke patients treated with tPA not on DOACs since January 1, 2012. We performed propensity score matching on demographic information and seven prior clinical diagnostic groups, resulting in a total of 17,164 acute stroke patients evenly matched between groups. We recorded mortality rates, frequency of ICH, and need for blood transfusions for each group over the ensuing 7- and 30-day periods. Patients treated with tPA on DOACs had reduced mortality (3.3% vs 7.3%; risk ratio [RR] 0.456; P < 0.001), fewer ICHs (6.8% vs 10.1%; RR 0.678; P < 0.001), and less risk of major bleeding as measured by frequency of blood transfusions (0.5% vs 1.5%; RR 0.317; p < 0.001) at 7 days post thrombolytic, than the tPA patients not on DOACS. Findings for 30 days post-thrombolytics were similar/statistically significant with lower mortality rate (7.2% vs 13.1%; RR 0.550; P < 0.001), fewer ICHs (7.6% vs 10.8%; RR 0.705; P < 0.001), and fewer blood transfusions (0.9% vs 2.0%; RR 0.448; P < 0.001). Acute ischemic stroke patients treated with tPA who received DOACs within 48 hours of thrombolysis had lower mortality rates, reduced incidence of ICH, and less blood loss than those not on DOACs. Our study suggests that prior use of DOACs should not be a contraindication to thrombolysis for ischemic stroke.

Correlation between HBF and blood transfusion frequency in sickle cell patients referred to thalassemia specialized center in Damascus

Correlation between HBF and blood transfusion frequency in sickle cell patients referred to thalassemia specialized center in Damascus

Morbidity pattern and impact of hydroxyurea therapy among sickle cell patients in Raipur district of Chhattisgarh

ABSTRACT Background: Sickle cell disease (SCD) is a disorder marked by a single-point mutation in the beta-globin gene. Hydroxyurea is a globally accepted disease-modifying agent that sounds to be effective in managing clinically and probably preventing complications of SCD. The current study aims to document the morbidity pattern and impact of Hydroxyurea therapy in the Outpatient Department of Sickle Cell Institute, Raipur. Materials and Methods: This cross-sectional study was conducted among randomly selected sixty-five patients (adults and children above six years). After obtaining informed consent, relevant data were collected in a predesigned pretested questionnaire. The appropriate statistical exercise was applied for the interpretation of results and inferences. Results: Acute febrile illness 54 (83%) and 53 (81.5%) reported pain crisis observed to have the most common morbidity among the study subjects, followed by 55.4% (36), 33 (50.8%) jaundice and difficulty breathing, respectively. Joint pain was the most commonly observed complaint, particularly at the knee joint (76.9%). Other complaints such as hand-foot syndrome (24.6%), epistaxis (27.7%), and acute chest syndrome (21.5%). Vaso-occlusive crisis (72.4%), difficulty in walking (60.0%) and eyesight (35.4%), leg ulcers (9.2%), and dactylitis (3.1%) were also documented as clinical manifestations among study participants. Less than half (44.46%) had an awareness about SCD. Hydroxyurea therapy was highly significant in improving the patient’s clinical picture (P &lt; 0.01), especially following the frequency of hospitalization and the requirement for blood transfusion. Conclusion: Pain crisis is the most common morbidity among study participants with a low level of knowledge about SCD with febrile illness. Hydroxyurea therapy was found to be quite effective as a disease-modifying therapy, especially for reducing the frequency of blood transfusion and lowering hospitalization rates among SCD patients.

Comparative assessment of quality of life among adolescents with sickle cell disease and sickle cell trait: evidence from Odisha, India.

The present study aims to assess the quality of life (QOL) of adolescents with sickle cell disease (SCD) and sickle cell trait (SCT) in hard-to-reach regions in Koraput district of Odisha state. 387 adolescents with sickle cell genes (HbSS = 52, HbAS = 135, HbA = 200) were selected through their medical records from southern parts of Odisha. A validated and pretested QOL scale was modified to assess the QOL. The questionnaires were modified by aiming to describe the proportion of adolescents who feel restricted in different domains, measuring the extent within each domain, and finding an aggregate score of QOL. Furthermore, to explore the expenditure on health, 552 households were selected randomly, of which 72 families had HbS individuals. This study found a significantly lower health-related QOL in adolescents with SCD. However, most psychosocial sub-domains, for instance, worry about the illness, frequency of angry days, feeling jealousness toward other normal adolescents, and negative feelings of sadness on some days, are similarly affected in adolescents with SCT and SCD. The overall QOL of SCD individuals is more affected (percentage of affected mean score = 60.93%), followed by SCT individuals (35.63%). Healthy adolescents' QOL is relatively unaffected (13% were affected). The yearly frequency of blood transfusion received (1.7 ± 0.4) and hospitalization (2.1 ± 0.9) was significantly higher in adolescents with SCD. The healthcare expenditure was significantly higher (3.6% to 81.3% of the family income) in families with HbS than in families without HbS (0.8% to 19.2%) (p < 0.05). The overall QOL was affected in both SCD and SCT adolescents. The focus should be given equally to both SCD and SCT individuals, in spite of only SCD individuals.

Partial Splenic Embolization in Paediatric Sickle Cell Disease Patients with Hypersplenism.

To assess the safety and efficacy of partial splenic embolization (PSE) to reduce the need of transfusions and improve hematologic parameters in patients with hypersplenism and sickle cell disease (SCD). This prospective study includes 35 homozygous hemoglobin S patients with SCD and hypersplenism who underwent PSE from 2015 until 2021 in Kinshasa. Patients were evaluated, before and after PSE (1, 3 and 6months), using clinical, laboratory and ultrasonographic methods. PSE was performed with the administration of gelatin sponge particles embolizing 60-70% of the splenic parenchyma. The mean age was 10 (± 4) years and (21/35, 60%) were male. After PSE Leucocytes decreased at 3 months (16 692.94 vs 13 582.86, p = 0.02) and at six months Erythrocytes increased 2 004 000 vs. 2 804 142 (p < 0.001), Platelets increased (168 147 vs. 308 445, p < 0.001) and Hemoglobin increased (5.05g/dL vs. 6.31g/dL, p < 0.001) There was a significant dicrease in the need of transfusions from 6 (2-20) before PSE to 0.06 (0-1) after PSE (p < 0.001). The most frequent complication was splenic rupture (4/35, 11.4%), seen only and in all patients with hypoechogenic nodules at baseline. PSE is a safe procedure in patients with SCD and hypersplenism, that do not have hypoechogenic nodules in the spleen. PSE improves the hematological parameters and reduces the frequency of blood transfusions.

Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair.

Frailty is common in elderly and multimorbid patients and associated with increased vulnerability to stressors. In a single centre study frailty according to Fried criteria was assessed in consecutive patients before transcatheter mitral and tricuspid valve repair. Postprocedural infections, blood transfusion and bleeding and renal failure were retrospectively assessed from records. Median follow-up time for survival was 560 days (IQR: 363 to 730 days). 90% of 626 patients underwent mitral valve repair, 5% tricuspid valve repair, and 5% simultaneous mitral and tricuspid valve repair. 47% were classified as frail. Frailty was associated with a significantly increased frequency of bleeding (16 vs 10%; p = 0.016), blood transfusions (9 vs 3%; p = < 0.001) and infections (18 vs 10%; p = 0.006), but not with acute kidney injury (20 vs 20%; p = 1.00). Bleeding and infections were associated with longer hospital stays, with a more pronounced effect in frail patients (interaction test p < 0.05, additional 3.2 and 4.1 days in frail patients, respectively). Adjustment for the occurrence of complications did not attenuate the increased risk of mortality associated with frailty (HR 2.24 [95% CI 1.62-3.10]; p < 0.001). Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.

Role of lactate level in predicting admission need to intensive care unit and short term outcomes in patients with acute gastrointestinal bleeding

Abstract Background One of the most common emergencies seen in emergency departments is acute gastrointestinal bleeding (GIB). It’s associated with more disease burden and mortality. Increased venous lactate levels are common in critically ill patients, and it has been used as a possible predictor of patients’ outcomes in many critical cases, but not much is known about its predictive role in patients with acute GIB. With increasingly limited health care resources, there has been such an interest in coast saving measures and measuring lactic acid through venous blood gases is such a simple bedside test which can be easily done to patients with acute GIB at emergency department. Objective This study assessed the predictable value of lactate level on hospital admission on resource use, including length of hospital stay and admission to the intensive care unit (ICU), as well as other patient-oriented outcomes, including the need for blood transfusions and endoscopy. Patients and methods A prospective cohort hospital based study that included 300 patients with acute GIB who presented to emergency department (ED) of Assiut University Hospital between September 2019 and June 2022 were subjected to venous blood lactate through venous blood gases. Results The current study enrolled 300 patients with acute GIB. Two hundred of those patients had elevated blood lactate and 100 patients had normal blood lactate. It was found that patients with elevated blood lactate had significantly prolonged hospital stay (7.38 days ± 2.05 days vs. 3.96 days ± 1.74 days; (P &lt; 0.001). Also they had higher frequency of blood transfusion (98% vs. 72%), ICU admission (95% vs. 67%) and mortality (9% vs. 3%) in comparison to those with normal lactate level. Conclusion It was found that venous lactate level is an effective predictor for patient’s outcomes among patients with acute GIB.

Audiologic and vestibular assessment in children and adolescents with transfusion dependent beta thalassemia major: The era of deferasirox film coated tablet

BackgroundHearing impairment has frequently been described in β-thalassemia patients with a significant impact on the patients’ quality of life. Most studies provided evidence of deferoxamine (DFO) dose-related ototoxicity, however, the data is scarce regarding deferasirox (DFX) as a sole iron chelator. AimWe aimed to assess the prevalence and risk factors of sensorineural hearing loss (SNHL) and vestibular dysfunction in regularly transfused β-thalassemia patients who had been treated with DFX film coated tablets. MethodsWe conducted a case control study on 57 transfusion dependent β-thalassemia patients with a mean age of 15.3 years who received DFX FCT as monotherapy for at least one consecutive year, and 57 healthy age and sex-matching controls. Comprehensive audiological evaluations using pure tone audiometry (PTA) and transient evoked otoacoustic emission (TEOAE) as well as vestibular evaluation using Video-nystagmography (VNG) were done. ResultsSNHL was identified in 12 patients (21.1 %) using PTA and a statistically significant difference was detected between controls and patients at 6 KHz and 12 KHz frequencies. A higher incidence of SNHL was detected using TEOAE, 22 patients (43.1 %) failed to pass TEOAE, with a statistically significant decrease in the signal at frequencies 1, 4 KHz bilaterally and at frequencies 1.5, 2 KHz in the right ear compared to controls. Canal paresis was detected in 21 (36.8 %) of thalassemic children using bithermal caloric test with significantly more unilateral weakness than control children (P = 0.008). We found no significant correlation between audio-vestibular dysfunction and age, sex, serum ferritin, frequency of blood transfusion and dose of DFX FCT in thalassemic children. ConclusionWe conclude that the incidence of SNHL and vestibular dysfunction was high among transfusion dependent β-thalassemia patients. Therefore, we recommend performing pre-treatment baseline audio-vestibular assessment and yearly audio-vestibular monitoring to early detect high risk patients and initiate timely management to prevent permanent damage.

Comparing Hearing Loss in Children with Adults Living with Sickle Cell Disease and Sickle Cell Traits.

Hearing loss is a neurological sequelae associated with sickle cell disease (SCD) and probably sickle cell trait (SCT) in children and adults but remains understudied. This study aimed to compare the hearing impairment among children and adults living with SCD or SCT. A comparative cross-sectional study conducted in four departments with SCD outpatient clinic in a tertiary hospital in Nigeria. Participants with Sickle cell disease (HbSS) and Sickle cell trait (HbAS) (cohort) and HbAA (control) had comprehensive ear and hearing assessments for sensorineural hearing loss. Audiometric results were categorized according to WHO classifications and data analysed with Statistical Analysis System (SAS 9.4). A total of 212 participants (106 cohort and control, respectively), aged 6 months to 55 years, were enrolled. Of these, 35% of children with SCD and 25% with SCT had hearing impairment, while 30% of adults with SCD, 36.1% with SCT, and 11% with HbAA had hearing impairment. There was asymmetry in the hearing impairment, with the left ear more affected in children and the right ear in adults. The odds ratio (OD) of hearing impairment was higher in HbSS (2.48 (95% confidence interval (CI):1.51-4.14); P = 0.0004) and HbAS (2.28 (95% CI: 1.1-4.58); P = 0.02) participants compared with HbAA but was not statistically significant when adjusted for frequency of hospitalization, crises, blood transfusion and routine drugs in HbAS (P = 0.49) unlike HbSS (P = 0.03). The prevalence of hearing loss among children and adults with SCD is higher than in those with HbA genotype. The frequency of hospitalization, crises, blood transfusion and taking routine drugs may influence hearing impairment in SCT but may not in SCD.

Estimation of Microalbuminuria in Children with Beta Thalassaemia Major: A Cross-sectional Study

Introduction: Improvement in the standard of care of Thalassaemia by regular blood transfusion increases life expectancy. Multiple transfusions with concurrent iron overload and chronic anaemia, leading to tissue-level hypoxemia, cause significant renal dysfunction. Microalbuminuria is a sensitive marker of glomerular damage, and studies in thalassemic children have demonstrated variable prevalence rates of microalbuminuria. Aim: To study the prevalence of microalbuminuria and its association with clinical and laboratory parameters in children with Beta Thalassaemia Major (BTM). Materials and Methods: A cross-sectional study was conducted from January 2018 to June 2019 at Indira Gandhi Institute of Child Health, Bangaluru, Karnataka,India. A total of 155 children with Beta Thalassaemia Major (BTM) aged 2-18 years, attending the Thalassaemia Day Care Centre, were included in the study. Their demographic details such as age, gender, clinical parameters like frequency of transfusions, type of chelation therapy, height, weight, Body Mass Index (BMI), organomegaly, and laboratory parameters like serum creatinine, ferritin, pretransfusion Hb%, and Urinary Microalbumin Creatinine Ratio (UMCR) were studied as per a predesigned proforma. The association between microalbuminuria with clinical and laboratory parameters was evaluated using the independent sample T-test or Mann-Whitney U test and Chi-square/Fischer’s-exact test. Results: A total of 155 children with BTM were studied. In the present study, out of a total of 155 patients, microalbuminuria was found in 66 (42.6%). A significant increase in the prevalence of microalbuminuria was observed as the age advanced, as the frequency of blood transfusions increased, with low pretranfusion haemoglobin (g%), and with elevated serum ferritin. Conclusion: In the present study, the prevalence of microalbuminuria was found to be 42.6%. Screening for microalbuminuria is recommended in all children with beta thalassaemia major for the early detection of renal dysfunction, prevention of disease progression, and improvement in the quality of their lives.

Quality of life in children aged 5- 14 years with beta thalessemia major

With recent advances for a chronic disease like thalassemia, where lifelong management is required, the quality of life, not just survival gains important. Owing to high burden of thalassemia in Odisha, this study analyses the quality of life in pediatric beta thalassemia major and the factors influencing the same. This was a hospital based cross-sectional study done in a tertiary care hospital, Cuttack during September 2019 to January 2020. Children aged 5-14 years, diagnosed with beta-thalassemia major with regular blood transfusion, were subjected to modified SF-36 questionnaire to assess the quality of life in total and domains- General health , Physical health , Social activities , Limitation of activities, Educational , Psychological and Family aspect. Score above 50 considered as good. Data analysed using SPSS 18.0.Statistical significance was assessed by ANOVA and Chi-square test. Among 200 cases studied, majority (70.5%) had poor score, with mean being 49.19+6.53. In terms of domain, family aspect led (62.0+ 15.60), followed by limitation of activities(58.25+27.69), psychological aspect (51.75+ 12.47), physical health (50.85+14.60), educational aspect (41.92+ 19.294), general health (41.40+12.32) and social aspect was 38.17+ 24.20.A significant association was noted between good quality of life and male gender (p-0.004), mother’s occupation (p-0.013), number of children (p-0.001), higher serum ferritin level (p&amp;#60;0.05) and blood transfusion frequency (p-0.015) in the study population. Considering the poor quality of life in children with thalassemia major, there is urgent need to focus on holistic approach towards management incorporating educational, emotional and physical rehabilitation, to ensure their productivity in the society.

Iron profile in sickle cell heterozygous children: A case control study

Iron deficiency is the most common nutritional deficiency worldwide &amp; it is an important public health problem in developing countries like India. Normally chronic hemolytic anemia are iron loaded because of excessive breakdown of RBC &amp; increased frequency of blood transfusion, but there is small or no transfusion on sickle cell trait. This study has been done to see the iron profile among sickle cell trait children in western Odisha. To determine the iron profile in children with sickle cell trait &amp; normal healthy controls &amp; compare them. This was a case control study that has been conducted over a period of two years. A total of 202 subjects were included in the study; 102 of them were sickle cell heterozygous &amp; 100 of them were normal healthy controls. Iron deficiency anemia among sickle cell trait &amp; healthy controls were screened using various clinical &amp; laboratory criteria. A total of 202(n=202) study populations comprising of 102 sickle cell trait &amp; 100 normal study populations were screened. A little female preponderance (n=109, 54%) was observed in this study. Abnormalities in blood parameters like MCV, MCH, MCHC, Serum ferritin were found to be statistically significant (p&amp;#60;0.005). Others clinical features like pallor, picophagia, sore tongue, fatigue was also found to be statistically significant (p&amp;#60;0.005). Out of 202 study populations 17 out of 102 sickle cell trait cases &amp; 16 out of 100 normal controls were found to have Iron deficiency anemia. In this study it showed that there were many sickle cell trait patients who were actually iron deficient. These patients should be screened carefully to look for Iron deficiency anemia. Clinical parameters like pallor, fatigue, picophagia, sore tongue &amp; others laboratories parameters like MCV, MCH, MCHC, Serum ferritin were helpful in diagnosing Iron deficiency anemia.

Exploring The Effect of Wheat Grass Juice on Thalassaemia: A Comprehensive Review

Thalassemia is a hereditary blood disorder characterized by a deficiency in the oxygen-carrying protein (haemoglobin) and a reduced number of red blood cells in the body compared to normal. Mild forms of thalassemia may not necessitate treatment, while severe cases may require blood transfusions or a stem-cell transplant from a donor. Wheatgrass extract is seen as a supplementary treatment option for thalassemia, although research in this field is still in its early stages. Wheatgrass is a low-calorie substance but rich in essential nutrients, including antioxidants like glutathione, vitamin C, and vitamin E that plays a crucial role in combating harmful free radicals in the body, reducing oxidative stress, and providing protection against conditions such as arthritis, cancer, and neurodegenerative diseases. The proposed mechanism behind wheatgrass extract involves the swift absorption of chlorophyll and its action at the cellular level in the bone marrow, facilitating heme production. Treatment with wheatgrass tablets has been found to maintain serum ferritin levels and increase HbF levels in children with thalassemia who undergo frequent blood transfusions. However, it does not appear to reduce the frequency of blood transfusions required. Wheatgrass tablets also contribute to an improved quality of life for children with thalassemia. The present study aims to investigate the effectiveness of wheatgrass therapy in patients with transfusion-dependent anemia, further extensive studies involving a larger patient population would be necessary.

A systematic review and meta-analysis on the impact of nail length in treating intertrochanteric fractures

The management of intertrochanteric hip fractures remains a subject of ongoing debate, particularly regarding the ideal nail length for treatment. To address this, a systematic review and meta-analysis, based on randomized controlled trials (RCTs), were conducted to assess the outcomes associated with using short and long nails to fix intertrochanteric femur fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for comprehensive reporting, a thorough search was conducted across four databases (Cochrane, Google Scholar, Web of Science, and PubMed) from inception until March 07, 2022. The study encompassed all RCTs comparing the outcomes of short and long nail fixation for intertrochanteric hip fractures. A total of 620 patients with intertrochanteric fractures from six RCTs were included in this analysis. Short nails were used in 50.3% of the patients (312 out of 620). The utilization of short nails was significantly associated with a reduction in operative time (weighted mean difference [WMD] = −20.33; 95% confidence interval [CI]: −29.90–−10.76) and decreased blood loss (WMD = −106.31; 95% CI: −155.43–−57.19). However, no substantial differences were observed between the two types of implants in terms of length of hospital stay, Harris hip score, reoperation rate, complication rate, and 1-year mortality rate. The length of nails used to treat intertrochanteric hip fractures does not have a notable impact on factors such as functional recovery, blood transfusion frequency, reoperation likelihood, complications, or 1-year mortality rates. Nonetheless, when comparing the fixation of intertrochanteric fractures, it is worth noting that short nails result in shorter surgery duration and reduced blood loss compared to long nails.

Is Postoperative Helmet Molding Therapy Necessary for Craniectomy for Sagittal Suture Synostosis?

Endoscopic strip craniectomy followed by postoperative remodeling helmet therapy for scaphocephaly is widely accepted, but the requirement of several helmets might burden patients or their families. This study examined whether craniectomy via a bicoronal approach without molding helmet therapy is worth considering. The authors retrospectively reviewed patients with nonsyndromic sagittal suture synostosis who underwent the modified Renier H technique between 2016 and 2021. We collected data on preoperative and postoperative cephalic index (CI), operative time, estimated blood loss, and blood transfusion rates. The authors also examined all related literature in English describing endoscopic craniectomy with postoperative helmet molding therapy for sagittal suture craniosynostosis. Among 17 patients, the average operative time was 92.2±15.6 minutes, the mean estimated blood loss was 35.8±22.4mL, and a blood transfusion was needed for 9 patients (52.9%). The mean preoperative and postoperative CIs were 69.1±2.6 and 78.4±2.2, respectively. A comparison of the literature review with the authors' results showed that their procedures required a slightly longer operative time and a higher frequency of blood transfusions. There are no significant differences in blood loss or preoperative and postoperative CIs reported in the literature. The open procedure required a higher operative time than endoscopic suturectomy. However, dealing with bleeding is more challenging with endoscopic suturectomy. The cost of the helmets and the duration patients have to wear them, which might be burdensome for the patients or their families when determining the optimal minimally invasive treatment, should also be considered.

Real-World Experience of Individuals with Sickle Cell Disease Treated with Voxelotor: Initial Report from the Multicenter, Prospective Prospect Study

Introduction: Sickle cell disease (SCD) is an inherited blood disorder in which sickle hemoglobin (HbS) polymerization results in red blood cell sickling, which in turn leads to chronic hemolytic anemia, unpredictable pain episodes, and recurrent vaso-occlusive crises (VOCs). Hemolysis and low hemoglobin (Hb) are associated with organ damage, increased morbidity, and early mortality. Voxelotor, a first-in-class HbS polymerization inhibitor, is approved in the US for the treatment of patients with SCD aged ≥4 years and in Europe for the treatment of hemolytic anemia due to SCD in patients aged ≥12 years. In the phase 3, randomized, controlled HOPE (NCT03036813) and the phase 2, open-label HOPE-KIDS 1 (NCT02850406) trials, patients treated with once daily oral voxelotor experienced increased Hb levels and reductions in markers of hemolysis at Week 24 compared with baseline. Here we report the first efficacy and safety data from patients with SCD enrolled in the prospective PROSPECT registry who received voxelotor in a real-world setting. Methods: PROSPECT (NCT04930445) is a post-marketing, open-label, observational, prospective patient registry of patients with SCD (aged ≥4 years) in the US. Eligible participants are being treated with voxelotor as prescribed by their physician as part of their usual care. Participants are treated and evaluated per standard of care and at the physician's discretion. Treatment, including interruptions and restarting treatment, continue at the discretion of the treating physician. Patients receive any additional medications or transfusions as determined and prescribed by their physician. Follow-up duration is 5 years after the first dose of voxelotor therapy. Study data are collected from patient medical records and secondary data sources and entered in case report forms via an electronic data capture system. Results: At data cutoff (May 30, 2023), 85 patients were enrolled at 5 sites. The mean (SD) age was 33.2 (15.3) years, 51.8% of patients were female, and most (92.9%) were Black or African American. Overall, 72.9% of patients were genotype HbSS, 62.4% were taking concurrent hydroxyurea, and mean (SD) Hb at baseline was 7.7 (1.53) g/dL. The mean (SD) duration of treatment, excluding gaps, was 47.0 (12.35) weeks. At the data cutoff, 76 patients (89.4%) continued voxelotor treatment; 7 patients (8.2%) never started voxelotor, and 2 patients (2.4%) discontinued treatment because of adverse events (AEs).The initial prescribed daily doses of voxelotor were 1500 mg (84.7%), 1000 mg (8.2%), 900 mg (4.7%), or 500 mg (2.4%). The most common reasons for prescribing voxelotor were to reduce either anemia (74.1%), frequency of VOCs (15.3%), pain (14.1%), or the frequency of blood transfusion (9.4%); multiple reasons could be selected. In 66 patients with recorded baseline and posttreatment Hb values, the observed mean (SD) peak posttreatment Hb value was 9.0 (1.75) g/dL, representing a mean (SD) increase from baseline of 1.3 (1.25) g/dL. The range of peak Hb change from baseline was −1.4 to 4.6 g/dL and 52/66 patients (78.8%) had a positive Hb response (Figure). Reductions in markers of hemolysis were also observed following voxelotor treatment, with nadir mean (SD) decreases from baseline of −23.9% (55.92%) in reticulocyte percentage (n=54), −1.8 (2.36) mg/dL in total bilirubin (n=61), and −1.6 (1.95) mg/dL in indirect bilirubin (n=38). AEs of special interest reported in &amp;gt;3% of patients included diarrhea, headache, nausea, abdominal pain, and rash (Table); most of these AEs were mild or moderate in severity. Conclusions: PROSPECT is the first prospective patient registry of voxelotor, with the potential to follow up to 1000 participants for up to 5 years and enable long-term, robust data collection of real-world care patterns that could inform how best to incorporate voxelotor into the treatment paradigm of patients with SCD. In this initial cohort of participants enrolled to date, following voxelotor treatment for a mean duration of 47.0 weeks, the mean peak increase from baseline in Hb was 1.3 g/dL, and associated reductions in markers of hemolysis were observed. Safety data were consistent with the phase 3 HOPE and HOPE-KIDS 1 trials. Overall, these initial findings provide support for the real-world safety, tolerability, and effectiveness of voxelotor treatment in individuals with SCD. While enrollment is ongoing, updated data will be regularly reported.