Mean Hemoglobin Level Research Articles

Occult hepatitis B virus infections and risk factors among school-going adolescent voluntary blood donors in Kwale County Kenya, January 2020-June 2021: Cross sectional study.

Occult hepatitis B virus (HBV) infections remain a safety concern worldwide. The prevalence in Kenya ranges from 2.6% to 4.4% among secondary school-going voluntary blood donors. This study estimated the prevalence of occult HBV infections among school-going voluntary blood donors through donations made to Kwale Satellite Blood Transfusion Center (KSBTC). This was a retrospective cross-sectional study on data collected by the KSBTC between January 2020 and June 2021 among secondary school-going voluntary blood donors. Data were collected in MS Excel 2013 and analyzed in Epi Info 7. Descriptive statistics were calculated and we compared donors with positive Hepatitis B surface antigen (HBsAg) to those with negative HBsAg. Crude Prevalence Odds Ratios (cPOR) at 95% confidence intervals (CI) were calculated to identify factors associated with positive HBsAg. A total of 613 records were analyzed. The mean age of the donors was 19.1 years (± 1.8 years), there were 457 males (74.5%), 502 individuals were in the age group 18-25 years (82.3%), and the mean hemoglobin level was 14.1 g/dl (±1.6 g/dl). First-time blood donors made up 84.8% of all donors (513/605) and the mean inter-donation period was 20 months (±5.8 months) for repeat donors. The sero-positivity for HBsAg was 8.8% (54/613). Age category 16-17 years with positive HBsAg were 10.2% (11/108), femaleswere10.9% (17/156), and first-time donors were 9.4% (48/513). On bivariate analyses, first-time blood donors were 1.5 times more likely to test positive for HBsAg compared to repeat donors (cPOR = 1.5, 95% CI 0.61-3.57). Females were 1.4 times more likely to test positive for HBsAg compared to male donors (cPOR = 1.4, 95% CI 0.76-2.54). The majority of the voluntary blood donors were males and the majority of occult HBV infections came in the first-time blood donor group. We recommend increasing targeted recruitment of repeat donors by encouraging healthy first-timer donors to be regular donors, and suggest this population should be vaccinated against HBV infections.

Prophylactic effect of rectal and sublingual misoprostol on postpartum hemorrhage in mothers with preeclampsia following cesarean section surgery; a double-blind randomized controlled trial

BackgroundPostpartum hemorrhage is one of the three major causes of maternal morbidity and mortality, so delay in the diagnosis and proper management of postpartum hemorrhage is of great importance. The present study aimed to determine the prophylactic effect of misoprostol on postpartum hemorrhage in patients with preeclampsia. MethodsThis was a double-blind randomized controlled clinical trial performed on 128 pregnant women with preeclampsia undergoing cesarean section in Kamali hospital in Karaj. After cesarean delivery, immediately after clamping the umbilicus, the first group was administered 400 μg of rectal misoprostol and the second group was given 400 μg of sublingual misoprostol. The third group (control) was given 30 units of oxytocin during surgery and within 12 h after surgery, respectively. Hemoglobin and hematocrit were measured 24 h later. The estimated bleeding rate by the physician, the need for additional medication to control bleeding, and the amounts of hemoglobin and hematocrit in the first 24 h were compared in the three groups. Finally, the obtained information was entered into SPSS version 21 and analyzed using statistical tests. ResultsThe mean hemoglobin and hematocrit levels 6 and 12 h after cesarean section were significantly lower in the oxytocin group than in the sublingual and rectal misoprostol groups (Hemoglobin level (mg/dl) for oxytocin group 10.39 ± 0.73 and 9.53 ± 1.09 vs. sublingual misoprostol 11.05 ± 0.71 and 10.39 ± 0.84 vs. rectal misoprostol 10.92 ± 0.85 and 10 ± 1.01; hematocrit level for Hemoglobin level (%) for oxytocin group 31.27 ± 2.29 and 28.64 ± 2.93 vs. sublingual misoprostol 33.09 ± 2.20 and 31.05 ± 2.37 vs. rectal misoprostol 32.54 ± 2.7 and 29.92 ± 2.86) (p < 0.005). The mean estimation of visual bleeding in the oxytocin group was higher than the other three groups, followed by the rectal and the sublingual groups, respectively. However, there was no significant difference between the three groups regarding visual bleeding. There was no significant difference in hemoglobin and hematocrit between the two groups of sublingual and rectal misoprostol before and 6 and 12 h after the surgery (P > 0.05). ConclusionIt seems that sublingual or rectal misoprostol administration along with oxytocin is associated with a reduction in postpartum cesarean section bleeding compared to oxytocin administration alone.

The Effect of Recombinant Erythropoietin on the Levels of Hemoglobin, Mean Corpuscular Volume, LDH, and Length of Stay at the Hospital in COVID-19 Patients

Background: Erythropoietin plays a significant role in the growth of red blood cells, hemoglobin levels, and tissue oxygenation in critically ill patients, as well as anti-inflammatory and neuroprotective effects. Objectives: This study aimed to evaluate the effect of recombinant erythropoietin on improving COVID-19 patients. Methods: This study was conducted on 20 COVID-19 participants with hemoglobin of ≥ 9. The inclusion criteria was at least one severe COVID-19 symptom/sign in this interventional study. The primary outcome was a combination of hospital stay length and paraclinical evaluation (LDH and hemoglobin level). The outcomes and side effects were evaluated on day 0 (before the intervention) and five (post-intervention). Results: The mean hemoglobin level was 10 ± 1.1 gr/dL in the intervention group and 8 ± 0.7 gr/dL in the control group post-treatment, indicating a significant difference between the groups (P = 0.04). The mean hospital stay length (6 ± 2 days) in the intervention group was significantly less than the control group (9 ± 4 days) (P = 0.001). At the end of the treatment, the mean LDH was significantly lower in the intervention group (503 ± 264 µ/L) than in the control group (725 ± 320 µ/L; P = 0.017). Conclusions: According to the results, this study provides the first solid evidence for the positive effects of recombinant erythropoietin on COVID-19.

Prevalence of raised body mass index in paediatric sickle cell disease.

Children with sickle cell disease (SCD) have historically weighed less than their healthy peers. More recently, a retrospective chart review from six institutions in New England reported nearly one-quarter of children and adolescents with SCD had raised body mass index (BMI). This study aimed to examine rates of children with SCD with raised BMI in Mississippi compared to state and national norms and assess the correlation between haemoglobin and BMI. A retrospective chart review of paediatric patients with SCD at the University of Mississippi Medical Center (UMMC) was conducted using data from the most recent clinic visit. Mississippi and national weight status estimates for youth 10-17 years were obtained from the 2016-2017 National Survey of Children's Health. For youth 10-17 years with SCD (n =345), 21.4.% of children with SS/Sβ° and 36.1% with SC/Sβ+ had raised BMI compared to Mississippi and national rates, 39.2 and 31%, respectively. The prevalence of children with raised BMI with SC/Sβ+ did not differ from state and national rates, while children with SS/Sβ° were half as likely as their Mississippi peers to have raised BMI. Haemoglobin levels were different among children with SCD who had low BMI (8.80 g/dL), average BMI (9.2g/dL) and raised BMI (10.5g/dL) (P < 0.001). Children with SCD evaluated at UMMC have similar rates of raised BMI compared to state and national norms. Children with raised BMI have higher mean haemoglobin levels compared to children with SCD with low or average BMI. Historically, patients with SCD have been underweight and normal weight. Our paediatric and adolescent patients with SCD now have prevalence rates of raised BMI that approach state and national rates. Further work must be done to determine whether this reflects healthier children with SCD or raises concerns about life-style-related comorbidities.

JAK2 Mutation and Its Assessment in Relation to Profile of Young Polycythemia Patients in India

Abstract Purpose The main aim of this study was to detect the presence of JAK2 mutation and its assessment in relation to the clinical, hematological, and mutational profile of young patients with established polycythemia. Methods Cross-sectional observational study was undertaken over a period of 1 year in a tertiary care center. Sixty patients were included in our study between the age 18 and 50 years with confirmed diagnosis of polycythemia vera. Reports of all the investigations including bone marrow biopsy and JAK2 mutation testing were assessed. Results Presence of JAK2 mutation V617F was found in 38% patients, while bone marrow panmyelosis was present in 67% patients. Higher mean hemoglobin levels were observed in JAK2 mutation-positive patients, compared with those who were negative. Thrombosis-related complications were observed in five patients, all of whom were JAK2 mutation positive, while out of the 18 patients requiring phlebotomy, 15 patients were JAK2 mutation positive. Conclusion JAK2 mutation V617F in young Indian population is seen in significantly less cases as compared with Western data, while bone marrow panmyelosis is frequently observed and thus a significant finding for diagnosing polycythemia in our setting. Median hemoglobin was greater for JAK2 mutation-positive cases and so were the phlebotomy requirements and thrombotic events occurrences. Forty-two percent patients had history of some exposure to high-altitude areas adhering to the fact that high altitude is an established risk factor for developing polycythemia and the same is reinforced by our study.

Efficacy and Safety of Hydroxyurea as Adjuvant Therapy in Pediatric Patients of Transfusion-Dependent Beta-Thalassemia Major at Zhob, Balochistan.

BackgroundHydroxyurea is being used effectively in sickle cell anemia and thalassemia intermedia. Its role in transfusion-dependent beta-thalassemia major yet needs to be clearly established. This study has been carried out to assess the efficacy and safety of hydroxyurea as adjuvant therapy in pediatric cases of transfusion-dependent beta-thalassemia major disease.Materials and methodsThis quasi-experimental study was carried out at District Headquarter Hospital (DHQ), Zhob, from February 2021 to January 2022. One hundred ten cases fulfilling the inclusion-exclusion criteria were selected and divided into groups of 55 each. Group A cases received hydroxyurea (10-20 mg/kg/day) in addition to blood transfusion and chelation therapy. Group B received a blood transfusion and chelation therapy only. Both groups were compared in terms of blood transfusion requirement, mean hemoglobin, and mean serum ferritin levels. All the data were analyzed with SPSS 21 (IBM Corp., Armonk, NY).ResultsOf Group A cases, three were dropped because of side effects of hydroxyurea, and two were lost to follow-up. Similarly, three cases of Group B lost to follow-up, one patient withdrew consent, and one child died at home; thus both groups were left with 50 cases each. The mean age of participants was 11.98 + 3.74 years. There were 51 males and 49 females. Both the groups were comparable in terms of age and gender. Similarly, mean hemoglobin levels and serum ferritin levels were comparable at the start of the study. After one year, there was a significant improvement in mean hemoglobin level (p<0.001) and a significant reduction in serum ferritin levels (p=0.014) in the group taking adjuvant hydroxyurea. The requirement of packed red blood cells (RBCs) significantly decreased in cases taking hydroxyurea (p<0.001).ConclusionHydroxyurea is a safe and effective treatment that significantly decreases the packed RBC transfusion requirement in transfusion-dependent thalassemia children, improves hemoglobin levels, and reduces serum ferritin levels compared to the children on blood transfusions alone.

Clinical Characteristics and Symptomatology Associated With Dengue Fever.

BackgroundEarly diagnosis and prompt treatment are critical to reducing overall morbidity and mortality associated with dengue fever. Thus, to better understand the condition, the present study was conducted to assess the clinical signs and symptomatology associated with dengue fever in patients in a tertiary care hospital.MethodsThis prospective observational study was conducted at a tertiary care hospital in Karachi, Pakistan between July and December 2021. All patients who tested positive for the dengue virus either based on antigen or antibodies were included in the study. Convenient sampling was used. A structured proforma was used for data collection. Microsoft Excel (Microsoft Corporation, Redmond, WA) and Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY) were used for the entry and analysis of data, respectively.ResultsMore than half of the patients were suffering from fever (82.5%), headache/body ache/joint pain (80.5%), and vomiting (55%). Bleeding was observed in 16 (8%) patients and was directly related to platelet count (OR: 0.981; 95% CI: 0.971-0.992), and more than half of the patients (56%) required platelet transfusion. Laboratory values included a mean platelet count of 145.22 ± 90.36 thousand, a mean total leukocyte count (TLC) of 6.87 ± 5.76 thousand, and a mean hemoglobin level of 13.71 ± 2.11 g/dl. Of the patients, 171 (85.5%) individuals tested positive for antigen nonstructural protein 1 (Ns1Ag), and 68 (34%) tested positive for either immunoglobulin G (IgG) or immunoglobulin M (IgM), or both dengue-specific antibodies. Those with dengue-specific antibodies were less likely to bleed as 6.2% were IgG and IgM positive and 31.2% were positive for both antibodies. The regression model showed a significant relationship between bleeding and platelet transfusion (p < 0.001), hospital stay (p < 0.005), and diarrhea (p < 0.001).ConclusionIn conclusion, the study revealed that males were more frequently infected with the virus as compared to females. Furthermore, fever, headache/joint pain/body aches, diarrhea, and low platelet count are the major clinical and laboratory outcomes. Patients with a low level of platelets are more prone to bleeding, and platelet transfusion increased survival chances in such patients.

A Study on Evaluating the pattern of medicine use by patients undergoing dialysis in a tertiary care hospital of Eastern India

Background: Patients of end stage renal diseases on hemodialysis often suffer from multiple comorbidities leading to poly pharmacy which might lead to potential drug-drug interaction. Aims and Objectives: The aim of this study was to assess the pattern of medicines prescribed to patients undergoing dialysis in a tertiary care hospital. Materials and Methods: A cross-sectional observational study was conducted on patients admitted in dialysis unit to assess the pattern of drug use among them in a tertiary care hospital in eastern India from June to December 2019. With prior approval from the Institutional Ethics Committee the demographic details, biochemical and hematological parameters and details of medicine use were captured in a pre-designed, pre-validated form. The data were interpreted in mean, percentage, and diagrams using Microsoft Excel 2010. Results: Among the recruited patients (n=160), majority of them were homemakers (30.62%) and unemployed (30%), out of which 42.75% were male and 51.25% were female suffering from chronic kidney diseases (70.62%) and acute kidney injury (29.37%). The mean age of the study population was 46.7±16.35 years. The mean pre-dialyzed systolic and diastolic pressure (mm Hg) and pulse rate recorded was 140.56±21.94, 83.04± 13.29, and 81.97±5.51, respectively. Before hemodialysis, the mean hemoglobin level was 11.135±1.219 gm/dl, urea139.81±69.29 mg/dl, creatinine 6.48±3.77mg/dl, sodium 136.63±4.07mEq/L, and potassium 4.47± 1.00 mEq/L. Major comorbidities found associated with these patients were hypertension (68.75%), diabetes mellitus (52.5%), and hypothyroidism (11.87%). The commonly prescribed drugs were anti-hypertensive (73.8%), proton pump inhibitors mainly pantoprazole (68.1%), diuretic (86.2%), calcium supplements (74.3%), insulin (53.1%), and erythropoietin (49.3%). Average number of drugs administered per patient was 5.3±1.78. Conclusion: Patients in the dialysis unit are exposed to multiple drugs at a time due to their association with multiple comorbidities. Physician need to deal such patients very cautiously to avoid drug-drug interactions and adverse drug effects.

Is anemia a risk factor in pneumonia progression in covid-19-infected patients?

Abstract Background Determining the factors contributing to the development of severe coronavirus 2019 disease (COVID-19) disease is of great importance for health guidance. In this study, the authors aimed to investigate whether there is a relationship between anemia and progression of COVID-19 pneumonia. Patients and methods Records of 201 patients whose RT-PCR positivity for COVID-19 was confirmed between August 2020 and October 2020, when admissions and hospitalizations were at their peak, were retrospectively reviewed. The scoring system based on visual evaluation was used for evaluating the severity of the disease on each computed tomography (CT). To determine the progression status of pneumonia, the score difference was calculated by the difference between two CT scores. The patients were divided into two groups according to their hemoglobin levels as anemic and nonanemic patients. Results A significant difference was reported between the CT score difference groups in terms of mean age (P&lt;0.001). The mean age of the group that did not show progression was significantly lower than the other groups. Although the mean hemoglobin level of the group that did not show progression was higher than the other groups, no significant difference was reported between the groups (P=0.768). There was no significant difference between the CT score difference groups in terms of the presence or absence of anemia (P=0.791). Conclusion No significant relationship was found between hemoglobin levels, anemia, and pneumonia progression in COVID-19-infected patients.

Effectiveness of Ivermectin among COVID-19 patients: A Randomized Controlled Trial

Objectives: To determine the effectiveness of Ivermectin among COVID-19 patients in terms of mortality and biochemical / hematological attributes.&#x0D; Materials and Methods: A Randomized Controlled Trial (RCT) was carried out in Department of Infectious Diseases (DID) of Holy Family Hospital Rawalpindi during March 2021 through concurrent parallel study design. Apart from seeking Ethical approval for this research, DID was also licensed from Drug Regulatory Authority of Pakistan (DRAP) for this trial. Total 90 PCR positive COVID-19 patients were enrolled in this study via 1:1 randomization in experimental and control group without blinding. The control group received Standard of Care (SOC) starting from day 1 while experimental group was given SOC along with Ivermectin (200µg/kg) for 5 days. Study participants were assessed on day 0, 4, 7 and 10 for general symptoms through physical examination, blood oxygen saturation and diverse hematological and biochemical indicators in addition to adverse events. Data analysis was done by means of SPSS version 25.0. and Microsoft Excel 2010. Mean ± SD for age, length of hospital stay and time to PCR negativity were calculated. Independent sample t-test was applied to determine the mean difference in age, duration of hospital stay, time to PCR negativity, SpO2, oxygen supply, serum Hemoglobin, TLC, platelet count, Clinical Severity Score (CSS), urea and creatinine levels of both groups. The difference in secondary outcome (expiry / discharge) of both groups was compared by means of chi-square test. P-value ≤ 0.05 was considered significant. 95% Confidence Interval was also computed. Relative Risk (RR) was also measured to verify the effectiveness of Ivermectin in COVID patients&#x0D; Results: Males constituted the majority (56.7%) of our study participants. Statistically insignificant difference in mean age (P = 0.42) and mean length of hospital stay (P= 0.32) between experimental and control group subjects was observed. Mean time to PCR negativity was reported to be significantly less (P= 0.002) in experimental group. Significant improvement was seen in PCR negativity (P&lt;0.05), mean Clinical Severity Score (CSS) (P0.02), mean hemoglobin level (P=0.03) and mean platelet count (P=0.03). Difference in health outcome of both groups was determined to be statistically insignificant (P&lt;0.2, 95% CI (-0.20 – 0.12)). Relative Risk of 0.8 proved the protective effect of Ivermectin in COVID.&#x0D; Conclusion: Ivermectin was quite effective in reducing mortality and improving the health outcome in COVID-19 patients.

Prevalence of Severe Anemia among Pregnant Females and Factors Associated With Anemia in Pregnancy

Background: According to World health organization anemia is most common among females during pregnancy and child birth. Maternal and fetal morbidity and mortality is high due to anemia in pregnancy as it is a contributing factor in poor pregnancy outcome. It is the main cause of maternal death, almost 29% of women die due to anemia in pregnancy. Half of the maternal mortality causes are related to anemia in pregnancy either directly or indirectly. What so ever is the cause of anemia in pregnancy, its management is important for mother and child health. The consequences of anemia have serious health implications especially among pregnant females. Methodology: The cross-sectional study was conducted to find prevalence of anemia during first, second and third trimester of pregnancy and factors related to cause of anemia. A total of 340 pregnant females of government and private hospitals of Lahore city during the period from February 2017 to August 2018 were included in study after sample size calculation through convenient sampling. Sociodemographic, economic status, education level, number of children born to females and gestational period were the factors that were studied among anemic pregnant females. Data analysis was done and frequencies of continuous variables and descriptive analysis for categorical variables were determined. Prevalence of anemia was determined by multinomial logistic regression. Results: Our study showed females were with mean age 27.9 (±SD=5.4) and in age group 31-39 years (53.8%) were more anemic during pregnancy as compared to females &lt;30 years of age. Most of the females (67.1%) were housewives and had primary level of education (49.1%). Among these females (30%) were with mild anemia, (53.5%) were with moderate anemia and (16.5%) were with severe anemia. The mean hemoglobin level was 9.8g/dl (SD=±1.6). Among pregnant females 152(45%) were anemic during third trimester of pregnancy. Result showed 167(48.8%) females were anemic having children &gt; 3. Sociodemographic factors, education level, number of children born to female, economic status all were significantly associated with moderate anemia during pregnancy (p=0.00). Conclusion: Our study showed that although the prevalence of anemia is more among pregnant females but the severe anemia was less. So, it is a preventable health problem which can be controlled by different public health approaches to reduce the burden of disease on the health system. The strategies to control anemia in reproductive age women is important to prevent it among pregnant women. the early diagnosis and immediate correction of anemia is important to reduce the complications of pregnancy and its poor outcome. Early identification of factors is significantly important in managing the problem. Keywords: anemia, pregnancy, prevalence of anemia, gestational period.

Frequency of Anemia and its Types in Type II Diabetes Mellitus Patients without Renal Insufficiency

Background: Diabetes mellitus is one of the most common diseases of twenty-first century. Anemia is 2 to 3 times more common in Diabetic Mellitus patients as compared to normal individuals. Aims and Objective: We aimed to determine the frequency of anemia and its types in patients with type II diabetes mellitus without renal insufficiency. Methodology: It was an observational study done at the Medicine department of Nishtar Medical University and Hospital Multan for six months from December 2021 to May 2022. We included 200 diabetic patients aged between 18 to 80 years. All the patients had normal renal function test with the duration of diabetes being more than one year. Men with HB level &lt; 13.0g/dL and women with a HB level &lt; 12.0g/dL were considered to have anemia. Data was collected through a structured proforma. SPSS version 20.0 was used for data analysis. Results: Out of 200 patients, there were 118 (59%) females and 82 (41%) males. The mean age of patients was 49.64±13 yrs (25-79 yrs.), the mean duration of diabetes was 5.98±4.65 (1-25 years), mean hemoglobin level was 11.97±2.3 mg/dl (7-16mg/dl) and mean MCV was 86.7±9.5 (64-110). Seventy-eight (39%) had anemia, and the remaining 122 (61%) patients were non-anemic. Out of 78 anemic patients, 33 (42.3%) had microcytic anemia, 33 (42.3%) had normocytic anemia and 13 (16.6%) had macrocytic anemia. 108 (54%) had controlled diabetes mellitus and 92 (46%) had uncontrolled diabetes mellitus. There were 52 (66.7%) anemic patients with uncontrolled diabetes and 26 (33.3%) with controlled diabetes (P-value= 0.000). Conclusion: We concluded that diabetics patients without renal insufficiency have a significant risk of anemia. Our findings also revealed that in diabetic patients without renal insufficiency, poor glycemic management, longer disease duration, and old age significantly increase the risk of anemia. Key words: Anemia, Type 2 Diabetes mellitus, Glycosylated Hemoglobin, Renal insufficiency

The Effect of an Earthquake Experienced During Pregnancy on Maternal Health and Birth Outcomes.

Maternal health in pregnancy and birth outcomes were compared between pre- and post-Varzaghan earthquake. In this retrospective descriptive study, before and after the earthquake, 550 and 450 women were enrolled respectively. Neonatal weight, height, and head circumference, as well as maternal weight gain and hemoglobin (Hb) levels were obtained using medical records at health centers. Chi-square test and Independent t-test were used to analyze differences in pregnancy outcomes. A P-value less than 0.05 was considered significant. A significant increase in inadequate gestational weight gain (44.1% vs 58.9%) was observed (P = 0.043) before and after the earthquake. The mean hemoglobin level in the first trimester before the earthquake was significantly higher than after the earthquake (P = 0.001). Before-after earthquake comparisons showed that the mean birth weight, birth height, and birth head circumference were decreased significantly (P < 0.05). In addition, the rates of preterm birth (18.91% vs 10.90%), abortion (17.11% vs 10.54%), and stillbirth (3.78% vs 1.82%) were increased significantly after the earthquake (P < 0.05). Earthquake causes inadequate gestational weight gain and decreased hemoglobin levels, which lead to adverse birth outcomes. More longitudinal and well-designed studies are desired to investigate the longitudinal consequences of disasters on susceptible groups.

S285: INHIBITION OF COMPLEMENT C1S WITH SUTIMLIMAB IN PATIENTS WITH COLD AGGLUTININ DISEASE (CAD): 2-YEAR FOLLOW-UP FROM THE CARDINAL STUDY

Background: CAD is a rare chronic autoimmune hemolytic anemia characterized by classical complement pathway (CP)-mediated hemolysis. Sutimlimab is a first-in-class humanized monoclonal antibody that selectively inhibits C1s of the C1 complex, preventing CP activation, while leaving the alternative and lectin pathways intact. One-year interim follow-up from the CARDINAL study (NCT03347396) have previously demonstrated that sutimlimab resulted in sustained improvements in hemolytic markers and quality of life. Aims: To report 2-year sutimlimab efficacy and safety from the CARDINAL Part B extension. Methods: CARDINAL was a Phase 3, open-label, single-arm study with a 26-week treatment period (Part A) and a 2-year extension (Part B) after the last patient (pt) finishes Part A. Sutimlimab was administered through intravenous infusions on Days 0 and 7, followed by biweekly dosing. Efficacy data through Week 131, the last data recording within the 2-year Part B period, are reported here. Efficacy endpoints included change from baseline in hemolytic markers, pharmacodynamic (PD) markers and blood transfusions. Quality of life (QOL) was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale. Safety was recorded until end-of-study visit 9 weeks after their last dose; endpoints included incidence of treatment-emergent adverse event (TEAE) and serious TEAE (TESAE). Descriptive statistics, frequency, and percentage were used to analyze outcomes. Results: Of the 24 pts enrolled in Part A, 22 completed Part A and entered Part B, with 19 (86.4%) pts completing Part B. Sutimlimab treatment improved mean (SD) hemoglobin (Hb) levels within one week; mean Hb remained >11 g/dL from Week 5–131 (baseline: 8.64 (1.67) (Figure). Mean total bilirubin was normalized from Week 3–131 (Figure). Mean FACIT-Fatigue scores improved within 1 week and remained ≥5 from Week 1–123 (Figure), consistent with a clinically meaningful change. Improvements in Hb, bilirubin, and FACIT-Fatigue correlated with normalization of C4 and near-complete inhibition of CP activity. Normalization of mean absolute reticulocyte count was observed alongside normalized haptoglobin levels and reductions in LDH. From Week 26–131, 15 (68.2%) pts remained transfusion-independent. All 22 pts experienced ≥1 TEAE; 12 (54.5%) pts experienced ≥1 TESAE. Serious infections were reported in 7 (31.8%) pts, including one pt with sepsis due to streptococcus pneumoniae. No meningococcal infections were reported. Three pts discontinued the study due to AEs (cyanosis and klebsiella pneumoniae (n=1); vitreous hemorrhage (n=1); cyanosis and gastrointestinal symptoms including erosive gastritis (n=1)). No pts developed systemic lupus erythematosus, serious hypersensitivity or anaphylaxis. Two pts died during the study (klebsiella pneumoniae (n=1); exacerbation of CAD (n=1) in a patient with a femoral neck fracture and complex medical history including myelodysplastic syndrome, approximately 1.5 months after receiving the last dose of sutimlimab). Image:Summary/Conclusion: Sutimlimab, a first-in-class selective anti-C1s classical complement pathway inhibitor, maintained mean Hb levels >11g/dL, achieved sustained normalization of mean bilirubin, haptoglobin and reticulocyte count. Sutimlimab continued to improve FACIT-Fatigue scores, with no newly identified safety concerns at 2 years of treatment. This study has demonstrated that sutimlimab is an effective and well-tolerated long-term therapy for the management of chronic CAD through continued upstream inhibition of the classical CP.

Study of Dyslipidemia and its Association with Serum Ferritin and Amount of Blood Transfusion in β- Thalassemia Major Patients in a Tertiary Level Hospital

Introduction: Beta-thalassemia is thought to be the most common genetic blood condition in the world. Different kinds of Beta-thalassemia major have been shown to have lipid problems. The goal of this study is to evaluate the lipid profiles of beta-thalassemia major patients. The aim of the study was to study the association of dyslipidemia with serum ferritin levels and amount of blood transfusion among Beta thalassemia patients. Methods: This descriptive cross-sectional study was conducted at the Department of Medicine and Hematology, Sir Salimullah Medical College Hospital, Bangladesh. The study duration was 6 months, from January 2017 to July 2017. The targeted study sample size was 96, but due to the short duration of the study, a total of 40 patients were selected as the study population. Result: Hematological tests showed the mean hemoglobin level in the thalassemia group was 7.23 gm/dl, with a standard deviation of 1.23. Mean MCV, MCH, and MCHC in the thalassaemic group were significantly lower at 69.83 fl (SD8.34), 23.10 PGM (SD3.57), and 28.03 % (SD 2.58) compared to the normal range (P-value &lt;0.001 in all parameters). Beta-thalassemia major patients had significantly lower high-density lipoprotein and low-density lipoprotein (LDL) (p&lt;0.001) compared to the normal range. However, serum triglycerides levels of Beta-thalassemia patients (211.5±31.54 mg/dl) were significantly higher [p-value &lt; 0.001].But total cholesterol level was not statically significant among participants ( P-value 0.428). High levels of serum triglycerides were associated with high ferritin levels and an increased amount of blood transfusion. Low levels of HDL-C and LDL-C were associated with a high level of ferritin and an increased amount of blood transfusion. Conclusion: Our study revealed that there was a significant difference in various lipid levels between patients with beta-thalassemia major and normal values which may help physicians to design the therapeutic module for the treatment of such patients.

Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer Using Three-Dimensional Conformal Technique.

Optimal regimens using recent radiotherapy (RT) equipment for bleeding gastric cancer (GC) have not been fully investigated yet. We retrospectively reviewed the clinical data of 20 patients who received RT for bleeding GC in our institution between 2016 and 2021. Three-dimensional conformal RT was performed. The effectiveness of RT was evaluated by the mean serum hemoglobin (Hb) level and the number of transfused red blood cell (RBC) units 1 month before and after RT. The median first radiation dose was a BED of 39.9 Gy. The treatment success rate was 95% and the rebleeding rate was 10.5%. There was a significant increase in the mean Hb level (8.0 ± 1.1 vs. 9.8 ± 1.3 g/dL, p = 0.01), and a significant decrease in the mean number of transfused RBC units (6.8 ± 3.3 vs. 0.6 ± 1.5 units, p < 0.01). Severe toxicity was observed in two patients (anorexia [n = 1] and gastrointestinal [GI] perforation [n = 1]). Reirradiation was attempted in three patients (for hemostasis [n = 2] and for mass reduction [n = 1]). The retreatment success rate for rebleeding was 100%. GI perforation occurred in two patients who had received hemostatic reirradiation. Palliative RT for bleeding GC using recent technology had excellent efficacy. However, it may be associated with a risk of GI perforation.

THE RELATIONS BETWEEN NEUTROPHIL-LYMPHOCYTIC RATIO AND DIFFERENT COMORBIDITIES IN CORONAVIRUS-INFECTED PATIENTS

Aim: The study’s aim was to determine the neutrophil-to-lymphocyte ratio (NLR) is most helpful predictor factor for COVID-19-related serious illness. Methods: A total of 51 patients with COVID-19 infection with laboratory-confirmed reports were enrolled in this study: Age, neutrophil-to-lymphocyte (LYMLYM) ratio (NLR), an examination, and comparison. Data analysis, compilation, and report writing were completed based on the acquired data. Using SPSS.ver-23, standard statistical procedures were used to analyze the mean and standard deviation, as well as the Pearson correlation. If p&lt;0.05, it is deemed significant. Results: The mean hemoglobin level was 12.44±3.55%, the mean platelet count was 1.95±0.65 cumm, the mean white blood cell count was 17400 ±6455.22 cumm, and the mean NLR was 5.72±1.24. When we looked at people who had hypertension, diabetes mellitus, and high cholesterol, we found that the NLR value was significantly higher in people with these diseases (p=0.05). Conclusion: We found that NLR is an excellent way to predict COVID-19-infected patients who are likely to get a lot of other illnesses and have a lot of problems early on.

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients.

BackgroundPost‐transplant anaemia and reduced muscle mass and strength are highly prevalent in kidney transplant recipients (KTRs). Decreased haemoglobin levels, a marker of anaemia, could adversely affect muscle mass and strength through multiple mechanisms, among others, through diminished tissue oxygenation. We aimed to investigate the association between haemoglobin levels with muscle mass and strength in KTRs.MethodsWe included stable KTRs from the TransplantLines Biobank and Cohort study with a functional graft ≥1 year post‐transplantation. Muscle mass was assessed using 24 h urinary creatinine excretion rate (CER) and bioelectrical impedance analysis (BIA). Muscle strength was assessed with a handgrip strength test using a dynamometer and, in a subgroup (n = 290), with the five‐times sit‐to‐stand (FTSTS) test. We used multivariable linear and logistic regression analyses to investigate the associations of haemoglobin levels with muscle mass and strength.ResultsIn 871 included KTRs [median age 58 (interquartile range (IQR), 48–66)] years; 60% men; eGFR 51 ± 18 mL/min/1.73 m2) who were 3.5 (1.0–10.2) years post‐transplantation, the mean serum haemoglobin level was 13.9 ± 1.8 g/dL in men and 12.8 ± 1.5 g/dL in women. Lower haemoglobin levels were independently associated with a lower CER (std. β = 0.07, P = 0.01), BIA‐derived skeletal muscle mass (std. β = 0.22, P < 0.001), handgrip strength (std. β = 0.15, P < 0.001), and worse FTSTS test scores (std. β = −0.17, P = 0.02). KTRs in the lowest age‐specific and sex‐specific quartile of haemoglobin levels had an increased risk of being in the worst age‐specific and sex‐specific quartile of CER (fully adjusted OR, 2.09; 95% CI 1.15–3.77; P = 0.02), handgrip strength (fully adjusted OR, 3.30; 95% CI 1.95–5.59; P < 0.001), and FTSTS test score (fully adjusted OR, 7.21; 95% CI 2.59–20.05; P < 0.001).ConclusionsLow haemoglobin levels are strongly associated with decreased muscle mass and strength in KTRs. Future investigation will need to investigate whether maintaining higher haemoglobin levels may improve muscle mass and strength in KTRs.

Clinical presentation patterns of patients with coeliac disease in Gaza Strip: a cross-sectional descriptive study

BackgroundCoeliac disease is an autoimmune disease of the small intestine precipitated by the ingestion of gluten in genetically susceptible individuals. Clinical presentation of patients with coeliac disease patients varies depending on age and has been associated with other autoimmune conditions. In the Gaza strip, the patterns of clinical presentations and associations have not been reported. We aimed to assess these factors. MethodsThis cross-sectional descriptive study was done in July, 2015. We administered a structured questionnaire to all patients who were diagnosed as having coeliac disease and were registered at Ard El Insan Association, a Palestinian charitable society that provides preventive and therapeutic services, family guidance, and health education to patients with nutritional diseases through clinics in the Gaza Strip. The questionnaire focused on the presenting symptoms, coexisting diseases, and the diet of each patient. Patients provided verbal consent for their data to be used in this study. We used SPSS Statistics version 23.0 for data management and descriptive statistical analysis. Findings55 patients aged 2–40 years were included in our study with a mean age of 20 (SD 11·7) years. 23 (42%) patients were younger than 18 years. 19 (34%) were boys or men and 36 (66%) were girls or women. The mean age of the first presentation with gastrointestinal complaints was 10 (SD 9) years, whereas the mean age of diagnosis was 16 (10) years. The most common presenting symptoms were anorexia (76%), abdominal distention (73%), and diarrhoea (73%). In addition, 78% of patients had poor weight gain, 71% had iron deficiency anaemia, 40% had arthralgia, and 33% had short stature and had experienced delayed puberty. 18 (33%) patients had a family history of coeliac disease. The proportion of patients who had other autoimmune diseases was 23%, with the most frequent being urticaria (9%), type 1 diabetes (4%), asthma (4%), alopecia (4%), and thyroiditis (2%). 44 (80%) patients adhered to therapeutic diets. The mean level of haemoglobin at diagnosis was 10·0 (SD 1·7) g/L, but at the latest visit was 11·6 (1·2) g/L. InterpretationOur findings suggest that coeliac disease occurs notably more frequently in girls and women than in boys and men in Gaza Strip and that diagnosis can take 5–6 years after the first gastrointestinal complaint. On the other hand, a substantial number of patients presented with non-gastrointestinal symptoms. Therefore, an awareness of the broad spectrum of presentations of coeliac disease is necessary to avoid delays in diagnosis. FundingNone.

Does placental abruption cause neonatal anemia?

Placental abruption can result in serious perinatal morbidity and mortality. However, it is not clear whether placental abruption could lead to neonatal anemia, as a direct relation has not been described yet. The objective of this study is to investigate whether there is a relation between occurrence of placental abruption and neonatal anemia. All women with a clinical diagnoses of placental abruption between January 2016 and April 2021 in Amsterdam UMC, from both the VU University Medical Center and Amsterdam Medical Center, were included. Demographic data and delivery outcomes were collected retrospectively using the medical files. The primary outcome was neonatal anemia, defined as hemoglobin levels less than the fifth percentile for gestational age. A total of 65 mothers and 65 neonates were included in our study. Average gestational age was 30 + 5 weeks. Mean hemoglobin level of the neonates at birth was 16.5g/dl (10.2 mmol/L) with hemoglobin levels comparable to the reference curve. Two neonates (3.6%) were diagnosed with anemia based on their hemoglobin level at birth, and six (9.2%) neonates received a blood transfusion within 24 h after birth. With this study, we found that the hemoglobin levels of the neonates born after placental abruption are comparable to the reference curve and do not show more neonates than expected below the fifth percentile for gestational age. It remains unclear whether there is fetal blood loss during a placental abruption but our results suggest that at least a big amount of fetal blood is not lost, since we did not found a large number of anemic neonates. Severe neonatal anemia in the case of placental abruption does not need to be expected.