Current Issue : January - March Volume : 2014 Issue Number : 1 Articles : 5 Articles
Background: Anemia is a common problem in diabetic patients. Diabetic patients have a greater severity of\r\nanemia as the level of Glomerular Filtration Rate (GFR) decreases compared to non-diabetic patients. Despite these\r\nfacts, anemia is unrecognized and largely untreated in patients with diabetes in Ethiopia particularly in those\r\npatients attending Fenote Selam Hospital. Therefore, this study was aimed to assess the association of anemia and\r\nrenal function test among diabetes mellitus patients attending Fenote Selam Hospital, North West of Ethiopia.\r\nMethods: An Institutional -based cross-sectional study was conducted from February 2012 to April 2012 on\r\ndiabetes mellitus (DM) patients. Systematic random sampling technique was used to get the total sample size of\r\n384 patients. A total of seven ml of venous blood was collected from diabetes mellitus patients; two ml was\r\ncollected by EDTA anticoagualted vacutainer test tube for haemoglobin determination and 5 ml venous blood was\r\ncollected by plain vacutainer tube for creatinine and Blood urea nitrogen determination. The data were double\r\nentered and analyzed using SPSS-16 statistical software. The degree of association between independent and\r\ndependent variables was assessed using bivariate and multivariate logistic regression analysis in terms of P-value\r\nand odds ratio with 95% confidence interval.\r\nResults: Out of the total 384 DM patients included in the study 73 (19%) were anemic. Fifty three (13.8%), forty\r\neight (12.5%), and two hundred eighty three (73.7%) DM patients had an estimated GFR <60 ml/min/1.73 m,\r\n60 ââ?¬â?? 90 ml/min/ 1.73 m, and > 90 ml/min/1.73 m respectively. One hundred eleven (28.9%) diabetic patients had\r\nincreased urine albumin level. There was a statistically significant association between anaemia and Glomerular\r\nfiltration rate (P<0.05) with Odds ratio of 8.58 and CI (10.21, 49.94). As the glomerular filtration rate increase, the risk\r\nto be anemic will decrease dramatically.\r\nConclusion: The study showed that there was a significant association between anaemia and Glomerular filtration\r\nrate in DM patients. Therefore, DM patients should be strictly monitored for renal failure and anemia for proper\r\nmanagement of diabetes patients....
Background: Congenital hemangiomas are benign abnormal proliferation of blood vessels. Noninvoluting\r\ncongenital hemangiomas are a rare variant which persist, and may become bigger. Hemangiomas are known to be\r\nassociated with thrombocytopenia, microangiopathic hemolytic anemia and Kasabach-Merritt phenomenon.\r\nKasabach-Merritt phenomenon is characterized by consumptive coagulopathy with microangiopathic haemolyic\r\nanemia and thrombocytopenia. Platelet sequestration in the hemangioma or increased destruction which may\r\neither be immune or non immune are also further contributors to thrombocytopenia.\r\nCase presentation: A 45 year old female with a non involuting hemangioma and baseline thrombocytopenia was\r\nobserved to develop repeated episodes of transient severe thrombocytopenia associated with a variety of infectious\r\nconditions. Laboratory investigations suggested a peripheral mechanism. Platelet counts always returned to\r\nbaseline levels on resolution of the precipitating infection.\r\nConclusion: The authors report this phenomenon as the first reported case of baseline thrombocytopenia\r\ncomplicated by recurrent episodes of transient severe thrombocytopenia following infections associated with a non\r\ninvoluting congenital hemangioma. The observations made in this patient were unique and hitherto unreported in\r\nmedical literature. Both peripheral sequestration and destructive consumption were considered likely. Consumptive\r\nmechanisms were likely to encompass either or both immune and non immune causes. Further studies are needed\r\nto establish the precise pathogenesis....
Background: Hypogammaglobulinemia may be part of several different immunological or malignant conditions,\r\nand its origin is not always obvious. Furthermore, although autoimmune cytopenias are known to be associated\r\nwith common variable immunodeficiency (CVID) and even may precede signs of immunodeficiency, this is not\r\nalways recognized. Despite novel insight into the molecular immunology of common variable immunodeficiency,\r\nseveral areas of uncertainty remain. In addition, the full spectrum of immunological effects of the B cell depleting\r\nanti-CD20 antibody Rituximab has not been fully explored. To our knowledge this is the first report of development\r\nof CVID in a patient with normal immunoglobulin prior to Rituximab treatment.\r\nCase presentation: Here we describe the highly unusual clinical presentation of a 34-year old Caucasian male with\r\ntreatment refractory immune thrombocytopenic purpura and persistent lymphadenopathy, who was\r\nsplenectomized and received multiple courses of high-dose corticosteroid before treatment with Rituximab resulted\r\nin a sustained response. However, in the setting of severe pneumococcal meningitis, hypogammaglobulinemia was\r\ndiagnosed. An extensive immunological investigation was performed in order to characterize his immune status,\r\nand to distinguish between a primary immunodeficiency and a side effect of Rituximab treatment. We provide an\r\nextensive presentation and discussion of the literature on the basic immunology of CVID, the mechanism of action\r\nof Rituximab, and the immunopathogenesis of hypogammaglobulinemia observed in this patient.\r\nConclusions: We suggest that CVID should be ruled out in any patient with immune cytopenias in order to avoid\r\ndiagnostic delay. Likewise, we stress the importance of monitoring immunoglobulin levels before, during, and after\r\nRituximab therapy to identify patients with hypogammaglobulinemia to ensure initiation of immunoglobulin\r\nreplacement therapy in order to avoid life-threatening invasive bacterial infections. Recent reports indicate that\r\nRituximab is not contra-indicated for the treatment of CVID-associated thrombocytopenia, however concomitant\r\nimmunoglobulin substitution therapy is of fundamental importance to minimize the risk of infections. Therefore,\r\nlessons can be learned from this case report by clinicians caring for patients with immunodeficiencies,\r\nhaematological diseases or other autoimmune disorders, particularly, when Rituximab treatment may\r\nbe considered....
Several intravenous iron complexes are available for the treatment of iron deficiency anemia (IDA). Iron dextran (DEX) is associated with an elevated risk of potentially serious anaphylactic reactions, whereas others must be administered in several small infusions to avoid labile iron reactions. Ferric carboxymaltose (FCM) is a nondextran intravenous iron which can be administered in high single doses. A randomized, open label, and multicenter comparison of FCM to DEX in adults with IDA and baseline hemoglobin of =11.0?g/dL was conducted. A total of 160 patients were in the safety population (FCM n=82;DEX n=78)Adverse events, including immune system disorders (0% in FCM versus 10.3% in DEX, P= 0.003and skin disorders (7.3% in FCM versus 24.4% in DEX, P = 0.004)were less frequently observed in the FCM group. A greater portion of patients in the FCM group experienced a transient, asymptomatic decrease in phosphate compared to patients in the DEX group (8.5% in FCM versus 0% in DEX, P = 0.014). In the FCM arm, the change in hemoglobin from baseline to the highest observed level was 2.8?g/dL, whereas the DEX arm displayed a change of 2.4?g/dL (P = 0.20).Treatment of IDA with FCM resulted in fewer hypersensitivity-related reactions than DEX....
Imatinib mesylate provides good results in the treatment of CML in general. But what about the results of this treatment in CML\r\nassociated with additional cytogenetic abnormalities at diagnosis among black Africans? For this, we retrospectively studied 27\r\ncases of CML associated with additional cytogenetic abnormalities, diagnosed in the department of clinical hematology of the\r\nUniversity Hospital of Yopougon in CÃ?â? ote dââ?¬â?¢Ivoire, from May 2005 to October 2011. The age of patients ranged from 13 to 68 years,\r\nwith amean age of 38 years and a sex ratio of 2. Patients were severely symptomatic with a high Sokal score of 67%. CML in chronic\r\nphase accounted for 67%.Theprevalence of additional cytogenetic abnormalities was 29.7%. Therewere variants of the Philadelphia\r\nchromosome (18.5%), trisomy 8 (14.8%), complex cytogenetic abnormalities (18.5%), second Philadelphia chromosome (14.8%), and\r\nminor cytogenetic abnormalities (44.4%). Complete hematologic remission was achieved in 59%, with 52% of major cytogenetic\r\nremission. The outcome was fatal in 37% of patients. Death was related in 40% to hematologic toxicity and in 30% to acutisation.\r\nThe median survival was 40 months....
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