OBJECTIVE: To describe the common causes of headache as well as the different methods of Phlebotomy(Fasd) and wet Cupping(Hijamat) based on Persian Medicine.METHODS: In this study, we searched Google Scholar, Science ...OBJECTIVE: To describe the common causes of headache as well as the different methods of Phlebotomy(Fasd) and wet Cupping(Hijamat) based on Persian Medicine.METHODS: In this study, we searched Google Scholar, Science Direct, Pub Med and Scopus to get any in vitro or clinical evidence of the efficacy and possible mechanisms of phlebotomy or wet cupping on different types of headaches. Also different types of headaches, according to PM, under the title of "Sodaa"; extracted from famous Persian medical text books with key words including "Sodaa","Bayze" and "Shaqiqe".RESULTS: According to PM, diseases(dystemperament) are created by abnormal alteration in temperament. Temperament is a monolithic quality yielded by interaction between opposing qualities of four elements that are coldness, hotness, dryness and wetness. Headaches are caused by dystemperament(sue-Mizaj) in brain or in total body that are divided into simple and corporal. Common forms of the latter type are Vaporal and Migrant headache(Bokhari and Rihi). Each of these headaches is treated either through phlebotomy or wet cupping.CONCLUSION: In Persian Medicine, Fasd and Hijamat are easy and economical methods for treatment of headache with reasonable results. By describing the precise areas and indications of phlebotomy and wet cupping, this study provides the first step for future clinical trials in this field.展开更多
Introduction: Anaemia contributes to increased morbidity and mortality in hospitalised patients, yet unnecessary blood tests from inpatients may actually induce a “hospital acquired anaemia” (HAA). This study examin...Introduction: Anaemia contributes to increased morbidity and mortality in hospitalised patients, yet unnecessary blood tests from inpatients may actually induce a “hospital acquired anaemia” (HAA). This study examines the incidence of phlebotomy-induced anaemia during a hospital admission. Methods: Patients admitted to the Royal Bournemouth Hospital between 2009 and 2011 for a period of more than two weeks were identified. Those with normal haemoglobins on admission (Hb > 130 g/dL in men;Hb > 120 g/dL in women) were selected to be included in the study. One hundred and sixty two patients were randomly selected from this group and their admission and discharge haemoglobin was recorded, and the change in Hb was calculated. The number of blood tests taken during admission was calculated from each patient from which volume of blood lost was determined. Age, sex and co-morbidities, bleeding complications and blood transfusions were noted. T-test for unequal variance was used for analysis. Results: Of the 162 patients, 69 (42.5%) developed a HAA (defined as haemoglobin drop from normal to <110 g/dL). The average number of blood tests taken in the anaemia group was 37, compared to only 23 in the “no-anaemia” group. i.e. 132 mls in the anaemia group vs. only 80.2 mls in no-anaemia group. Further analysis of the anaemia group revealed that 40 patients developed a “mild anaemia” (defined as drop in Hb from normal to <110 g/dL) and 29 developed a moderate/severe anaemia (drop from a normal Hb at admission to <100 g/dL). Significantly higher volume of blood was withdrawn from this moderate/severe anaemia group compared to those that developed a mild anaemia 177.9 mls vs. 121.34 mls (p-Value 0.007, F = 0.001) 95% CI 2.08 to 9.22. Conclusion: This study suggests that patients admitted for inpatient stays of more than two weeks may be at high risk of HAA as a consequence of diagnostic blood loss. This anaemia in turn may have detrimental consequences, especially in patients with pre-existing cardio-respiratory disease. There needs to be increased awareness of the risk posed to patients as a result of diagnostic phlebotomy and further studies are required to study its impact on LOS, morbidity and mortality outcomes.展开更多
BACKGROUND Juvenile hemochromatosis(JH)is an early-onset,rare autosomal recessive disorder of iron overload observed worldwide that leads to damage in multiple organs.Pathogenic mutations in the hemojuvelin(HJV)gene a...BACKGROUND Juvenile hemochromatosis(JH)is an early-onset,rare autosomal recessive disorder of iron overload observed worldwide that leads to damage in multiple organs.Pathogenic mutations in the hemojuvelin(HJV)gene are the major cause of JH.CASE SUMMARY A 34-year-old male Chinese patient presented with liver fibrosis,diabetes,hypogonadotropic hypogonadism,hypophysis hypothyroidism,and skin hyperpigmentation.Biochemical test revealed a markedly elevated serum ferritin level of 4329μg/L and a transferrin saturation rate of 95.4%.Targeted exome sequencing and Sanger sequencing revealed that the proband had a novel mutation c.863G>A(p.R288Q)in the HJV gene which was transmitted from his father,and two known mutations,c.18G>C(p.Q6H)and c.962_963delGCinsAA(p.C321*)in cis,which were inherited from his mother.The p.R288W mutation was previously reported to be pathogenic for hemochromatosis,which strongly supported the pathogenicity of p.R288Q reported for the first time in this case.After 72 wk of intensive phlebotomy therapy,the patient achieved a reduction in serum ferritin to 160.5μg/L.The patient's clinical symptoms demonstrated a notable improvement.CONCLUSION This study highlights the importance of screening for hemochromatosis in patients with diabetes and hypogonadotropic hypogonadism.It also suggests that long-term active phlebotomy could efficiently improve the prognosis in severe JH.展开更多
AIM:Smoking may affect adversely the response rate to interferon-α.Our objective was to verify this issue among chronic hepatitis C patients. METHODS:Over the year 1998,138 chronic hepatitis C male Egyptian patients ...AIM:Smoking may affect adversely the response rate to interferon-α.Our objective was to verify this issue among chronic hepatitis C patients. METHODS:Over the year 1998,138 chronic hepatitis C male Egyptian patients presenting to Cairo Liver Center, were divided on the basis of smoking habit into:group I which comprised 38 smoker patients(>30 cigarettes/d) and group Ⅱ which included 84 non-smoker patients. Irregular and mild smokers(16 patients)were excluded. Non eligible patients for interferon-α therapy were excluded from the study and comprised 3/38(normal ALT)in group I and 22/84 in group Ⅱ(normal ALT,advanced cirrhosis and thrombocytopenia).Group I was randomly allocated into 2 sub-groups:group Ia comprised 18 patients who were subjected to therapeutic phlebotomy while sub-group Ib consisted of 17 patients who had no phlebotomy.In sub-group la,3 patients with normal ALT after repeated phlebotomies were excluded from the study.Interferon-α 2b 3 MU/TIW was given for 6 mo to 15 patients in group Ia,17 patients in group Ib and 62 patients in group Ⅱ. Biochemical,virological end-of-treatment and sustained responses were evaluated. RESULTS:At the end of interferon-α treatment,ALT was normalized in 3/15 patients(20%)in group Ia and 2/17 patients(11.8%)in group Ib compared to17/62 patients (27.4%)in group Ⅱ(P=0.1).Whereas 2/15 patients(13.3%) in group Ia.and 2/17 patients(11.8%)in group Ib lost viraemia compared to 13/62 patients(26%)in group Ⅱ (P=0.3).Six months later,ALT was persistently normal in 2/15 patients(13.3%)in group 1a and 1/17 patients (5.9%)in group Ib compared to 9/62 patients(14.5%)in group Ⅱ(P=0.47).Viraemia was eliminated in 1/15 patients (6.7%)in group Ia and 1/17 patients(5.9%)in group Ib compared to 7/62 patients(11.3%) in group Ⅱ,but the results did not mount to statistical significance(P=0.4). CONCLUSION:Smokers suffering from chronic hepatitis C tend to have a lower response rate to interferon-α compared to non-smokers.Therapeutic phlebotomy improves the response rate to interferon-α therapy among this group.展开更多
Iron overload increases the risk of diabetes via mechanisms of abnormal glucose metabolism: insulin deficiency, insulin resistance, and/or hepatic dysfunction. Iron reduction upregulates glucose uptake and improves he...Iron overload increases the risk of diabetes via mechanisms of abnormal glucose metabolism: insulin deficiency, insulin resistance, and/or hepatic dysfunction. Iron reduction upregulates glucose uptake and improves hepatocytes insulin receptor activity. This study was conducted to examine the effects of iron depletion—via controlled phlebotomy—on the hypoglycemic treatment in poorly controlled type 2 diabetes mellitus (T2DM) patients with non-genetic iron overload. Forty three patients with poorly controlled T2DM and iron overload were divided into 2 groups: iron depletion group and control group. Regular phlebotomy was performed for iron depletion group on monthly basis until serum ferritin reached 20 μg/L or less. Both groups were examined and compared for blood pressure, serum ferritin, lipid profile, HFE-gene, HbA1c, HOMA-IR and number of medicines used for diabetic control. The results had revealed that group differences of HbA1c (-2.64, 95% CI -3.23 to 2.04, p < 0.001) and HOMA-IR (-0.68, 95% CI -0.98 to -0.37, p < 0.001) showed significant decreases in iron depletion group at end of study. Significant decrease in the numbers of hypoglycemic medicines in iron depletion group was shown at end of study (p < 0.001);66.7% of iron depletion group patients were receiving 1 or 2 medicines at end of studyversus none of the control group. Diastolic blood pressure (DBP), triglycerides and LDL-C decreased significantly while HDL-C levels showed significant rise after iron depletion. It can be concluded from the present study that iron depletion therapy is beneficial for improving the efficiency of glycemic control, DBP, and dyslipidemia in poorly controlled type 2 diabetics with iron over load.展开更多
<strong>Introduction:</strong> <span style="font-family:Verdana;">Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies...<strong>Introduction:</strong> <span style="font-family:Verdana;">Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different indications of packed cell transfusion in the neonatal intensive care unit of a tertiary care hospital. This endeavor will help in the establishment of guidelines regarding transfusion and the threshold on which any intervention should be done also it would be a step towards the identification of preventable causes that lead to transfusion and transfusion-related risks and hazards.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Objective:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">To determine the indication of packed cell transfusion and their frequencies in preterm neonates.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Design:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">This was a cross-sectional study.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Setting:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The study was carried out in the neonatal intensive care unit (NICU).</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Duration:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The duration of the study was 1 year.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Material and Methods:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">A total of 246 preterm neonates admitted to Aga Khan University Hospital (AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the inclusion criteria and requiring packed cell transfusion were included. After the approval from ethical review committee, charts were reviewed for gestational age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were recorded. Indications of packed cell transfusion (intraventricular hemorrhage, infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen requirement, hematological causes, other causes of hemorrhage and other causes) were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and hematocrit levels were also recorded. Other information like number and volume of transfusion and day of life on which transfusion was administered was also documented.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:""> </span></b><span style="font-family:""><span style="font-family:Verdana;">A total of 246 critically ill children were enrolled in this study. Of t</span><span style="font-family:Verdana;">he total, 52.8% were baby boys and 47.2% were baby girls. 57% of babies were born via cesarean section and 43% were born via vaginal delivery. Out of total preterm newborns admitted in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean birth weight of newborns was 1500 (±600) grams.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">Indications of packed cell transfusion observed in our study are intraventricular hemorrhage 10%, 26% sepsis/infection</span><span style="font-family:Verdana;">, 4% hematological disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen requirement, 13% other hematological causes and 9.3% other causes.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">An increase in oxygen requirement and anemia of prematurity were the indications that were observed in the extremely preterm and very preterm groups. Sepsis and increase oxygen requirement are some of the major causes of transfusions observed in the late preterm group. Preventable indications can be one of the areas that can be worked on and will reduce the need for transfusion in preterm babies with subsequent prevention of transfusion-associated risks.</span>展开更多
AIM： TO assess the effect of iron reduction after phlebotomy in rats with ＂normal＂ hepatic iron concentration （HIC） on the progression of hepatic fibrosis, as a result of bile duct ligation （BDL）. METHODS： Rat...AIM： TO assess the effect of iron reduction after phlebotomy in rats with ＂normal＂ hepatic iron concentration （HIC） on the progression of hepatic fibrosis, as a result of bile duct ligation （BDL）. METHODS： Rats underwent phlebotomy before or after sham operation or BDL. Animals undergone only BDL or sham operation served as controls. Two weeks after surgery, indices of hepatic damage and fibrosis were evaluated. RESULTS： Phlebotomy lowered HIC. Phlebotomy after BDL was associated with body weight increase, lower hepatic weight, less portal hypertension, less periportal necrosis, less portal inflammation, lower hepatic activity index score and higher albumin levels. On the other hand, phlebotomy before BDL was associated with body weight decrease and hepatic activity index score increase. Phlebotomy after sham operation was not associated with any hepatic or systemic adverse effects. CONCLUSION： Reduction of HIC after induction of liver damage may have beneficial effects in BDL rats. However, iron deficiency could induce impairment of liver function and may make the liver more susceptible to insults like BDL.展开更多
Polycythemia vera has been reported as a known condition in cats as early as 1966. This condition manifests as an increased mass in red blood cells and elevated hematocrit and is defined as an idiopathic chronic myelo...Polycythemia vera has been reported as a known condition in cats as early as 1966. This condition manifests as an increased mass in red blood cells and elevated hematocrit and is defined as an idiopathic chronic myeloproliferative disorder. The patient described in this paper presented with hyperemic gums and pinna and an acute onset of progressive ataxia and lethargy. Several possible underlying primary conditions such as cardiac disease and renal malignancy were excluded by running basic blood work and radiographic imaging. Initial blood work revealed a significantly elevated packed cell volume (88%). After diagnosis, treatment with phlebotomy and chemotherapy lead to a reduction in hematocrit and elimination of neurologic signs. This case study represents the diagnosis and successful management of this disease in a private practice setting. Polycythemia vera is relatively uncommon in dogs and cats, but should still be considered in cases of neurologic disorders, especially with the presence of bright red ears, paws, or gums.展开更多
Hereditary hemochromatosis is a condition characterized by iron overload, which is both treatable and preventable. It’s mainly related to hepcidin deficiency related to mutations in genes involved in hepcidin regulat...Hereditary hemochromatosis is a condition characterized by iron overload, which is both treatable and preventable. It’s mainly related to hepcidin deficiency related to mutations in genes involved in hepcidin regulation. Iron overload increases the risk of disease such as liver cirrhosis, heart disease and diabetes. Two HFE genotypes have been commonly described in cases of iron overload, C282Y homozygosity and C282Y/H63D compound heterozygoty. The diagnosis of this rare disease now can be explored by biological and imaging tools. We report a case of compound heterozygous C282Y/H63D discovered by family screening for elevated serum ferritin.展开更多
Objective:To evaluate the efficacy and safety of blood-letting therapy(BLT)in treatment of hypertension.Methods:A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register ...Objective:To evaluate the efficacy and safety of blood-letting therapy(BLT)in treatment of hypertension.Methods:A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials,Excerpt Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure,Chinese Scientific Journal Database,Chinese Biomedical Literature Database,and Wanfang Database to identify randomized controlled trials(RCTs)in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs(BPAD)against placebo,no treatment or antihypertensive drugs.The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials.The Review Manager 5.3 software was used for meta-analysis.Results:A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified.Compared with antihypertensive drugs,blood pressure was significantly reduced by BLT(RR=1.21,95%CI:1.01 to 1.44,P=0.03;heterogeneity:P=0.06,I^2=60%)and BPAD(RR=1.25,95%CI,1.02 to 1.53,P=0.03;heterogeneity:P=0.01,I^2=71%).Moreover,a significant improvement in Chinese medicine syndrome by BLT(RR=1.32;95%CI:1.14 to 1.53,P=0.0002;heterogeneity:P=0.53,I^2=0%)and BPAD(RR=1.47;95%CI:1.06 to 2.04,P=0.02;heterogeneity:P=0.13,I^2=56%)was identified.The reported adverse effects were well tolerated.Conclusions:Although some positive findings were identified,no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design,significant heterogeneity,and insufficient clinical data.Further rigorously designed trials are warranted to confirm the results.展开更多
Non-alcoholic fatty liver disease(NAFLD)has become the most common cause of chronic liver disease worldwide,and is closely associated with the increased risk of the prevalence of obesity and diabetes.NAFLD begins with...Non-alcoholic fatty liver disease(NAFLD)has become the most common cause of chronic liver disease worldwide,and is closely associated with the increased risk of the prevalence of obesity and diabetes.NAFLD begins with the presence of>5%excessive lipid accumulation in the liver,and potentially de-velops into non-alcoholic steatohepatitis,fibrosis,cirrhosis and hepatocellular carcinoma.Therefore,insight into the pathogenesis of NAFLD is of key importance to its effective treatment.Iron is an essential element in the life of all mammalian organisms.However,the free iron deposition is positively associated with histological severity in NAFLD patients due to the production of reactive oxygen species via the Fenton reaction.Recently,several iron metabolism-targeted therapies,such as phlebotomy,iron chela-tors,nanotherapeutics.and ferroptosis,have shown their potential as a therapeutic option in the treatment of NAFLD and as a clinical strategy to intervene in the progression of NAFLD.Herein,we review the recent overall evidence on iron metabolism and provide the mechanism of hepatic iron overload-induced liver pathologies and the recent advances in iron metabolism-targeted therapeutics in the treatment of NAFLD.展开更多
文摘OBJECTIVE: To describe the common causes of headache as well as the different methods of Phlebotomy(Fasd) and wet Cupping(Hijamat) based on Persian Medicine.METHODS: In this study, we searched Google Scholar, Science Direct, Pub Med and Scopus to get any in vitro or clinical evidence of the efficacy and possible mechanisms of phlebotomy or wet cupping on different types of headaches. Also different types of headaches, according to PM, under the title of "Sodaa"; extracted from famous Persian medical text books with key words including "Sodaa","Bayze" and "Shaqiqe".RESULTS: According to PM, diseases(dystemperament) are created by abnormal alteration in temperament. Temperament is a monolithic quality yielded by interaction between opposing qualities of four elements that are coldness, hotness, dryness and wetness. Headaches are caused by dystemperament(sue-Mizaj) in brain or in total body that are divided into simple and corporal. Common forms of the latter type are Vaporal and Migrant headache(Bokhari and Rihi). Each of these headaches is treated either through phlebotomy or wet cupping.CONCLUSION: In Persian Medicine, Fasd and Hijamat are easy and economical methods for treatment of headache with reasonable results. By describing the precise areas and indications of phlebotomy and wet cupping, this study provides the first step for future clinical trials in this field.
文摘Introduction: Anaemia contributes to increased morbidity and mortality in hospitalised patients, yet unnecessary blood tests from inpatients may actually induce a “hospital acquired anaemia” (HAA). This study examines the incidence of phlebotomy-induced anaemia during a hospital admission. Methods: Patients admitted to the Royal Bournemouth Hospital between 2009 and 2011 for a period of more than two weeks were identified. Those with normal haemoglobins on admission (Hb > 130 g/dL in men;Hb > 120 g/dL in women) were selected to be included in the study. One hundred and sixty two patients were randomly selected from this group and their admission and discharge haemoglobin was recorded, and the change in Hb was calculated. The number of blood tests taken during admission was calculated from each patient from which volume of blood lost was determined. Age, sex and co-morbidities, bleeding complications and blood transfusions were noted. T-test for unequal variance was used for analysis. Results: Of the 162 patients, 69 (42.5%) developed a HAA (defined as haemoglobin drop from normal to <110 g/dL). The average number of blood tests taken in the anaemia group was 37, compared to only 23 in the “no-anaemia” group. i.e. 132 mls in the anaemia group vs. only 80.2 mls in no-anaemia group. Further analysis of the anaemia group revealed that 40 patients developed a “mild anaemia” (defined as drop in Hb from normal to <110 g/dL) and 29 developed a moderate/severe anaemia (drop from a normal Hb at admission to <100 g/dL). Significantly higher volume of blood was withdrawn from this moderate/severe anaemia group compared to those that developed a mild anaemia 177.9 mls vs. 121.34 mls (p-Value 0.007, F = 0.001) 95% CI 2.08 to 9.22. Conclusion: This study suggests that patients admitted for inpatient stays of more than two weeks may be at high risk of HAA as a consequence of diagnostic blood loss. This anaemia in turn may have detrimental consequences, especially in patients with pre-existing cardio-respiratory disease. There needs to be increased awareness of the risk posed to patients as a result of diagnostic phlebotomy and further studies are required to study its impact on LOS, morbidity and mortality outcomes.
基金National High Level Hospital Clinical Research Funding,No.2022-NHLHCRF-LX-02-0101.
文摘BACKGROUND Juvenile hemochromatosis(JH)is an early-onset,rare autosomal recessive disorder of iron overload observed worldwide that leads to damage in multiple organs.Pathogenic mutations in the hemojuvelin(HJV)gene are the major cause of JH.CASE SUMMARY A 34-year-old male Chinese patient presented with liver fibrosis,diabetes,hypogonadotropic hypogonadism,hypophysis hypothyroidism,and skin hyperpigmentation.Biochemical test revealed a markedly elevated serum ferritin level of 4329μg/L and a transferrin saturation rate of 95.4%.Targeted exome sequencing and Sanger sequencing revealed that the proband had a novel mutation c.863G>A(p.R288Q)in the HJV gene which was transmitted from his father,and two known mutations,c.18G>C(p.Q6H)and c.962_963delGCinsAA(p.C321*)in cis,which were inherited from his mother.The p.R288W mutation was previously reported to be pathogenic for hemochromatosis,which strongly supported the pathogenicity of p.R288Q reported for the first time in this case.After 72 wk of intensive phlebotomy therapy,the patient achieved a reduction in serum ferritin to 160.5μg/L.The patient's clinical symptoms demonstrated a notable improvement.CONCLUSION This study highlights the importance of screening for hemochromatosis in patients with diabetes and hypogonadotropic hypogonadism.It also suggests that long-term active phlebotomy could efficiently improve the prognosis in severe JH.
文摘AIM:Smoking may affect adversely the response rate to interferon-α.Our objective was to verify this issue among chronic hepatitis C patients. METHODS:Over the year 1998,138 chronic hepatitis C male Egyptian patients presenting to Cairo Liver Center, were divided on the basis of smoking habit into:group I which comprised 38 smoker patients(>30 cigarettes/d) and group Ⅱ which included 84 non-smoker patients. Irregular and mild smokers(16 patients)were excluded. Non eligible patients for interferon-α therapy were excluded from the study and comprised 3/38(normal ALT)in group I and 22/84 in group Ⅱ(normal ALT,advanced cirrhosis and thrombocytopenia).Group I was randomly allocated into 2 sub-groups:group Ia comprised 18 patients who were subjected to therapeutic phlebotomy while sub-group Ib consisted of 17 patients who had no phlebotomy.In sub-group la,3 patients with normal ALT after repeated phlebotomies were excluded from the study.Interferon-α 2b 3 MU/TIW was given for 6 mo to 15 patients in group Ia,17 patients in group Ib and 62 patients in group Ⅱ. Biochemical,virological end-of-treatment and sustained responses were evaluated. RESULTS:At the end of interferon-α treatment,ALT was normalized in 3/15 patients(20%)in group Ia and 2/17 patients(11.8%)in group Ib compared to17/62 patients (27.4%)in group Ⅱ(P=0.1).Whereas 2/15 patients(13.3%) in group Ia.and 2/17 patients(11.8%)in group Ib lost viraemia compared to 13/62 patients(26%)in group Ⅱ (P=0.3).Six months later,ALT was persistently normal in 2/15 patients(13.3%)in group 1a and 1/17 patients (5.9%)in group Ib compared to 9/62 patients(14.5%)in group Ⅱ(P=0.47).Viraemia was eliminated in 1/15 patients (6.7%)in group Ia and 1/17 patients(5.9%)in group Ib compared to 7/62 patients(11.3%) in group Ⅱ,but the results did not mount to statistical significance(P=0.4). CONCLUSION:Smokers suffering from chronic hepatitis C tend to have a lower response rate to interferon-α compared to non-smokers.Therapeutic phlebotomy improves the response rate to interferon-α therapy among this group.
文摘Iron overload increases the risk of diabetes via mechanisms of abnormal glucose metabolism: insulin deficiency, insulin resistance, and/or hepatic dysfunction. Iron reduction upregulates glucose uptake and improves hepatocytes insulin receptor activity. This study was conducted to examine the effects of iron depletion—via controlled phlebotomy—on the hypoglycemic treatment in poorly controlled type 2 diabetes mellitus (T2DM) patients with non-genetic iron overload. Forty three patients with poorly controlled T2DM and iron overload were divided into 2 groups: iron depletion group and control group. Regular phlebotomy was performed for iron depletion group on monthly basis until serum ferritin reached 20 μg/L or less. Both groups were examined and compared for blood pressure, serum ferritin, lipid profile, HFE-gene, HbA1c, HOMA-IR and number of medicines used for diabetic control. The results had revealed that group differences of HbA1c (-2.64, 95% CI -3.23 to 2.04, p < 0.001) and HOMA-IR (-0.68, 95% CI -0.98 to -0.37, p < 0.001) showed significant decreases in iron depletion group at end of study. Significant decrease in the numbers of hypoglycemic medicines in iron depletion group was shown at end of study (p < 0.001);66.7% of iron depletion group patients were receiving 1 or 2 medicines at end of studyversus none of the control group. Diastolic blood pressure (DBP), triglycerides and LDL-C decreased significantly while HDL-C levels showed significant rise after iron depletion. It can be concluded from the present study that iron depletion therapy is beneficial for improving the efficiency of glycemic control, DBP, and dyslipidemia in poorly controlled type 2 diabetics with iron over load.
文摘<strong>Introduction:</strong> <span style="font-family:Verdana;">Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different indications of packed cell transfusion in the neonatal intensive care unit of a tertiary care hospital. This endeavor will help in the establishment of guidelines regarding transfusion and the threshold on which any intervention should be done also it would be a step towards the identification of preventable causes that lead to transfusion and transfusion-related risks and hazards.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Objective:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">To determine the indication of packed cell transfusion and their frequencies in preterm neonates.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Design:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">This was a cross-sectional study.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Setting:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The study was carried out in the neonatal intensive care unit (NICU).</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Study Duration:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">The duration of the study was 1 year.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Material and Methods:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">A total of 246 preterm neonates admitted to Aga Khan University Hospital (AKUH) neonatal intensive care unit in the tenure of 1 year, fulfilling the inclusion criteria and requiring packed cell transfusion were included. After the approval from ethical review committee, charts were reviewed for gestational age, birth weight, mode of delivery (normal vaginal or Cesarean-section) were recorded. Indications of packed cell transfusion (intraventricular hemorrhage, infection or sepsis, anemia of prematurity, phlebotomy losses, increase oxygen requirement, hematological causes, other causes of hemorrhage and other causes) were observed and recorded. Pre-transfusion hemoglobin levels (g/dL) and hematocrit levels were also recorded. Other information like number and volume of transfusion and day of life on which transfusion was administered was also documented.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:""> </span></b><span style="font-family:""><span style="font-family:Verdana;">A total of 246 critically ill children were enrolled in this study. Of t</span><span style="font-family:Verdana;">he total, 52.8% were baby boys and 47.2% were baby girls. 57% of babies were born via cesarean section and 43% were born via vaginal delivery. Out of total preterm newborns admitted in NICU, 22.8% were extremely preterm, 35.4% were very preterm and 41.9% were late preterm. Mean gestational age was observed to be 31 (±4) weeks and the mean birth weight of newborns was 1500 (±600) grams.</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">Indications of packed cell transfusion observed in our study are intraventricular hemorrhage 10%, 26% sepsis/infection</span><span style="font-family:Verdana;">, 4% hematological disorders, 12.8% anemia of prematurity, 25.2% was related to increase in oxygen requirement, 13% other hematological causes and 9.3% other causes.</span><span style="font-family:""> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><b><span style="font-family:""> </span></b><span style="font-family:Verdana;">An increase in oxygen requirement and anemia of prematurity were the indications that were observed in the extremely preterm and very preterm groups. Sepsis and increase oxygen requirement are some of the major causes of transfusions observed in the late preterm group. Preventable indications can be one of the areas that can be worked on and will reduce the need for transfusion in preterm babies with subsequent prevention of transfusion-associated risks.</span>
文摘AIM： TO assess the effect of iron reduction after phlebotomy in rats with ＂normal＂ hepatic iron concentration （HIC） on the progression of hepatic fibrosis, as a result of bile duct ligation （BDL）. METHODS： Rats underwent phlebotomy before or after sham operation or BDL. Animals undergone only BDL or sham operation served as controls. Two weeks after surgery, indices of hepatic damage and fibrosis were evaluated. RESULTS： Phlebotomy lowered HIC. Phlebotomy after BDL was associated with body weight increase, lower hepatic weight, less portal hypertension, less periportal necrosis, less portal inflammation, lower hepatic activity index score and higher albumin levels. On the other hand, phlebotomy before BDL was associated with body weight decrease and hepatic activity index score increase. Phlebotomy after sham operation was not associated with any hepatic or systemic adverse effects. CONCLUSION： Reduction of HIC after induction of liver damage may have beneficial effects in BDL rats. However, iron deficiency could induce impairment of liver function and may make the liver more susceptible to insults like BDL.
文摘Polycythemia vera has been reported as a known condition in cats as early as 1966. This condition manifests as an increased mass in red blood cells and elevated hematocrit and is defined as an idiopathic chronic myeloproliferative disorder. The patient described in this paper presented with hyperemic gums and pinna and an acute onset of progressive ataxia and lethargy. Several possible underlying primary conditions such as cardiac disease and renal malignancy were excluded by running basic blood work and radiographic imaging. Initial blood work revealed a significantly elevated packed cell volume (88%). After diagnosis, treatment with phlebotomy and chemotherapy lead to a reduction in hematocrit and elimination of neurologic signs. This case study represents the diagnosis and successful management of this disease in a private practice setting. Polycythemia vera is relatively uncommon in dogs and cats, but should still be considered in cases of neurologic disorders, especially with the presence of bright red ears, paws, or gums.
文摘Hereditary hemochromatosis is a condition characterized by iron overload, which is both treatable and preventable. It’s mainly related to hepcidin deficiency related to mutations in genes involved in hepcidin regulation. Iron overload increases the risk of disease such as liver cirrhosis, heart disease and diabetes. Two HFE genotypes have been commonly described in cases of iron overload, C282Y homozygosity and C282Y/H63D compound heterozygoty. The diagnosis of this rare disease now can be explored by biological and imaging tools. We report a case of compound heterozygous C282Y/H63D discovered by family screening for elevated serum ferritin.
基金Supported by the National Natural Science Foundation of China(No.81403375)
文摘Objective:To evaluate the efficacy and safety of blood-letting therapy(BLT)in treatment of hypertension.Methods:A comprehensive electronic and manual bibliographic searches were performed in Cochrane Central Register of Controlled Trials,Excerpt Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure,Chinese Scientific Journal Database,Chinese Biomedical Literature Database,and Wanfang Database to identify randomized controlled trials(RCTs)in which hypertensive patients were treated with BLT or BLT plus antihypertensive drugs(BPAD)against placebo,no treatment or antihypertensive drugs.The Cochrane Risk Assessment Tool was used to assess the methodological quality of trials.The Review Manager 5.3 software was used for meta-analysis.Results:A total of 7 RCTs with 637 hypertensive patients from 1989 to 2017 were identified.Compared with antihypertensive drugs,blood pressure was significantly reduced by BLT(RR=1.21,95%CI:1.01 to 1.44,P=0.03;heterogeneity:P=0.06,I^2=60%)and BPAD(RR=1.25,95%CI,1.02 to 1.53,P=0.03;heterogeneity:P=0.01,I^2=71%).Moreover,a significant improvement in Chinese medicine syndrome by BLT(RR=1.32;95%CI:1.14 to 1.53,P=0.0002;heterogeneity:P=0.53,I^2=0%)and BPAD(RR=1.47;95%CI:1.06 to 2.04,P=0.02;heterogeneity:P=0.13,I^2=56%)was identified.The reported adverse effects were well tolerated.Conclusions:Although some positive findings were identified,no definite conclusions regarding the efficacy and safety of BLT as complementary and alternative approach for treatment of hypertension could be drew due to the generally poor methodological design,significant heterogeneity,and insufficient clinical data.Further rigorously designed trials are warranted to confirm the results.
基金This study was supported by the National Natural Science Foundation of China (Grant Nos.32171370 and 11505193),the Natural Science Foundation of Guangdong Province (Grant No.2022A1515010415)the Research Foundation of Guangzhou First People's Hospital (Grant No.KY09040029).
文摘Non-alcoholic fatty liver disease(NAFLD)has become the most common cause of chronic liver disease worldwide,and is closely associated with the increased risk of the prevalence of obesity and diabetes.NAFLD begins with the presence of>5%excessive lipid accumulation in the liver,and potentially de-velops into non-alcoholic steatohepatitis,fibrosis,cirrhosis and hepatocellular carcinoma.Therefore,insight into the pathogenesis of NAFLD is of key importance to its effective treatment.Iron is an essential element in the life of all mammalian organisms.However,the free iron deposition is positively associated with histological severity in NAFLD patients due to the production of reactive oxygen species via the Fenton reaction.Recently,several iron metabolism-targeted therapies,such as phlebotomy,iron chela-tors,nanotherapeutics.and ferroptosis,have shown their potential as a therapeutic option in the treatment of NAFLD and as a clinical strategy to intervene in the progression of NAFLD.Herein,we review the recent overall evidence on iron metabolism and provide the mechanism of hepatic iron overload-induced liver pathologies and the recent advances in iron metabolism-targeted therapeutics in the treatment of NAFLD.
