Lower hair cortisol among patients with sickle cell disease may indicate decreased adrenal reserves

xlomafota13 shared this article with you from Inoreader Lower hair cortisol among patients with sickle cell disease may indicate decreased adrenal reserves Via American Journal of Blood Research Am J Blood Res. 2021 Apr 15;11(2):140-148. eCollection 2021. ABSTRACT INTRODUCTION: Sickle cell disease (SCD) is a chronic illness that presents with a wide range of phenotypic variation. Stress may be a contributing factor to differences that are found in this population. OBJECTIVES: Our objective is to determine the relationship between hair cortisol content (HCC), a biomarker of stress, and other clinical measures in individuals with SCD. METHODS: We collected hair samples and other clinical measures from 73 subjects with SCD (mean age: 39 ± 12 years, 63% female). RESULTS: HCC was lower among individuals who had greater than 30% hemoglobin S, compared with those who had less than 30% hemoglobin S (W=272.5, P=0.01). Lower HCC was also associated with report of not being on a chronic transfusion program (β=48.34, SE=14.09, P=0.001) and higher ferritin levels (β=-0.006, SE=0.002, P=0.02). Furthermore, HCC was signi ficantly correlated with serum cortisol (rs=0.26, P=0.03) and corticosterone (rs=0.29, P=0.01). We also observed a consistent pattern of low steroid values among our population. CONCLUSION: Our findings suggest that individuals with higher hemoglobin S and ferritin, both markers of severe SCD, may have decreased cortisol levels. This is consistent with the relationship we observed between higher HCC among individuals who are on a chronic blood transfusion program, which typically increases quality of life. Our results suggest that hair cortisol may be an indicator in patients with SCD who could be at risk for developing adrenal insufficiency. We recommend that clinicians treating patients with SCD follow the Endocrine Society guidelines for testing for adrenal insufficiency and treat accordingly. PMID:34079627 | PMC:PMC8165714 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hospital acquired infection in a department of hematology-oncology care in the Congo

xlomafota13 shared this article with you from Inoreader Hospital acquired infection in a department of hematology-oncology care in the Congo Via American Journal of Blood Research Am J Blood Res. 2021 Apr 15;11(2):191-198. eCollection 2021. ABSTRACT OBJECTIVES: Hospital Acquired Infection (HAI) is a major cause of morbidity and mortality in hemato-oncology. The study aims to report the incidence of hospital-acquired infections in patients with hematological malignancies and the risk factors associated with them. MATERIAL AND METHODS: An observational study with cross-sectional data collection was carried out from January 1, 2019, to April 30, 2020, in the department of hematology of Brazzaville University Hospital. The study concerned 77 patients diagnosed with hematological malignancies admitted for a course of chemotherapy. Written consent was obtained from each participant. Participants were divided into two groups: with HAI (n=50) and without HAI (n=27). They were compared using the chi-square test and Student's T-test. Univariate and multivariate analyses of the association of HAI with all the risk fa ctors were performed for analysis of the 2 x k contingency tables and repeated using logistic regression. RESULTS: The cumulative incidence was 64.9% with a 95% confidence interval of [53.8-74.7]. The time to onset of HAIs was 10.6±6.50 days. The incidence of HAI was significantly greater in acute myelogenous leukemia (80%), grade 4 neutropenia (80%). The risk factors were hospitalization stay of over 14 days (OR: 1.09), the regimen: daunorubicin-aracytine (OR: 5.96), the hemoglobin level on admission (OR: 0.72), and the neutropenia of grade 4 (OR: 7.9). The most common clinically identified focus of infection was peripheral venous infections. The fatality rate was 10%. CONCLUSION: The determination of HAI and the identification of its risk factors make it possible to establish prevention strategies. PMID:34079634 | PMC:PMC8165720 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Eltrombopag post autologous hematopoietic stem cell transplant - an emerging indication in younger pediatric patients

xlomafota13 shared this article with you from Inoreader Eltrombopag post autologous hematopoietic stem cell transplant - an emerging indication in younger pediatric patients Via American Journal of Blood Research Am J Blood Res. 2021 Apr 15;11(2):168-171. eCollection 2021. ABSTRACT BACKGROUND: Engraftment of neutrophils and platelets after hematopoietic stem cell transplant (HSCT) is imperative for optimal outcomes. Eltrombopag has been used in adults after HSCT to boost platelet production. Its use in pediatric post HSCT patients has been limited. METHODS: The clinical and laboratory details of a post autologous HSCT patient were fetched by a retrospective review of the records. RESULTS: A 5-year old male child had primary thrombocytopenia post autologous HSCT for refractory Hodgkin lymphoma. Although the stem cell dose infused was adequate, the child had a delay in the engraftment of platelets. After ruling out the causes of post HSCT thrombocytopenia, eltrombopag was started for the child. With the use of eltrombopag, normal thrombopoiesis was restored in the child. CONCLUSION: Eltrombopag was effective and safe in overcomi ng post-HSCT primary thrombocytopenia in our patient. PMID:34079631 | PMC:PMC8165717 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anti-globulin test positivity indicates advanced disease in Indian CLL patients

xlomafota13 shared this article with you from Inoreader Anti-globulin test positivity indicates advanced disease in Indian CLL patients Via American Journal of Blood Research Am J Blood Res. 2021 Apr 15;11(2):157-162. eCollection 2021. ABSTRACT Autoimmune Hemolytic Anemia (AIHA) occurs in 10% to 25% of Chronic Lymphocytic Leukemia (CLL) while Direct Antiglobulin Test (DAT) positivity seen in 35% of cases. The prevalence and prognostic significance of DAT positivity is not well documented especially in Indian population. The present study was undertaken to know prevalence and prognostic significance of DAT positivity in CLL in India by associating it with stage and CD 38 expression. The study included fifty-eight newly diagnosed and untreated cases of CLL staged according to Binet and Rai system. Complete hemogram, DAT and immuno-phenotyping by flow cytometry was done to diagnose CLL and to assess CD 38 expression. Student's t test and Chi square test was used to calculate difference between means. p value ≤0.05 was considered significant. Results-DAT positivity was found in 27.58% cases. A positive association was seen between DAT and advanced Rai and Binet stage (P = 0.024 and P = 0.014 respectively). A positive association was also seen between DAT and CD 38 (P = 0.008). The study concluded that DAT positivity in Indian CLL patients is high as compared to West. As DAT correlated with advanced Rai/Binet stage, as well as CD 38 positivity, it can be considered as a surrogate marker for advanced disease and used to select patients needing close follow up especially at places where molecular and flow cytometric set up for prognostication is not available. PMID:34079629 | PMC:PMC8165719 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transverse plane ultrasound-guided caudal epidural injections: sonographic anatomy and stepwise technique

xlomafota13 shared this article with you from Inoreader Transverse plane ultrasound-guided caudal epidural injections: sonographic anatomy and stepwise technique Via radiol anat Surg Radiol Anat. 2021 Jun 2. doi: 10.1007/s00276-021-02776-9. Online ahead of print. ABSTRACT PURPOSE: The present study aims to provide a step-by-step procedural and anatomical familiarization guide for transverse plane ultrasound (US)-guided caudal epidural (CE) injection. METHODS: The study cohort consisted of 23 chronic low back pain patients (23-67 years old) previously unresponsive to conservative management. A transverse plane US-guided CE injection was perform ed, with each procedure step documenting and emphasizing sonographic anatomy. Several Thiel's method fixed cadaveric specimen dissections were also performed to demonstrate relevant CE injection-related anatomy. RESULTS: The sacral hiatus location can be estimated by visually forming an equilateral triangle between the posterior superior iliac spines and the sacral apex (trigonum sacrale). Follow-up palpation locates the sacral cornua, guiding transducer placement visualizing over the paired cornua 'bull frog's eye's appearance, with the epidural space visualized as a hypoechoic line, between the eyes. Then, 2-3 ml of 1% lidocaine is injected subcutaneously at the mid-point between the sacral cornua and superficial to the posterior sacrococcygeal ligament (SCL). Although keeping the cornua, superficial posterior SCL and epidural space in view, the needle is slowly advanced to the epidural space at around a 20 degree cephalad angle till the tip becomes visible. Expansion of the epidural space is monitored under the transverse sacral ligament as the injectant is slowly introduced. CONCLUSION: The present study demonstrated the anatomical landmarks necessary for the transverse ultrasound caudal epidural technique and that the cornua, superficial posterior SCL, CE space, and other relevant sacral hiatal anatomy are well visualized with this technique. PMID:34080063 | DOI:10.1007/s00276-021-02776-9 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion

xlomafota13 shared this article with you from Inoreader Post-Operative Dysphagia in Anterior Cervical Discectomy and Fusion Via otol rhinol Ann Otol Rhinol Laryngol. 2021 Jun 2:34894211015582. doi: 10.1177/00034894211015582. Online ahead of print. ABSTRACT OBJECTIVE: We sought to identify risk factors associated with long-term dysphagia, characterize changes in dysphagia over time, and evaluate the incidence of otolaryngology referrals for patients with long-term dysphagia following anterior cervical discectomy with fusion (ACDF). METHODS: About 56 patients who underwent ACDF between May 2017 to February 2 019 were included in the study. All patients were assessed for dysphagia using the Eating Assessment Tool (EAT-10) survey preoperatively and late postoperatively (≥1 year). Additionally, 28 patients were assessed for dysphagia early postoperatively (2 weeks-3 months). Demographic data, medical comorbidities, intraoperative details, and post-operative otolaryngology referral rates were collected from electronic medical records. RESULTS: Of the 56 patients enrolled, 21 patients (38%) had EAT-10 scores of 3 or more at long-term follow-up. None of the demographics, comorbidities, or surgical factors assessed were associated with long-term dysphagia. Patients who reported no long-term dysphagia had a mean EAT-10 score of 6.9 early postoperatively, while patients with long-term symptoms had a mean score of 18.1 (P = .006). Of the 21 patients who reported persistent dysphagia symptoms, 3 (14%) received dysphagia testing or otolaryngology referrals post-operatively. CON CLUSION: Dysphagia is a notable side effect of ACDF surgery, but there are no significant demographics, comorbidities, or surgical risk factors that predict long-term dysphagia. Early postoperative characterization of dysphagia using the EAT-10 questionnaire can help predict long-term symptoms. There is inadequate screening and otolaryngology follow-up for patients with post-ACDF dysphagia. PMID:34075815 | DOI:10.1177/00034894211015582 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Social Representation of ‘Vocal Hygiene’ in India and Bhutan: A Cross-Sectional Survey

xlomafota13 shared this article with you from Inoreader Social Representation of 'Vocal Hygiene' in India and Bhutan: A Cross-Sectional Survey Via Journal of Voice The study aimed to explore the professional and recreational and/or personal voice use patterns and social representation of 'vocal hygiene' in two culturally and geographically diverse societies: India and Bhutan. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.