Erythropoiesis Stimulating Agents in Heart Failure Patients with Anemia: A Meta-Analysis

Background  

Anemia is prevalent in patients with heart failure and an independent prognostic sign of poor outcome. The current report is a meta-analysis of published clinical trials assessing the use of erythropoeisis stimulating agents (ESA) in heart failure (HF) patients with anemia.     

Comparison of two regimens of RhG-CSF in neutropenic neonatal septicemia: a randomized clinical trial

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals (Tehran, Iran). The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10 μg/kg/s.c. to neonates in group A and as 10 μg/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups (P>0.05). The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups (P>0.05). The results of this study showed that administration of a single dose of RhG-CSF (10 μg/kg) was effective in treating neonatal septicemic neutropenia.     

Suppression of Lymphoblastoid Cell Line Proliferation by Antisera to HLA-DR and Other HLA Antigens

We have observed that certain antisera to HLA antigens suppress the in vitro proliferation of lymphoblastoid cell lines. An antiserum to HLA-B8 demonstrated suppressor activity associated with the presence of B8 antigen on the target LCLs; this activity was removed by absorption with platelets or with B8-positive LCLs. An antiserum to HLA-DRw7 suppressed proliferation of all six DRw7-positive LCLs and none of 12 DRw7-negative LCLs; this activity was removed by absorptions with three DRw7-positive LCLs, each representing a different HLA-D allele (i.e. Dw7, 10 and 11); it could not be removed by triple serial absorptions with platelets from multiple-donor pools. These experiments indicate that the suppressor activity of this serum is specifically associated with antibodies to DRw7. Our model of LCL growth suppression by HLA antisera is easily manipulated and provides a definitive tool for further characterizing HLA antigens and antisera in a complement-independent system.     

The Prognostic Value of Anemia in Patients with Diastolic Heart Failure

Anemia is prevalent in heart-failure patients, and it has been associated with increased mortality rates. In a retrospective study, we evaluated the effects of anemia on long-term survival in patients who experienced purely diastolic heart failure.Heart-failure patients with preserved systolic function (left ventricular ejection fraction, ≥0.50) were evaluated retrospectively. Of 294 patients, 162 had anemia (group 1) and 132 had no anemia (group 2) upon baseline examination. Anemia was defined as a hemoglobin level below 12 g/dL in women and below 13 g/dL in men. Multivariate Cox proportional hazards regression was conducted in order to test whether hemoglobin levels were an independent predictor of 5-year hospitalization and mortality rates in patients with diastolic heart failure. A P value less than 0.05 was considered statistically significant.Group 1 patients had a shorter mean survival time (37.8 ± 1.8 vs 44.9 ± 1.8 mo, P = 0.01); however, there was no significant difference between the groups in hospitalization rate (7.2 ± 7.1 vs 7.5 ± 6.3, P = 0.677). In a subgroup analysis, anemia was a significant predictor of higher mortality rates in elderly patients (age, >75 yr) who had diastolic heart failure (P = 0.018).We found that anemia is associated with increased long-term mortality rates in patients who have diastolic heart failure. In addition, anemia appears to be an independent predictor of worse outcomes in elderly heart-failure patients.Key words: Age factors, anemia/blood/complications/epidemiology/mortality, diastole, heart failure/blood/complications/mortality/physiopathology, hemoglobins/analysis, patient readmission, prevalence, risk assessment, survival analysis, ventricular function/leftAnemia is defined by the World Health Organization as a hemoglobin (Hb) level below 12 g/dL in women and below 13 g/dL in men.¹ A low Hb level is a significant risk factor in heart-failure patients: its association with increased death in this patient population has been shown, and it is an independent predictor of death.^2–4 Anemia has also been associated with increased rates of hospital readmission for heart failure.The optimal Hb level in patients with heart failure is still unclear, although a longitudinal study⁵ of a large population of patients with chronic heart failure showed that very high levels (≥17 g/dL) or low levels (<13 g/dL) independently predicted death and hospitalization for heart failure.In most studies in which the effect of anemia in heart failure has been examined, the focus has been on patients who experienced systolic heart failure. In the present study, we sought to evaluate the relationship of Hb levels with short- and long-term survival in patients who experienced diastolic heart failure with preserved systolic function.     

Primary intramedullary histiocytic sarcoma

Intramedullary primary central nervous system lymphoma (PCNSL) is a rare central nervous system (CNS) malignancy affecting mostly the brain, but it may also involve the leptomeninges, eyes, and spinal cord. A 71-year-old woman presented with back pain and progressive unilateral lower extremity weakness owing to an intramedullary primary histiocytic sarcoma of the spine, a rare PCNSL subtype. To the authors' knowledge, this is the first case of an intramedullary PCNSL caused by histiocytic sarcoma.     

Case report: Duane Retraction Syndrome associated with hand anomaly

Duane Retraction Syndrome is a congenital eye movement disorder characterized by a failure of cranial nerve VI to develop normally, resulting in restriction or absence of abduction, restricted adduction and narrowing of the palpebral fissure and retraction of the globe on attempted adduction. Patients with Duane Retraction Syndrome appear to have a significant increase in the number of associated congenital malformations. In the present paper, the authors report a case of Duane Retraction Syndrome with a unique hand abnormality not reported previously.