Maria Mainou

Efficacy and safety of empagliflozin for type 2 diabetes: a systematic review and meta-analysis.

To assess the efficacy and safety of the novel sodium‐glucose cotransporter 2 (SGLT2) inhibitor empagliflozin compared with placebo or other antidiabetic agents in patients with type 2 diabetes.

Splenic infarction as a rare complication of infectious mononucleosis due to Epstein–Barr virus infection in a patient with no significant comorbidity: Case report and review of the literature

Abstract We report the case of a 17-y-old boy diagnosed with infectious mononucleosis due to Epstein–Barr virus infection who complained of left upper quadrant pain. A magnetic resonance imaging scan showed a splenic infarct in the enlarged spleen. Other causes of splenic infarction were excluded. Thus, infectious mononucleosis may cause splenic infarction in patients without other comorbidities.

Safety And Efficacy Of 4 Years Of Deferasirox Treatment For Sickle Cell Disease Patients

Deferasirox (DFRA) is a novel oral chelator agent for treatment of iron overload. Although well established in the treatment of β-thalassemia major (β-TM), it has not yet been fully investigated in patients with sickle cell disease. The aim of this report is to present the preliminary results of a pilot study assessing the effect of 4 years of DFRA treatment in six patients with sickle cell disease who are in need of recurrent transfusions. Our results show a significant reduction of ferritin levels and improvement of liver hemosiderosis, assessed by means of magnetic resonance imaging T2* (MRI T2*). None of the patients presented any serious adverse effects and the treatment was well tolerated. These results are in accordance with previous studies about the use of DFRA in sickle cell disease.

Rivaroxaban Use in Patients with Hemoglobinopathies

Abstract The use of rivaroxaban in patients with hemoglobinopathies and thrombotic events has not been studied extensively. Here we present eight cases of such patients, five receiving rivaroxaban for stroke and systemic embolism prevention due to non-valvular atrial fibrillation and three for deep vein thrombosis treatment. The follow-up period ranged from 6 to 34 months. During this period none of the patients experienced any thrombotic or bleeding event.There were no other adverse events reported. Further studies with larger numbers of patients with hemoglobinopathies are needed to determine the use of rivaroxaban and ensure its safety in this patient setting.

Glucagon-like peptide-1 receptor agonists and microvascular outcomes in type 2 diabetes: A systematic review and meta-analysis

We conducted a systematic review and meta‐analysis of randomized controlled trials to assess the effect of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) on microvascular endpoints in adult patients with type 2 diabetes. We included 60 studies with 60 077 patients. GLP‐1 RAs marginally reduced urinary albumin‐to‐creatinine ratio compared with placebo or other antidiabetic agents (weighted mean difference − 2.55 mg/g; 95% confidence interval [CI] −4.37 to −0.73 and −5.52; −10.89 to −0.16, respectively) and had no clinically relevant effect on change in estimated glomerular filtration rate. Treatment with GLP‐1 RAs did not increase incidence of diabetic retinopathy, macular oedema, retinal detachment and retinal haemorrhage, irrespective of comparator. Nevertheless, incidence of vitreous haemorrhage was higher in subjects treated with GLP‐1 RAs compared with placebo (odds ratios 1.93; 95% CI 1.09 to 3.42). In conclusion, GLP‐1 RAs are safe regarding nephropathy‐ and retinopathy‐related outcomes. Caution may be warranted for incidence of vitreous haemorrhage. The low overall quality of evidence highlights the need for consistent assessment and reporting of microvascular endpoints in future trials.

In vitro evidence of complement activation in patients with sickle cell disease

Sickle cell disease (SCD) remains a devastating and painful condition leading to significant morbidity and mortality in the era of hydroxycarbamide.[1][1] Current understanding of disease pathophysiology has focused not only on the interaction between sickle red blood cells and neutrophils,

Association between response rates and survival outcomes in patients with newly diagnosed multiple myeloma. A systematic review and meta‐regression analysis

We performed a systematic review and meta‐regression analysis of randomized control trials to investigate the association between response to initial treatment and survival outcomes in patients with newly diagnosed multiple myeloma (MM).

A Case of Fatal Agranulocytosis That Developed in a Patient with β-Thalassemia Major Treated with Deferiprone.

Abstract A 29-year-old male with transfusion-dependent β-thalassemia major (β-TM), splenectomized and on chelation therapy with deferiprone (DFP or L1) due to heart and liver hemosiderosis, presented with high fever and agranulocytosis. Deferiprone was discontinued and a broad spectrum antibiotic therapy was started intravenously. The patient remained febrile and showed no recovery of neutrophil count even after the initiation of granulocyte colony-stimulation factor (G-CSF). After 12 days at the hospital, he developed respiratory failure and was transferred to the intensive care unit (ICU) where he developed multi-organ failure and died 3 days later. To investigate the mechanism of agranulocytosis, bone marrow mononuclear cells of a healthy volunteer were plated on culture dishes, with or without the patient’s serum. The observation of colony forming units of progenitor cells in dishes that contained the patient’s serum, provided inconclusive explanation of the possible mechanism of DFP-induced agranulocytosis. This is a case of fatal agranulocytosis developing in a patient being treated with DFP, a well recognized but rare complication of this drug. Further studies are required in order to elucidate the possible pathogenic mechanism of agranulocytosis due to DFP and to provide clear guidelines in order to best care for the patient.

Splenic infarction as a complication of infectious mononucleosis in a patient with no significant comorbidity

Beta-lactamase producing bacteria (BLPB) are responsible for severe nosocomial infections, difficult to control and which constitute an important and growing public health problem, with respect to antibiotic resistance. Objective: This study intended to characterize patients with cultures positive for BLPB, characterize the population susceptible to infection with BLPB, and the resistance profile of these agents, and identify risk factors for this infection as well as potential associated complications and mortality. Methods: This was a descriptive retrospective study, made in the hospital in question during a 9 month period (2012 January 1 to September 15), by consulting clinical processes, at a time when there was a substantial increase in these infections in our hospital. Results: We identified 332 isolates (242 cultures with Escherichia coli and 90 Klebsiella pneumoniae), corresponding to 191 patients. Of these 67% were considered infections associated with health care, 24% of community infections and 9% colonization. The average age of these patients was 69.5 years, the majority being female. The average hospital days stood at 20.9 days and the mean time between admission and positive culture was 7.4 days. In more than 90% of the patients noted the presence of invasive devices. 65% of patients had a history of hospitalization in the previous 3 months, 59% had done last month antibiotic treatment (beta-lactams, cephalosporins and quinolones) and 51% had both factors. The existence of comorbidities was also studied and found that hypertension, diabetes mellitus, cerebrovascular disease, heart disease and chronic kidney disease were the most prevalent. It was also found that the most frequent sites of isolation were the urinary tract and blood (21.7% of bacteraemia). 38.3% of these patients with an overall mortality of 19% were readmitted. All of these bacteria were sensitive to carbapenem, except two cases which were sensitive only to amikacin and tigecycline. Conclusion: Elderly patients with more pathologies, with previous antibiotics or hospitalization, and with invasive devices have more susceptibility to infectious by beta-lactamase producing bacteria. Identifying groups and factor risks is important to take effective control infection measures.