American journal of hematology
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Review Meta Analysis
Thalidomide versus bortezomib based regimens as first-line therapy for patients with multiple myeloma: a systematic review.
Thalidomide (T) or bortezomib (B) in combination with melphalan plus prednisone (MP) is superior to MP as first line therapy for previously untreated myeloma. However, direct head-to-head comparison of Melphalan, Prednisone plus Bortezomib (MPB) versus Melphalan, Prednisone plus Thalidomide (MPT) is lacking. We performed an indirect meta-analysis to assess the treatment effects of MPB versus MPT via common comparator MP using the systematic review and meta-analytical techniques. ⋯ The indirect comparison of MPB versus MPT showed no difference between MPB versus MPT for all outcomes but a significant benefit for complete response (RR 2.34, 95% CI 1.12-4.90), and grade III/IV adverse events (RR 0.53, 95% CI 0.38-0.73) favoring MPB. There is an uncertainty about definitive superiority of one type of regimen over the other. Therefore, direct head-to-head comparison between these competing regimens is warranted.
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Pulse oximetry estimates arterial blood oxygen saturation based on light absorbance of oxy- and deoxy-hemoglobin at 660 and 940 nm wavelengths. Patients with unexpectedly low SpO₂ often undergo cardio-pulmonary testing to ascertain the cause of their hypoxemia. However, in a subset of patients, a variant hemoglobin is responsible for low SpO₂ measurements. ⋯ Abnormal absorption spectra explain the discrepancy between SpO₂ and SaO(2) for some variants. The differential diagnosis of possible variant hemoglobin ought to be considered in asymptomatic patients found to have unexpectedly low SpO₂. The correct diagnosis will help to spare patients from unnecessary investigations and anxiety.
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Letter Review Case Reports
HIV-negative, HHV-8-unrelated primary effusion lymphoma-like lymphoma: report of two cases.
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Variation in bleeding in the perioperative period is a complex and multifactorial event associated with immediate and delayed consequences for the patient and health care resources. Little is known about the complex genetic influences on perioperative bleeding. ⋯ In this review, polymorphisms in the platelet receptor genes, plasminogen activator inhibitor, and angiotensin genes among others will be discussed. We will explore the nature, effects, and implications of the genetics that influence perioperative bleeding above and beyond surgical bleeding, particularly in cardiac surgery.
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Morbid obesity is a health problem that has been shown to be refractory to diet, exercise, and medical treatment. Surgeries designed to promote weight loss, termed bariatric surgery and typically involving a gastric bypass procedure, have recently been implemented to treat obesity with high success rates. However, long-term sequelae can result in micronutrient deficiencies. ⋯ Postoperatively, oral iron prophylaxis and vitamin C in addition to a multivitamin should be prescribed for bypass patients, especially for vulnerable populations. Once iron deficiency has developed, it may prove refractory to oral treatment, and require parenteral iron, blood transfusions, or surgical interventions. Bariatric surgery patients require lifelong follow-up of hematological and iron parameters since iron deficiency and anemia may develop years after surgery.