Clinical Emergencies Presented by Anemia

Anaemia affects 24.8% of the population worldwide. It has wide variety in terms of clinical manifestation of the disease severity. It can also ranges from almost asymptomatic to severe haemolytic anaemia. In contrast to all other nucleated cells, RBCs show very interesting biology.

An alteration in any of the major factors in RBCs (eg. shape, size, and structural or functional or quantitional abnormalities in haemoglobin) usually results in compensatory changes in the other compensatory factors. Sometimes, the compensatory responses may fail because of severity of disease or due to underlying pathologic conditions.

The result of failed compensatory responses is cellular dysfunction, tissue hypoxia and eventual cell death, which ultimately leads to severity in anaemia and emergency situations due to it. In this paper, we have concentrated to focus on how the extrinsic and intrinsic defects on RBCs cause severe haemolytic anaemia, leading to emergencies.

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THE COST-EFFECTIVENESS OF IBRUTINIB IN TREATMENT OF RELAPSED OR REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment options for patients with previously-treated Chronic Lymphocytic Leukemia are limited; no standard of care exists. In the Phase III RESONATE trial, oral, once-a-day, first-in-class covalent Bruton’s tyrosine kinase inhibitor ibrutinib was associated with improved Progression-Free Survival (PFS) (Hazard Ratio 0.106, 95% Confidence Interval and Overall Survival compared with ofatumumab. The current study evaluated the cost-effectiveness of ibrutinib compared to commonly-used therapies for Relapsed or Refractory (R/R) CLL.

A health state model simulated a cohort of R/R CLL patients receiving ibrutinib, ofatumumab, Idelalisib+Ofatumumab (IO), or Physician’s Choice (PC) (a mixed bag of treatments) until death or disease progression, at which point they received subsequent treatment or best supportive care. PFS and OS were extrapolated based on data from RESONATE (ibrutinib and ofatumumab) and from indirect treatment comparisons.

The analysis was conducted over a 30-year time horizon from a Swedish healthcare payer perspective. Health outcomes and costs were discounted per Swedish guidelines. Costs, Life Years (LYs), Quality-Adjusted LYs (QALYs), and incremental costs per QALYs were evaluated.

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A Rare Case of Non-rheumatic Streptococcal Acute Myocarditis

Non-rheumatic Streptococcal Acute Myocarditis, also known as Strep Pharyngitis Acute Myocarditis (SPAM) occurs in young adults, typically within five days of the initial streptococcal pharyngitis, and is characterized by typical cardiac symptoms, abnormal electrocardiography, and elevated cardiac biomarkers in the absence of obstructive coronary artery disease.

Patients may also report myalgias, arthralgias, and constitutional symptoms. Although a rare complication of Group A and G streptococcal infections, prompt recognition is important to ensure appropriate management.

This article discusses the case of a 33-year-old male who presented with substernal chest pain and monoarticular arthralgia two days after diagnosis with streptococcal pharyngitis, and reviews available literature on the evaluation and management of SPAM.

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Microbial Prevalence and Antimicrobial Resistance in Children and Adolescents with Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a common multifactorial upper respiratory disease with a key role of microbes in worsening of disease and its associated co-morbidities. Further, significant region specific variation in patient demographics and antibiotic resistance of causative bacteria are reported to pose difficulty in diagnosis and treatment.

In India, studies on the etiology and antibiotic resistance in chronic rhinosinusitis are very meager, especially in children. The present study aimed to determine the prevalence of common causative microbes and their antibiotic resistance in children and adolescents with chronic rhinosinusitis in South Indian population.

Subjects and methods: The present study was conducted on 89 children and 99 adolescents with chronic rhinosinusitis who visited MAA ENT Institute, Hyderabad, South India. The study samples were collected under the nasal endoscopic guidance from the middle meatus at first visit and sinuses at surgery.

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Orbital Involvement in Primary Paranasal Sinus Space Occupying Lesions

Orbit is an innocent bystander that is afflicted by lesions of the Paranasal Sinuses (PNS). Orbits share 3 walls with the sinuses, frontal sinuses on the supero-medial aspects of the orbits, ethmoid sinuses medially and maxillary sinuses inferiorly.

Between the ethmoids and the orbits, there is lamina papyraecea which is a very thin bone. Between the maxillary sinus and the floor of the orbit, the bone is weakened by the passage of the infraorbital nerve. The periorbita or the periosteum of the orbit is a tough structure that resists invasion by tumors.

Once the tumor transgresses this robust layer, it spreads to the orbital spaces easily due to lack of barriers that check tumor spread. There is also rich vascular communication between the sinuses and the orbit, which acts as a conduit for spread of infections and tumors. The last but not the least is the communication between the nasal cavity and the orbit through the Nasolacrimal Duct.

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The Dilemma of Rhinitis

Rhinitis is a widespread condition that causes significant morbidity worldwide and profoundly affects patients' quality of life. Given its prevalence and relative chronicity, the economic impact of rhinitis is significant.

It has been demonstrated that allergic rhinitis is a strong risk factor for the onset of asthma in adults. This led to the development of the United Airways Concept. Despite this prevalence, rhinitis is still an ill-defined disease that is associated with many controversial entities and few proven facts. The term “rhinitis’’ is, in itself, controversial as it implies an inflammatory disease of the nasal mucous membrane.

Clinical experience however has showed that the common symptoms of itching, sneezing, discharge, and blockage may exist without actual inflammation. Therefore, strictly speaking, the term “rhinopathy” is a more correct term, but it is rarely used.

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The Benefit and Tolerability of Adjuvant Chemotherapy in Elderly Stage III Colon Cancer Patients

The benefit of adding oxaliplatin to adjuvant fluoropyrimidine chemotherapy in patients >70 years is controversial. This retrospective audit investigated usage, benefit and tolerability of adjuvant chemotherapy for colon cancer in older adults. Materials and methods: Patients aged >60 years with stage III colon cancer referred for adjuvant chemotherapy between 2010–2012 were identified from a tertiary hospital oncology database.

Data were collected on demographics, chemotherapy received, completion rates, toxicities, relapse and survival. Comparison was made between the older group (age >70 years) and the younger group (age 60-70 years). Results: 95 eligible patients were identified; 50 in the older group (median age 76), 45 in the younger group (median age 66), 56% male, 82% NZ European and 5% Maori.

Older patients were less likely to receive adjuvant chemotherapy (76% and 91% in the older and younger group respectively, p=0.0017), especially oxaliplatincontaining regimens (14% and 47% of older and younger groups, respectively). Similar proportions in each group completed >80% of planned chemotherapy doses with no significant difference in early discontinuation due to toxicities.

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