|Year : 2013 | Volume
| Issue : 2 | Page : 134-135
K Shreedhara Avabratha
Department of Pediatrics, Father Muller Medical College, Mangalore, India
|Date of Web Publication||16-Sep-2013|
K Shreedhara Avabratha
Department of Pediatrics, Fr Muller Medical College, Mangalore - 575 002, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Avabratha K S. Journal beat. Muller J Med Sci Res 2013;4:134-5
1. A No-Prophylaxis Platelet-Transfusion Strategy for Hematologic Cancers 
N Engl J Med 2013;368:1771-1780.
In patients with hematologic cancers, severe thrombocytopenia frequently develops as a consequence of the disease or its treatment. Most platelet transfusions are administered as prophylaxis, to increase low platelet counts and to reduce the risk of bleeding. However, the degree to which prophylactic platelet transfusions prevent bleeding remains unclear. This trial assessed whether a policy of not giving prophylactic platelet transfusions was as effective and safe as a policy of providing prophylaxis.
This was a randomized, open-label, non-inferiority trial conducted at 14 centers in the United Kingdom and Australia. Patients were randomly assigned to receive, or not to receive, prophylactic platelet transfusions when morning platelet counts were less than 10 × 10 9 per liter. Eligible patients were persons 16 years of age or older who were receiving chemotherapy or undergoing stem-cell transplantation and who had or were expected to have thrombocytopenia. The primary end point was bleeding of World Health Organization (WHO) grade 2, 3, or 4 up to 30 days after randomization.
A total of 600 patients (301 in the no-prophylaxis group and 299 in the prophylaxis group) underwent randomization between 2006 and 2011. Bleeding of WHO grade 2, 3, or 4 occurred in 151 of 300 patients (50%) in the no-prophylaxis group, as compared with 128 of 298 (43%) in the prophylaxis group (adjusted difference in proportions, 8.4 percentage points; 90% confidence interval, 1.7 to 15.2; P = 0.06 for non-inferiority). Patients in the no-prophylaxis group had more days with bleeding and a shorter time to the first bleeding episode than did patients in the prophylaxis group. Platelet use was markedly reduced in the no-prophylaxis group. A pre-specified subgroup analysis identified similar rates of bleeding in the two study groups among patients undergoing autologous stem-cell transplantation.
In conclusion, the results indicate that prophylactic platelet transfusions reduced rates of bleeding events in patients with hematologic cancers, supporting the need for continued use of prophylactic platelet transfusion. The proportion of patients who had bleeding events of WHO grade 2, 3, or 4 was reduced by 7% overall in the group that received prophylactic platelet transfusions.
2. Significance of weakly positive urine pregnancy tests 
Al Ameen J Med Sci 2013;6(1):75-79.
Cessation of menstruation in regularly menstruating women is an anxious situation both in infertility and unwanted pregnancy. Most of the women use Home Pregnancy Test (HPT) kit to determine their pregnancy status before seeking professional health care. Sensitivities of 10-50 IU/L became possible with the availability of monoclonal antibodies and refined techniques capable of giving positive result for pregnancy at the time of the first missed period. The assay is conducted by adding 2 drops of urine to the specimen well of the test device and observe the formation of colored lines. The urine migrates via capillary action along the membrane to react with the colored conjugates. Positive result form a colored line at the test line region of the membrane by reacting with the specific colored antibody conjugates. Low level of hCG in urine give weakly positive results. But, both the results are reported as a positive pregnancy test by a non-professional. Mostly, the manufactures of these kits do not quote the sensitivity of these kits and quote both positive and weakly positive result as positive for pregnancy. Human gonadotropin (hCG) levels indicate the health of the trophoblastic tissue, and low level of βhCG is associated with poor decidual reaction. A weakly positive result indicates low hCG level and requires further evaluation.
The objective of this study was to determine the pregnancy outcome of weakly positive urine pregnancy tests (UPT) in 207 women by trans-vaginal sonograghy (TVS). Women visiting Antenatal Clinic for confirmation of pregnancy with weakly positive UPT were advised to repeat UPT after 48 hours on morning urine sample. Repeat UPT with weakly positive results were advised TVS to know the pregnancy outcome. TVS of these weakly positive results showed early pregnancy failure (EPF) in 138 (66.6%), viable pregnancy in 58 (28%), and no pregnancy in 11 (5.3%).
In conclusion, these kits require a manufacturer's instruction to distinguish positive and weakly positive results and an advice for further evaluation by an expert. The authors further add that whenever a woman presents with a HPT kit positive result, it should be retested by a professional with experience in pregnancy testing and TVS may be utilized to know the pregnancy outcome.
3. Association between iron status, iron-deficiency anemia, and severe early childhood caries: A case-control study 
BMC Pediatrics 2013;13:22.
Severe tooth decay is known to affect the health and well-being of young children. However, little is known about the influence of Severe Early Childhood Caries (S-ECC) on childhood nutritional status. The purpose of this study was to contrast ferritin and hemoglobin levels between pre-schoolers with S-ECC and caries-free controls.
Children were recruited as part of a larger case-control study examining differences in nutritional status between those with and without S-ECC. Pre-schoolers with S-ECC were recruited on the day of their dental surgery, while caries-free controls were recruited from the community. Parents completed a questionnaire, and the children underwent venipuncture. Statistics included descriptive, bivariate, and logistic regression analyses. A P value ≤ .05 was significant. A total of 266 children were recruited; 144 with S-ECC and 122 caries-free.
The mean age was 40.8 ± 14.1 months. The mean ferritin concentration for all children was 29.6 ± 17.9 μg/L while the mean hemoglobin level was 115.1 ± 10.1 g/L. Children with S-ECC were significantly more likely to have low ferritin (P = .033) and low hemoglobin levels (P > .001). Logistic regression analyses revealed that children with S-ECC were nearly twice as likely to have low ferritin levels and were over six times more likely to have iron-deficiency anemia than caries-free controls.
The authors conclude that children with S-ECC appear to be at significantly greater odds of having low ferritin status compared with caries-free children and also appear to have significantly lower hemoglobin levels than the caries-free control group. Children with S-ECC also appear to be at significantly greater odds for iron-deficiency anemia than cavity-free children.
| References|| |
|1.||Stanworth SJ, Estcourt LJ, Powter G, Kahan BC, Dyer C, Choo L, et al. A no-prophylaxis platelet-transfusion strategy for hematologic cancers, N Engl J Med 2013;368:1771-80. |
|2.||Kumar SR, Thobbi VA, Nayak SA. Significance of weakly positive urine pregnancy tests, Al Ameen J Med Sci 2013;6:75-9. |
|3.||Schroth RJ, Levi J, Kliewer E, Friel J, Moffatt ME. Association between iron status, iron deficiency anaemia, and severe early childhood caries: A case-control study, BMC Pediatrics 2013;13:22. |