Cardiac complications and iron overload in beta thalassemia major patients-a systematic review and meta-analysis.

Despite the major improvement in therapeutic management of thalassemia major, iron overload is considered a challenging conundrum in these patients and heart disease still remains a major cause of morbidity and mortality in these patients. Therefore, this study aimed to investigate the prevalence of cardiac iron overload and cardiovascular complications in transfusion-dependent thalassemia patients in the worldwide. The following databases were searched: ISI/Web of Science, Embase, PubMed, Scopus, up to February 30, 2018. The quality of the studies was evaluated using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. The random model based on Metaprop was used. One hundred forty-two studies were included. The total number of patients included was 26,893. The mean age of patients was 22.6 (SD = 1.7) years. Based on Metaprop, the overall prevalence of cardiac iron overload/myocardial sidoresis (T2* < 20 ms) and cardiac complications in thalassemia major patients in the worldwide was 25% (95% CI 22-28%) and 42% (95% CI 37-46%), respectively. The results of this study show that the prevalence of cardiac iron overload and cardiovascular complications in patients with thalassemia major is almost high. Therefore, iron chelation and careful monitoring of serum ferritin level will prevent the cardiac iron overload, and interval monitoring of patients with transfusion-dependent thalassemia (TDT) by echocardiography and electrocardiography will help with early detection of cardiovascular complications.

Successful delivery in patients with FXIII deficiency receiving prophylaxis: report of 17 cases in Iran.

To prevent pregnancy loss in women with severe FXIII deficiency, prophylactic replacement therapy with a source of FXIII throughout pregnancy is essential. The aim of this study was to evaluate the bleeding score and rate of successful deliveries in FXIII-deficient pregnant Iranian women receiving regular prophylaxis. Seventeen FXIII-deficient women 18-35 years old (mean 24 years) were enrolled in the study. All patients except one had a history of at least one miscarriage. Patients received regular prophylaxis with 10 IU kg(-1) FXIII concentrate every 4 weeks before pregnancy and every 2 weeks during pregnancy for a period of 24-62 months. All bleeding episodes were recorded, and the bleeding score was determined on a standard form before and after the start of prophylaxis. After starting prophylaxis, monochloroacetic acid tests and 5 m urea tests were normal in all patients, and the bleeding score significantly decreased from 11-16 (mean 12 ± 1.5) to 23 (mean 2.2 ± 0.4) (P < 0.001). Thirteen minor bleeding episodes occurred during prophylaxis. All patients successfully delivered at 36 weeks' gestation and there were no significant coagulation complications during or after delivery. In this study, successful pregnancy maintenance and delivery were achieved in Iranian women with severe FXIII deficiency. Precise detection and diagnosis of this condition in women with coagulation disorders is essential to enable implementation of appropriate prophylaxis to prevent pregnancy loss.

Causes of new cases of major thalassemia in sistan and balouchistan province in South-East of iran.

BACKGROUND: Thalassemia is the most common monogenic disease in South-East of Iran. Despite the 70% reduction in Iranian thalassemia cases after thalassemia control comprehensive program, 601 affected babies were born in Sistan and Balouchistan Province, Iran from 2002 to 2010, so this study aims at investigating the causes of new thalassemia cases. METHODS: Data from this retrospective cross-sectional study was collected through interviews and information in the patients' hospital records. RESULTS: Data revealed that 52.4% of fathers and 78.4% of mothers of thalassemic children had elementary education or less. In addition, 78.6% of the couples did not undergo premarital screening for thalassemia and 71.2% of the couples were not notified of their own minor thalassemia until a child was born with major thalassemia. Of the diagnosed minor couples, about 25% did PND and the others did not carry out because mothers were unaware of proper gestational age and of the importance of this issue, financial problems, and the husbands' disagreement to take the tests. Moreover, 16 mothers, in spite of being diagnosed of having a major fetus, refused to terminate the pregnancy. CONCLUSION: The most preventable causes for affected births include couples' unawareness of being minor and unawares of the PND importance and process.

Molecular basis and prenatal diagnosis of ß-thalassemia among Balouch population in Iran.

OBJECTIVE: To determine the molecular spectrum of ß-thalassemia mutations among at-risk Balouch couples in Iran. METHODS: Mutations' detection in DNAs extracted from the blood of partners of at-risk couples was characterized, and chorion villus sampling by amplification refractory mutation system and DNA sequencing was performed. Fetal diagnosis was also confirmed by linkage analysis. RESULTS: Out of a total of 1234 at-risk Balouch couples referred to the center for prenatal diagnosis (PND) from June 2002 to June 2010, a high percentage of '67.4%' were from consanguineous marriages and 37.4% had between one and four affected children. The trend in referring gradually increased from 34 cases in 2002 to 357 cases in 2010. The astonishing finding was that, unlike most previous studies, only IVS 1-5 with an unusual frequency of 87.20% along with codon 8/9 (+G) with 4% constitutes about 91% of mutations. Altogether, 729 PNDs were made in 583 couples, 25% of whom had over one PND, and surprisingly five PNDs were made in the same woman within just 8 years. CONCLUSION: Regarding the limited types of frequent mutations among Balouch population, it is hopefully believed that the incidence of ß-thalassemia could be controlled by a correct diagnosis in the due time.

Downregulation of telomerase activity in human promyelocytic cell line using RNA interference.

Telomerase is a ribonucleoprotein complex. It consists of two main components, human telomerase reverse transcriptase (hTERT) and human telomerase RNA. High telomerase activity is present in most malignant cells, but it is barely detectable in majority of somatic cells. The direct correlation between telomerase reactivation and carcinogens has made hTERT a key target for anticancer therapeutic studies. In this study, for the first time, we evaluated the ability of the new generation of short interfering RNA (siRNA) to regulate telomerase activity in the human promyelocytic leukemia cell line (HL-60). Transient transfection cell line by hTERT siRNAs resulted in statistically significant suppression of hTERT messenger RNAs which were detected by quantitative real-time polymerase chain reaction, while the expressed hTERT protein levels were measured by flow cytometry. The results of telomeric repeat amplification protocol showed that telomerase activity was significantly reduced upon transfection of the HL-60 cell line with hTERT siRNAs. The results of this study showed that telomerase activity and cell proliferation were efficiently inhibited in the hTERT siRNA-treated leukemic cell line.