Evaluation of Proteinuria in ß-Thalassemia Major Patients With and Without Diabetes Mellitus Taking Deferasirox.

BACKGROUND: ß-thalassemia is the most common heredity disease in Iran. Regular blood transfusion is critical to sustain life and normal growth. Deferasirox is an oral chelator. One of the side effects of the deferasirox is proteinuria. OBJECTIVES: This study aimed to investigate the safety of deferasirox on kidney function in diabetic and nondiabetic ß-thalassemia major patients. MATERIALS AND METHODS: In this cross-sectional study, 34 diabetic and 36 nondiabetic patients who take deferasirox (Exjade) 20 to 40 mg/kg/d were studied. Exclusion criteria included patient with renal failure, proteinuria, hepatitis B, hepatitis C, and the patients who refused to continue the study to the end. Subjects were divided into diabetic and nondiabetic groups. Spot urine protein/creatinine ratio, urinary analysis, alanine transaminase, aspartate transaminase, creatinine, fasting blood sugar, blood urea nitrogen, and serum ferritin were checked every 3 months. Patients were followed for a period of 1 year. RESULTS: In the ninth month after therapy there was a significant relationship in mean change of spot urine protein/creatinine ratio between diabetic and nondiabetic (P=0.011). Spot urine protein/creatinine ratio in diabetic and nondiabetic group was 0.19±0.18 and 0.1±0.05, respectively, which showed no significant relationship between the 2 groups at the end of study (P=0.162). CONCLUSION: The results of our study showed that consumption of deferasirox is safe, as there was no significant relationship between spot urine protein/creatinine ratio in diabetic and nondiabetic group. Deferasirox consumption is not associated with increased proteinuria in diabetic patients compared with nondiabetic group having only a transient proteinuria.

The frequency of silent cerebral ischemia in patients with transfusion-dependent ß-thalassemia major.

The aim of this study is to determine the frequency of silent cerebral ischemia (SCI) in a group of patients with ß-thalassemia major and correlate them with demographic parameters, blood and spleen status, volume and frequency of transfusions. In this cross-sectional study, 40 ß-thalassemic patients over 10 years old who had no neurologic deficit were studied. Brain MRI was performed to detect SCI. Silent cerebral ischemia was classified according to number and size. Silent cerebral ischemia was found in 15 patients (37.5 %). Mean number of SCI was 6.73 ± 10.33 (1-40), and mean size of the brain lesions was 3.07 ± 2.81 mm (1-11 mm). The patients with SCI were significantly older (31.1 ± 6.5 vs. 25 ± 6.8 years, P = 0.009), and most of them were splenectomized (80% vs. 36 %, P = 0.01). Interestingly, 10 out of 15 patients with SCI had platelet count less than 500,000/mm(3). Eight of these patients (80 %) were splenectomized. Other variables had no statistically significant association with the presence of SCI. Older age and splenectomized multitransfused ß-thalassemic patients even with normal platelet count have a higher incidence of SCI. The effect of splenectomy is more significant in statistical analysis. In splenectomized patients with a high platelet count and even with normal platelet count, aspirin therapy is indicated. Based on the results, it seems that regular blood transfusions are not going to have a significant effect on the number and size of SCI.

The role of intravitreal bevacizumab in experimental posterior penetrating eye injury.

PURPOSE: The purpose of this study was to investigate the effect of intravitreal bevacizumab on an experimental rabbit model of penetrating posterior ocular injury. METHODS: The right eyes of 40 white New Zealand rabbits were included in a penetrating posterior ocular injury model that was consisted of a 5-mm circumferential incision placed 8 mm behind the limbus at the supratemporal quadrant. They were randomly divided into two groups. The rabbits in Group 1 (n = 20) received 1.25 mg (0.05 mL) of intravitreal bevacizumab via pars plana injection and those in Group 2 (control group, n = 20) received 0.05 mL of intravitreal balanced salt solution. On Day 28, the eyes were enucleated and evaluated by gross inspection and light microscopy. Clearance time of vitreous hemorrhage, presence of fibrous proliferation or retinal detachment, greatest linear dimension of fibrosis, and grade of fibrous extension were regarded as outcome measures. Nominal variables were evaluated by the chi-square or the Fisher's exact test; continuous variables were evaluated using the Mann-Whitney U test. RESULTS: At the end of the surgery, all the eyes had moderate (n = 9 and 7 in the case and control groups, respectively) or severe vitreous hemorrhage (n = 11 and 13 in the case and control groups, respectively) (P = 0.52). Average clearance time of vitreous hemorrhage was 3.42 ± 2.71 and 6.47 ± 3.58 days in bevacizumab and control groups, respectively (P = 0.01). The incidence of ophthalmoscopically visible fibrous proliferation was 31.6% in the bevacizumab group and 63.2% in the control group (P = 0.05). The greatest linear dimension of fibrosis was 0.91 ± 1.14 mm in the bevacizumab group and 2.00 ± 1.58 mm in the control group (P = 0.02). Retinal detachment rate was 11% (n = 2, all rhegmatogenous) and 21% (n = 4, 2 rhegmatogenous and 2 tractional) in the bevacizumab and control groups, respectively (P = 0.66). Choroidal congestion, optic disk edema, and macular edema were seen in 1 eye (5.5%) of the bevacizumab group, whereas they were found in 4 (22%), 4 (22%) and 3 (16.5%) eyes of the control group, respectively. These differences, however, did not reach statistical significance. CONCLUSION: This study showed that intravitreal injection of bevacizumab may reduce the extent of fibrovascular and/or fibrocellular proliferation and may accentuate the clearance of vitreous hemorrhage after an experimental model of posterior penetrating ocular injury in rabbits. These alterations may affect the long-term anatomical and/or functional success rate of posterior segment surgeries in these eyes.