Concurrent coronary artery disease and immune thrombocytopenia: a systematic review.

Introduction: Coronary artery disease (CAD) management in the setting of immune thrombocytopenia (ITP) remains very challenging to clinicians as a reasonable balance between bleeding and thrombosis risks needs to be achieved, and the evidence guiding such management is scarce. Methods: We conducted a systematic review following the PRISMA guidelines to summarize the available literature on the management and outcomes of CAD coexisting with ITP. We searched PubMed and Embase for studies published in English exploring CAD and ITP management until 05 October 2022. Two independent reviewers screened and assessed the articles for inclusion. Patients' characteristics, CAD treatment modalities, ITP treatment, and complications were reported. Results: We identified 32 CAD cases, among which 18 cases were revascularized with percutaneous coronary intervention (PCI), 12 cases underwent coronary artery bypass graft surgery (CABG), and two cases were managed conservatively. More than 50% were men, with a mean age of 61 ± 13 years and a mean baseline platelet count of 52 ± 59 × 109/L. Irrespective of the revascularization modality, most patients were treated with either corticosteroids alone, intravenous immunoglobulins (IVIG) alone, or in combination. Among those who underwent PCI, two patients had bleeding events, and one patient died. Similarly, among those with CABG, one patient developed bleeding, and one patient died. Conclusion: We found that revascularization with either PCI or CABG with the concurrent use of corticosteroids and/or IVIG for ITP was feasible, with an existing non-negligible risk of bleeding and mortality.

Artificial intelligence in sickle disease.

Artificial intelligence (AI) is rapidly becoming an established arm in medical sciences and clinical practice in numerous medical fields. Its implications have been rising and are being widely used in research, diagnostics, and treatment options for many pathologies, including sickle cell disease (SCD). AI has started new ways to improve risk stratification and diagnosing SCD complications early, allowing rapid intervention and reallocation of resources to high-risk patients. We reviewed the literature for established and new AI applications that may enhance management of SCD through advancements in diagnosing SCD and its complications, risk stratification, and the effect of AI in establishing an individualized approach in managing SCD patients in the future. Aim: to review the benefits and drawbacks of resources utilizing AI in clinical practice for improving the management for SCD cases.

Rituximab in the treatment of idiopathic thrombocytopenic purpura (ITP).

The objective of this study was to evaluate the efficacy and safety of rituximab in the treatment of patients with idiopathic thrombocytopenic purpura (ITP). A prospective study was performed at Mubarak Al-Kabeer University Hospital involving the use of rituximab in 14 patients who had previously been treated with steroids, steroid sparing drugs, and splenectomy. Several variables have been collected and analyzed including age, gender, treatment received prior to rituximab, co-morbid condition, platelet count before treatment, response to treatment, duration of response, relapses, response to re-treatment, and adverse effects. Of the 14 treated patients, complete remission was achieved in 11 patients, partial remission in two patients, and no response in one patient. Median duration of responses were 12.5 months, ranging from 2 to 19 months. Four patients had at least one relapse. Responses were seen in splenectomized and non-splenectomized patients. This study is the first attempt to evaluate the efficacy and safety of rituximab in the treatment of ITP in the Middle East area. Our findings support the result of other case reports, case series, and pilot studies; however, a randomized control trial is needed to confirm the results of our study.