β-thalassemia major is one of the most common hematologic disorders in the world. It causes severe anemia and patients require regular blood transfusions, which causes different complications such as iron overload and alloimmunization. Regulatory T cells (Tregs) have an important role in regulation of immune responses. FoxP3 is the major marker of Tregs and its expression can be influenced by different factors. GDF-15 is another gene that plays a role in iron homeostasis and regulation of immune system in different diseases. The aim of this study was to assess the frequency of Tregs and FoxP3/GDF-15 gene expression in β-thalassemia major patients with and without alloantibody as well as its correlation with different factors such as serum ferritin and folate levels. This study was conducted on 68 β-thalassemia major patients with and without alloantibodies in comparison with 20 healthy individuals with matched age and sex as control group. Enzyme-linked immunosorbent assay (ELISA), flow cytometry, and real-time PCR were performed in order to evaluate serum ferritin and folate levels, frequency of Tregs, and the expression of FoxP3 and GDF-15 genes, respectively. The percentage and absolute count of Tregs were increased in patients compared with controls (P = 0.0003), but there was no difference between responders and non-responders (P > 0.05). The Tregs count correlated positively with serum ferritin. No correlation was observed between target genes and serum ferritin and folate, but there was a positive significant correlation between the expression of FoxP3 and GDF-15 genes, which shows the immunosuppressive role of GDF-15.

Evaluation of regulatory T cells frequency and FoxP3 / GDF-15 gene expression in β-thalassemia major patients with and without alloantibody; correlation with serum ferritin and folate levels

Open a cess: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj Post total splenectomy outcome in thalassemia patients Muntadhar M. Isa1*, Amir Thayeb2, Ahmad Yani2, Muhammad Bayu Z. Hutagalung3 Introduction: Splenectomy in thalassemia patient is indicated in the transfusion-dependent patient when hypersplenism increases blood transfusion requirement, prevents adequate control of body iron with chelation therapy and increased risk for infection. Method: This study was retrospective study aims to evaluate the outcome of splenectomy in pediatric thalassemia patients and its related factor. A total 34 thalassemia patient with post total splenectomy patients was included in this study. Result: Mean age was 20.7 ± 6.5 years old with majority mild malnutrition (61.8%) and the majority of spleen size Schaffner 6-7 (73.5%). The duration between thalassemia diagnosis and total splenectomy was 6-7 years. Statistical analysis showed significant decreased of mean blood transfusion volume from 4691.4 cc per year to 3764.2 cc per year (p = 0.048), decreased mean blood transfusion volume from 219.6 cc per Kg Body Weight (BW) per year to 125.5 cc per Kg BW per year (p<0.001) and decreased of blood transfusion frequency from 12-14 times per year to 6-8 times per year (p<0.001). There is only one case subcutaneous emphysema as complication after splenectomy. Conclusion: Overall, this study showed total splenectomy improve the outcome of thalassemia with hypersplenism with low rate of complication.

Post total splenectomy outcome in thalassemia patients

Methods:This study included 13 patients with the confirmed diagnosis of SIJ pyogenic infection who needed drainage after failure to respond to conservative treatment. The study was carried out between February 2012 and November 2015. Once suspected of having SIJ infection, patients where sent for radiographic and Laboratory tests. The drainage procedure was performed in the operative theatre using local infiltration anesthesia and under conscious sedation.

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Drainage of Pyogenic Sacro-Iliac Joint Infection Using a Percutaneous Technique (Case Series of 13 Patients)

Psoas Abscess (Presentation; Assessment and Management)

https://doi.org/10.1016/j.jtumed.2022.02.010

Splenectomy perspective for non-malignant hematological disorders: A cross-sectional study in the Eastern Province of KSA

OBJECTIVE: To determine the benefits of elective splenectomy in selected patients with thalassemia
major.
STUDY DESIGN: Prospective descriptive study.
PLACE OF STUDY: Liaquat University Hospital Jamshoro.
DURATION OF STUDY: July 2014 to June 2015.
PATIENTS AND METHODS: 27 selected patients of Thalassemia major were evaluated after open
elective splenectomy via midline incision for the benefits achieved post operatively.
RESULTS: Out of 27 patients 19 (70.3%) were male and 08(29.6%) were female, age ranges from 5-10
years with a mean age of 7 years. Out of 27 patients, 25 patients (81.48%) had a uneventful recovery,
only 2 patients (7.4%) developed post-operative complications. No mortality was observed in this series.
Post-operative long term maintenance of adequate hemoglobin and improved quality of life was
observed in 26(96.29%) patients. Only 1(3.7%) patient who developed postoperative incisional hernia
was not satisfied with the procedure.
CONCLUSION: We conclude that splenectomy is a safe and beneficial procedure in selected patients of
thalassemia major.

Splenectomy: Does it help in Patients with Thalassemia Major -

Background: Psoas abscess is a rare condition but one with potential for severe morbidity. Many factors may be implicated in the treatment outcome of the condition and efforts must be directed to identify, understand and control the factors for a better prognosis.
Objective: To identify the factors associated with surgical treatment outcome of psoas muscle abscess.
 Methodology: This descriptive cross-sectional study was conducted upon a sample of 58 patients (chosen via non-probability, consecutive sampling) scheduled for surgical treatment for psoas muscle abscess (aged 18 to 60 years) at department of General Surgery at Liaquat University Hospital, Hyderabad & Jamshoro. All the patients underwent surgical treatment. The data was recorded via pre-structured questionnaire comprising of inquiries pertaining to socio-demographic details, presenting complaints, and factors association with surgical treatment outcome (in terms of resolution of abscess cavity). Data was analyzed via SPSS version 20.
Results: Mean age of study subjects was 37.6 ± 12.5 years. Out of all 72.4% were males and 27.5% were females. Most common presentation of patients was pain in flanks, followed by fever. The commonest etiological factor was tuberculosis (TB) and consequently spinal (TB) was the most common. Resolution of abscess cavity was noted among 77.5% of the cases with a greater proportion of recovery falling in line non- tuberculous etiology.
Conclusions: After careful consideration, it can be concluded that secondary psoas muscle and that with tuberculous etiology have a poorer surgical outcome, thus greater care and more effective surgical techniques may be employed to achieve complete resolution of abscess.

Factors Associated with Surgical Treatment Outcome of Psoas Muscle Abscess

Objective: To compare the outcome of percutaneous ultrasound guided aspiration V/S open surgical drainage for psoas muscle abscess.
Methodology: This comparative study was conducted in department of general surgery at Liaquat medical university hospital Hyderabad/Jamshoro, from June 2017 to November 2017. Diagnosed Patients of psoas muscle abscess size more than 5cm, between 18 to 60 years of age and either of gender were included. Patients were randomly divided into two groups, A and B by odd and even method, patients in group A abscess was aspirated by percutaneous ultrasound guided aspiration and patients in group B was underwent open surgical drainage, all the data were entered in the pre designed performa and analyzed into SPSS V:16.0
Results: A total of 58 patients of Psoas muscle abscess were selected, the mean age of study subjects of group A was 38.5+10.5 and group B was 36.5+12.7 (p-673). Early post-operative pain relief was assessed among patients of group A as compared to group B. As per outcome resolution of abscess cavity was significantly high among patients of group B (p-0.004), while post-operative Hospital stay was significantly lower in group A (p-0.002).
Conclusion: Both techniques has their own benefits like percutaneous aspiration has shorter duration of hospital stay while in complete resolution of abscess cavity was found in open surgical drainage group of patients.

Outcome of Percutaneous Ultrasound Guided Aspiration versus Open Surgical Drainage of Psoas Muscle Abscess

Background: Complicated intra-abdominal infections have become a major health challenge that merits safe and efficacious therapy. Antibiotic therapy is the treatment of choice, however the duration of antibiotic use is debatable. 
Objective: To compare the safety and efficacy of the short course and long course antibiotic therapy towards the treatment and the progressive outcome of patients presented with complicated intra-abdominal infections. 
Methodology: This comparative study was carried out on 94 subjects (chosen via non-probability, consecutive sampling), who presented with complicated intra-abdominal infections, had signs and symptoms of infection along with ultrasound abdomen examination consistent with infective foci and routine blood test showing raised total leukocyte count, at the Department of Surgery - Liaquat University Hospital, Hyderabad. Subjects were divided into two groups (47 in each) through a random assignments. Group-A was kept on a short course (5-7-days) while Group-B was kept on a long course (7-10 days) antibiotic therapy. Data were documented using a structured questionnaire, including inquiries related to sociodemographic details, disease specifics, and observed for the outcome variables (mainly postoperative early resolution of infection and long hospital stay). 
Results: In Group A, resolution of infection was achieved in 59.57%, 29.79% and 10.64% patients on day 5, 6 and 7, espectively. In Group B, esoluation of infection was only reported as 42.55%, 36.17% and 21.28% on day 5, 6 and 7, respectively. The median duration of taking antibiotic was almost half in short course group than the long. Surgical site infections were commonly observed in Group B patients. There was no mortality observed in both groups. There is no significance difference observed in primary outcome of clinical cure among the groups. 
Conclusion: It can be concluded that the short course antibiotic therapy has good efficacy to treat CIAI when the primary foci of infection are surgically extracted with adequate source control.

https://www.journaljpri.com/index.php/JPRI/article/download/35398/66858

Comparative Analysis of Short-Course Vs Long Course Antibiotic Therapy among Patients with Complicated Intra-Abdominal Infections

Objective:  To evaluate success rate of the endoscopic third Ventriculostomy (ETV) in non-communicating type of hydrocephalus in pediatric age group.
Material and Methods:  This study was carried in the department of neurosurgery at Liaquat university hospital, Jamshoro in which an endoscopic third Ventriculostomy procedure was performed in patients (n = 55) with non-communicating hydrocephalus from October 2016 to April 2017. Post-operative follow-up was done on the 15th day post-operative to assess clinical and radiological improvement.
Results:  55 patients were included in this study, 26 (47.27%) males and 29 (52.73%) females. The mean age was 3.96 years. The most common etiology was aqueductal stenosis 28 (50.90%) patients followed by posterior fossa tumors in 18 (32.72%) patients. The operative technique was successful in 41 (74.55%) patients. Out of 41 successful patients, 34 (82.92%) patients had clinical as well as radiological improvement whereas 7 (17.07%) patients had clinical improvement only.
Conclusion:  The success rate of ETV was 74.55% in the non-communicating hydrocephalus in the pediatric age group in our study. Endoscopic third Ventriculostomy is an effective treatment for non-Communicating hydrocephalus in pediatric age groups by diversion of CSF intracranially. This procedure provides shunt freedom and can be used alternative to shunts in pediatric age groups with non-communicating hydrocephalus.

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Riaz Ahmed Memon

Papers

Splenectomy: Does it help in Patients with Thalassemia Major -

Factors Associated with Surgical Treatment Outcome of Psoas Muscle Abscess

Outcome of Percutaneous Ultrasound Guided Aspiration versus Open Surgical Drainage of Psoas Muscle Abscess

Comparative Analysis of Short-Course Vs Long Course Antibiotic Therapy among Patients with Complicated Intra-Abdominal Infections

Success Rate of Endoscopic Third Ventriculostomy (ETV) in Non-Communicating Hydrocephalus in Pediatric Age Group