Context: Luspatercept is an erythroid maturation agent that has been shown to improve anemia by influencing late-onset erythropoiesis. Objective: To determine safety and efficacy of luspatercept in patients aged >18 years of age and diagnosed with either myelodysplastic syndrome or beta-thalassemia. Design: Systematic review. Methods: A literature search was performed on PubMed, Embase, clinicaltrials.gov, Web of Science, and Cochrane using the MeSH terms “anemia” and “Immunoglobulin fc fragments” from database inception until 4/20/2021. After screening 420 articles, 2 randomized clinical trials (RCT, N=565) and 2 phase II trials (N=122) were included. Results: In 4 clinical trials (N=687), subcutaneous luspatercept (0.125 mg/dl to 1.75 mg/dl) was administered every 21 days for at least 48 weeks or 5 cycles to treat anemia in beta-thalassemia (N=288) and MDS (N=211) patients. The median pre-transfusion hemoglobin level was 7.6 g/dl in MDS patients and 10 g/dl in beta-thalassemia patients. Median red cell transfusion burden varied between 14 RBC units/24 weeks to 8 RBC units/8 weeks. Cappellini et al. and Piga et al. (N=400) showed >33% reduction in RBC transfusion burden in 71% (n=159/224) of patients (vs 29.5% with placebo) and >20% reduction in 80% (n=51/64) of patients with beta-thalassemia. Platzbecker et al. and Fenaux et al. (N=287) showed more than 4 RBC unit reduction/8 weeks in 47% (n=100/211) of patients with MDS treated with luspatercept (vs 21% with placebo). High-dose-treated patients had a mean increase in Hb ranging from 0.36 g/dl to 1.52 g/dl. The most common side effects included headache, back pain, bone pain, fatigue, and diarrhea in 19.6% (n=98), 19.4% (n=97), 13% (n=65), 9% (n=45), and 7.4% (n=37), respectively. More than grade 3 adverse effects were bone pains, hyperuricemia, and back pain in 6.4% (n=32), 1.2% (n=6), and 0.6% (n=3), respectively. Conclusion: Luspatercept showed better efficacy than placebo in beta-thalassemia and MDS patients to treat anemia and was well-tolerated by these patients. High-dose luspatercept has shown promising results in terms of erythroid response, measured as either a reduction in transfusion burden or a mean increase in hemoglobin levels. A number of clinical trials are ongoing to assess its efficacy in myelofibrotic disorders to further extend its usage. Luspatercept is an erythroid maturation agent that has been shown to improve anemia by influencing late-onset erythropoiesis. To determine safety and efficacy of luspatercept in patients aged >18 years of age and diagnosed with either myelodysplastic syndrome or beta-thalassemia. Systematic review. A literature search was performed on PubMed, Embase, clinicaltrials.gov, Web of Science, and Cochrane using the MeSH terms “anemia” and “Immunoglobulin fc fragments” from database inception until 4/20/2021. After screening 420 articles, 2 randomized clinical trials (RCT, N=565) and 2 phase II trials (N=122) were included. In 4 clinical trials (N=687), subcutaneous luspatercept (0.125 mg/dl to 1.75 mg/dl) was administered every 21 days for at least 48 weeks or 5 cycles to treat anemia in beta-thalassemia (N=288) and MDS (N=211) patients. The median pre-transfusion hemoglobin level was 7.6 g/dl in MDS patients and 10 g/dl in beta-thalassemia patients. Median red cell transfusion burden varied between 14 RBC units/24 weeks to 8 RBC units/8 weeks. Cappellini et al. and Piga et al. (N=400) showed >33% reduction in RBC transfusion burden in 71% (n=159/224) of patients (vs 29.5% with placebo) and >20% reduction in 80% (n=51/64) of patients with beta-thalassemia. Platzbecker et al. and Fenaux et al. (N=287) showed more than 4 RBC unit reduction/8 weeks in 47% (n=100/211) of patients with MDS treated with luspatercept (vs 21% with placebo). High-dose-treated patients had a mean increase in Hb ranging from 0.36 g/dl to 1.52 g/dl. The most common side effects included headache, back pain, bone pain, fatigue, and diarrhea in 19.6% (n=98), 19.4% (n=97), 13% (n=65), 9% (n=45), and 7.4% (n=37), respectively. More than grade 3 adverse effects were bone pains, hyperuricemia, and back pain in 6.4% (n=32), 1.2% (n=6), and 0.6% (n=3), respectively. Luspatercept showed better efficacy than placebo in beta-thalassemia and MDS patients to treat anemia and was well-tolerated by these patients. High-dose luspatercept has shown promising results in terms of erythroid response, measured as either a reduction in transfusion burden or a mean increase in hemoglobin levels. A number of clinical trials are ongoing to assess its efficacy in myelofibrotic disorders to further extend its usage.

BACKGROUND:The emergence of the COVID-19 pandemic has affected the lives of many people, including medical students. The present study explored internet addiction and changes in sleep patterns among medical students during the pandemic and assessed the relationship between them.METHODS:A cross-sectional study was carried out in seven countries, the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, using a convenience sampling technique, an online survey comprising demographic details, information regarding COVID-19, the Pittsburgh Sleep Quality Index (PSQI), and the Internet Addiction Test (IAT).RESULTS:In total, 2749 participants completed the questionnaire. Of the total, 67.6% scored above 30 in the IAT, suggesting the presence of an Internet addiction, and 73.5% scored equal and above 5 in the PSQI, suggesting poor sleep quality. Internet addiction was found to be significant predictors of poor sleep quality, causing 13.2% of the variance in poor sleep quality. Participants who reported COVID-19 related symptoms had disturbed sleep and higher internet addiction levels when compared with those who did not. Participants who reported a diagnosis of COVID-19 reported poor sleep quality. Those living with a COVID-19 diagnosed patient reported higher internet addiction and worse sleep quality compared with those who did not have any COVID-19 patients in their surroundings.CONCLUSION:The results of this study suggest that internet addiction and poor sleep quality are two issues that require addressing amongst medical students. Medical training institutions should do their best to minimize their negative impact, particularly during the current COVID-19 pandemic.

Introduction: Omega-3 fatty acids have for long been shown to reduce the incidence of cardiovascular (CV) diseases.Omega-3 fatty acids mainly exist in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid in fish oils.Cod liver oil is found to have a high concentration of these omega-3 fatty acids.This study aims to explore the benefits of using cod liver oil in reducing the incidence of myocardial infarction (MI) among at-risk patients.Method: This open-label placebo-controlled two-arm interventional study was conducted in the internal medicine and cardiology unit of tertiary care hospital between January 2018 to January 2021.During this period, 870 patients at risk of CV events were enrolled in the study after obtaining informed consent.The study group received 415 mg cod liver oil daily, in addition to their current treatment, in a bottle without label and the control group received no additional treatment to their standard treatment.Patients were followed up for 12 months or till the development of MI.Result: Patients treated with cod liver oil had comparatively fewer incidences of MI; however, the difference was not significant (p-value: 0.09).Furthermore, the difference was non-significant for both fatal and nonfatal MI.The relative risk for total MI incidence was 0.70 (0.44-1.10).Conclusion: According to our study, adding cod liver oil to the diet does not play a major role in reducing the risk of MI.Further large-scale studies are needed to understand the role of cod liver oil in reducing the risk of CV events, including MI.

IntroductionAlternative medicine during treatment is often used to make the quality of life (QoL) better.Women with early-stage breast cancer, particularly the ones who possess lower QoL, are more prone to opt for complementary medicine.This study aims to explore the effects exerted by intravenous vitamin C (IVC) on symptoms and adverse events associated with breast cancer treatment. MethodsThis single-center, parallel-group, single-blind interventional study was conducted in the oncology ward of a tertiary care hospital in Pakistan.For this study, after informed consent was taken, breast cancer patients with Union for International Cancer Control stages IIA to IIIb were included in the study.Three hundred and fifty (n = 350) patients were randomized into two groups at a ratio of 1:1.Study group was randomized to receive 25 grams per week of IVC at a rate of 15 grams per hour for four weeks in addition to their current standard treatment, and the control group received placebo (normal saline drip with label removed) in addition to their current standard treatment. ResultsIn patients who had received IVC, there was a significant decrease in the mean severity score after 28 days for the following symptoms: nausea (2.65 ± 0.62 vs. 2.59 ± 0.68; p-value: 0.0003), loss of appetite (2.26 ± 0.51 vs. 2.11 ± 0.52; p-value: 0.007), tumor pain (2.22 ± 0.45 vs. 1.99 ± 0.40, p-value: <0.0001), fatigue (3.11 ± 0.32 vs. 2.87 ± 0.29; p-value: <0.0001), and insomnia (2.59 ± 0.35 vs. 2.32 ± 0.36, p-value: <0.0001). ConclusionOur study showed improvement in the mean severity score of nausea, fatigue, tumor pain, loss of appetite, and fatigue.More studies are also needed to assess the long-term effects of IVC in the cancer management.This shall help incorporate the use of IVC in standard practice to make the journey of cancer management comfortable for the patients.