A newly emerging pandemic of coronavirus disease 2019 caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. The ongoing substantial research endeavor to comprehend its associated coagulopathy requires proportional progress on guidance establishment. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is expected to be a precursory formulation for prospective guideline development.
Background:The standard treatment for multiple myeloma (MM) which ineligible transplant is melphalan prednisone (MP). Curcumin has anti‐inflamatory, anti angiogenesis, decrease proliferation and delay progression of monoclonal gammopathy undetermined significant or smoldering myeloma. There is no study of curcumin in MM patientsAims:To evaluate the effect of curcumin addition to remission status at MM patient with regiment MPMethodsThis experimental study was involved 35 patients which randomly into treatment (n = 17) and control (n = 16). The treatment group was given melphalan 4 mg/m2, prednisone 40 mg/m2 (MP) for 7 days and curcumin 8 gram daily for 28 days. The control group was given MP and placebo. Remision status was evaluated after 4 cycles treatment. The difference between two groups was analysed by Mann‐Whitney U‐Test. Trend analysis was evealuated by Friedman. Remission status was evaluated by Chi‐square. Multivariate analysis was evaluated by multiple logistic regression.Results:There was a significant decrease of NF‐KB, VEGF, TNF‐α, LDH levels in the treatment group compared with control. There was a decreasing trend of IL‐6 levels in the treatment group significantly. There was significant difference of remission status beetween the treatment and control group [(75 vs 33.3), X2 = 6.89,df = 1, p = 0.009]. There was significant correlation between TNF‐α levles and remission status [OR = 1.35; (95% CI = 1.03‐1.7.6), p = 0.03].Summary/Conclusion:The curcumin addition on MM patient with MP regiment improved the remision status through decreased of TNF‐α levels.
Latar belakang Sindroma evan (Evans syndrome) merupakan penyakit yang sangat jarang, dimana terjadi suatu keadaan anemia hemolitik otoimun yang bersamaan dengan immune thrombocytopenia (ITP). Penyakit ini diperkenalkan pertama kali pada tahun 1951 oleh Evan dkk Kasus Seorang laki-laki pegawai toko 23 tahun datang dengan keluhan cepat lelah dan perdarahan gusi hilang timbul selama 4 bulan terakhir.Laboratorium hemoglobin 4,8 gr%, trombosit 11.900 /mm, leukosit 11.090/mmk, retikulosit yaitu 12,4 %. Pada pemeriksaan gambaran darah tepi ditemukan sferosit pada eritrosit dan giant trombosit. Ureum, kreatinin, natrium, kalium, kalsium normal . Protein total 8,4 gr/dl albumin 3,2 gr/dl. Didapatkan hiperbilirubinemia (4,48 mg/dl) dengan dominasi bilirubin indirek (2,20 mg/dl). Didapatkan peningkatan dari kadar ANA sebesar 79 U, tetapi anti Ds-DNA tidak meningkat (201,9 U). Pemeriksaan coomb pada penderita ini menunjukkan hasil yang positif baik direk (+3) maupun indirek (+2).Selanjutnya pasien diberikan injeksi intravena metilprednisolon 125 mg/12 jam dan siklosporin oral 50 mg/12 jam selama 5 hari dilanjutkan pemberian metilprednisolon dan siklosporin oral sampai pasien pulang dan selama dirumah. Kesimpulan Anemia hemolitik otoimun dan immune thrombocytopenia yang terjadi bersamaan (sindroma Evan) merupakan kelainan yang jarang dijumpai. Penegakan diagnosis disertai dengan menyingkirkan penyebab anemia dan trombositopenia imun sekunder yang lain. Pemberian steroid dan imunosupresan pada sebagian besar pasien masih menunjukkan hasil yang cukup baik dalam mencapai keadaan remisi.
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