The incidence of cardiovascular events and mortality is higher in patients with chronic kidney disease (CKD) compared to the general population. Homocysteine (Hcy) appears to be an independent risk factor for cardiovascular diseases in general populations and patients with CKD. Further, hyperhomocysteinemia can cause endothelial damage and increase the activity and production of coagulation factors, and its prevalence among patients with end-stage renal disease is approximately 85%–100%. Most treatments, which lower Hcy levels and have been considered in previous studies, include folic acid, B vitamins, omega-3 fatty acids, and N-acetylcysteine. However, the effect of therapies that can decrease Hcy levels and thus cardiovascular events in these patients is still unclear. The results are conflicting and require further investigation. To guide treatment decisions and improve patient outcomes, multiple databases were searched, including Web of Science, PubMed, and Medline to summarize the available evidence (i.e., clinical trial and meta-analyses) on Hcy-lowering interventions and cardiovascular events.

Background: Bendamustine, a bifunctional mechlorethamine alkylating agent, is used in the treatment of patients with hematologic malignancies. Myelosuppression and cytotoxic effect arises quite often after bendamustine treatment. To date, there have been no recommendations for routine chemoprophylaxis for Pneumocystis carinii pneumonia (PCP) in patients under treatment with this agent. The present systematic review aimed to evaluate the existing data on bendamustine effects on pneumocystis pneumonia.Method: English papers were systematically reviewed using Web of Science, Embase, Google Scholar, PubMed, and Cochrane library. There was no time constraint for the paper search. The used keywords included "Pneumonia, Pneumocystis"or "Pneumocystis Pneumonia"or "Pneumocystis jirovecii" and "Bendamustine hydrochloride or Bendamustine. "Through our search, 113 papers were found, 26 of which were chosen following a review of the titles and abstracts; ultimately, 10 were included in the research.Result: A total of 10 studies (out of 113 studies) were retrieved. The papers were classified into seven case reports, two clinical trials, and one retrospective analysis study. The case reports included 14 patients diagnosed with PCP after bendamustine administration between 2003 and 2019. The patients' mean age was with a range of 66.8. Non-Hodgkin's lymphoma (including diffuse large B-cell lymphoma and mantle cell lymphoma) (n = 9, 60%), chronic lymphocytic leukemia (n = 4, 26.6%), and breast cancer (n = 2, 13.4%) were the most prevalent types of malignancy.Bendamustine, along with rituximab, were the most commonly prescribed chemotherapy regimens during the treatments. Finally, the mortality rate among the patients whose results were reported (n = 9) was 44.44% (n = 4). Conclusion:The present review described PCP infection in patients with malignancies after the treatment with bendamustine, a chemotherapeutic agent associated with lymphopenia. Further research is required to determine the PCP risk

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life‐threatening clinical syndrome, which may present with FUO. The possible diagnosis of HLH must be considered in the differential diagnosis when a patient presents with FUO.

Coronavirus disease-2019 (COVID-19) became a serious public health problem and caused a rapid pandemic. Fever, dry cough, and dyspnea are the most common symptoms of COVID-19. In addition to the respiratory symptoms, gastrointestinal manifestations of COVID-19 are also increasingly recognized. Herein, the authors present a patient with COVID-19 complicated with acute pancreatitis.

Objective: One of the most common diseases with high morbidity and mortality rates is chronic kidney disease. Cardiovascular disease affects most patients with chronic kidney disorders, particularly patients undergoing dialysis; hence, appropriate prevention and management approaches are essential. This study aimed to evaluate the reduction of inflammatory biomarkers, especially homocysteine, by omega-3 fatty acids in peritoneal dialysis patients. Methods: This study enrolled 60 peritoneal dialysis patients who met specified inclusion and exclusion criteria and were randomized to intervention or placebo groups. Omega-3 capsules were given at a dose of 3 g/d for 8 weeks. Inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), homocysteine, albumin, and lipid profile measured before and after the study. Findings: Results of this trial revealed that the levels of homocysteine, hs-CRP, and albumin did not change significantly during the study. Analysis of lipid profiles before and after intervention showed omega-3 has no significant effect on the level of total cholesterol or low-density lipoprotein cholesterol; However, the level of triglyceride reduced remarkably ( P = 0.002). In addition, serum levels of high-density lipoprotein cholesterol increased at the end of the study ( P < 0.001). Conclusion: Omega-3 does not seem to be able to change the inflammatory markers significantly, particularly homocysteine. More extensive trials must be conducted to better understand the impact of omega-3 on inflammatory and nutritional markers, particularly in peritoneal dialysis patients.

Protein energy malnutrition is a common problem in patients with chronic kidney disease (CKD). Scattered reports indicate that supplementation of Carnitine may improve patients' clinical symptoms, with significant improvement in nutritional parameters. This systematic review was done to document the evidences of Carnitine effects in nutritional status of CKD patients. Peer-reviewed RCTs on Carnitine administration at any dose in CKD patients with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to October 2017 using selected MeSH terms related to the study topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carried out with Comprehensive Meta-analysis software. Data are presented as standard mean difference (SMD) and 95% confidence interval (CI). According to the predefined criteria, a total of 14 randomized controlled clinical trials were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that Carnitine can significantly increase the levels of albumin (SMD: -0.861; 95% CI: -1.321, -0.402), total protein (SMD: -0.418; 95% CI: -0.695, -0.141), total cholesterol (SMD: -0.350; 95% CI: -0.564, -0.135), LDL cholesterol (SMD: -0.362; 95% CI: -0.551, -0.173), transferrin (SMD: -1.465; 95% CI: -1.822, -1.108), and hemoglobin (SMD: -0.525; 95% CI: -0.732, -0.318); however there were no conclusive effects of Carnitine on body weight (SMD: -0.057; 95% CI: -0.404, 0.291) and BMI (SMD: -0.567; 95% CI: -1.548, 0.415), in pooled analyses. The results of this meta-analysis showed that there are considerable useful pieces of evidence so far about the effect of Carnitine on nutritional factors; however, there is still doubt about some evidences with this regard. It seems necessary to carry out clinical trials with stronger designs to evaluate the impact of these primary outcomes on the patients' clinical conditions. Having this evidences, the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined.

Megaloblastic anemia is a common disorder with various manifestations. Of the many causes, cobalamin or folate deficiency can eventuate into megaloblastic anemia. It can lead to pancytopenia and mild to moderate splenomegaly, but massive splenomegaly rarely seen in this situation. We describe a 39-yearold woman with marked enlargement of the spleen and pancytopenia that was found to have megaloblastic anemia. The splenomegaly and blood count resolved 4 months after initiation of vitamin B12 therapy. It is important to know massive splenomegaly may occur in megaloblastic anemia, and although it is rare, bur can reversible with early treatment.

No abstract