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Simple Summary: There is a noticeable dearth of information regarding chronic myeloid leukemia (CML) within the Gulf region. This study seeks to address this gap by offering comprehensive insights into the status of CML in the Gulf, encompassing aspects such as diagnosis, testing, treatment objectives, toxicities, and discontinuation. Through a survey completed by 15 experts and subsequent discussions, this research sheds light on the management and treatment approaches for CML within the region. Remarkably, the practices observed among these experts closely align with global standards, although unique challenges pertinent to the Gulf region were distinctly identified during the discourse. Studies on chronic myeloid leukemia (CML) in the Gulf region are scarce, consisting of a survey and expert meeting that included 15 experts in 2023 which discussed CML diagnosis, testing, treatment objectives, toxicities, and discontinuation in the Gulf region. Most patients were reported to be in first-line therapy, and the most common treatments were imatinib/imatinib generic in first-line and dasatinib in second- and third-lines. Mutation analysis was not reported to be routinely performed at the time of diagnosis but rather in case of progression to accelerated/blast phase or any sign of loss of response. While all participants were aware that BCR-ABL should be monitored every three months during the first year of treatment, 10% reported monitoring BCR-ABL every six months in practice due to test cost and lab capability. The most important first-line therapy objective was "achievement of major molecular response" (MMR) in younger patients and "overall survival" in older ones. The most important treatment objectives were "MMR" and "early molecular response followed by prolongation of overall survival" in the short term and "treatment-free remission" in the long term. The current practices in CML in the Gulf region appear to be similar to global figures. [ABSTRACT FROM AUTHOR]

Introduction: Despite recent advances in diagnosis, prognostication, and treatment options, chronic lymphocytic leukemia (CLL) is still a largely incurable disease. New concepts on diagnosis, staging, treatment, and follow-up on CLL have been incorporated throughout recent years. The lack of regional consensus guidelines has led to varying practices in the management of patients with CLL in the region. This manuscript aims to reach a consensus among expert hematologists regarding the definitions, classifications, and related practices of CLL. The experts developed a set of statements utilizing their personal experience together with the current literature on CLL management. This consensus aims to provide guidance for healthcare professionals involved in the management of CLL and serves as a step in developing regional guidelines. Methods: Eight experts responded to 50 statements regarding the diagnosis, staging, treatment, and prognosis of CLL with three potential answering alternatives ranging between agree, disagree, and abstain. This consensus adopted a modified Delphi consensus methodology. A consensus was reached when at least 75% of the agreement to the answer was reached. This manuscript presents the scientific insights of the participating attendees, panel discussions, and the supporting literature review. Results: Of the 50 statements, a consensus was reached on almost all statements. Statements covered CLL-related topics, including diagnostic evaluation, staging, risk assessment, different patient profiles, prognostic evaluation, treatment decisions, therapy sequences, response evaluation, complications, and CLL during the COVID-19 pandemic. Conclusion: In recent years, CLL management has progressed significantly, with many diagnostic tests and several novel treatments becoming available. This consensus gathers decades of consolidated principles, novel research, and promising prospects for the management of this disease. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is a leading cause of morbidity and mortality in patients with active cancer who require anticoagulation treatment. Choice of anticoagulant is based on careful balancing of the risks and benefits of available classes of treatment: vitamin K antagonists, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs). Results from randomized controlled trials have shown the consistent efficacy of DOACs versus LMWH in the treatment of cancer-associated venous thromboembolism (VTE). However, increased major gastrointestinal bleeding was observed for edoxaban and rivaroxaban, but not apixaban, compared with LMWH dalteparin. Most guidelines recommend DOACs for the treatment of cancer-associated VTE in patients without gastrointestinal or genitourinary cancer, and with considerations for renal impairment and drug–drug interactions. These updates represent a major paradigm shift for clinicians in the Middle East and North Africa. The decision to prescribe a DOAC for a patient with cancer is not always straightforward, particularly in challenging subgroups of patients with an increased risk of bleeding. In patients with gastrointestinal malignancies who are at high risk of major gastrointestinal bleeds, apixaban may be the preferred DOAC; however, caution should be exercised if patients have upper or unresected lower gastrointestinal tumors. In patients with gastrointestinal malignancies and upper or unresected lower gastrointestinal tumors, LMWH may be preferred. Vitamin K antagonists should be used only when DOACs and LMWH are unavailable or unsuitable. In this review, we discuss the overall evidence for DOACs in the treatment of cancer-associated VTE and provide treatment suggestions for challenging subgroups of patients with cancer associated VTE. Plain Language Summary: Patients with cancer are at risk of blood clots forming in their veins, which can cause illness and death. To prevent such blood clots, most patients with cancer need anticoagulant therapy. There are three types of anticoagulants available for the treatment of cancer-associated blood clots in a vein, namely, vitamin K antagonists, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs). Drug trials have shown that DOACs are more effective than LMWH; however, DOACs can have a greater risk of causing major gastrointestinal bleeding. Among DOACs, edoxaban and rivaroxaban are drugs associated with higher rates of gastrointestinal bleeding. Recently updated guidelines for doctors recommend that DOACs be used as the first treatment for patients with cancer at risk of blood clot formation in a vein. For doctors in the Middle East and North Africa, this new approach differs from existing practices. Notably, choosing a treatment also depends on the type of cancer, because gastrointestinal cancers and cancers of the genitals and urinary system have an especially high risk of gastrointestinal bleeding. The choice also depends on the presence of kidney problems, drug–drug interactions, and access to the drugs. Apixaban may be the preferred DOAC in patients with gastrointestinal cancer, but this drug should be used with care in patients with upper or unresected lower gastrointestinal tumors. For patients with upper or unresected lower gastrointestinal tumors, treatment with LMWH may be preferred. Vitamin K antagonists should be used only when DOACs and LMWH are unavailable or unsuitable. [ABSTRACT FROM AUTHOR]

A four-year-old pregnant African lioness with dystocia was referred to the university teaching hospital. History-taking revealed the parturition had started four hours ago, but the cubs couldn't come out due to incomplete dilation of the cervix. This article describes the procedures before, during, and after the surgical operation, including the anesthesia protocol performed and performing a Cesarean section through the midline celiotomy to remove a dead and two live cubs from the uterus and successfully heal the dam without any complications. This surgery was performed about three years ago. After the operation to date, the lioness is in perfect health and she gave birth to 2 and 3 healthy cubs, respectively in two of her last parturition with no need for any help. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is neoplasm of the plasma cells derived from the postgerminal B-cell lineage and it ranges from premalignant conditions like monoclonal gammopathy of unknown significance and smoldering MM (SMM) to malignant diseases such as overt MM. With advances in science and technology, the understanding of the disease has increased paving the way for advanced therapeutic options and better patient outcomes. Thus, this article is a narrative review summarizing the recent advances in the epidemiology, clinical presentation, risk stratification, and MM patient populations treatment and to provide insights by the authors who are experts in the field of MM management who are considered as Gulf Myeloma Working Group and who were the members of 'Approaches to MM Management' Advisory Board meeting held on October 29, 2021. The expert panel provided several recommendations and drawn consensus statements pertaining to MM management in the Gulf countries. [ABSTRACT FROM AUTHOR]

Peste des petits ruminants virus (PPRV; family Paramyxoviridae, genus Morbillivirus) causes a highly contagious disease with a high death rate in wild and domestic small ruminants. Four PPRV lineages (L1-L4) [...]

BACKGROUND: In Saudi Arabia (KSA) and the United Arab Emirates (UAE), only limited epidemiological data and treatment guidance exist for acquired thrombotic thrombocytopenic purpura (aTTP), a rare, life-threatening blood disorder. AIMS: Expert insights from KSA and UAE were used to obtain local epidemiological data, to characterize current disease management and unmet needs, and to formulate recommendations for the improvement of the diagnosis and treatment of aTTP. Costs and socioeconomic burden were a secondary focus. METHODS: Hematologists from KSA and UAE with clinical experience in the diagnosis and management of aTTP individually answered questions on the burden and management of aTTP via an online survey. Based on these insights, a draft consensus was discussed and refined jointly by the hematologists in a live session for each country. Payers provided information on the economic burden and cost of aTTP management. RESULTS: The experts estimate the incidence of aTTP to 5–6 (KSA) and 1–2 (UAE) per 1,000,000 person-years and anticipate it increasing. Most of the presenting patients are aTTP-naive. Recurrent disease is rare. Diagnosis of aTTP should involve ADAMTS13 activity testing. Plasma exchange and immunosuppression are the current standard of care. Key unmet needs include a lack of awareness of aTTP, access to rapid testing and novel treatments to improve outcomes. CONCLUSION: The expert consensus to address the unmet needs and improve aTTP outcomes include increasing aTTP awareness and access to ADAMTS13 testing; the development of national guidelines; and, additionally, strategies to improve patients' long-term quality of life. [ABSTRACT FROM AUTHOR]

Background: There is still much to understand about COVID-19, especially in regards to the long term effects and the clinical syndromes that follow the acute primary infection. A serious multisystem inflammatory syndrome was described initially in children 1 and then in adults as well. Multisystem inflammatory syndrome in adults (MIS--A) is a severe illness requiring admission in patients ≥21 years old, with severe extra pulmonary involvement, raised inflammatory markers and evidence of previous COVID-19 infection within 12 weeks. Materials and methods: A 22-year-old male was admitted after few days of neck pain, swollen lymph nodes, headache and temperature, followed by vomiting, diarrhea, and abdominal pain. Three weeks before the onset of symptoms he was diagnosed with mild COVID-19 infection. The medical and family history were unremarkable. On admission he was hemodynamically stable and apyrexial. Some cervical lymph nodes were palpated, otherwise no other abnormality was detected. A CXR was normal. During admission CT chest chest--abdo--pelvis and CT pulmonary angiogram were normal. Within 24 hours the patient developed severe cardiogenic shock and was transferred to ICU where inotropes were started. An echocardiogram showed global hypokinesia, EF 30--35%, no chamber dilatation, and stunned myocardium. Given the history of COVID-19 infection with negative Polymerase chain reaction and positive serology, deranged LFTs, pancytopenia, raised troponin and inflammatory markers, a diagnosis of MIS--A was made and confirmed when all the other etiology tests returned negative. Methylprednisolone, IVIG, Tocilizumab, and prophylactic enoxaparin were administered. Result: The patient improved within 24 hours. The inotropes were discontinued within 72 hours. The cardiac ejection fraction improved to 55% on day 6. The patient was discharged asymptomatic after 12 days on Prednisolone 60 mg. Conclusions: MIS-A is likely to become a common presentation and it is important to bring it to the attention of our colleagues working in primary and secondary care. The MIS-A can be severe even in patients with previous oligo symptomatic COVID--19 infection. The quick deterioration observed in our case suggests that prompt recognition and treatment are critical to achieve complete resolution. In patients presenting with acute febrile illness MIS--A should be routinely included in the differential diagnosis. The MIS-A is ultimately a diagnosis of exclusion and therefore a thorough diagnostic workup is required. The combination of supportive management and multidrug anti-inflammatory treatment was effective in our case but robust evidence is needed. [ABSTRACT FROM AUTHOR]

Considerable progress has been made in the understanding of the risk factors for venous thromboembolism (VTE). The clinical applications of molecular techniques have allowed identification of important inherited, yet not uncommon, risk factors for VTE, such as mutations that cause Factor V Leiden and prothrombin G20210A. However, advances in our understanding have raised several questions regarding the need for, and duration of anticoagulation. At the end of the treatment period, low molecular weight heparins have become the drugs of choice and standard-of-care for VTE. In this review, cost effective diagnostic approaches for patients with suspected deep vein thrombosis, and recommended treatment options using evidence-based approaches, are described.