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Nowadays, synthetic fiber composites are in decline because of their high initial cost and detrimental impact on the environment. The main aim of this work is to develop natural fiber composite materials that are made from moringa and bamboo fibers by using the hand lay-up method by maintaining a constant 40 vol.% of epoxy content. Both the natural composites were treated with NaOH and also compared with their hybrid composite. The mechanical properties, such as compression, hardness, impact, tensile, flexural properties were investigated. Additionally, thermo gravimetric analysis of composites was also carried out. The biggest boost in compressive strength was seen in bamboo with 60% volume, with improvements ranging from a pure resin value of 13.06 to 68.43% compared to moringa 60% and 30–30% moringa-bamboo. The maximum rise in impact strength was recorded by BM-30/30 at 21J. In addition to this, the highest hardness value was observed by moringa-reinforced composites (MM-60) and noted to be around 40.83 HV. Tensile and flexural properties of all the composites reveal improvement as compared with neat epoxy composites. Bamboo exhibits a considerable improvement in thermal stability as compared with other compositions. Scanning electron micrographs were used to analyze the structure-property correlations.

Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management, are available. In flap surgery for pressure sores, a variety of flap types may be used; each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforator-enhanced rhomboid flap technique for ischial sore construction. Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital. The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap. Postoperative follow-ups and evaluations were performed. Results: The mean age of the study group was 43.7 ​± ​13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases. The mean surface area of sores was 24.8 ​± ​6.3 ​cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ​± ​0.98 ​cm and required around 6.8 ​± ​1.9 weeks to heal. Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.

This study reports the green synthesis of silver nanoparticles (AgNPs) using the fruit extract of Withania somnifera and their application as a colorimetric sensor for selective manganese (Mn2+) ion detection. The synthesis of AgNPs was optimized by varying pH, reaction time, and concentrations of fruit extract and AgNO3. UV–visible spectroscopy revealed that the highest absorbance of AgNPs occurred at pH 11, indicating optimal conditions for NPs formation. The absorbance behavior over time demonstrated the nucleation and stabilization processes, with optimal stability achieved after 1800 min. Increasing concentrations of fruit extract and AgNO3 enhanced NPs synthesis, reaching a plateau at 1.0 mL of extract and 1.0 mM AgNO3, respectively. Transmission electron microscopy (TEM) confirmed the formation of spherical AgNPs of 43–85 nm. Fourier-transform infrared spectroscopy (FTIR) indicated the involvement of functional groups such as O-H and C=O in the reduction and stabilization of AgNPs. The green-synthesized AgNPs exhibited notable antioxidant activity, with moderate free radical scavenging abilities compared to ascorbic acid. The colorimetric detection of Mn2+ was achieved through the aggregation of AgNPs, leading to a visible color change. UV–vis absorption spectra showed a prominent peak at 412 nm, with a linear relationship between absorbance change and Mn2+ concentration, demonstrating high sensitivity and selectivity. Comparative studies with other metal ions (Co2+, Cr3+, Ni2+) confirmed the specificity of AgNPs towards Mn2+. In conclusion, the green-synthesized AgNPs from W. somnifera offer a cost-effective and environmentally friendly approach for Mn2+ detection, with significant potential for environmental monitoring and biomedical applications.

Background: Surgical site infections (SSIs) are associated with increased morbidity, monetary loss and mortality. The physical aspects of the operation room (OR) including airflow, humidity, pressure, and particulate counts are essential part of SSI prevention. Humidity control is vital to avoid static electricity buildup.Temperature control helps prevent hypothermia. Limiting OR traffic and door opening are essential to prevent airflow disturbance and minimze particles in OR environment. We have recently studied electronic monitoring of OR traffic and the traffic was higher than what was expected. Our aim was to evaluate our real-life measurement of these OR parameters as part of SSI prevention bundle. Methods: This is a prospective study focused on the OR physical environmental factors as part of operative SSI prevention bundle. The study was conducted for 4 weeks at an academic medical center. The study was conducted in two different generations of OR for neurosurgical and ophthalmologic procedures. We performed direct observation of OR traffic as well as environmental parameters (temperature, humidity, pressure, and particulate count) for the entire length of the procedure. We used both directly measured data as well as automated data generated by facilities. Results: The study showed that temperature, humidity, and pressure wer tightly controlled in the OR. This observation was consistent between manual data and automatically generated data. The OR traffic was not easily monitored by the current automatic data and was measured by direct observation. The correlations between particulate count and OR traffic was strongest for 0.3μm (0.7370, and weakest for 1.0μm ( 0.087). The 5.0μm particulate size had a moderate positive correlation of 0.344, Additionally, shorter procedures had less particulate matter in the OR environment. Automated data were only available in the new ORs but could not predict traffic without automated door monitors. But the automated data could easily portray the temperature, humidity and pressure minute by minute. Conclusion: OR traffic increases the particle count particularly the small size. Other physical aspects of the OR environment were tightly controlled. The ability to automatically monitor OR parameters could be extremely helpful for assuring patient safety as well as reviewing OR factors in SSI cases.

Abstract Background Premature ejaculation (PE) is considered to be the most common male sexual disorder affecting 20% to 66% of sexually active men. Most of the patients had already tried on demand dapoxitine with no improvement. We aimed in the current study to assert the efficacy and safety profile of daily intake of 30 mg duloxetine in treating patients with lifelong premature ejaculation (LPE) as well as patients with acquired premature ejaculation (APE). Results The current study showed significant improvement in intravaginal ejaculatory latency time (IELT) after intake of duloxetine. All participants had a median Arabic index of premature ejaculation (AIPE) of 26, median IELT of 180 s, median male sexual quality of life (SQOL) of 43 after being treated with duloxetine (p value

In this article, Persea americana aqueous peels extract was used to synthesize silver nanoparticles in a simple and environmentally friendly manner. The properties of synthesized silver nanoparticles (AV-AgNPs) were studied via several techniques, including UV–vis spectroscopy, DLS, TEM, EDX, and FTIR. The UV–Vis spectra analysis revealed that the highest absorption peak occurred at 428 nm, providing strong evidence for forming AV-AgNPs. The TEM results indicate that the synthesized AV-AgNPs were uniformly dispersed, exhibiting a spherical shape with an average size of 24 nm. EDX imaging also confirmed the presence of AgNPs. FTIR analysis shows P. americana's phenolic compounds and proteins significantly contribute to AV-AgNP synthesis and stabilization. In addition, the antimicrobial activity of AV-AgNPs was assessed against pathogenic bacteria commonly found in humans, exhibiting a moderate zone of inhibition against the selected pathogens. Additionally, AV-AgNPs were used in antioxidant studies with the robust antioxidant properties 2, 2 diphenyl-1-picrylhydrazyl (DPPH). In vitro studies have shown that AV-AgNPs can remarkably inhibit α-amylase in a dose-dependent manner, indicating their potential as antidiabetic agents. In silico research, it was revealed that naringenin derived from P. americana exhibited a strong binding to S. typhi and B. cereus (−8.7 and −7.5 kcal/mol, respectively). At the same time, quercetin demonstrated a high binding affinity and energy to α-Amylase (−8.9 kcal/mol). This study presents the first investigation into the biosynthesis of AgNPs utilizing the aqueous peel extract derived from P. americana with multiple uses, including antioxidant, antimicrobial, and antidiabetic activity.

IntroductionImmune thrombocytopenia (ITP) management with co-existing acute coronary syndrome (ACS) remains challenging as it requires a clinically relevant balance between the risk and outcomes of thrombosis and the risk of bleeding. However, the literature evaluating the treatment approaches in this high-risk population is scarce.Methods and ResultsIn this review, we aimed to summarize the available literature on the safety of ITP first- and second-line therapies to provide a practical guide on the management of ITP co-existing with ACS. We recommend holding antithrombotic therapy, including antiplatelet agents and anticoagulation, in severe thrombocytopenia with a platelet count < 30 × 109/L and using a single antiplatelet agent when the platelet count falls between 30 and 50 × 109/L. We provide a stepwise approach according to platelet count and response to initial therapy, starting with corticosteroids, with or without intravenous immunoglobulin (IVIG) with a dose limit of 35 g, followed by thrombopoietin receptor agonists (TPO-RAs) to a target platelet count of 200 × 109/L and then rituximab.ConclusionOur review may serve as a practical guide for clinicians in the management of ITP co-existing with ACS.

In recent years, smart water sensing technology has played a crucial role in water management, addressing the pressing need for efficient monitoring and control of water resources analysis. The challenge in smart water sensing technology resides in ensuring the reliability and accuracy of the data collected by sensors. Outliers are a well-known problem in smart sensing as they can negatively affect the viability of useful analysis and make it difficult to evaluate pertinent data. In this study, we evaluate the performance of four sensors: electrical conductivity (EC), dissolved oxygen (DO), temperature (Temp), and pH. We implement four classical machine learning models: support vector machine (SVM), artifical neural network (ANN), decision tree (DT), and isolated forest (iForest)-based outlier detection as a pre-processing step before visualizing the data. The dataset was collected by a real-time smart water sensing monitoring system installed in Brussels’ lakes, rivers, and ponds. The obtained results clearly show that the SVM outperforms the other models, showing 98.38% F1-score rates for pH, 96.98% F1-score rates for temp, 97.88% F1-score rates for DO, and 98.11% F1-score rates for EC. Furthermore, ANN also achieves a significant results, establishing it as a viable alternative.

Acute lymphoblastic leukemia (ALL) poses a significant health challenge, particularly in pediatric cases, requiring precise and rapid diagnostic approaches. This comprehensive review explores the transformative capacity of deep learning (DL) in enhancing ALL diagnosis and classification, focusing on bone marrow image analysis. Examining ten studies conducted between 2013 and 2023 across various countries, including India, China, KSA, and Mexico, the synthesis underscores the adaptability and proficiency of DL methodologies in detecting leukemia. Innovative DL models, notably Convolutional Neural Networks (CNNs) with Cat-Boosting, XG-Boosting, and Transfer Learning techniques, demonstrate notable approaches. Some models achieve outstanding accuracy, with one CNN reaching 100% in cancer cell classification. The incorporation of novel algorithms like Cat-Swarm Optimization and specialized CNN architectures contributes to superior classification accuracy. Performance metrics highlight these achievements, with models consistently outperforming traditional diagnostic methods. For instance, a CNN with Cat-Boosting attains 100% accuracy, while others hover around 99%, showcasing DL models’ robustness in ALL diagnosis. Despite acknowledged challenges, such as the need for larger and more diverse datasets, these findings underscore DL’s transformative potential in reshaping leukemia diagnostics. The high numerical accuracies accentuate a promising trajectory toward more efficient and accurate ALL diagnosis in clinical settings, prompting ongoing research to address challenges and refine DL models for optimal clinical integration.

Five hundred and sixty broilers were placed into seven groups. The first negative control (A) was fed the baseline diet (BD); the second positive control (B) was fed BD and exposed to clostridium infection; and the third and fourth groups (C, D) were the same as the positive control with 500 and 1000 g/ton of feed, respectively. The fifth group (E) served as a positive control for the addition of lincomycin, whereas the sixth and seventh groups (F, G) received the same designed diet as the E group but supplemented with HA at 500 and 1000 g/ton of feed, respectively. Birds infected with Clostridium perfringens had considerably decreased body weight. However, a dietary combination of HA and lincomycin resulted in a greater improvement in growth. Body weight increased after 35 days, but feed intake dropped, therefore HA and lincomycin supplementation enhanced feed conversion ratio. Supplementing with HA and lincomycin increased crude protein retention. Furthermore, these additions mitigated the detrimental effects of clostridial infection on the gut by reducing degenerative changes in intestinal villi and increasing villi length, particularly at higher HA/lincomycin doses. In conclusion, nutritional supplementation with humic acid and lincomycin improved blood biochemistry, and gut morphology in broilers infected with Clostridium difficile.

Summary: Background: Patients with chronic lymphocytic leukemia (CLL) have a higher risk of developing other malignancies (OMs) compared to the general population. However, the impact of CLL-related risk factors and CLL-directed treatment is still unclear and represents the focus of this work. Methods: We conducted a retrospective international multicenter study to assess the incidence of OMs and detect potential risk factors in 19,705 patients with CLL, small lymphocytic lymphoma, or high-count CLL-like monoclonal B-cell lymphocytosis, diagnosed between 2000 and 2016. Data collection took place between October 2020 and March 2022. Findings: In 129,254 years of follow-up after CLL diagnosis, 3513 OMs were diagnosed (27.2 OMs/1000 person-years). The most common hematological OMs were Richter transformation, myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Non-melanoma skin (NMSC) and prostate cancers were the most common solid tumors (STs).The only predictor for MDS and AML development was treatment with fludarabine and cyclophosphamide with/without rituximab (FC ± R) (OR = 3.7; 95% CI = 2.79–4.91; p

IntroductionCoronary artery disease (CAD) management in the setting of immune thrombocytopenia (ITP) remains very challenging to clinicians as a reasonable balance between bleeding and thrombosis risks needs to be achieved, and the evidence guiding such management is scarce.MethodsWe conducted a systematic review following the PRISMA guidelines to summarize the available literature on the management and outcomes of CAD coexisting with ITP. We searched PubMed and Embase for studies published in English exploring CAD and ITP management until 05 October 2022. Two independent reviewers screened and assessed the articles for inclusion. Patients' characteristics, CAD treatment modalities, ITP treatment, and complications were reported.ResultsWe identified 32 CAD cases, among which 18 cases were revascularized with percutaneous coronary intervention (PCI), 12 cases underwent coronary artery bypass graft surgery (CABG), and two cases were managed conservatively. More than 50% were men, with a mean age of 61 ± 13 years and a mean baseline platelet count of 52 ± 59 × 109/L. Irrespective of the revascularization modality, most patients were treated with either corticosteroids alone, intravenous immunoglobulins (IVIG) alone, or in combination. Among those who underwent PCI, two patients had bleeding events, and one patient died. Similarly, among those with CABG, one patient developed bleeding, and one patient died.ConclusionWe found that revascularization with either PCI or CABG with the concurrent use of corticosteroids and/or IVIG for ITP was feasible, with an existing non-negligible risk of bleeding and mortality.

Abstract Background Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19. Methods This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries. Data collection was conducted between April and May 2021. The COVID-19 diagnosis was confirmed by the real-time polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 on nasal or pharyngeal swabs. Severe cases of COVID-19 were defined by hospitalization and the need of oxygen or admission into ICU. Development and type of thrombotic events, presence and severity of bleeding complications were reported during treatment for COVID-19. Bleeding events were classified using ISTH definition. STROBE recommendations were used in order to enhance reporting. Results A total of 793 patients from 79 centers were included in the study with 593 being hospitalized (74.8%). Among these, 511 were defined as having severe COVID: 162 were admitted to the ICU while 349 received oxygen supplementation outside the ICU. Most patients (90.5%) were receiving thromboprophylaxis. During COVID-19 treatment, 11.1% developed a thromboembolic event, while 5.0% experienced bleeding. Thrombosis developed in 21.6% of patients who were not receiving thromboprophylaxis, in contrast to 10.6% of patients who were on thromboprophylaxis. Bleeding episodes were more frequent in patients receiving intermediate/therapeutic versus prophylactic doses of low-molecular-weight heparin (LWMH) (8.1% vs. 3.8%, respectively) and in elderly. In multivariate analysis, peak D-dimer level and C-reactive protein to albumin ratio were poor prognostic factors for thrombosis occurrence (OR = 1.022, 95%CI 1.007‒1.038 and OR = 1.025, 95%CI 1.001‒1.051, respectively), while thromboprophylaxis use was protective (OR = 0.199, 95%CI 0.061‒0.645). Age and LMWH intermediate/therapeutic dose administration were prognostic factors in multivariate model for bleeding (OR = 1.062, 95%CI 1.017–1.109 and OR = 2.438, 95%CI 1.023–5.813, respectively). Conclusions Patients with CLL affected by severe COVID-19 are at a high risk of thrombosis if thromboprophylaxis is not used, but also at increased risk of bleeding under the LMWH intermediate/therapeutic dose administration.

Epigenetic modifications, mainly aberrant DNA methylation, have been shown to silence the expression of genes involved in epigenetic diseases, including cancer suppression genes. Almost all conventional cancer therapeutic agents, such as the DNA hypomethylation drug 5-aza-2-deoxycytidine, have insurmountable side effects. To investigate the role of the well-known DNA protectant (ectoine) in skin cell DNA methylation and cancer cell proliferation, comprehensive methylome sequence analysis, 5-methyl cytosine (5mC) analysis, proliferation and tumorigenicity assays, and DNA epigenetic modifications-related gene analysis were performed. The results showed that extended ectoine treatment globally hypomethylated DNA in skin cells, especially in the CpG island (CGIs) element, and 5mC percentage was significantly reduced. Moreover, ectoine mildly inhibited skin cell proliferation and did not induce tumorigenicity in HaCaT cells injected into athymic nude mice. HaCaT cells treated with ectoine for 24 weeks modulated the mRNA expression levels of Dnmt1, Dnmt3a, Dnmt3b, Dnmt3l, Hdac1, Hdac2, Kdm3a, Mettl3, Mettl14, Snrpn, and Mest. Overall, ectoine mildly demethylates DNA in skin cells, modulates the expression of epigenetic modification-related genes, and reduces cell proliferation. This evidence suggests that ectoine is a potential anti-aging agent that prevents DNA hypermethylation and subsequently activates cancer-suppressing genes.

Enterococci are important microorganisms of the gut microbiome in many mammals and cause millions of infections annually. An increasing resistance to antibiotics has led to their emergence as superinfecting nosocomial pathogens in humans. Enterococcus hirae is rarely identified in humans. In this study, we present a case of the polymicrobial osteomyelitis involving Enterococcus hirae in a 33-year-old male patient with traumatic tibia-fibula fracture after a motor vehicle accident. He underwent a right below-the-knee amputation and antibiotics with excellent improvement. Our case study helps to confirm the unexpected presence of Enterococcus hirae in a human specimen. Further studies are needed to elucidate the clinical implications of Enterococcus hirae.

Burns are one of the most common and devastating forms of trauma. Burns are a significant problem with high associated morbidity and mortality worldwide. Burn wound infection is a serious complication, which plays an important role in increasing the overall fatality rate in burn patients. In this study, we report a case of the polymicrobial burn wound infection involving V mimicus in a 56-year-old male, who was transferred from an outside hospital to the inpatient burn unit after sustaining traumatic and burn injuries in a firework explosion accident. The patient underwent surgical treatment and antibiotics with good improvement. Although rare, our case study will help to underscore the important role of V mimicus as a human pathogen.

Environmental Sound Recognition (ESR) plays a crucial role in smart cities by accurately categorizing audio using well-trained Machine Learning (ML) classifiers. This application is particularly valuable for cities that analyzed environmental sounds to gain insight and data. However, deploying deep learning (DL) models on resource-constrained embedded devices, such as Raspberry Pi (RPi) or Tensor Processing Units (TPUs), poses challenges. In this work, an evaluation of an existing pre-trained model for deployment on Raspberry Pi (RPi) and TPU platforms other than a laptop is proposed. We explored the impact of the retraining parameters and compared the sound classification performance across three datasets: ESC-10, BDLib, and Urban Sound. Our results demonstrate the effectiveness of the pre-trained model for transfer learning in embedded systems. On laptops, the accuracy rates reached 96.6% for ESC-10, 100% for BDLib, and 99% for Urban Sound. On RPi, the accuracy rates were 96.4% for ESC-10, 100% for BDLib, and 95.3% for Urban Sound, while on RPi with Coral TPU, the rates were 95.7% for ESC-10, 100% for BDLib and 95.4% for the Urban Sound. Utilizing pre-trained models reduces the computational requirements, enabling faster inference. Leveraging pre-trained models in embedded systems accelerates the development, deployment, and performance of various real-time applications.

Date palm (Phoenix dactylifera L.) fruits contain high concentrations of phenolic compounds, particularly flavonoids and other micronutrients, which impact human health due to their potent antioxidant, anti-inflammatory, and anticancer characteristics. In the present study, the effect of ethyl acetate, hydroethanol, hydromethanol, and aqueous extract from three date palm varieties (i.e., Ajwa, Siwi, and Sukkari) on phytochemical profiles and antioxidant and anticancer activities was investigated. Fruit extracts were screened for their antioxidant activity using the DPPH· method. Phenolic constituents were quantified and identified using HPLC-DAD. Extracts (ethyl acetate, hydroethanol, and hydromethanol) were assessed for cytotoxicity on nine human cancer cell lines, i.e., MG-63, HCT116, MCF7, MDA-MB-231, HEPG2, HUH7, A549, H460, and HFB4, using the sulphorhodamine-B (SRB) assay. Results showed that the ethyl acetate extract of the Sukkari fruits has the greatest antioxidant potential with an IC50 value of 132.4 ± 0.3 μg·mL−1, while the aqueous extract of Ajwa date fruits exhibited the lowest antioxidant effect with an IC50 value of 867.1 ± 0.3 μg·mL−1. The extracts exhibited potent to moderate anticancer activities against the investigated cancer cell line in a source-dependent manner. Methanol extract of Siwi fruits exhibited the most potent anticancer activity (IC50 = 99 ± 1.6 µg·mL−1), followed by the same extract of Sukkari fruits with an IC50 value of 119 ± 3.5 µg·mL−1 against the cell line of human breast cancer (MDA-MB-231). Additionally, principal component analysis (PCA) was investigated to determine the relationship among the investigated traits and treatments. Our findings reveal that date palm fruit-derived extracts are excellent sources of biologically active constituents and substantiate their potential use in new anticancer strategies from natural resources.

Brain abscess is a focal intracranial infection that may present as a life-threatening emergency. Brain abscess can present with a wide range of clinical syndromes, and it results in high morbidity and mortality worldwide. Here we describe a rare case of the polymicrobial right parietal brain abscess, especially associated with Actinomyces in a 59-year-old male who presented with acute onset of left-sided weakness and altered mental status. The patient underwent surgical treatment (burrhole aspiration) and antibiotics with good improvement. Prompt diagnosis and treatment are critical for brain abscess and ultimately lead to better patient outcomes.

Abstract Gastrointestinal manifestations of leukemias have been well recognized. Typically, acute leukemias cause typhlitis or appendicitis more commonly than chronic leukemias. Our case points to appendicitis as possible manifestation of chronic myelogenous leukemia.

Abstract Coronavirus disease 2019 (COVID‐19) is a respiratory viral illness that is caused by coronavirus 2 (SARS‐CoV‐2). The disease often presents with non‐specific symptoms such as fever, headache, and fatigue, accompanied by respiratory symptoms (e.g., cough and dyspnea) and other systemic involvement. Currently, the virus had shown significant changes and mutations that resulted in the emergence of different strains. Each strain varies in its virulence, disease severity, and the response of the body's immune system. Sickle cell disease characterized by hemolytic anemia particularly in associated with stress. Patients with sickle cell disease infected with SARS‐CoV‐2 are reported to have increased risk for hospitalization, thrombosis, and other complications compared with non‐sickle cell patients. The Omicron variant causes mild disease in general population; however, in patients with sickle cell disease, the data are limited. We present two patients known to have sickle cell disease presented with a severe acute painful crisis that required hospitalization after infection with Omicron variant of the SARS‐CoV‐2 virus.

Background: Musculoskeletal manifestations are common in sickle cell disease (SCD). Vaso-occlusive crisis can manifest acutely as joint and bone pain, osteomyelitis and/or arthritis. It can also lead to chronic bone aches, bone deformities, degenerative arthritis, pathological fractures, and osteoporosis. Hyperbaric oxygen (HBO) therapy is a mode of treatment in which the patient is exposed to very high arterial and tissue oxygen pressure, during multiple sessions. It has been used as primary or adjunctive therapy for a variety of medical disorders, including necrotizing infection and sickle cell crisis. Case Report: In this case series, 3 patients with SCD and avascular necrosis were treated with 15–40 sessions of HBO and were assessed 6–12 months by MRI after treatment. They showed different clinical outcomes and MRI changes. Conclusion: We concluded that HBO can result in some subjective improvement, especially in early stages. Further studies on severe cases are needed.

Varicella zoster is a secondary infection caused by the virus of chickenpox, after becoming latent in neurons of dorsal root ganglia or trigeminal ganglia. Varicella zoster virus (VZV) can be reactivated years later to produce shingles (zoster), generally in immunocompromised adults to produce neurological deficits and rash. Meningeal involvement of VZV is also reported and can be diagnosed. Herein, we report a 39-year-old immunocompetent male adult with a rare manifestation caused by VZV. The report is an association between facial nerve palsy and a polymerase chain reaction-confirmed VZV meningitis, even without the dermal typical rash. The patient eventually recovered after receiving acyclovir intravenously.

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by dysregulated growth and the proliferation of myeloid cells in the bone marrow caused by the BCR-ABL1 fusion gene. Clinically, CML demonstrates an increased production of mature and maturing granulocytes, mainly neutrophils. When a patient is suspected to have CML, peripheral blood smears and bone marrow biopsies may be manually examined by a hematologist. However, confirmatory testing for the BCR-ABL1 gene is still needed to confirm the diagnosis. Despite tyrosine kinase inhibitors (TKIs) being the mainstay of treatment for patients with CML, different agents should be used in different patients given their stage of disease and comorbidities. Moreover, some patients do not respond well to certain agents and some need more aggressive courses of therapy. Given the innovations and development that machine learning (ML) and artificial intelligence (AI) have undergone over the years, multiple models and algorithms have been put forward to help in the assessment and treatment of CML. In this review, we summarize the recent studies utilizing ML algorithms in patients with CML. The search was conducted on the PubMed/Medline and Embase databases and yielded 66 full-text articles and abstracts, out of which 11 studies were included after screening against the inclusion criteria. The studies included show potential for the clinical implementation of ML models in the diagnosis, risk assessment, and treatment processes of patients with CML.

Thalassemia is an autosomal recessive genetic disorder that affects the beta or alpha subunits of the hemoglobin structure. Thalassemia is classified as a hypochromic microcytic anemia and a definitive diagnosis of thalassemia is made by genetic testing of the alpha and beta genes. Thalassemia carries similar features to the other diseases that lead to microcytic hypochromic anemia, particularly iron deficiency anemia (IDA). Therefore, distinguishing between thalassemia and other causes of microcytic anemia is important to help in the treatment of the patients. Different indices and algorithms are used based on the complete blood count (CBC) parameters to diagnose thalassemia. In this article, we review how effective artificial intelligence is in aiding in the diagnosis and classification of thalassemia.

Thrombocytopenia is a medical condition where blood platelet count drops very low. This drop in platelet count can be attributed to many causes including medication, sepsis, viral infections, and autoimmunity. Clinically, the presence of thrombocytopenia might be very dangerous and is associated with poor outcomes of patients due to excessive bleeding if not addressed quickly enough. Hence, early detection and evaluation of thrombocytopenia is essential for rapid and appropriate intervention for these patients. Since artificial intelligence is able to combine and evaluate many linear and nonlinear variables simultaneously, it has shown great potential in its application in the early diagnosis, assessing the prognosis and predicting the distribution of patients with thrombocytopenia. In this review, we conducted a search across four databases and identified a total of 13 original articles that looked at the use of many machine learning algorithms in the diagnosis, prognosis, and distribution of various types of thrombocytopenia. We summarized the methods and findings of each article in this review. The included studies showed that artificial intelligence can potentially enhance the clinical approaches used in the diagnosis, prognosis, and treatment of thrombocytopenia.

Philadelphia-negative (Ph-) myeloproliferative neoplasms (MPNs) are a group of hematopoietic malignancies identified by clonal proliferation of blood cell lineages and encompasses polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The clinical and laboratory features of Philadelphia-negative MPNs are similar, making them difficult to diagnose, especially in the preliminary stages. Because treatment goals and progression risk differ amongst MPNs, accurate classification and prognostication are critical for optimal management. Artificial intelligence (AI) and machine learning (ML) algorithms provide a plethora of possible tools to clinicians in general, and particularly in the field of malignant hematology, to better improve diagnosis, prognosis, therapy planning, and fundamental knowledge. In this review, we summarize the literature discussing the application of AI and ML algorithms in patients with diagnosed or suspected Philadelphia-negative MPNs. A literature search was conducted on PubMed/MEDLINE, Embase, Scopus, and Web of Science databases and yielded 125 studies, out of which 17 studies were included after screening. The included studies demonstrated the potential for the practical use of ML and AI in the diagnosis, prognosis, and genomic landscaping of patients with Philadelphia-negative MPNs.

Case report: The main strategy to control the SARS-CoV-2 pandemic is through global vaccination. One of the rare side effects of vaccination is Immune Thrombocytopenic Purpura (ITP). We present a 31 years old lady with a history of ITP, came on her 8th week of pregnancy with fever and dry cough after receiving the first dose of Pfizer vaccine. The ITP flare worsened after the second dose of the vaccine. Patients with ITP should have their second dose of vaccine delayed if they had flare particularly if pregnant.

Objective: Thalassemia is one of the most common hemoglobinopathies, with around 5% of the world's population expected to have some degree and type of thalassemia. Beta thalassemia (BT) occurs due to a deficient production of the beta-globin chain of hemoglobin. Extramedullary hematopoiesis (EMH) is one of the complications of BT, mainly observed in minor/intermedia subtypes. EMH is the production of blood cells outside the marrow as a compensatory response to longstanding hypoxia. Due to chronic transfusions, it is not expected in patients with beta-thalassemia major (BTM). However, there are increasingly reported cases of EMH in BTM. The incidence of EMH in BTM is thought to be

Objective: Following the launch of the TKI's (tyrosine kinase inhibitors) for the treatment of CML, establishing its significant control over the disease, other dimensions have emerged in regard to the safety of treatment, particularly the effect on Male fertility and fatherhood. This study was conducted to review the real-life data on the effect of TKI on the fertility of male patients in the National Center of cancer care and research (NCCCR) in Qatar. Case report: Inclusion Criteria: Male patient diagnosed with CML, in Chronic or accelerated phase; 18 years of age or older and actively receiving tyrosine kinase inhibitors including (Imatinib, dasatinib,nilotinib) with the following: -Patients with no known issues with regards to fertility, (fertility is intact) Patients who developed fertility issues after the diagnosis of CML and starting TKI's. has been evaluated by an andrologist, and his evaluation concluded its TKI related. Methodology: A single-center study conducted a mixed-design study by phone interviews with CML male patients in the Chronic or accelerated phase, being followed up in NCCCR (national center for cancer care and research), evaluating the effect of Imatinib, Dasatinib, nilotinib, on their fertility whether they are taking it as first, a second, or third line of treatment. Results: 150 patients were interviewed to be included in the study, 22 patients had concerns related to medications safety and possible transmission of the disease, 33 patients had their families completed by the time of diagnosis. 26 patients have met the inclusion criteria, offspring's total number was 43, 97.6% were full-term, had a normal delivery, and normal average weight at delivery. No stillbirths, fetal demise, or congenital anomaly were reported. All offspring had normal development and growth. Conclusion: Around 98% of male CML patients taking imatinib, Dasatinib, Nilotinib had their offspring born normally with no delivery complications noted, all had no congenital anomaly had normal growth and development, and no CML-related cancers were diagnosed. Further studies with a larger sample size are required to shed light on the TKI outcome on fatherhood in CML patients.

Objective: The evidence guiding VTE management in SCD, specifically in terms of anticoagulant choice, is scarce. Therefore, we conducted a systematic review that evaluates the effectiveness and safety of direct oral anticoagulants (DOACs) in SCD with VTE. Methodology: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the English literature (PubMed, SCOPUS, and Google Scholar) for randomized controlled trials, observational studies, reviews, case series, and case reports for patients with SCD treated with DOAC for thromboembolic disease. Results: The current data demonstrated that the use of DOACs for VTE in SCD has similar effectiveness in the prevention of VTE recurrence in comparison to other anticoagulants, including VKAs and injectable anticoagulants with a better safety profile. However, given the absence of clinical practice guidelines for the treatment of VTE among patients with SCD, the clinical practice guidelines recommendations for VTE treatment can be applied to patients with SCD. Conclusion: In view of the current evidence and based on the results observed; using DOACs was associated with lesser bleeding incidence and fewer complications comparing to VKAs. We think it is rational to use DOACs for VTE treatment among patients with SCD rather than use VKAs.

Objective: Radioactive iodine (RAI) with I131 has an established role in managing differentiated thyroid carcinoma, namely papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma. However, concerns have been raised about its possible carcinogenic effects. Papers of t-CML following I131 are increasingly reported, and thus this review is dedicated to highlighting it. Methodology: All reports from the 1960s to date related to CML following RAI therapy were searched on Google Scholar and PubMed. Different search terms with Boolean function to search for the relevant articles. Results: We identified ten articles reporting 12 cases, as presented in table 1. We found that most of the reports were for men (8/12) under the age of 60 years (10/12), and the primary tumor was of PTC characteristics (5/12 were PTC, and 3/12 were mixed papillary-follicular carcinoma). The dose of I131 ranged between 30 millicuries (mCi) to 850 mCi; the mean dose was 331 mCi. Also, t-CML developed within the first ten years (9/12), mainly between 4-7 years post-exposure. Conclusion: A few reports found a statistically significant increased risk of leukemia following RAI therapy; some suggested a relative risk of 2.5 for I131 vs. no I131. Observed findings from these studies include a linear relationship between the cumulative dose of I131 and the risk of leukemia, doses higher than 100 mCi were associated with a greater risk of developing secondary leukemia, and most of the leukemias developed within the initial ten years of exposure.

Objective: The exact incidence of avascular necrosis (AVN) in chronic myeloid leukemia (CML) is still unknown as the number of cases is limited. AVN was reported as an initial presenting manifestation in few CML patients. On the other hand, AVN was linked to medications used in CML treatment, specifically interferon-alpha (IFN-α) therapy and tyrosine kinase inhibitors (TKI). Our review aims to describe the pathophysiology, patients’ clinical characteristics, and outcomes of AVN in CML. Methodology: We searched PubMed and Google Scholar for the case reports and series of patients with CML who developed AVN from inception to July 2021. We found 21 cases of AVN in CML patients,17 cases with AVNFH, and four cases with ONJ. Articles in the grey literature and non-English language publications were excluded. Patient characteristics, hematological parameters, management, and outcomes of AVN were extracted from those articles. Results: The median age was 39 years with an almost equal distribution between males and females. WBC counts were strikingly elevated in patients who initially presented with AVNFH (above 10,0000 in most cases). AVN related to CML management has been linked to TKIs and standard IFN-α therapies. Only 6 (out of 17) patients who developed AVNFH eventually required a hip replacement, and one (out of 17) developed a recurrent episode of AVNFH. All the reported cases of CML with ONJ were associated with TKIs Conclusion: Given the lack of data, we could not conclude whether AVN has an adverse prognostic effect on CML. However, the overall prognosis is comparable with AVN associated with other conditions. Clinicians should consider AVN in CML patients with either hip or jaw pain because early detection and management are essential to decrease morbidity and long-term disability in such patients. A further prospective study with a larger sample size is needed to clarify the different aspects of AVN in CML patients.

Objective: Due to mild symptoms, congenital methemoglobinemia is rarely diagnosed and reported as a cause of the cyanosis, especially in adults. Despite the benign nature of congenital methemoglobinemia, it is crucial to keep it in the differential diagnosis list when assessing cyanotic patients, mainly if he has a normal PaO2. Patients are usually asymptomatic and are treated for cosmetic purposes, but they might suffer from severe complications if exposed to oxidative agents. Case report: A 33-year-old lady presented to ED with difficulty breathing and bluish discoloration gradually increased over days, without fever or cough. she mentioned having recurrent similar episodes since childhood. family history positive for similar episodes in the sister. physical examination positive for central and peripheral cyanosis, with o2sat of 88% and RR of 20, the rest of examination within normal limits. laboratory tests normal except for ht 48.9%, PO2 160 on ABGs. Methodology: The patient's clinical picture of cyanosis with no evidence of cardiovascular or pulmonary diseases and the discrepancy between PaO2 and O2 saturation on oximeter required thinking of methemoglobinemia as a possible diagnosis despite the patient's age and the absence of any exposures. Methemoglobin level 20.9% (0-1.5%). Hemoglobin electrophoresis did not detect any abnormal hemoglobin. The activity of NADH cytochrome b5 reductase or the level were not done. Results: We searched PubMed and Google Scholar, we found 22 articles with a total of 30 patients with congenital methemoglobinemia. The mean age of the patients was 25 years (range 2 days-61 years); most of them were previously healthy. Out of 30 patients, 16 were treated with ascorbic acid or methylene blue or both with improvement, 14 either were not treated or treatment not mentioned in the report. Our patient received ascorbic acid 500 mg BID orally and improved clinically and laboratory. Conclusion: Due to mild symptoms, congenital methemoglobinemia is rarely diagnosed and reported as a cause of the cyanosis, especially in adults. Despite the benign nature of congenital methemoglobinemia, it is crucial to keep it in the differential diagnosis list when assessing cyanotic patients, mainly if he has a normal PaO2. Patients are usually asymptomatic and are treated for cosmetic purposes, but they might suffer from severe complications if exposed to oxidative agents.

Objective: The aim of this review is to assess patients with chronic myeloid leukemia with concomitant JA2 positive for - their characteristics - response to treatment Methodology: We searched the English literature (Google Scholar, PubMed, and SCOPUS) for studies, reviews, case series, and case reports of patients with chronic myeloid leukemia who had JAK2 mutation. Inclusion criteria: were the presence of JAK2 mutation in CML patients with BCR-ABL1 rearrangement and, secondly, age ≥18yrs. The search included all articles published up to 20th April 2021. Results: A total of 25 patients met our criteria of the search. Twenty-two patients were diagnosed in the chronic phase, 2 patients in the accelerated phase, and one patient transformed to the blast phase. More females n=16 and 10 males. The mean age at the time of diagnosis was 61.3 years. 9 patients had to be switch to second-line therapy. Age and gender distribution and the presence of splenomegaly or organomegaly are almost the same. Males were slightly more than females. Conclusion: It is difficult to conclude that multi-kinase inhibitors are superior to imatinib in treating CML with concomitant JAK2 mutation. But the result of the reported cases showed that multi-kinase inhibitors are more likely to be successful in achieving remission and loss of JAK2 mutation. However, it is difficult to generalize the result without further studies due to the few numbers of patients and the unusual association.

Objective: The aim of this retrospective study is to evaluate fertility in the Philadelphia-negative MPN male patients and the effect of treatment received on male fertility and the outcome. Methodology: This is a single-center, mixed-design study (retrospective + phone interviews) conducted within the National Center for Cancer Care and Research. Results: 120 patients were interviewed, only 19 patients (15.7%) had met the inclusion criteria. The majority of patients had lost follow-up or cannot be contacted, and 29.1% of patients had their families completed by the time of diagnosis. The treatment received includes hydroxyurea, interferon, and ruxolitinib. The mode of delivery was normal vaginal delivery in 68% of the pregnancies. The total number of conceptions was 27; three stillbirths were reported. Conclusion: The data showed that most MPN male patients on treatment had their offspring born normally with no delivery complications, no reported congenital anomaly or growth retardation, and no report of MPN-related cancers. Though, further studies with a larger sample size are required to fully understand the effect of medications on the outcome of fatherhood in Philadelphia negative MPN patients.

Myeloproliferative neoplasms (MPNs) are clonal hematopoietic stem cell disorders characterized by the overproduction of mature myeloid cells and are often associated with an acquired genetic mutation of Janus Kinase2V617F . Various epidemiological studies have indicated associations between environmental factors, lifestyle factors, and host characteristics with developing MPNs. This review aims to collect and summarize the existing information on these risk factors and establish their association with pathogenesis MPNs. Medline, Embase, PubMed, and grey literature were systematically searched using key terms for MPNs, and epidemiological study designs, that is, cross-sectional studies, case-control, and cohort, that investigated the risk factors for MPNs published were identified. Out of the 4621 articles identified, 20 met the selection criteria and were included in this review. Heterogeneity, study reliability, and bias were assessed. A significant association was found between smoking and the development of MPNs. This relationship has been explained by the substantial increase in several proinflammatory mediators and systematic oxidative stress causing hyperstimulation of myeloid compartments leading to the development of MPNs. Obesity was modestly linked with an increased risk of MPNs. The underlying mechanisms have been linked to changes in endocrine, metabolic, and inflammatory systems. No strong association was found between exposure to hazardous substances, that is, benzene and MPNs, but further investigation on the effects of increased levels and duration of exposure on hematopoietic stem cells will be beneficial. Unique individual and host variations have been determined as a modifier of disease pathogenesis and phenotype variations. There is a higher incidence rate of females developing MPNs, specifically ET, than males with higher PV incidence. Therefore, gender contributes to the heterogeneity in myeloproliferative neoplasm. Studies identified as part of this review are very diverse. Thus, further in-depth assessment to explore the role of these etiological factors associated with MPNs is warranted.

Objective: To determine the beneficial effect of bariatric surgery on the treatment of type 2 diabetes mellitus in obese patients.Patients and methods: This prospective study was conducted in Al-Sader teaching hospital and Al-Musawi privet hospital from August 2013 to August 2017 on 332 patients with body mass index between 35-55, their age was range from 30-60 years, and they were 185 (55.7%) females and 147 (44.3%) males. All patients in this study were diabetic type 2 with different stages of the disease, types of medications, C peptide levels, HbA1c and BMI. They were subjected to three different bariatric procedures; laparoscopic sleeve gastrectomy (LSG), mini gastric bypass (MGB), and laparoscopic Roux-en-Y gastric bypass (LRYGB), they were followed for a period of 1-4 years regarding their glycemic control, HbA1c, type and number of medications.Results: Three hundred and thirty two patients were included in this study, 111 patients (33.5%) had MGB, 88 patients (26.5%) had LRYGB, 133 patients (40%) had LSG according to the following selection criteria; duration and severity of DM, C peptide, other comorbidities and the patients preference Resolution of DM was achieved in 100 patient (90%) of MGB, 77 patient (87%) of LRYGB and 75 patient (57%) of LSG while other patients had no improvement. Conclusion: Bariatric surgery for obese diabetic patients resulted in complete resolution in most patients, improvement of diabetes in some and overall improvement in the quality of life in all patients.

Glycyrrhetinic acid (GA) is a principal bioactive pentacyclic triterpenoid from Glycyrrhiza uralensis. Uridine diphosphate-dependent glycosyltransferases (UGTs) have been widely used to catalyze glycosylation of diverse nature products for the development of potential therapeutic compounds. In this study, we have characterized a UGT109A3 from Bacillus subtilis, which can glycosylate both the free C3 hydroxyl and C30 carboxyl groups of GA to yield a unique 3, 30-O-β-D-diglucoside-GA. By coupling the microbial UGT109A3 to plant sucrose synthase (SUS), GA-diglucoside could be biosynthesized in an efficient and economical way. With a fed-batch glycosylation, a large scale of GA-diglucoside (6.26 mM, 4.98 g/L in 8 h) could be enzymatically transformed from GA. The obtained GA-diglucoside showed a significant water solubility improvement of around 3.4 × 103 fold compared with that of the parent GA (29 μM). Moreover, it also exhibited dose-dependent cytotoxicity toward human colon carcinoma Caco-2 cell line according to MTT assay, having an IC50 at 160 μM. This study not only establishes efficient platform for producing GA-glucosides, but is also valuable for developing further the biosynthesis of other complex glycosylated natural products.

Streptobacillus moniliformis is a pleomorphic, fastidious gram-negative bacillus that colonizes rodent respiratory tracts and causes rat-bite fever in humans. Rat-bite fever is associated with septic arthritis, usually monoarticular or pauciarticular. We report a rare case of polyarticular septic arthritis caused by S. moniliformis; the disease was initially misdiagnosed as inflammatory arthritis.

Background: The economic outcome research of approved tyrosine kinase inhibitors for treating the chronic phase of chronic myeloid leukemia in developing is scarce. The aim of this study was to assess the cost-effectiveness of dasatinib and nilotinib for newly diagnosed chronic myeloid leukemia patients. Methods: A decision tree model was developed linking clinical effectiveness (defined as major molecular response) and/or complete cytogenetic response, utility, and cost data over a 12-month period. Patients are recruited from Qatar Cancer Registry. The probability of primary clinical outcome is calculated from DASISION (dasatinib) and ENESTnd (nilotinib) trials. Direct healthcare costs were derived from the national healthcare payer system, whereas adverse effects data were derived from local incident reporting system. Results: In the first-line treatments of chronic myeloid leukemia patients, nilotinib has greater major molecular response (39% nilotinib vs 12% dasatinib) and complete cytogenetic response (24% nilotinib vs 16% dastinib) response outcomes, and more adverse effects than dasatinib (13.3% vs 4%). Moreover, nilotinib is more cost-effective with annual costs (USD63,589.59) and after 12 months of follow-up. Despite the lower acquisition annual cost of dasatinib (USD59,486.30), the incremental cost-effectiveness ratio of nilotinib (vs dasatinib) per major molecular response/complete cytogenetic response achieved was USD15,481.10 per year. There were no cases in both arms that progressed to accelerated or blast phase. At a threshold of 3 times gross domestic product per capita of Qatar and according to World Health Organization recommendation, the nilotinib use is still cost-effective. Conclusion: Upfront therapy of chronic myeloid leukemia–chronic phase patients by nilotinib plan appears to be more cost-effective than dasatinib.

Introduction: Anaplasmosis is a tick-borne illness caused by Anaplasma phagocytophilum. A review of CDC reports showed an increase in Anaplasmosis, with 1,193 cases reported in 2009 compared to 5,672 cases reported in 2017, with the majority of cases between May and October. Neurologic manifestations are uncommon. Case: A 72-year-old male presented in August with acute left-sided weakness. Patient was found to have an acute kidney injury (creatinine 5.3 mg/dL), thrombocytopenia (platelet count 25,000/mL), and rhabdomyolysis (CPK 25,000 units/L). Workup for an acute stroke was negative. Peripheral blood smears showed Anaplasma neutrophil inclusions in >30 % of the buffy coat prep. PCR testing was positive for Anaplasmosis. He was treated with doxycycline for 10 days, with improvement within 48 h. He was discharged home after a 13-day hospital course with no residual neurological deficits.A review of our medical system between January 1st, 2016 and December 31st, 2018 revealed 20 cases of Anaplasmosis. All cases presented between May and December and had fever of unclear etiology, but only our case presented with stroke-like symptoms. All cases involved people living in heavily wooded areas, with a mean age of 70 years. Discussion: The typical presentation of Anaplasmosis is a nonspecific febrile illness with leukopenia and thrombocytopenia. Although headache is common, stroke-like symptoms are a rare but known complication. Elderly and immunocompromised patients living in heavily wooded areas are at higher risk for Anaplasmosis. Delayed diagnosis was common (55 % of case review) and associated with worse prognosis.

Mycobacterium tuberculosis is the etiological agent of tuberculosis in humans. Tuberculosis is not only a highly contagious infectious disease, but also one of the top causes of death globally, especially in developing countries. Tuberculosis generally affects the lungs, and tuberculosis of the azygos lobe of the lung is extremely rare. This case report presents such a unique finding.

There has been less volume of literature focusing on the Immune-related Hematological Adverse Drug Events (Hem-irAEs) of Immune Checkpoint Inhibitors (ICPis) in cancer patients. Furthermore, there has been no consensus about the management of hematological toxicity from immunotherapy in the recently published practice guidelines by the European Society for Medical Oncology (ESMO). We conducted a systematic review of case reports/series to describe the diagnosis and management of potentially rare and unrecognized Hem-irAEs. We searched Medline, OVID, Web of Science for eligible articles. Data were extracted on patient characteristics, Hem-irAEs, and management strategies. We performed quality assessment using the Pierson-5 evaluation scheme and causality assessment using the Naranjo scale. Our search retrieved 49 articles that described 118 cases. The majority of patients had melanoma (57.6%) and lung cancer (26.3%). The most common Hem-irAEs reported with ICPis (such as nivolumab, ipilimumab, and pembrolizumab) were thrombocytopenia, hemolytic and aplastic anemias. Less reported adverse events included agranulocytosis and neutropenia. Steroids were commonly used to treat these adverse events with frequent success. Other used strategies included intravenous immunoglobulins (IVIG), rituximab, and transfusion of blood components. The findings of this review provide more insights into the diagnosis and management of the rarely reported Hem-irAEs of ICPis.