Momelotinib is an oral inhibitor of Janus kinase 1 and 2 (JAK1/JAK2) and of activin A receptor type 1 (ACVR1). Its key distinguishing feature is the suppression of hepcidin through ACVR1 inhibition, which mitigates the iron-restricted anemia observed in myelofibrosis (MF) due to the hyperinflammatory state. It is the first agent approved for intermediate- or high-risk MF with potential to treat anemia and reduce transfusion dependence.

We successfully performed a fetoscopic laser ablation (FLA) followed by amniopatch immediately after spontaneous preterm premature rupture of the membranes (PPROM) occurred in a 23-week monochorionic-diamniotic twin pregnancy complicated by Stage II twin-to-twin transfusion syndrome (TTTS). Since the severe polyhydramnios-anhydramnios sequence was still observed after spontaneous PPROM, we established an emergent multidisciplinary meeting and consulted the hospital Fetal Ethical Boards. After multidisciplinary consensus and ethical approval, the procedure was successfully performed on the same day without complications. On Postoperative Day 1, no more leakage of fluid was observed. The patient had an uncomplicated course during the entire pregnancy, with complete resolution of the TTTS and the PPROM. At 34 weeks' gestation, she delivered two healthy twins by cesarean section. The infants are now 4 years old with complete normal neurological development. In conclusion, we demonstrate that FLA with amniopatch is a feasible option in specific cases of TTTS with preoperative PPROM.

BackgroundIron deficiency anemia (IDA) is a prevalent nutritional deficiency linked to immune modulation and allergic conditions. This study investigates the association between IDA and allergic diseases, including atopic dermatitis, asthma, allergic rhinitis, food allergy, and allergic eosinophilia.ObjectiveTo evaluate the association between iron deficiency anemia (IDA) and the prevalence of allergic conditions, including atopic dermatitis, asthma, allergic rhinitis, food allergy, and allergic eosinophilia, using a large nationally representative dataset.MethodsA retrospective, cross-sectional design was employed using data from the National Inpatient Sample (2016-2020). Logistic regression models adjusted for confounders such as payer type, race, socioeconomic status, and hospital characteristics were used to assess associations.ResultsAmong 32,966,720 patients, 1,247,309 (3.8%) had IDA. After adjustment, IDA was significantly associated with increased odds of allergic conditions: atopic dermatitis (OR = 1.30), asthma (OR = 1.21), allergic rhinitis (OR = 1.21), food allergy (OR = 1.18), and allergic eosinophilia (OR = 1.24).ConclusionIDA was significantly associated with allergic conditions in this analysis, suggesting that iron status may represent a clinically relevant factor in patients with allergic diseases, as seen in this large national inpatient sample. Future longitudinal studies are needed to clarify causal pathways and develop targeted interventions. Addressing nutritional deficiencies may reduce the burden of allergic diseases and improve health outcomes.

Babesia caballi is a tick-borne protozoan parasite responsible for causing equine babesiosis, a disease with considerable variation in prevalence across different regions of the world. This report presented a confirmed case of B. caballi infection in a three-year-old mare originating from Gonbad-e Kavus, Iran, highlighting the clinical, laboratory and diagnostic aspects of the disease. The affected mare showed classical clinical signs including persistent fever, generalized weakness, tachycardia and pale mucous membranes, which are indicative of systemic infection and anemia. Laboratory evaluations revealed evidence of hepatic and renal compromise as well as hematological parameters consistent with active inflammatory processes. Microscopic examination of blood smears and molecular techniques such as PCR were employed to confirm the presence of B. caballi, while simultaneously excluding co-infections with other common equine pathogens including Theileria equi and Anaplasma phagocytophilum. This case underscored the critical need to combine conventional diagnostic approaches with molecular methods to achieve accurate detection, effective treatment and appropriate management strategies for equine babesiosis in endemic regions.

Iron deficiency anemia is a common nutritional and clinical condition that can arise from chronic blood loss, insufficient dietary intake, impaired absorption, or parasitic infection, especially in areas where such infections are endemic. In elderly male patients, a thorough evaluation is necessary to rule out gastrointestinal bleeding and malignancy. A 60-year-old male farmer experienced exertional dyspnea, generalized weakness, pallor, weight loss, and gradual changes in his nails. Physical examination revealed the characteristic spoon-shaped nails of koilonychia. Laboratory tests confirmed severe microcytic hypochromic anemia with significantly depleted iron stores, as indicated by a hemoglobin level of 4.2 g/dL, serum ferritin of 1.92 ng/mL, low serum iron, and elevated total iron-binding capacity. Upper gastrointestinal endoscopy, performed to investigate the severe iron deficiency anemia, revealed multiple live Ascaris lumbricoides worms in the duodenum, consistent with duodenal ascariasis. The patient was treated with albendazole, red cell concentrate transfusion based on his clinical condition, and oral iron supplementation. At the three-month follow-up, he demonstrated marked clinical, hematological, and biochemical improvement, including improvement of koilonychia. This case underscores that parasitic infestation can coexist with or contribute to severe iron deficiency anemia in endemic areas. Stool microscopy remains an important standard diagnostic test, whereas endoscopy should be viewed as part of a broader evaluation for unexplained severe anemia, not as a first-line test for ascariasis.

Kaposi sarcoma (KS) is an angioproliferative malignancy associated with human herpesvirus-8 (HHV-8) infection and is strongly linked to immunosuppression, particularly in the setting of human immunodeficiency virus (HIV). Although cutaneous involvement is the most common presentation, visceral disease-especially within the gastrointestinal (GI) tract-may occur and is frequently underrecognized due to its often asymptomatic or nonspecific clinical manifestations. We report the case of a 41-year-old male who presented with severe, unexplained anemia without overt GI bleeding. Endoscopic evaluation revealed multiple violaceous, polypoid lesions throughout the stomach, duodenum, and colon. Histopathological examination, supported by immunohistochemical staining positive for CD31, CD34, and HHV-8, confirmed the diagnosis of KS. Subsequent HIV testing was strongly reactive, with confirmatory HIV-1 RNA testing subsequently requested. This case highlights the diagnostic challenge posed by GI KS and underscores the importance of maintaining a high index of suspicion in patients presenting with unexplained anemia. Early recognition through comprehensive endoscopic and histopathological evaluation is critical, as it may reveal previously undiagnosed HIV infection and significantly influence clinical management and prognosis.

Autoimmune atrophic gastritis causes loss of oxyntic glands, reduced acid secretion, compensatory hypergastrinemia, and impaired iron and vitamin B12 absorption. A 46-year-old woman with minimal gastrointestinal symptoms had fasting serum gastrin > 1800 ng/L, an erythrocyte sedimentation rate of 109 mm/h, hemoglobin 8.2 g/dL, and microcytosis. Anti-parietal cell and intrinsic factor antibodies were positive. Endoscopy and Sydney-protocol biopsies showed oxyntic-restricted atrophy, preserved antral mucosa, and linear-to-micronodular enterochromaffin-like-cell hyperplasia; C-reactive protein was normal, and computed tomography showed no pancreatic or duodenal mass. After iron and vitamin B12 replacement, hemoglobin rose to 11.0 g/dL, and the erythrocyte sedimentation rate fell to 60 mm/h, whereas gastrin remained > 1800 ng/L at the measured 12-week follow-up. The findings support autoimmune atrophic gastritis as the explanation for the hypergastrinemia and an anemia-associated contribution to the raised erythrocyte sedimentation rate. This case reinforces the need to interpret severe hypergastrinemia in relation to gastric acid status and extreme erythrocyte sedimentation rate values in relation to hematological factors.

Diabetic nephropathy is the leading cause of end-stage renal disease worldwide, and ischemia-modified albumin (IMA) has been proposed as a biomarker of oxidative stress in type 2 diabetes mellitus (T2DM). The present hospital-based cross-sectional study evaluated serum IMA levels together with biochemical, haematological, urinary and comorbidity profiles in patients with T2DM with and without nephropathy. The primary outcome was the between-group difference in serum IMA; there was no healthy control group. A total of 50 patients were enrolled between November, 2021 and March, 2024, including 25 patients with T2DM without nephropathy (group A) and 25 patients with diabetic nephropathy (group B). Clinical and laboratory records were available for 19 patients in group A and 16 patients in group B; the others contributed IMA values only. In group B, chronic kidney disease (CKD) stage 5D was documented in 9 patients, CKD on maintenance haemodialysis in 1 patient, acute-on-chronic kidney disease in 1 patient, CKD of unspecified stage in 4 patients, and 10 patients had no clinical record. Serum IMA levels did not differ significantly between the groups [group A: Median, 0.332 absorbance units (ABSU); group B: Median, 0.317 ABSU; Mann-Whitney test; P=0.727; mean difference (group A vs. B), 0.054 ABSU, 95% confidence interval, -0.08 to 0.19]; thus, a clinically relevant difference cannot be excluded. The result was similar following adjustment for serum albumin and in sensitivity analyses (all P>0.5). Blood urea (P=0.0003) and serum creatinine (P<0.0001) levels were higher in group B; the serum potassium level was nominally higher (P=0.040), but within the normal range in both groups. Among the patients with records, anaemia (14/18, 78% vs. 10/15, 67%) and infection (12/18, 67% vs. 9/15, 60%) were more frequent in group A than in group B. Heavy proteinuria (+++/++++) was recorded only in group B (2/7 tested) and all adverse in-hospital outcomes occurred in group B; however, these comparisons rest on very small numbers. In the present small study without a healthy control group, serum IMA did not differ between patients with T2DM with and without nephropathy, and the findings are compatible with IMA reflecting systemic oxidative stress rather than nephropathy-specific injury. Larger prospective studies with standardized IMA assays, albumin adjustment and comprehensive biochemical profiling are required to clarify the clinical utility of IMA in diabetic kidney disease.

Background Vitamin B12 deficiency is a common but often underrecognized complication in patients with type 2 diabetes mellitus (T2DM) undergoing long-term metformin therapy. If undetected, it may lead to serious complications including neuropathy, cognitive decline and anemia. Objective To determine the prevalence and risk factors of vitamin B12 deficiency in type 2 diabetes mellitus (T2DM) patients on metformin at a tertiary care center in Nepal. Method An analytical cross-sectional study was conducted among 318 patients with type 2 diabetes mellitus (T2DM) receiving metformin therapy. Serum vitamin B12 levels and relevant clinical and demographic data were collected. Descriptive statistics summarized baseline characteristics, while univariate and bivariate analyses were done. Multivariable logistic regression was then performed to identify independent predictors of vitamin B12 deficiency. Statistical significance was set at p < 0.05, and all analyses were conducted using Stata version 14. Result Vitamin B12 deficiency was observed in 21.7% (69 out of 318 participants). Multivariable regression analysis identified age (AOR: 1.07; 95% CI: 1.04 to 1.08; p < 0.001), metformin dose (AOR: 1.002; 95% CI: 1.001 to 1.003; p < 0.001) and longer metformin use (AOR: 1.11; 95% CI: 1.03 to 1.19; p = 0.005) were significantly associated with higher odds of deficiency. No significant associations were found with sex, smoking, alcohol use, vegetarian diet, HbA1c, lipid profiles, neuropathy, retinopathy or serum creatinine (p > 0.05). Conclusion Vitamin B12 deficiency is prevalent among metformin-treated T2DM patients, with age, duration and dose of metformin as key risk factors. Regular monitoring and supplementation are crucial for this patient population.