Myelofibrosis (MF) is a rare, clonal disorder of pluripotent hematopoietic stem and progenitor cells. It is characterized by abnormal proliferation of hematopoiesis, associated with pathologically increased fibrosis in the bone marrow, which is primarily caused by activation of the JAK2 signaling pathway. Myelofibrosis (MF) may occur de novo as primary myelofibrosis (PMF), or secondarily as a consequence of polycythemia vera (PV) or essential thrombocythemia (ET), termed post-PV-MF and post-ET-MF, respectively. The latter two are collectively referred to as secondary myelofibrosis. The most recent updates of the diagnostic criteria by the WHO and ICC were published in 2022. These revisions defined prefibrotic primary myelofibrosis (pre-PMF) as a distinct subentity alongside "classic" overtly fibrotic PMF and secondary myelofibrosis. A hallmark of pre-PMF is an initial isolated thrombocytosis, whereas in overt MF, anemia is frequently present already at diagnosis. Splenomegaly is also more commonly detected at diagnosis in overt fibrotic MF than in pre-PMF. The prognosis of MF is determined by patient age, the presence of constitutional symptoms, as well as hematologic and genetic parameters. Increasingly, cytogenetic and molecular genetic markers play a decisive role. The most common causes of death in MF include transformation to acute myeloid leukemia, infections, and cardiovascular complications. The only potentially curative treatment is allogeneic stem cell transplantation (alloSCT), which is generally indicated in transplant-eligible patients with unfavorable prognosis, that is, those classified as high- or very-high risk according to the MIPSS70+ v2.0. For symptomatic treatment of MF, a variety of therapeutic options are available. In recent years, oral therapy with the JAK1/2 inhibitor ruxolitinib has become the standard of care. Since 2021, the JAK2/FLT3 inhibitor fedratinib has also been approved in the EU (note: in Switzerland, fedratinib will no longer be available as of February 28, 2025, as Swissmedic did not extend its time-limited approval). Since 2024, the JAK1/2 and ACVR1/ALK2 inhibitor momelotinib has been approved for MF treatment in the EU (irrespective of risk category) and in Switzerland (restricted to intermediate- or high-risk disease) for patients with moderate or severe anemia and/or after prior treatment with ruxolitinib. Compared to the other two JAK inhibitors, momelotinib is particularly effective in patients with clinically symptomatic moderate to severe anemia. Results from studies investigating additional JAK inhibitors, combination therapies, and novel agents have also demonstrated significant efficacy and point toward future therapeutic developments, although these approaches are not yet available for routine clinical practice.

Anemia's high global prevalence and socio-economic burden necessitate early diagnosis, yet reliance on invasive blood testing creates significant barriers to diagnosis and treatment. To address this, we developed a deep learning model using the Detection Transformer framework for the rapid, non-invasive assessment of anemia severity in a real-world emergency department setting. Comparing a lip-focused model to a full-face approach, the former proved superior, achieving 85.0% accuracy. This significantly outperformed the full-face model (77.0%) and clinical judgments by both senior (59.3%) and junior (49.95%) physicians, with a rapid processing time of 127.50 ms. By integrating key medical knowledge to classify anemia into three severity levels, our model surpasses clinician performance, demonstrating its potential as a powerful, automated tool for clinical decision support.

Massive splenomegaly refers to a marked and clinically significant enlargement of the spleen beyond normal limits. Although uncommon, it is clinically significant because it may be associated with hematologic, infectious, infiltrative, malignant, or portal hypertensive disorders. Chronic hemolytic anemias are a recognized cause of marked splenic enlargement due to persistent erythrocyte destruction and reticuloendothelial hyperplasia. Ongoing hemolysis also increases bilirubin production, predisposing patients to pigment gallstone formation and biliary tract disease. We report the case of a 29-year-old male who presented with jaundice and imaging findings consistent with choledocholithiasis. His medical history was notable for chronic hemolytic anemia and recurrent episodes of jaundice. Magnetic resonance cholangiopancreatography confirmed common bile duct stones and marked splenomegaly. The patient underwent exploratory laparotomy with splenectomy and common bile duct exploration followed by choledochoduodenal anastomosis. Intraoperatively, a massively enlarged spleen and hepatomegaly were identified. Significant bleeding from the splenic pedicle required vascular control and a blood transfusion. The postoperative course was favorable, with progressive reduction in bilirubin levels and no evidence of further complications. Histopathological examination demonstrated a congestive spleen with extensive hemorrhagic areas. This case highlights the importance of a multidisciplinary approach in the evaluation and management of massive splenomegaly and illustrates that timely surgical treatment can achieve satisfactory outcomes in selected patients.

The global prevalence of iron (Fe) deficiency anemia (IDA) continues to pose major public health challenges, necessitating the development of effective fortification strategies. Dairy-based systems are promising vehicles for Fe fortification and delivery due to their widespread consumption and nutritional value, although their complex matrix presents significant challenges for maintaining Fe bioavailability and product quality. This review critically evaluates current knowledge on Fe fortification in dairy systems, integrating evidence on Fe forms, physicochemical interactions between Fe and the matrix, and their consequent effects on Fe bioavailability and physical functionality. Emerging fortification strategies are highlighted. Conventional Fe salts, including ferrous sulfate, ferrous fumarate, and ferric pyrophosphate, have varying degrees of solubility and absorption but are often associated with adverse sensory changes, lipid oxidation, and reduced product stability. Fe-ligand complexes, including protein-, carbohydrate-, and Maillard reaction product (MRP)-based systems, can impart improved stability to the fortified product and bioavailability by minimizing interactions with inhibitors of Fe absorption. The incorporation of Fe into dairy matrices influences product pH and structural and functional properties while also accelerating lipid oxidation and sensory deterioration when inorganic salts are used. Strategies such as Fe chelation, microencapsulation, and co-fortification with enhancers have shown potential to mitigate these limitations. In addition, the role of prebiotics, probiotics, and MRPs in modulating Fe absorption remains complex and context dependent. Despite promising advancements, gaps remain in understanding interactions between Fe, proteins, carbohydrates and MRP and their implications for Fe fortification of dairy systems. Future research should focus on developing integrated fortification approaches enabling the design of next-generation functional dairy foods to effectively combat global Fe deficiency.

Rucaparib (RUBRACA[Ⓡ]) is the first FDA-approved poly (ADP-ribose) polymerase (PARP) inhibitor for men with BRCA mutation-associated metastatic castration-resistant prostate cancer (mCRPC). Rucaparib's efficacy in patients with mCRPC associated with DNA damage repair (DDR) deficiency was demonstrated in the TRITON2 and TRITON3 trials. In TRITON2, rucaparib demonstrated meaningful antitumor activity in men with measurable BRCA-mutated disease, with objective responses observed across both germline and somatic mutations. In TRITON3, rucaparib improved radiographic progression-free survival (rPFS) over physician's choice of therapy (docetaxel or a second-generation androgen-receptor pathway inhibitor [ARPI]). Rucaparib is the only drug to have shown improved rPFS versus docetaxel in mCRPC. Rucaparib demonstrated a consistent and manageable safety profile similar to other PARP inhibitors, with the most common adverse events being fatigue/asthenia, musculoskeletal pain, nausea, and anemia/decreased hemoglobin. Men with mCRPC face prolonged and complex treatments, during which maintaining quality of life, minimizing toxicity, and preserving functional status are major priorities. For patients with BRCA mutations, rucaparib offers a targeted oral alternative to chemotherapy that can delay mCRPC progression while reducing many of the logistical, physical, and clinical burdens commonly associated with chemotherapy. Its oral administration and flexible dosing enable an individualized approach that reduces treatment interruptions and maximizes clinical benefits.

Patient blood management (PBM) is a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. Globally, PBM guidelines have been developed locally in several countries and societies based on the expertise and resources of each. In Lebanon, the presence of prevalent iron deficiency anemia and hemoglobinopathies, together with scarce resources and economic constraints, necessitate generating local PBM guidelines to improve outcomes, cost-effectiveness, and safety. The following guidelines were established based on the recommendations of a multidisciplinary taskforce committee of Lebanese experts from different medical specialties including hematology, obstetrics, gynecology, surgery, anesthesiology, critical care, and pediatrics. The recommendations provide key practice points for the optimization of red blood mass, minimization of blood loss, and optimization of tolerance to anemia in different settings, supported by evidence from international guidelines in the field of PBM.

Breastfeeding and complementary feeding are key public health practices for child development and attainment of optimal nutritional status, with additional beneficial effects on maternal health. In Madagascar, we conducted a secondary analysis of a cluster randomised clinical trial data (Pan-African Clinical Trial Register PACTR201905784271304) to assess the practice of delayed complementary feeding (DCF) at nine months postpartum (T3 visit) and continued breastfeeding (CB) at 24 months (T4). Factors associated with the prevalence of DCF were investigated using a generalized estimating equation (GEE) for binomial outcome with logarithmic link function to account for clustering, prevalence ratio (PR) with 95% confidence intervals (CIs) were estimated. A Cox proportional hazards model was used to assess factors associated with breastfeeding termination (BT). A total of 1863 women were evaluated at T3, 2332 at T4. At T3, 1848 (98.8%) were breastfeeding and 479 (25.7%) were delaying complementary feeding. At T4, 1269 (54.4%) were breastfeeding. Median time for BT was 21 months (range 2-25). Secondary education (PR = 0.67, CI 0.49-0.93) and anaemia (PR = 0.75, CI 0.65-0.88) were associated with lower prevalence of DCF at T3, being a farmer with a higher prevalence (PR = 3.45, CI 1.90-6.28). Older age was associated with longer CB (hazard ratio 0.68, CI 0.49-0.96 for 30-50 years). The association between being farmer mothers and DCF at nine months requires further investigations. Two main lines of public health actions are identified: health education, with intergenerational mentoring initiatives from older to younger women, and integrating maternal and child health programmes to improve both maternal anaemia and child development in a life-cycle approach.