Taher, Alì

AbstractThe intricate interplay of anemia and iron overload under the pathophysiological umbrella of ineffective erythropoiesis in non-transfusion-dependent β-thalassemia (NTDT) results in a complex variety of clinical phenotypes that are challenging to diagnose and manage. In this article, we use a clinical framework rooted in pathophysiology to present 4 common scenarios of patients with NTDT. Starting from practical considerations in the diagnosis of NTDT, we delineate our strategy for the longitudinal care of patients who exhibit different constellations of symptoms and complications. We highlight the use of transfusion therapy and novel agents, such as luspatercept, in the patient with anemia-related complications. We also describe our approach to chelation therapy in the patient with iron overload. Although tackling every specific complication of NTDT is beyond the scope of this article, we touch on the management of the various morbidities and multisystem manifestations of the disease.

Key points Psycho‐oncology, a multidisciplinary field that addresses the patients' and their caregivers' physical, psychological, social, and behavioral well‐being, is extensively integrated in cancer care in high‐income countries Psycho‐oncology services remain underdeveloped, fragmented, and poorly implemented in low‐ and middle‐income countries, particularly those in the Arab Middle East and North Africa region To upgrade these services, accommodation to both (i) the unique needs of Arab low‐ and middle‐income countries and (ii) the best practices of psycho‐oncology is crucial There is scarcity of research on the barriers and challenges faced during building or expanding psycho‐oncology services in the Arab low‐ and middle‐income countries We summarize a priori challenges that may be encountered in psychosocial capacity building in similar Arab low‐ and middle‐income countries using Lebanon as a pilot program

Inflammatory bowel diseases (IBD) are systemic conditions characterized by multiple intestinal and extra-intestinal manifestations related to the associated chronic inflammatory state. Among their diverse extra-intestinal complications, venous thromboembolism (VTE) remains one of the most under recognized causes of morbidity and mortality in these patients, highlighting the need for a better understanding of the underlying mechanism of hypercoagulability, in addition to the role of acquired and inherited risk factors that further increase the risk of thrombosis with its impact on patients’ outcomes. We hereby present a review of the data regarding thrombosis in the setting of IBD, elucidating the possible role for screening in this high-risk category of patients and specifically in areas where inherited thrombophilia is expected to be highly prevalent, reporting two patients with IBD, one who developed a cerebrovascular event and another one who had recurrent VTE events; nevertheless, both of them had inherited thrombophilic mutations. The identification of specific genetic abnormalities in those patients reintroduces the controversy related to the need to screen a specific category of patients with IBD for hereditary thrombophilia, especially in regions characterized by a higher prevalence of such thrombophilic alterations.