Age as a factor in severe bacterial infection in transfusion-dependent patients with thalassemia major

Nutritional immunity: transition metals at the pathogen-host interface

Transition metals occupy an essential niche in biological systems. Their electrostatic properties stabilize substrates or reaction intermediates in the active sites of enzymes, and their heightened reactivity is harnessed for catalysis. However, this heightened activity also renders transition metals toxic at high concentrations. Bacteria, like all living organisms, must regulate their intracellular levels of these elements to satisfy their physiological needs while avoiding harm. It is therefore not surprising that the host capitalizes on both the essentiality and toxicity of transition metals to defend against bacterial invaders. This Review discusses established and emerging paradigms in nutrient metal homeostasis at the pathogen-host interface.

Survival, mortality, and complications in patients with beta-thalassemia major in northern Taiwan

BACKGROUND

Advances in treatment have improved the prognosis in beta-thalassemia major. We present the survival and complications pattern of those patients in northern Taiwan born after 1970.

PROCEDURE

One-hundred and sixty patients with beta-thalassemia major born after 1970 were collected. The Kaplan-Meier method and log-rank test were used to estimate and compare survival. Cox regression models were used to examine the associations of bone marrow transplantation (BMT), time of BMT procedure, and time of complications with survival.

RESULTS

Better survival was observed for patients born after 1980 (P = 0.0121). Heart disease, BMT-related deaths, and infections were the main causes of death. Among the living patients over age 15, hypogonadotropic hypogonadism, HCV infection, diabetes, heart failure, and arrhythmia were the common complications. No patients under age 15 had complications.

CONCLUSIONS

Survival for patients with beta-thalassemia major has improved significantly in Taiwan. More time is required to demonstrate whether these modalities added to the treatment of these patients will impact favorably on their outcome. Our success with BMT is improving and we are now in a position to offer this curative alternative.