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OBJECTIVE: Many patients with transfusional iron overload are at risk for progressive organ dysfunction and early death and poor compliance with older chelation therapies is believed to be a major contributing factor. Phase II/III studies have shown that oral deferasirox 20-30 mg/kg/d reduces iron burden, depending on transfusional iron intake.

METHODS: The prospective, open-label, 1-yr ESCALATOR study in the Middle East was designed to evaluate once-daily deferasirox in patients > or =2 yr with beta-thalassaemia major and iron overload who were previously chelated with deferoxamine and/or deferiprone. Most patients began treatment with deferasirox 20 mg/kg/d; doses were adjusted in response to markers of over- or under-chelation. The primary endpoint was treatment success, defined as a reduction in liver iron concentration (LIC) of > or =3 mg Fe/g dry weight (dw) if baseline LIC was > or =10 mg Fe/g dw, or final LIC of 1-7 mg Fe/g dw for patients with baseline LIC of 2 to <10 mg Fe/g dw.

RESULTS: Overall, 233/237 enrolled patients completed 1 yr's treatment. Mean baseline LIC was 18.0 +/- 9.1 mg Fe/g dw, while median serum ferritin was 3356 ng/mL. After 1 yr's deferasirox treatment, the intent-to-treat population experienced a significant treatment success rate of 57.0% (P = 0.016) and a mean reduction in LIC of 3.4 mg Fe/g dw. Changes in serum ferritin appeared to parallel dose increases at around 24 wk. Most patients (78.1%) underwent dose increases above 20 mg/kg/d, primarily to 30 mg/kg/d. Drug-related adverse events were mostly mild to moderate and resolved without discontinuing treatment.

CONCLUSIONS: The results of the ESCALATOR study in primarily heavily iron-overloaded patients confirm previous observations in patients with beta-thalassaemia, highlighting the importance of timely deferasirox dose adjustments based on serum ferritin levels and transfusional iron intake to ensure patients achieve their therapeutic goal of maintenance or reduction in iron burden.

BACKGROUND: Practicing different forms of exercises during pregnancy could have beneficial effects on maternal outcomes during labor. OBJECTIVE: To evaluate the effect of antenatal exercise on the duration of the delivery. SEARCH STRATEGY: Electronic databases including Web of Science, SCOPUS, The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed were searched using the relevant keywords during August 2019. SELECTION CRITERIA: Randomized controlled trials (RCTs) that compared any type of antenatal exercise versus no exercise in women who had vaginal delivery. DATA COLLECTION AND ANALYSIS: Data were extracted from eligible studies and pooled in a meta-analysis model. Mean Difference (MD) was used in continuous outcomes, while Risk Ratio (RR) was used to deal with dichotomous outcomes. The main outcome was the duration of the first and second stages of labor while the secondary outcomes included the rate of perineal lacerations and analgesia request by women. RESULTS: Exercise significantly reduced the duration of second stage of labor (SMD= -0.82, 95 % CI [-1.48, -0.16], p = 0.01). No significant difference was noticed regarding the duration of the first stage of labor, perineal lacerations and request for analgesia. CONCLUSION: Antenatal exercise could reduce the duration of the second stage of labor with racial differences.

Growth, yield, and chemical composition responses of two faba bean cultivars due to foliar application of 28-homobrassinolide (HBR) and 24-epibrassinolide (EBR) were studied in two field experiments conducted at the Experimental Farm of Faculty of Agriculture, Cairo University at Giza, Egypt, during 2003/2004 and 2004/2005. The application of 0.10 mg l−1 EBR improved the growth characters and yield of the two cultivars over the control. Treatment with 0.05 mg l−1 EBR and 0.50 mg l−1 HBR stimulated plant growth and productivity but less effectively than treatment with 0.10 mg l−1 EBR. This increment was more pronounced in Sakha 1 cultivar as compared with Giza 40 cultivar. Application of 0.10 mg l−1 EBR gave, along with a 28% rise in productivity of Sakha 1 cultivar and 21.8% rise in productivity of Giza 40 cultivar, a better quality of yield with regard to an enhancement in the concentration of N, P, K, Fe, Zn, Mn, Cu, protein, and total carbohydrates. These considerable effects of EBR and HBR on plant development and yield promotion, together with the environmentally safe aspects of these compounds, would mark a major development in the field of plant growth regulators, and would minimize the risks associated with agrochemicals by reducing environmental contamination.