Elham Ashrafi

Background: Toxicity‐related treatment cessation (TTC) limits optimal outcomes in newly diagnosed multiple myeloma (NDMM), but its determinants and prognostic relevance remain unclear. Methods: A total of 3095 NDMM patients were enrolled between 2018 and 2024 in the Asia–Pacific and Australia–New Zealand Myeloma and Related Diseases Registries. Baseline features, treatments, and outcomes were analyzed to identify predictors of TTC and assess its association with progression‐free survival (PFS) and overall survival (OS). Results: TTC occurred in 9% of patients. Advanced age and renal function were independent predictors in multivariable logistic regression, whereas comorbidity burden was not significant after adjustment. Proteasome inhibitor exposure was associated with lower odds of TTC, while immunomodulatory drug use was not independently associated. Patients with TTC had inferior unadjusted survival (median PFS 22.1 vs. 34.4 months; median OS 53.8 vs. 70.8 months; both p < 0.001). In adjusted analyses, TTC was not associated with PFS or OS; however, in age‐stratified analyses, TTC remained associated with shorter PFS in patients aged < 70 years (adjusted HR 1.44, p = 0.03), with no significant association observed in patients ≥ 70 years. Conclusion: TTC may reflect physiologic vulnerability and retains prognostic relevance in younger patients. It may serve as a practical marker to complement frailty assessment in NDMM.

Background: Immunosuppressive therapy (IST) is standard first‐line treatment for severe aplastic anaemia (AA) in patients ineligible for allogeneic transplantation. Thrombopoietin receptor agonists (TPO‐RAs) are increasingly added to IST to improve haematologic recovery, but long‐term safety remains uncertain. Methods: We conducted a PRISMA‐guided systematic review and meta‐analysis. MEDLINE, EMBASE and CENTRAL were searched from inception to April 2025. Randomised controlled trials and observational studies comparing TPO‐RA plus IST with IST alone were analysed separately using random‐effects models. The primary outcome was overall haematologic response at 6 months; secondary outcomes included response at 3 and 12 months, complete response, survival, relapse and clonal evolution. Results: Twenty studies (2 randomised and 18 observational) were included. In randomised trials, TPO‐RA plus IST showed a non‐significant trend towards higher overall response at 6 months (OR 2.01; 95% CI 0.76–5.28), while complete response was significantly higher at 3 and 6 months. Observational studies consistently demonstrated higher overall and complete response rates. No significant differences were observed in survival, relapse or clonal evolution. Conclusion: Limited randomised evidence does not demonstrate statistically significant benefit across all outcomes, while observational data suggest potential haematologic advantages. Further high‐quality trials are required to clarify the effectiveness and long‐term safety of adding a TPO‐RA to IST in AA. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission

Purpose: To estimate the prevalence, burden of refractive errors and their associated trend from 1990 to 2018 and geographic inequalities in Iran. Methods: Data regarding the epidemiology of refractive errors was extracted from three different sources: systematic review of published literature, data from visual school screening programs, and data from Iran’s national health survey (NHS). The pool of all available data on refractive errors as well as demographic, location, and socioeconomic status covariates were fitted in spatio-temporal and Gaussian process regression models to predict the prevalence of refractive errors from the years 1990 to 2018 in 31 provinces grouped by age and sex in order to calculate years lived with disability (YLDs). Results: In 2018, the age-adjusted prevalence of refractive errors was 16.32% (95% uncertainty interval [UI]: 12.44–21.48%) in both sexes, 17.98% (95% UI: 13.74– 23.61%) in women, and 14.66% (95% UI: 11.14–19.36%) in men. The prevalence of refractive errors reveals that it increases with age. Refractive errors contributed to 441.41 and 348.38 YLDs in men and women, respectively. The age-standardized prevalence growth was 31.30% in females and 24.32% in males from the years 1990 to 2018. Significant geographical heterogeneity was observed. The age-standardized YLDs rates of refractive errors represent an increasing trend of 28.9% increase from 1990 to 2018. Conclusion: Over 28 years, the prevalence of refractive errors increased significantly. Women tend to have higher rates of prevalence. The prevalence increased in older ages. Border provinces had the lowest prevalence. Age-standardized YLDs rates of refractive errors increased by about 30%.

Posterior corneal astigmatism has an important role in diagnosis and treatment of astigmatism, but it is usually overlooked.This cross-sectional study aimed to investigate the distribution of poste...

Purpose: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. Methods: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. Results: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). Conclusion: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.