Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 5 Articles
Background: Heterotaxy is a relatively uncommon congenital anomaly that is usually diagnosed incidentally on\nimaging studies in adults. We present an unusual case of venous thromboembolism in a 26 year old pregnant\nfemale with Heterotaxy syndrome.\nCase presentation: A 26 year-old pregnant female at 13 weeks gestation suffered cardiac arrest with successful\ncardiac resuscitation and return of spontaneous circulation. The cardiac arrest was secondary to massive pulmonary\nembolism requiring thrombolytic therapy and stabilization of hemodynamics. She had extensive evaluation to\ndetermine the etiology for the pulmonary embolism and was noted to have an anatomic variation consistent\nwith heterotaxy syndrome on imaging studies. After thrombolysis the patient was treated with UFH and then\nswitched to enoxaparin without complication until 25 weeks of gestation when she experienced worsening\nabdominal pain with associated headaches, lightheadedness and elevated blood pressures needing elective induction of\nlabor. The infant died shortly after delivery. The anticoagulation was continued for additional 3 months and she\nwas subsequently placed on low dose aspirin to prevent recurrent venous thromboembolic episodes. She is currently\nstable on low dose aspirin and is into her third year after the venous thromboembolism without any recurrence.\nConclusion: To our knowledge, this is the first reported case of venous thromboembolism in pregnancy associated with\nheterotaxy syndrome. A discussion on pathophysiology of venous thromboembolism in pregnancy and heterotaxy\nsyndrome has been undertaken along with treatment approach in such situations...
Assessment of thromboembolic risk is crucial\nfor proper management of atrial fibrillation (AF) patients.\nCurrently used risk score base only on scarce clinical data\nand do not take into consideration parameters including\nechocardiographic findings. The aim of this study was to\nevaluate if left atrium (LA) enlargement is associated with\nhigher thromboembolic risk assessed by CHADS2 and\nCHA2DS2-VASc scores in a cohort of unselected nonvalvular\nAF patients. Data from 582 AF hospitalizations\noccurring between November 2012 and January 2014 were\nanalyzed. All patients underwent a standard transthoracic\nechocardiography and had their thromboembolic risk\nassessed in both CHADS2 and CHA2DS2-VASc scores.\nIn 494 enrolled patients (48.5 % male; mean age\n73.4 �± 11.5 years) AF was classified as paroxysmal in 233\n(47.3 %), as persistent in 109 (22.1 %), and as permanent\nin 151 (30.6 %) patients. LA was enlarged in 426 (86.2 %)\npatients. Enlargement was classified as mild in 99 (20.0 %)\npatients, as moderate in 130 (26.3 %) patients, and as\nsevere in 196 (39.7 %) patients. Patients with enlarged LA\nhad higher mean CHADS2 score (2.0 �± 1.5 vs. 2.6 �± 1.3;\np = 0.0005) and CHA2DS2-VASc (3.8 �± 2.0 vs.\n4.4 �± 1.8; p = 0.02) score than patients with normal LA.\nThe both mean scores rose along with rising LA diameter.\nLA enlargement is highly prevalent in AF patients. Higher\nthromboembolic risk assessed by both CHADS2 and\nCHA2DS2-VASc scores is associated with presence of LA\nenlargement. Echocardiographically assessed LA size may\nbe an additional parameter useful in thromboembolic risk\nstratification of AF patients....
Background: Ethiopia is one of the most seriously HIV affected countries in Sub-Saharan Africa. Anemia is a known\npredictor of disease progression and death among HIV infected patients. In this study, we investigated the magnitude\nand correlates of anemia among HIV infected patients receiving HAART at a referral hospital in Ethiopia.\nMethods: A retrospective cohort study was conducted from November 2011 to February 2012 in Zewditu Memorial\nHospital, Addis Ababa, Ethiopia. Records of 1061 patients on HAART were selected using simple random sampling\ntechnique. Socio-demographic and clinical characteristics of the study patients were collected using standardized data\nextraction instrument. Data were analyzed using STATA version 11.0. Odds ratios with 95% confidence intervals were\nused to quantify the strength of association between anemia and its potential predictors.\nResults: The prevalence of anemia at baseline was 42.9%. However, the prevalence significantly decreased to 20.9% at\n6 months (p < 0.001) and to 14.3% at 12 months (p = 0.001) after HAART initiation. At baseline, male sex (AOR = 1.55;\n95% CI: 1.18-2.03), clinical stage III/IV (AOR = 2.03; 95% CI: 1.45-2.83) and TB co-infection (AOR = 1.52; 95% CI: 1.08-2.13)\nwere independently associated with the odds of being anemic. After 6 months of HAART, male sex (AOR = 1.59; 95% CI:\n1.13-2.23), baseline anemia (AOR = 2.38; 95% CI: 1.71-3.33) and TDF-based HAART (AOR = 2.87; 95% CI: 1.80-4.60) were\nindependently associated with the odds of being anemic. Besides, anemia was independently associated with older\nage at 6 months. After 12 months of HAART, baseline anemia (AOR = 2.01; 95% CI: 1.36-2.97), age group 25ââ?¬â??34 years\n(AOR = 5.92; 95% CI: 1.39-25.15), age group 45ââ?¬â??54 years (AOR = 4.78; 95% CI: 1.07-21.36), CD4 count below 200 cells/mm3\n(AOR = 2.15; 95% CI: 1.21-3.82) and 200ââ?¬â??350 cells/mm3 (AOR = 1.91; 95% CI: 1.13-3.25) were independently associated\nwith the odds of being anemic.\nConclusions: Although a remarkable reduction in the prevalence of anemia was observed following initiation of HAART,\na significant proportion of HIV patients remained anemic after 12 months of HAART suggesting the need for routine\nscreening and proper treatment of anemia to mitigate its adverse effects....
Echogenic liposomes (ELIP), that can encapsulate\nboth recombinant tissue-type plasminogen activator\n(rt-PA) and microbubbles, are under development to improve\nthe treatment of thrombo-occlusive disease. However,\nthe enzymatic activity, thrombolytic efficacy, and\nstable cavitation activity generated by this agent has yet to\nbe evaluated and compared to another established ultrasound-\nenhanced thrombolytic scheme. A spectrophotometric\nmethod was used to compare the enzymatic activity\nof the rt-PA incorporated into ELIP (t-ELIP) to that of rt-\nPA. An in vitro flow model was employed to measure the\nthrombolytic efficacy and dose of ultraharmonic emissions\nfrom stable cavitation for 120-kHz ultrasound exposure of\nthree treatment schemes: rt-PA, rt-PA and the perfluorocarbon-\nfilled microbubble Definity, and t-ELIP. The enzymatic\nactivity of rt-PA incorporated into t-ELIP was\n28 % that of rt-PA. Thrombolytic efficacy of t-ELIP or rt-\nPA and Definity was equivalent when the dose of t-ELIP\nwas adjusted to produce comparable enzymatic activity.\nSustained bubble activity was nucleated from Definity but\nnot from t-ELIP exposed to 120-kHz ultrasound. These\nresults emphasize the advantages of encapsulating a\nthrombolytic and the importance of incorporating an\ninsoluble gas required to promote sustained, stable\ncavitation activity....
Background: Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after\nhematopoietic stem cell transplantation (HSCT). We investigated the efficacy and safety of high-dose Valacyclovir as\npre-emptive therapy in patients with CMV antigenemia after HSCT.\nMethods: In a retrospective single center study of 61 patients, we compared the rates of viral clearance, recurrent\nantigenemia and adverse events in patients with pp65 CMV antigenemia who received high dose Valacyclovir\n(n = 15), Valganciclovir (n = 16), and Foscarnet (n = 30).\nResults: Overall, 60/61 (98 %) of cases achieved CMV antigenemia clearance by day 28, and no patient developed\nCMV disease. After adjusting for age, sex, diagnosis, CMV serological status, donor type, CMV antigen level,\ngraft-versus-host disease (GVHD) therapy, and conditioning regimen, there were no significant differences in the\nrates of viral clearance at day 14 in patients who received Valganciclovir (0.18, 95 % confidence interval (CI) 0.01 to\n2.15, p = 0.17) and Foscarnet (OR 0.22, 95 % CI 0.03 to 2.40, p = 0.22), compared with Valacyclovir (assigned\nOR = 1.00). Recurrent antigenemia by day 180 after clearance of the initial CMV episode occurred in 34/61 (56 %) of\npatients. Using the multivariate model adjusting for the same covariates, there were also no significant differences\nin secondary episodes of CMV between treatment groups. With regards to adverse effect monitoring, Foscarnet led\nto significantly increased creatinine levels (P = 0.009), while Valganciclovir led to significant decrease in neutrophil\ncounts (P = 0.012).\nConclusion: High dose Valacyclovir is a potential alternative to Valganciclovir and Foscarnet in the stable post-HSCT\npatient who has cytopenia and is not keen for inpatient treatment of CMV antigenemia....
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