Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 8 Articles
Background: When availability and/or affordability of anti-hemophilic factor concentrates are limited, optimal\nprophylaxis regimens in severe hemophilia A (HA) remain to be determined. In selected situations, low-dose\ndaily prophylaxis (LDDP) may be an effective and economical option. The goal of our study was to evaluate\nif subjects on a LDDP regimen could achieve adherence and good clinical outcome.\nMethods: Seventeen subjects (age between 15.2 and 28.4) on LDDP suffering from severe/moderate HA were\nfollowed prospectively for 2 to 3 years as part of a health-related quality of life (HRQoL) study. Bleeding and\ntreatments data were collected using electronic diaries and validated every three months. The SF-36 questionnaire\nwas administered at the beginning of the study and then every 6 months until the end of the study.\nResults: The subjects (mean age 22.0, median 21.9, standard deviation 4.06), were all from a single centre\nand on LDDP for at least 12 months as part of their routine care before entering the study. Fifteen subjects\nwere prescribed a daily dose of 500 IU factor VIII (FVIII) and 2 subjects received 1000 IU FVIII per day,\nresulting into a median dose of 7.1 IU/kg/day (ranging from 4 to 13 IU/kg/day) and of 2591 IU/kg/year.\nMedian adherence (the percentage of the prescribed daily dose received) was 84 % (mean 80 %, range 57 %\nto 94 %) throughout the study. Seventy-six bleeds in the 6 index joints and 51 other types of bleeds were\nobserved throughout the study. The median annualized bleeding rate in joints (ABRjoints) was 0.7 and the\nmedian annualized bleeding rate for all bleeds (ABRall) was 1.6. The Physical Component and Mental Component\nSummary scores of SF-36, and the Hemophilia Joint Health Score were not significantly different over the course of\nthe study (respective medians of 49.8, 52.4 and 16.0 at entry; vs. 52.5, 51.5 and 16.0 upon exit).\nConclusions: This prospective longitudinal study in youth and young adults shows that LDDP may be associated\nwith low ABRs, adequate adherence and HRQoL comparable to previously reported....
Background. Blood transfusion is a therapeutic procedure usually undertaken in patients with severe anaemia. In Ghana, severe\nanaemia ismostly due to malaria caused by severe Plasmodium falciparuminfection, road traffic accidents, and haemoglobinopathyinduced\nacute haemolysis. Method. This cross-sectional study evaluated coinheritance of sickle cell haemoglobin variant and G6PD\nenzymopathy among individuals that donated blood at the Holy Trinity Hospital, Berekum, in the Brong-Ahafo Region, Ghana.\nDemographic data and other pertinent information were captured using questionnaire. Sickle cell haemoglobin variants were\ndetermined using cellulose acetate electrophoresis (pH 8.6). Qualitative G6PD status and quantitative G6PD enzyme activity were\ndetermined using methaemoglobin reduction and Trinity Biotech G6PD test kit, respectively. Results. Prevalence of sickle cell trait\n(SCT) and G6PD enzymopathy coinheritance was 7%. In addition, 19.5% of the donors had 10%ââ?¬â??60% of normal G6PD enzyme\nactivity suggesting that these donor units are prone to stressor-induced acute haemolysis when given to recipients. Mild G6PD\nactivity (...
Background: The most common complication of coronary artery perforation, a rare complication of percutaneous\ncoronary intervention (PCI), is hemopericardium with cardiac tamponade. However, localized extra-coronary bleeding\ncan lead to epicardial hematoma, which is a rare phenomenon. We report the case of an unusual delayed presentation\nof post-PCI hematoma with unrecognized guidewire perforation.\nCase presentation: A 70-year-old man with idiopathic thrombocytopenic purpura (ITP) and a history of coronary\nartery bypass grafting (CABG) underwent PCI. A bare metal stent was implanted in left main coronary artery (LMCA)\nafter balloon dilation. The procedure was performed without any complications, and the patient was discharged 5 days\nlater. However, the patient was unexpectedly admitted by ambulance with cardiogenic shock and new-onset chest\npain the next day. Echocardiography did not show any wall motion abnormalities, but a large mass on the right\nventricle outflow tract was detected. Contrast-enhanced computed tomography showed a hematoma compressing\nthe main pulmonary artery trunk and the right ventricle. The patient developed sudden cardiopulmonary arrest and\ncardiopulmonary resuscitation was successful. The patient died during emergent surgical removal of the hematoma.\nLarge, dark red clots between the pulmonary artery trunk and aorta were observed. The suspected origin of the\nepicardial hematoma was blood oozing from the stent site in LMCA.\nConclusion: This is an unusual case with delayed development of localized hematoma following PCI in the absence of\nguidewire perforation. Furthermore, this case illustrated the potential of occasional critical complications in patients\nwith impaired blood clotting undergoing PCI....
Objectives: Over the past two decades, a large interest in cardiac marker elevations has developed\nin endurance sports events. The intense effort is not without risk. We aimed to see if the relatively\ncardiospecific biomarkers could show the damage on cardiac muscle cells. Methods: Fourteen\ncyclists were recruited for an international race (177 km). We studied different cardiac biomarkers,\nrenal function markers and blood cytology. The subjects were submitted to three blood test:\none before (T0), one just after (T1) and the last one 3 hours after the race (T3). Results: Blood cytology\nmarkers, namely erythrocytes, hemoglobin, hematocrit, and average hemoglobin concentration,\nwere found to evolve in a similar way. Renal function markers, such as creatinin, cystatin C\nand uric acid, showed a post effort increase that might be related to renal blood flow depletion\nduring exercise. Cardiac and muscular markers were all increased at T1. Conclusions: Physiological\nstress induced by an international cycling race certainly has consequences on cardiac muscle\ncells. Fortunately, those blood concentration variations are more representative of a transitional\nstate, due to an imbalance created by an intense aerobic effort maintained during several hours,\nrather than an irreversible injury....
Background: Bleeding events have been associated with the use of antiplatelet agents. This study estimated the\nincidence of bleeding events in patients previously hospitalized for a serious coronary event and determined the\nrisks of bleeding associated with the use of acetylsalicylic acid (ASA) and/or clopidogrel.\nMethods: A UK primary care database was used to identify 27,707 patients aged 50 to 84 years, hospitalized for a\nserious coronary event during 2000 to 2007 and who were alive 30 days later (start date). Patients were followed\nup until they reached an endpoint (hemorrhagic stroke, upper or lower gastrointestinal bleeding [UGIB/LGIB]),\ndeath or end of study [June 30, 2011]) or met an exclusion criterion. Risk factors for bleeding were determined in\na nested case-control analysis.\nResults: Incidences of hemorrhagic stroke, UGIB, and LGIB were 5.0, 11.9, and 25.5 events per 10,000 person-years,\nrespectively, and increased with age. UGIB and LGIB led to hospitalization in 73 and 23 % of patients, respectively.\nNon-users of ASA, who were mostly discontinuers, and current users of ASA had similar risks of hemorrhagic stroke,\nUGIB, and LGIB. Users of combined antithrombotic therapy (warfarin and antiplatelets) experienced an increased risk\nof hemorrhagic stroke (odds ratio [OR], 6.36; 95 % confidence interval [CI], 1.34ââ?¬â??30.16), whereas users of combined\nantiplatelet therapy (clopidogrel and ASA) experienced an increased risk of UGIB (OR, 2.42; 95 % CI, 1.09ââ?¬â??5.36). An\nincreased risk of LGIB (OR, 1.86; 95 % CI, 1.34ââ?¬â??2.57) was also observed in users of clopidogrel.\nConclusions: In patients previously hospitalized for a serious coronary event, combined antithrombotic therapy\nwas associated with an increased risk of hemorrhagic stroke, whereas combined antiplatelet therapy was associated\nwith an increased risk of UGIB.Non-use of ASA was rare in this population and use of ASA was not associated with\na significantly increased risk of hemorrhagic stroke, UGIB, or LGIB....
Background: Insulin-like growth factor binding protein-7 (IGFBP-7) modulates the biological activities of insulin-like\ngrowth factor-1 (IGF-1). Previous studies demonstrated the prognostic value of IGFBP-7 and IGF-1 among patients\nwith systolic heart failure (HF). This study aimed to evaluate the IGF1/IGFBP-7 axis in HF patients with preserved\nejection fraction (HFpEF).\nMethods: Serum IGF-1 and IGFBP-7 levels were measured in 300 eligible consecutive patients who underwent\ncomprehensive cardiac assessment. Patients were categorized into 3 groups including controls with normal\ndiastolic function (n = 55), asymptomatic left ventricular diastolic dysfunction (LVDD, n = 168) and HFpEF (n = 77).\nResults: IGFBP-7 serum levels showed a significant graded increase from controls to LVDD to HFpEF (median\n50.30 [43.1-55.3] vs. 54.40 [48.15-63.40] vs. 61.9 [51.6-69.7], respectively, P < 0.001), whereas IGF-1 levels showed\na graded decline from controls to LVDD to HFpEF (120.0 [100.8-144.0] vs. 112.3 [88.8-137.1] vs. 99.5 [72.2-124.4],\np < 0.001). The IGFBP-7/IGF-1 ratio increased from controls to LVDD to HFpEF (0.43 [0.33-0.56] vs. 0.48 [0.38-0.66] vs. 0.68\n[0.55-0.88], p < 0.001). Patents with IGFB-7/IGF1 ratios above the median demonstrated significantly higher left\natrial volume index, E/E� ratio, and NT-proBNP levels (all P � 0.02).\nConclusion: In conclusion, this hypothesis-generating pilot study suggests the IGFBP-7/IGF-1 axis correlates with\ndiastolic function and may serve as a novel biomarker in patients with HFpEF. A rise in IGFBP-7 or the IGFBP-7/IGF-1\nratio may reflect worsening diastolic function, adverse cardiac remodeling, and metabolic derangement....
The effect of blood pressure on pulse wave velocity (PWV) is well established. However, PWV variability with acute hemodynamic\nchanges has not been examined in the clinical setting. The aim of the present study is to investigate the effect of hemodynamic\nchanges on PWV in patients who undergo cardiothoracic surgery. Using data from 25 patients, we determined blood pressure\n(BP), heart rate (HR), and the left ventricular outflow tract (LVOT) velocity-time integral. By superimposing the radial arterial\nwaveform on the continuous wave Doppler waveform of the LVOT, obtained by transesophageal echo, we were able to determine\npulse transit time and to calculatePWV, stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). Increases\nin BP,HR, and SVR were associated with higher values forPWV. In contrast increases in SV were associated with decreases inPWV.\nChanges in CO were not significantly associated with PWV....
Background: Accurate diagnosis of acute coronary syndrome (ACS) in a timely fashion is challenging in the elderly\npopulation, especially elderly women, who usually exhibit atypical clinical symptoms. A multiple cardiac biomarker\n(MCB) based approach has been shown to improve diagnostic efficacy of ACS. However, data in various age groups\nand sex differences remain largely unexplored.\nMethods: Point-of-care testing (POCT) was performed on 290 patients (aged ââ?°Â¥18 years) who were admitted to the\nemergency department (ED) with symptoms of acute chest pain under suspicion of acute coronary syndrome (ACS).\nThe MCB approach in current work assessed four cardiac biomarkers: myoglobin, troponin I, creatine kinase-myocardial\nband isoenzyme fraction (CK-MB), and brain natriuretic peptide (BNP).\nResults: Overall, the MCB approach demonstrated considerably higher sensitivity for elderly patients than for younger\npatients in identifying ACS (80.0 % [64.1ââ?¬â??90.0] vs. 52.6 % [37.3ââ?¬â??67.5] for ââ?°Â¥65 years and <65 years groups), with younger\npopulation showed greater specificity (44.1 % [35.3ââ?¬â??53.4] vs. 84.9 % [76.9ââ?¬â??90.5] for ââ?°Â¥65 years and <65 years groups,\nrespectively). The highest sensitivity achieved for elderly women who reported chest pain was 87.5 % [95 % CI: 64ââ?¬â??96.5]).\nIn general, the sensitivity of this approach was higher for female patients than for male patients (80 % [58.4ââ?¬â??91.9] vs. 61 %\n[47.8ââ?¬â??73.0]).\nConclusions: The MCB approach can provide a quick and accurate clinical diagnosis in elderly and female patients, both\nof whom have traditionally proven to be challenging to diagnose from suspected acute coronary syndrome....
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