Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation / 器官移植

Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.

Analysis of APTT Mixing Test Results in Factor Ⅷ Inhibitor-Positive Hemophilia Patients / 中国实验血液学杂志

OBJECTIVE@#To analyze the results of activated partial thromboplastin time (APTT) mixing test in coagulation factor Ⅷ inhibitor-positive hemophilia patients, so as to increase the value of APTT mixing test in the screen of factor Ⅷ inhibitor.@*METHODS@#Eighty plasmas samples with different titers of coagulation factor Ⅷ inhibitors had been collected and diluted for routine immediate APTT mixing test and at 37 ℃ 2 hours incubation APTT mixing test. Fifteen samples were selected for immediate and normal temperature incubation for 15 min, 30min, 1 hour, 2 hours and 37 ℃ for 30 min, 1 hour, 2 hours APTT mixing test.@*RESULTS@#The results of APTT mixing test were significantly correlated with the titers of coagulation factor Ⅷ inhibitors. The ROC curve result showed that the best diagnostic cut-off value for 2 hours incubation APTT mixing test at 37 ℃ to determine the presence or absence of coagulation factor Ⅷ inhibitors was 43.8 s (sensitivity and specificity was 85.90% and 100%, respectively), while the best diagnostic cut-off value for distinguishing high-titer and low-titer Ⅷ inhibitors was 52.4 s (sensitivity and specificity was 98.18% and 95.65%, respectively). The critical coagulation factor Ⅷ inhibitor titer that could not be corrected by immediate APTT was 5.14 BU/ml, while that could not be corrected by 37 ℃ 2 hours incubation APTT was 1.31 BU/ml. Paired samples t -test was performed on the APTT mixing test results at different times and temperatures, and the differences were statistically significant (P < 0.05).@*CONCLUSIONS@#The APTT mixing test can be used as a screening index for coagulation factor Ⅷ inhibitors. APTT mixing test result shows a significant time-temperature dependence with lower titers of coagulation factor Ⅷ inhibitor. Patients with hemophilia who cannot be corrected by immediate APTT mixing test should be alert to the possibility of high titer of coagulation factor Ⅷ.

Prognostic value of AST/ALT ratio combined with APTT regimen in NVAF patients receiving rivaroxaban anticoagulant therapy / 国际生物医学工程杂志

Objective:To investigate the prognostic value of the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) combined with activated partial thromboplastin time (APTT) in elderly patients with non-valvular atrial fibrillation (NVAF) treated with rivaroxaban.Methods:One hundred and twenty-two elderly patients with NVAF who were anticoagulated with rivaroxaban from June 2020 to June 2021 in the Third Central Hospital of Tianjin were enrolled and divided into four groups based on the median method. The patients in the Q1 group ( n = 32) have low AST/ALT/low APTT. The patients in the Q2 group ( n = 27) have low AST/ALT/high APTT. The patients in the Q3 group ( n = 29) have high AST/ALT/low APTT. The patients in the Q4 group ( n = 34) have high AST/ALT/high APTT. The efficacy endpoint events, and safety endpoint events were analyzed in the four groups, and univariate and multivariate Cox regression analyses were performed for the composite endpoint events. Results:The effectiveness endpoint events were mainly cardiovascular deaths, the number of which in the Q1 to Q4 groups was 0 (0), 1 (3.70%), 4 (13.79%), and 5 (14.71%), respectively. The safety endpoint events were mainly non-major bleeding events, the number of which in the Q1 to Q4 groups was 5 (15.62%), 2 (7.41%), 6 (20.69%), and 5 (14.71%), respectively. Compared to the Q1 group, the Q4 group had an increased risk of composite endpoint events after incorporating traditional risk factor correction ( HR: 3.851, 95% CI: 1.167 to 12.704). Conclusions:AST/ALT ratio combined with APTT can provide risk stratification for distant bleeding and cardiovascular adverse events in elderly NVAF patients treated with rivaroxaban anticoagulation and has some predictive value for their prognosis.

A study of coagulation profile in preeclampsia compared to normal pregnancy

Background: Preeclampsia is a condition of unknown etiology of multiorgan disease and is distinguished by a raised blood pressure (B.P. >140/90 mmHg) and proteinuria (>300 mg per 24 h) and/or edema following 20 weeks of pregnancy. Aims and Objectives: The study was conducted to differentiate coagulation variables between normotensives and preeclamptic patients. Materials and Methods: Prior consent was obtained from Institutional Ethics Committee. Patients diagnosed with preeclampsia aged between 20 and 35 years were incorporated into the study. Patients with a previous history of hypertension, thyroid disease, and diabetes were excluded from the study. Age-matched controls were taken and analyzed. Data collection done by (i) BP measured in supine posture; (ii) bleeding time (B.T) estimation – by Duke’s method; (iii) clotting time (C.T) estimation – by Wright’s capillary tube method; (iv) platelet count (P.C) estimation – by automated hematology analyzer; and (v) prothrombin time (P.T) and activated partial thromboplastin time (APTT) – estimation by semi-automated analyzer. Results: The study revealed a significant interrelation between P.C and B.T when preeclampsia patients were correlated with normotensives patients while P.T, APTT, and C.T were insignificant statistically. Conclusion: A statistically significant change was observed proposing parameters derangement as the disease becomes more progressive.

Hemofilia adquirida A en embarazo. Caso clínico de medicina crítica en obstetricia por morbilidad extrema y su abordaje transdisciplinario perioperatorio / Acquired hemophilia A in pregnancy. Clinical case of critical medicine in obstetrics due to extreme morbidity and its perioperative transdisciplinary approach

Resumen: La identificación de múltiples factores de riesgo que predisponen a la hemorragia durante el evento obstétrico, como la hemofilia adquirida que es un trastorno que se desarrolla por la generación de autoanticuerpos inhibidores de factores de la coagulación, la interpretación objetiva de las pruebas de laboratorio rutinarias, el desarrollo de un pensamiento sistematizado en la integración diagnóstico-terapéutica por parte del personal de salud, y la disposición de los recursos farmacológicos hospitalarios, es lo que determina frecuentemente el pronóstico en pacientes obstétricas con morbilidad extrema que requieren atención multidisciplinaria en las diferentes unidades hospitalarias del sector salud de nuestro país. El objetivo es presentar un caso clínico de morbilidad extrema por hemofilia adquirida, su presentación clínica, evolución y desenlace fatal. Se presenta un caso referido de otra unidad del Sector Salud ISEM (Instituto de Salud del Estado de México), atendido en la Unidad de Cuidados Intensivos Obstétricos del Hospital «Mónica Pretelini Sáenz¼, resaltando la importancia en la integración diagnóstico-terapéutica y la interacción multifactorial de variables relacionadas con su desenlace fatal. Conclusiones: Desconocimiento de la patología, retraso en el diagnóstico, múltiples procedimientos condicionantes de hemorragia iatrógena y la limitación en recursos terapéuticos son factores que contribuyen a un desenlace fatal.

Abstract: The identification of multiple risk factors that predispose to bleeding during the obstetric event, such as acquired hemophilia, which is a disorder that develops due to the generation of autoantibodies that inhibit coagulation factors, the objective interpretation of routine laboratory tests , the development of systematized thinking in diagnostic-therapeutic integration by health personnel, and the provision of hospital pharmacological resources, is what frequently determines the prognosis in obstetric patients with extreme morbidity who require multidisciplinary care in the different hospital units of the health sector of our country. The objective is to present a clinical case of extreme morbidity due to acquired hemophilia, its clinical presentation, evolution and fatal outcome. A case referred from another unit of the ISEM (Instituto de Salud del Estado de México) Health Sector, treated at the Obstetric Intensive Care Unit of the «Mónica Pretelini Sáenz¼ Hospital, is presented, highlighting the importance of diagnostic-therapeutic integration, and the multifactorial interaction of variables related to its fatal outcome. Conclusions: Ignorance of the pathology, delay in diagnosis, multiple conditioning procedures of iatrogenic hemorrhage and the limitation in therapeutic resources are factors that contribute to a fatal outcome.

Manifestaciones clínicas de la deficiencia de factor XII en un lactante

RESUMEN Introducción: El factor XII o factor de Hageman pertenece al sistema de contacto al ser iniciador de la vía intrínseca de la coagulación. Concentraciones bajas de este factor se asocian a tiempo de tromboplastina parcial activado prolongado, sin embargo, no se producen manifestaciones hemorrágicas como ocurre en la deficiencia de otros factores. Objetivo: Describir las manifestaciones clínicas de un lactante con diagnóstico de deficiencia de factor XII de la coagulación. Presentación del caso: Se presenta un lactante de 10 meses que tuvo aparición espontánea de equimosis y se diagnosticó un déficit de factor XII. Conclusiones: Aunque no es común, la deficiencia del factor XII puede estar asociada a manifestaciones hemorrágicas como equimosis tal como se describe en el presente caso.

ABSTRACT Introduction: Factor XII or Hageman factor belongs to the contact system as it is the initiator of the intrinsic coagulation pathway. Low concentrations of this factor are associated with prolonged activated partial thromboplastin time, however, hemorrhagic manifestations do not occur as occurs in the deficiency of other factors. Objective: Describe the clinical manifestations of an infant diagnosed with coagulation factor XII deficiency. Case presentation: A 10-month-old infant who had spontaneous onset of ecchymosis and a factor XII deficiency was diagnosed. Conclusions: Although not common, factor XII deficiency may be associated with hemorrhagic manifestations such as ecchymosis, as described in the present case.

In vitroMeasurement of Anticoagulant Effect of Acacia Nilotica Aqueous Extract on Normal Human Plasma

Aims:To determine the anticoagulant effect of Acacia Nilotica aqueous extract on normal human plasma.Study Design:This is an experimental study.Place and Duration of the Study:Department of Haematology, Faculty of Medical Laboratory sciences, Alzaiem Alazhari, Khartoum –Sudan, during the period from July –August 2021. Methodology:A total of 20 human blood samples were collected for this study from apparently healthy subjects following ethical considerations. Samples were collected in tri-sodium citrate and platelets poor plasma (PPP) were immediately prepared by centrifugation. Aqueous solution of Acacia nilotica was prepared with distilled water (D.W), three concentrations of the solution (50%, 75% and 100%) were prepared. Prothrombin Time (PT) and Activated partial thromboplastin time (APTT) were tested by manual method before and after adding different concentrations of Acacia Nilotica solution. Statistical tests were performed by using SPSS version 16. Results:The results of study showed that Acacia Nilotica significantly prolonged the PT and APTT results of human plasma (Pvalues for 50%, 75% and 100% solutions were 0.000, 0.000 and 0.000 while for APTT 0.036, 0.000 and 0.000 for PT respectively). Also the study showed no significant correlation between control and A. nilotica concentrations among coagulation profile, except a significant positive correlation between control and 75% Acacia nilotica on APPT.Conclusion:Acacia Nilotica solutions had anticoagulant effect in human plasma, and could be nominated as a potential preventive agent for thromboembolic diseases

Clinical value of myoglobin in predicting multiple organ dysfunction in wasp sting patients / 中华急诊医学杂志

Objective:To investigate the clinical features and risk factors of multiple organ dysfunction syndrome (MODS) caused by wasp sting.Methods:A retrospective cohort study was conducted to collect the general data of wasp sting patients who had a clear history of wasp sting disease and clinical manifestations from June 2016 to December 2020 and were first diagnosed as wasp sting in hospital. Patients with hematological diseases, malignant tumors, severe liver and kidney dysfunction, cardiac insufficiency, and patients who had received hormone therapy before admission were excluded. Patients who were unable to obtain effective laboratory results due to hemolysis or other reasons within 48 h of admission were also excluded. The white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), hemoglobin count (HB), myoglobin (Mb/MYO), activated partial thromboplastin time (APTT), albumin (ALB), K, Na, and Cl of the blood samples collected within 48 h after admission were recorded. Patients were divided into the MODS group and non-MODS group according to whether MODS occurred during hospitalization. Uni- and multivariate analysis were used to analyze the factors affecting the occurrence of MODS in wasp sting patients during hospitalization, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive effect of myoglobin level on the occurrence of MODS in wasp sting patients during hospitalization.Results:Mb, WBC, NEU, APTT and serum potassium in the MODS group [3890.00 (1416.90-4057.00) ng/mL, (21.99 ± 8.18) × 10 9/L, (19.61 ± 7.33)× 10 9/L, (93.75 ± 45.77) s, and (4.99 ± 0.95) mmol/L] were significantly higher than those in the non-MODS group [73.50 (34.30-264.20) ng/mL, (13.40 ± 4.14)× 10 9/L, (11.18±4.73)× 10 9/L, (37.00 ± 17.16) s, and (4.05 ± 0.56) mmol/L] (all P < 0.05); blood chlorine and ALB [(101.50 (98.25-105.00) mmol/L and (35.36 ± 6.44) g/L)] were significantly lower than those in the non-MODS group [(105.00 (103.00-107.00) mmol/L and (40.71 ± 5.48) g/L)] (all P < 0.05). Multivariate logistic regression analysis showed that NEU ( OR = 0.729, 95% CI: 0.542~0.981), Mb ( OR = 0.999, 95% CI: 0.998~1.000), and APTT ( OR = 0.951, 95% CI: 0.921~0.982) were independent risk factors for MODS in wasp sting patients. ROC curve analysis showed that NEU, Mb and APTT could be used to evaluate the occurrence of MODS in wasp sting patients. Among them, Mb had the highest predictive value (AUC = 0.950, 95 % CI: 0.891~0.982). The optimal cutoff value of Mb for predicting the occurrence of MODS in wasp sting patients was 515.30 ng/mL, and the corresponding sensitivity and specificity were 90.62% and 87.23%, respectively. Conclusion:Mb is an independent risk factor for MODS in wasp sting patients, which can be used as a good predictor of MODS in wasp sting patients.

Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion / 中华劳动卫生职业病杂志

Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.

Actividad anticoagulante in vitro del extracto etanólico de las hojas de dos especies de la familia Euphorbiaceae / In vitro anticoagulant activity of the ethanolic extract of the leaves of two species of the family Euphorbiaceae

RESUMEN Las enfermedades cardiovasculares (ECV) son un conjunto de trastornos del corazón y de los vasos sanguíneos, que constituyen la principal causa de mortalidad en el mundo. En la búsqueda de alternativas para esta problemática, plantas medicinales de la familia Euphorbiaceae, han sido empeladas con fines terapéuticos, para prevenir, atenuar o curar los efectos generados por estas enfermedades. El objetivo de este trabajo fue conocer el perfil fitoquímico y evaluar la actividad anticoagulante in vitro de los extractos etanólicos de las hojas de Croton malambo y Acalypha hispida sobre plasma humano. Para ello, se obtuvo el extracto de las hojas y se le realizó el tamizaje fitoquímico, la evaluación del Tiempo de Tromboplastina Parcial activada (TTPa) y del Tiempo de Protombina (TP). En el perfil fitoquímico, se confirmó la presencia de alcaloides, taninos, flavonoides, leucoantocianidinas, fenoles, sesquiterpenlactonas, glucósidos cardiotónicos y terpenos. En la actividad anticoagulante, se evidenció la inhibición de la coagulación en la vía intrínseca, obteniendo resultados significativos para el TTPa, a diferencia que el test TP, donde los resultados obtenidos se encontraron similares al control. Esta investigación demuestra la acción anticoagulante de las plantas, ya que induce, significativamente, a una mayor prolongación del tiempo de coagulación; ambas especies presentaron una mayor actividad, a 200 mg/mL.

ABSTRACT Cardiovascular diseases (CVD) are a group of disorders of the heart and blood vessels, which correspond to the principal causes of death in the world. In the search for alternatives to this problem, medicinal plants of the Euphorbiaceae family have been investigated for therapeutic purposes to prevent, attenuate or cure the effects generated for these illnesses. The objective of this work was to know the phytochemical profile and evaluate the anticoagulant activity in vitro of the ethanolic extracts of the leaves of Croton malambo and Acalypha hispida on human plasma. For this, extract of their leaves was obtained, and phytochemical screening was performed, as well as the evaluation of the Activated Partial Thromboplastin Time (aPTT) and the Prothrombin Time (TP). The phytochemical profile confirmed the presence of alkaloids, tannins, flavonoids, leucoanthocyanidins, phenols, sesquiterpene lactones, cardiotonic glycosides, and terpenes. In the anticoagulant activity, the inhibition of coagulation in the intrinsic pathway was evidenced, obtaining significant results for aPTT, unlike the TP test where the results obtained were like the control. This research demonstrates the effectiveness of the plant with anticoagulant action since they significantly induce a longer prolongation of the clotting time, both species showed higher activity at 200 mg/mL.

The predictive value of D-dimer combined with activated partial thromboplastin time for slow / no reflow during PCI in patients with acute coronary syndrome / 中国医师杂志

Objective:To analyze the predictive value of D-dimer combined with activated partial thromboplastin time (APTT) for slow / no reflow in patients with acute coronary syndrome (ACS) during percutaneous coronary intervention(PCI).Methods:From June 2017 to June 2019, 316 cases of patients with ACS who were to undergo PCI in Guigang People′s Hospital were selected as the study objects. The patients were divided into slow / no reflow group (SNR) and normal blood flow group (CON) according to the blood flow grading of thrombolysis in myocardial infarction (TIMI) during the operation. The differences of D-dimer and APTT between the two groups before operation were compared, and the predictive value of D-dimer combined with APTT for SNR was analyzed.Results:According to TIMI blood flow grading, all the patients were divided into SNR group ( n=71, 22.47%) and CON group ( n=245, 77.53%). The level of D-dimer in SNR group was significantly higher than that in CON group, while APTT was significantly lower than that in CON group ( P<0.05). Logistic regression analysis showed that D-dimer elevation ( OR=1.011, 95% CI: 1.008-1.015, P<0.001) was an independent risk factor of slow / no reflow in PCI for ACS patients, while APTT elevation ( OR=0.868, 95% CI: 0.818-0.921, P<0.001) was a protective factor. The D-dimer and APTT predicted that the area under receiver operating characteristic (ROC) curve of slow / no reflow in PCI were 0.814 and 0.738 respectively. The area under ROC curve of combined detection of D-dimer and APTT increased to 0.869, and the sensitivity and specificity were 87.3% and 75.1% respectively ( P<0.001). Conclusions:The D-dimer and APTT have a high predictive value of slow / no reflow during PCI in ACS patients. The combined detection of the two is helpful to identify the occurrence of slow / no reflow in PCI.

The Sub – Acute Effects of Raw Honey on Prothrombin Time, Activated Partial Thromboplastin Time and Platelet Values in Albino Wistar Rats

For centuries honey has been regarded as wonderful gift of nature in which the properties of an excellent food, beneficial alike to adults and children, are combined with medicinal properties. Surprisingly, its sub-acute effect on coagulation is unknown. Hence; this present study aims at evaluating the effects of raw honey on coagulation in albino wistar rats. Thirty (30), 3-4 months old albino wistar rats both males and females were used for the study. The experimental animals were divided into five (A, B,C, D, E) groups with six rats per group. The test groups (B-E) were gavaged with graded doses (625, 1250, 2500, 5000mg/kg body weight) respectively of the raw honey once daily for nine days. Group A served as control. Two (2) animals were bled from each group after 3, 6 and 9 days through the ocular plexus. Four (4) ml of venous blood was collected. Two (2) ml was delivered into 0.25ml trisodium citrate anticoagulant bottle for determination of Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT). The remaining two (2) ml was delivered into K3EDTA anticoagulant bottle for platelet value determination. There was no statistical significant difference (P > 0.05) recorded in all the parameters investigated among the test groups when compared with the control group on Day 3. However, group B revealed a statistical significant decrease (P < 0.05) in PT when compared with the control group on Day 6. In addition, no statistical significant difference (P>0.05) was recorded on Day 9 when all the parameters investigated among the test groups were compared with the control group. Furthermore, there was no exposure related statistical significant difference (P>0.05) in the test groups in PT and APTT in the ANOVA. However, there was a time related significant difference (P<0.05) in platelet value of group C when Days 3, 6 and 9 were compared. It can be concluded that raw honey possesses a sub-acute coagulation stimulatory potentials which is likely to be dose and duration related.

Impact of Foeniculum vulgare Fortified Diet on Coagulation Profile and Some Biochemical Parameters

Aims:Coagulation profile shows the clotting ability of blood. Biochemical tests indicate health status of vital organs such as liver, heart and kidneys. Herbal products are being assessed for their role in affecting these parameters. We evaluated role of Foeniculumvulgareincorporated diet on coagulation profile and some important biochemical parameters.Study Design:Laboratory centred randomized controlled trial.Place and Duration of Study: Pharmacology Department of University of Karachi, Karachi between June 2018 and September 2018 Methodology: After selecting 30 healthy rabbits of either sex, we placed them in three groups; Control, 2% Foeniculumvulgareand 4% Foeniculumvulgaregroup. Control group was given standard diet whereas; 2% and 4% Foeniculumvulgaregroups were maintained on standard diet containing 2% and 4% Foeniculumvulgarecrushed seeds. Coagulation profile and some biochemical parameters were done after interval of a month, for two months.Results:Platelet count and fibrinogen increased while activated partial thromboplastin time (APTT) levels decreased in both the study groups animals as compared to control, while blood urea nitrogen (BUN), creatinine phosphokinase (CPK) and lactate dehydrogenase (LDH) elevation was noted both Foeniculumvulgaregroups but within normal range.Conclusion:Foeniculumvulgaremay have some role in affecting coagulation and biochemical profile These parameters, however, need clinical trial to validate reliability

Effect of Oral Administration of Ibuprofen on Prothrombin Time, Activated Partial Thromboplastin and Platelet Count in Wistar Albino Rats

Aim:Ibuprofen is analgesic, antipyretic and anti-inflammatory drug, which is widely used as a cheap over-the counter drug(OTC); however, this drug accompanies anti coagulation/anti platelets effects which sometimes might illicit adverse effects. In this study, we investigated effect of ibuprofen on prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count using wistar albino rats.Methods:A total of 21 rats grouped into 3(control, acute and chronic exposure groups, with all consisting of 7rats each) was used. The acute and chronic exposure group were given 0.7mg of ibuprofen orally for 1 and 21 days, respectively. Blood sample was collected via cardiac puncture thenanalyzed.Results:PT was significantly higher in both group 2 and 3 (acute and chronic exposure, respectively)than that of the control. Acute exposure group showed the highest PT rise.A PTT was not significantly different between group 2 and 3 versus the control group. Platelet count was significantly lower in both group 2 and 3than that in the control group (p<0.05). Group 3 (chronic exposure) showed the lowest platelet count.Conclusion:Oral administration of ibuprofen affected coagulation parameters and a longer exposure reduce platelets count. A strictly prescription for this drug may be needed to prevent its indiscriminate use

Prevalence and clinical manifestations of vitamin K deficiency in complicated severe acute malnutrition

Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that's why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03'11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92'1.57 kg. Average height/length was 70.66'8.38 cm and mean MUAC was 10.47'1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11'1.1 and mean aPTT was 45.30'9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.

Evaluation of Rosners index vs Brandt correction and Chang’s %, in the interpretation of mixing studies at varying dilutions

Background: For evaluation of unexplained prolongation of PT and PTT, mixing tests forms a great diagnostic tool. On mixing equal volume of patient plasma with normal pooled plasma, if there is correction it indicates factor deficiency and non-correction indicates inhibitors.Methods: Sysmex CS-5100 Coagulometer with Pathrombin SL APTT reagent, LA1 and LA2 reagents supplied by siemens were used. All data were expressed as Mean±SD. Statistical analysis was done using unpaired students t test. A p value of <0.05 was used to indicate statistical significance in all analyse.Results: APTT with (1:1) and (4:1) mixing study for detection of factor deficiency showed a sensitivity of 91% and 92% for RI, 88% and 90% for Changs %, and 75% for Brandt correction PNP aPTT + 5 secs respectively. For Inhibitors, RI shows a sensitivity of 79% and 89%, Changs 71 and 80% and Brandt test 50% for APTT (1:1) and (4:1) mix, respectively.Conclusions: Mixing tests forms an important diagnostic tool in differentiating factor deficiency from inhibitors especially in LAC patients. This study recommends mandatory use of mixing tests in LAC cases as also advocated by BSH, ISTH and CLSI. Rosners Index is more sensitive than changes % and Brandt correction in the interpretation of mixing studies. It can be safely concluded that RI can be used as a reference method for evaluation of mixing studies and its sensitivity is greatly increased by using PP4:1 PNP. It’s a matter of debate that whether these indices can be effective with other Analysers and reagents?

Correlation analysis on JAK2V617F mutation and clinical features in patients with myeloproliferative neoplasms and its clinical significance / 吉林大学学报(医学版)

Objective: To investigate the distribution of JAK2V617F mutation in the patients with myeloproliferative neoplasms (MPN), to explore the association between JAK2V617F mutation and the clinical features of MPN, and to clarify its clinical significance in the diagnosis and treatment of the MPN patients. Methods: A total of 170 patients with MPN were selected as the subjects and divided into true polycythemia (PV) group (n=68), primary thrombocytopenia (ET) group (n=88) and primary myelofibrosis (PMF) group (n=14). The JAK2V617F mutations in 170 patients with MPN were detected by allele-specific PCR (AS-PCR). The differences in gender, age, white blood cell count, hemoglobin, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, whether complicated with splenomegaly and thromboembolism of the JAK2V617F mutant-type and wild-type patients in each group were analyzed. Results: The total mutation rate of JAK2V617F mutation in 170 patients with MPN was 68. 2% (116/170), and the mutation rates in PV, ET, and PMF groups were 72. 1% (49/68), 68. 1% (60/88), and 50. 0% (7/14), respectively. The JAK2V617F mutation rate in PV group was higher than those in the other two groups, but there were no statistical differences (P = 0. 281). Compared with wild type group, the age of onset, the white blood cell and platelet counts of the PV patients with JAK2V617F mutation were significantly increased (P

Study on processing technology of Gardenia jasminoides carbon based on thermal analysis and comprehensive evaluation / 中草药

Objective: To optimize the processing technology of Gardenia jasminoides carbon and validate the process with pharmacodynamics research. Methods: The pyrolysis characteristics of different active components in G. jasminoides were analyzed by thermal analysis technology, and the optimum processing temperature range of G. jasminoides carbon was obtained; Taking the tannin content in G. jasminoides carbon as the index, two factors of stir-frying temperature and stir-frying time was chosen to optimize the processing technology of G. jasminoides carbon by response surface methodology, and the processing technology of G. jasminoides carbon was verified by pharmacodynamics experiment (hemostasis test). Results: The optimum processing temperature range of G. jasminoides carbon was 290.3-387 ℃, response surface methodology was used to optimize the processing technology of G. jasminoides carbon: The processing temperature was 330 ℃, the processing time was 5.91 min, and the tannin content was 3.120 mg/g; Compared with the blank group, the new method group and the traditional group could significantly shorten the clotting time of mice (P < 0.01), raw product group can significantly shorten the clotting time of mice (P < 0.05), the new method group can significantly shorten APTT in mice (P < 0.05), there was no significant difference in PT and TT in mice. Conclusion: The processing technology of G. jasminoides carbon was optimized by thermal analysis technology and response surface methodology, and the results were verified by pharmacodynamics experiments. The method can provide a reference for improving the processing technology of Chinese materia medica and quantifying the fire parameters in the process of processing.

Clinical analysis of 8 cases of connective tissue disease complicated with acquired hemophilia A / 中华风湿病学杂志

Objective To analyze the clinical features and treatment of connective tissue disease (CTD) complicated with acquired hemophilia A (AHA).Methods A retrospective analysis of 8 cases of CTD [5 cases of systemic lupus erythematosus (SLE),2 cases of Sj(o)gren's syndrome (SS),1 case of rheumatoid arthritis (RA)] related to clinical manifestations,diagnostic methods,treatment options and outcomes.Results At the onset of AHA,active disease was shown in 7 patients with CTD,and 5 cases had bleeding symptoms in different parts.There were 3 cases of anti-phospholipid syndrome in 5 cases of SLE,2 of which had thrombosis.In 8 patients,the activated partial thromboplastin time (APTF) was prolonged by 1.7 to 3.times,FⅧ∶ C was 9.2％ to 21％ (50％ to 150％),and the factor Ⅷ inhibitor titer was increased by 7.6 to 56 BU/m1 (Bethesda method).Seven patients were treated with sufficient hormones,immunosuppressive agents,human immunoglobulin (IVIG),and blood products.Five patients had clinically improved bleeding tendency and APIT,and one patient was ineffective.Conclusion CTD is easy to combine with AHA.Glucocorticoid combined with immunosuppressive agent can effectively treat CTD-related AHA.For refractory patients,rituximab can be an alternative.

In Vitro Assessment of Coagulation Activities in Human Plasma Treated With Ajwa Date (Phoenix dactylifera L.) Extracts

Abstract@#Introduction: Arterial and venous thromboses contribute to significant morbidity and mortality rate, thus an antithrombotic agent is needed for prevention and treatment of thrombosis. Ajwa dates (Phoenix dactylifera L.) reportedly contain a high level of salicylic acid which is a compound responsible for anticoagulation via antagonism of vitamin K. The present study was designed to assess coagulation activities in human plasma treated with Ajwa date extracts in vitro. Methods: Platelet-poor plasma samples from 27 donors were treated with ethanol crude date extract (ET) or aqueous crude date extract (AQ) of Ajwa dates at different concentrations to generate the following seven test groups from each donor: control (normal saline), ET-I (0.1 g/mL), ET-II (0.5 g/mL), ET-III (1.0 g/mL), AQ-I (0.1 g/ mL), AQ-II (0.5 g/mL) and AQ-III (1.0 g/mL). In vitro coagulation activities of Ajwa dates were assessed based on prothrombin time (PT, an assessment of extrinsic coagulation pathway), activated partial thromboplastin time (APTT, an assessment of the intrinsic coagulation pathway), and thrombin time (TT, an evaluation of level and function of fibrinogen). Results: A very significant prolongation of PT, APTT and TT were observed for the ET-II and ET-III groups and very significant prolongation of PT and TT was observed for the AQ-II and AQ-III groups. Significant prolongation of TT was observed in the AQ-I group. Conclusion: In conclusion, Ajwa date extracts had an anticoagulation effect on human plasma.