Evaluation of Haemostatic Effects of Petroselinum crispum(Parsley) in Wistar Rats

Petroselinum crispum(parsley or garden parsley), besides its use as an edible vegetable, is used in the treatment of various ailments with documented evidence validating some of these medicinal uses. The present study evaluates the impact of oral administration of P. crispumon blood coagulation parameters. Fresh leaves of P. crispum were locally sourced, authenticated and extracted using ethanol to obtain an ethanolic extract of P. crispum (PCE). Twenty-five (25) male Wistar rats were used for the study and were randomly assigned to five (5) animals of five (5) rats each. Group I served as the control group and was given distilled water, whereas groups II, III, and IV were treated as experimental groups and administered PCE at 200, 400, and 800mg/kg via oral gavage, respectively. Group V also received 800mg/kg of PCE with the administration terminated on the 28thday to allow for a 14-day recovery period. Platelet count (PLT) and other platelet indices were determined using an automated Haematology analyzer. Bleeding time (BT), clotting time (CT), prothrombin time (PT), activated partial thromboplastin time (aPTT) and plasma fibrinogen (FIB) were assayed following standard laboratory protocols. The results of the study show that the mean PLT were significantly reduced in the experimental animals compared to the control (p<0.05) while BT, CT, PT, aPTT and FIB significantly increased compared to the control (p<0.05). Also, BT, CT, PT, and aPTT recovered towards the control values after the 14-day withdrawal period. The present study shows ethanolic leaf extract of P. crispumprolonged blood coagulation. The current evidence suggests that P. crispumcould be a candidate for further exploration as a natural plant-based antithrombotic agent.

In vitro haemostatic efficacy of aqueous, methanol and ethanol plant extracts of three medicinal plant species in Palestine / Eficácia hemostática in vitro de extratos aquosos, metanólicos e etanólicos de três espécies de plantas medicinais na Palestina

Abstract The haemostatic efficacy of different extract types of Satureja thymbra L., Thymbra spicata L. (Lamiaceae) and Verbascum fruticulosum Post. (Scrophulariaceae) was evaluated in this study via the Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) analysis. Aqueous, methanol and ethanol extracts of the examined plant species leaves were prepared to a final concentration 50 mg/mL. In vitro PT and aPTT assays were conducted on normal platelet poor plasma blood samples by a digital coagulation analyzer. The obtained results revealed anticoagulation activity of all investigated plant species with observed variations among them. The aqueous and ethanol extracts of T. spicata as well as the aqueous extract of S. thymbra prolonged PT values significantly (p < 0.05). While, all V. fruticulosum extract types have had no significant effect on the PT values. The recorded aPTT data showed that all aqueous extracts have had a significant effect on the blood haemostasis as they increased aPTT values in all plant species under study. Out of which, both the ethanol and methanol extracts of T. spicata and methanol extract of S. thymbra showed similar effect. Of great concern, it was clearly noticed that the aqueous and ethanol extract of T. spicata and the aqueous extract of S. thymbra possess the strongest anticoagulation effect as they increased both PT and aPTT values significantly relative to the control (p < 0.05). The variable anticoagulation bioactivity among the studied plant species could be referred to the various solvents degrees of solubility of different phyto-constituents. Thus, the efficacy of the plant species extracts evaluation as anticoagulants or coagulants were related to the plant species and to the solvent of extraction.

Resumo A eficácia hemostática de diferentes tipos de extrato de Satureja thymbra L., Thymbra spicata L. (Lamiaceae) e Verbascum fruticulosum Post. (Scrophulariaceae) foi avaliada neste estudo pelo tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa). Os extratos aquosos, metanólicos e etanólicos das folhas das espécies de plantas examinadas foram preparados para uma concentração final de 50 mg/mL. Os ensaios de TP e TTPa in vitro foram realizados em amostras normais de sangue, pobre em plaquetas, por um analisador de coagulação digital. Os resultados obtidos revelaram atividade anticoagulante de todas as espécies de plantas investigadas, com variações observadas dentre elas. Os extratos aquosos e etanólicos de T. spicata e o extrato aquoso de S. thymbra prolongaram significativamente os valores de TP (p <0,05). Entretanto, todos os tipos de extratos de V. fruticulosum não tiveram efeito significativo sobre os valores de TP. Os dados registrados do TTPa mostraram que todos os extratos aquosos tiveram um efeito significativo na hemostase do sangue, pois aumentaram os valores de TTPa em todas as espécies de plantas em estudo. Dos quais, ambos os extratos etanólicos e metanólicos de T. spicata e o extrato metanólico de S. thymbra mostraram efeito semelhante. De grande preocupação, notou-se claramente que os extratos aquoso e etanólico de T. spicata e o extrato aquoso de S. thymbra apresentam efeito anticoagulante mais forte, aumentando os valores de TP e TTPa significativamente em relação ao controle (p <0,05). A variável bioatividade anticoagulante dentre as espécies vegetais estudadas pôde ser referida aos vários graus de solventes de solubilidade de diferentes fitoconstituintes. Assim, a eficácia da avaliação de extratos de espécies vegetais como anticoagulantes ou coagulantes foi relacionada às espécies vegetais e ao solvente de extração.

Our initial experience of three versus two rows circular stapler devices for stapled hemorrhoidopexy: a single institution review of 224 cases

Background: Stapled haemorrhoidopexy is a non-excisional approach for haemorrhoids as opposed to conventional open Milligan-Morgan and Ferguson closed haemorrhoidectomy techniques. It repositions the prolapsed haemorrhoid tissue and also causes vascular interruption to the haemorrhoids. This causes faster recovery and lesser post-operative pain.Methods: In authors institute, stapled haemorrhoidopexy was being carried out using two rows proximate PPH circular haemorrhoidal stapler. In February 2018, MIRUS three rows circular stapler was introduced. This is a retrospective observational study carried out at Artemis Hospital, Gurgaon, India. Authors studied records and operative notes of all patients who underwent stapled haemorrhoidopexy between February 2018 and September 2019 and compared key parameters.Results: A total of 224 patients underwent stapled haemorrhoidopexy between February 2018 and September 2019. 116 using MIRUS three rows circular stapler and 108 using two rows proximate PPH circular haemorrhoidal stapler. Most of the studied parameters were comparable with only significant statistical difference seen in higher use of haemostatic sutures in two rows stapler group compared to three rows stapler group. Haemostatic sutures were needed in three row stapler group for 27 patients and in two rows stapler group for 39 patients.Conclusions: Author’s initial experience shows slightly better haemostasis with three rows stapled haemorrhoidopexy with no significant difference in other parameters.

Latex proteins downregulate inflammation and restores blood-coagulation homeostasis in acute Salmonella infection

BACKGROUND Calotropis procera latex protein fraction (LP) was previously shown to protect animals from septic shock. Further investigations showed that LP modulate nitric oxide and cytokines levels. OBJECTIVES To evaluate whether the protective effects of LP, against lethal bacterial infection, is observed in its subfractions (LPPII and LPPIII). METHODS Subfractions (5 and 10 mg/kg) were tested by i.p. administration, 24 h before challenging with lethal injection (i.p.) of Salmonella Typhimurium. LPPIII (5 mg/kg) which showed higher survival rate was assayed to evaluate bacterial clearance, histopathology, leukocyte recruitment, plasma coagulation time, cytokines and NO levels. FINDINGS LPPIII protected 70% of animals of death. The animals given LPPIII exhibited reduced bacterial load in blood and peritoneal fluid after 24 h compared to the control. LPPIII promoted macrophage infiltration in spleen and liver. LPPIII restored the coagulation time of infected animals, increased IL-10 and reduced NO in blood. MAIN CONCLUSIONS LPPIII recruited macrophages to the target organs of bacterial infection. This addressed inflammatory stimulus seems to reduce bacterial colonisation in spleen and liver, down regulate bacterial spread and contribute to avoid septic shock.

Alteraciones hemostáticas provocadas por el veneno de la culebra mapanare (Porthidium lansbergii hutmanni) en pacientes venezolanos / Haemostatic alterations caused by the venom of Lansberg's hognosed pitviper (Porthidium lansbergii hutmanni) in Venezuelan patients

Objective: to describe the haemostatic characteristics of the venom as well as the potency appraisal of the polyvalent antiophidic serum against haemotoxicity from Porthidium lansbergii hutmani experimental envenomation. Methods: Evaluation was performed of the venom's lethality, haemorrhagic activity, effects on coagulation and platelet aggregation, proteolytic activity, and neutralization by the commercial antivenom available in the country. Results: Several components with haemostatic activities were found in Porthidium l. hutmanni venom when a study of fibrinogenolytic, haemorrhagic and proteolytic activities was conducted of a pool of P.l.h venom. Porthidium l. hutmanni venom lacked the coagulant and defibrinating activities that are characteristic of bothropic venoms. Porthidium l. hutmanni venom showed very high haemorrhagic and anticoagulant activities. These findings could be related to the presence of multiple metalloproteases, which was evidenced in this study, and also the possible presence of phospholipases or other anticoagulant activity proteins that were not defined here. They inhibited platelet aggregation, suggesting that the venom had some proteins with marked effects on haemostasis. The commercial antivenom proved to be of little effectiveness in neutralizing the crude venom haemorrhagic activity. Conclusions: These toxins cause many physiopathological alterations in bitten patients, creating a clinical picture characterized by oedema, local and systemic haemorrhages, and even necrosis, comparable to that seen in bothropic envenomation. Porthidium l. hutmanni venom has no in vitro procoagulant activity, typical of bothropic venoms, suggesting there are variances in its protein conformation. Porthidium l. hutmanni venom is used for horse immunization. However, in order to preserve the patient's life, it is necessary to improve the immunization process to produce antivenom containing high avidity and specificity antibodies against the major toxins present in this venom. Porthidium l. hutmanni venom has demonstrated being a venom with high lethal, haemorrhagic, proteolytic and procoagulant activities, whose description will have enormous utility among clinicians who deal with these accidents in its geographical distribution areas(AU)

Objetivo: Describir las características hemostáticas del veneno y evaluar la potencia del suero polivalente antiofídico contra la hemotoxicidad provocada por el envenenamiento experimental por Porthidium lansbergii hutmanni. Métodos: Se realizó una evaluación de la letalidad, actividad hemorrágica, efectos en la coagulación y agregación plaquetaria, actividad proteolítica y neutralización por el antiveneno disponible comercialmente en el país. Resultados: Se encontraron varios componentes con actividad hemostática en el veneno de Porthidium l. hutmanni al realizarse un estudio de la actividad fibrinogenolítica, hemorrágica y proteolítica de una muestra de veneno de Porthidium l. hutmanni. El veneno de Porthidium l. hutmanni no mostró la actividad coagulante o defibrinante característica de los venenos botrópicos. El veneno de Porthidium l. hutmanni mostró una elevada actividad hemorrágica y anticoagulante. Estos resultados podrían estar relacionados con la presencia de múltiples metaloproteasas, la que quedó demostrado en el estudio, y también a la posible presencia de fosfolipasas u otras proteínas de actividad anticoagulante que no se definen en el mismo. La inhibición de la agregación plaquetaria sugiere que el veneno contiene algunas proteínas con un marcado efecto sobre la hemostasis. El antiveneno comercial mostró poca efectividad en la neutralización de la actividad hemorrágica del veneno crudo. Conclusiones: Estas toxinas provocan muchas alteraciones fisiopatológicas en las víctimas de mordeduras, creando un cuadro clínico caracterizado por edema, hemorragias locales y sistémicas e incluso necrosis comparable con la que ocurre en el envenenamiento botrópico. El veneno de Porthidium l. hutmanni no tiene la actividad procoagulante in vitro típica de los venenos botrópicos, lo que apunta a variaciones en su conformación proteica. El veneno de Porthidium l. hutmanni de utiliza en la inmunización de los caballos. Sin embargo, para preservar la vida del paciente, es necesario mejorar el proceso de inmunización con vistas a producir un antiveneno que contenga anticuerpos de elevada avidez y especificidad contra las principales toxinas presentes en el veneno. El veneno de Porthidium l. hutmanni ha mostrado ser un veneno de elevada actividad letal, hemorrágica, proteolítica y procoagulante, cuya descripción tendrá una enorme utilidad para los médicos que atienden esos accidentes en sus áreas de distribución geográfica(AU)

Comparison of efficacy of Interathecal 0.5% Isobaric Levobupivacaine With Fentanyl Versus 0.5% Isobaric Bupivacaine with Fentanyl for Inguinal Hernia Repair

Introduction: As practice of medicine focuses increasinglyon outpatient care, spinal anaesthetics should provide shortacting and adequate anaesthesia without compromising earlyambulation and discharge from day care surgery unit. Bothclinical and preclinical trials have demonstrated a bettersafety profile for Levobupivacaine than for Bupivacaine. Inthis study we proposed to compare a combination of low doseLevobupivacaine with Fentanyl to low dose isobaric racemicBupivacaine with Fentanyl for the characteristics of spinalblockade with respect to onset and duration.Material and Methods: The present study was conductedamong 70 patients who were classified as American Society ofAnaesthesiologists (ASA) physical status I or II, undergoingelective inguinal hernia repair surgeries under spinalanaesthesia divided into two groups of 35 each. Patients inGroup LB were given Levobupivacaine 0.5% isobaric 5 mg(1ml) + Inj. Fentanyl 25 µg (0.5ml) and Group B were givenBupivacaine 0.5% isobaric 5 mg (1ml) + Inj. Fentanyl 25 µg(0.5ml). The onset of motor blockade (Time taken for motorblockade to reach Modified Bromage Scale 1) and duration ofmotor blockade (Regression of motor blockade to ModifiedBromage scale 0) were noted. Sensory and motor blocks wereassessed at the start of surgery and at the end of surgery forcomparison between groups.Results: Intrathecal 0.5% isobaric Levobupivacaine withFentanyl combination has slower onset of sensory blockadeand motor blockade, slower time for achieving peak sensorylevels when compared to 0.5% isobaric bupivacaine withFentanyl combination. But, intrathecal 0.5% isobaricLevobupivacaine has a faster onset of two segment regression,faster S2 regression and faster regression of motor blockwhen compared to 0.5% isobaric bupivacaine with Fentanylcombination. Similarly, the time to ambulation and timeto urination are also early with intrathecal 0.5% isobaricLevobupivacaine.Conclusion: Intrathecal 0.5% isobaric Levobupivacaineoffers an advantage for the patient for faster discharge hencecan be suitable for day care surgeries.

When do we need more than local compression to control intraoral haemorrhage?

OBJECTIVES: The aims of this study were to determine the effectiveness of local compression in patients presenting to the emergency room with intraoral bleeding and to identify when complex haemostatic measures may be required.MATERIALS AND METHODS: Five hundred forty patients who had experienced intraoral haemorrhage were retrospectively reviewed. The outcome variable was the haemostasis method used, i.e., simple (local compression with gauze) or complex (an alternative method after local compression has failed). Predictor variables were sex, age, American Society of Anesthesiologists (ASA) class, hepatic cirrhosis, bleeding disorder, use of antithrombotic agents, and site/cause of haemorrhage.RESULTS: The mean patient age was 48.9±23.9 years, 53.5% were male, 42.8% were ASA class II or higher, and 23.7% were taking antithrombotic agents. Local compression was used most often (68.1%), followed by local haemostatic agents, sutures, systemic tranexamic acid or blood products, and electrocautery. The most common site of bleeding was the gingiva (91.7%), and the most common cause was tooth extraction (45.7%). Risk factors for needing a complex haemostasis method were use of antithrombotic agents (odds ratio 2.047, P=0.009) and minor oral surgery (excluding extraction and implant procedures; odds ratio 6.081, P=0.001).CONCLUSION: A haemostasis method other than local compression may be needed in patients taking antithrombotic agents or having undergone minor oral surgery.

Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis

SUMMARY OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the harmonic scalpel compared to the conventional technique in patients submitted to total thyroidectomy. METHOD: This is a systematic review with inclusion of randomized controlled trials (RCTs) that compared both techniques. An electronic search was carried out in the Medline and Lilacs databases until June 2017. The outcomes analysed were operation time, intraoperative bleeding, surgical morbidity, and costs. RESULTS: Data from 31 primary studies were included. The use of the harmonic scalpel correlates to a shorter operation time (p <0.001) and a lower volume of intraoperative bleeding (p <0.001). There were no differences in the risk of transient (p = 0.53) and permanent (p = 0.70) hypocalcaemia, transient (p = 0.61) and permanent (p = 0.50) dysfunctions of the inferior laryngeal nerve and hematoma (p = 0.14). CONCLUSION: Total thyroidectomy using a harmonic scalpel is effective and safe compared to the conventional technique.

Plasma-Derived Microparticles in Polycythaemia Vera

Introduction: Microparticles are membrane bound vesicles, measuring less than 1.0 um, which are released during cellular activation or during apoptosis. Studies have shown that these circulating microparticles play a role in coagulation, cell signaling and cellular interactions. Increased levels of circulating microparticles have been observed in a number of conditions where there is vascular dysfunction, thrombosis and inflammation. The objective of this study was to determine the various plasma-derived microparticles in patients with polycythaemia vera (PV) in Universiti Kebangsaan Malaysia Medical Centre and to compare them with normal control. Methods: A total of 15 patients with PV and 15 healthy volunteers were included in this cross-sectional descriptive study. Plasma samples from both patients and healthy volunteers were prepared and further processed for isolation of microparticles. Flow cytometry analyses were then carried out in all samples to determine the cellular origin of the microparticles. Full blood count parameters for both groups were also collected. Data collected were analyzed using SPSS version 12.0. Results: Patients with PV had a significantly higher percentage of platelet derived microparticles compared to healthy controls (P 0.05). Conclusion: The median percentage of positive events for platelet derived microparticles was higher in patients with PV compared to normal healthy controls.

Comprometimento hemostático em pacientes com icterícia obstrutiva / Haemostatic impairment in patients with obstructive jaundice

A doença hepática é associada à alterações hemostáticas devido à diminuição na síntese dos fatores de coagulação. Neste sentido, objetivou-se avaliar o comprometimento da hemostasia em pacientes com icterícia obstrutiva. Os pacientes foram analisados por gênero, idade, etiologia da doença, tempo de protrombina (TP) e tempo de tromboplastina parcial (TTP) antes e após a cirurgia. A icterícia obstrutiva ocorreu com maior frequência entre as mulheres (60,0%), sendo a coledocolitíase a causa mais comum da doença (80,0%). Os valores pré-cirúrgicos do TTP estavam dentro da faixa normal. No entanto, todos os pacientes apresentaram um TP prolongado na avaliação pré-operatória. Uma redução significativa (p<0,001) foi verificada na análise pós-operatória do TP, atingindo a faixa normal em 66,7% dos pacientes estudados. Verificou-se uma correlação positiva (r = 0,813 p<0,001) entre os valores pré-operatórios do TP e a idade dos pacientes. Além disso, os valores pré-operatórios e pós-operatórios do TP foram significativamente mais elevados (p<0,05) entre pacientes com icterícia obstrutiva de etiologia tumoral. Os resultados deste estudo demonstraram uma forte correlação entre a idade dos pacientes e a atividade dos fatores de coagulação vitamina K dependentes, além de uma diminuição significativa na atividade destes fatores em pacientes com icterícia obstrutiva de etiologia tumoral.

Liver disease is associated with haemostatic abnormalities due to the decreased synthesis of the clotting factors. Therefore, this study aimed to evaluate the impairment of haemostasis in patients with obstructive jaundice. Patients were analyzed by gender, age, cause of jaundice, prothrombin time (PT) and partial thromboplastin time (PTT) before and after surgery. Obstructive jaundice occurred more commonly amongst the females (60.0%), and choledocholithiasis was the most frequent cause of the disease (80.0%). Presurgical PTT values were within the normal range, whereas all the patients showed increased PT in the preoperative evaluation. A significant decrease (p<0.001) was found in the postoperative PT measurement, reaching the normal range in 66.7% of the studied patients. A positive correlation was found between the preoperative PT values and the age of the patients (r = 0.813 p<0.001). In addition, preoperative and postoperative PT values were significantly higher (p<0.05) among the patients with obstructive jaundice of tumoral etiology. Results from this study have shown that activity of vitamin K-dependent clotting factors in obstructive jaundice was strongly correlated with subject's age and was significantly decreased in patients with tumoral etiology.

In vitro haemostatic efficacy of aqueous, methanol and ethanol plant extracts of three medicinal plant species in Palestine

Abstract The haemostatic efficacy of different extract types of Satureja thymbra L., Thymbra spicata L. (Lamiaceae) and Verbascum fruticulosum Post. (Scrophulariaceae) was evaluated in this study via the Prothrombin time (PT) and Activated partial thromboplastin time (aPTT) analysis. Aqueous, methanol and ethanol extracts of the examined plant species leaves were prepared to a final concentration 50 mg/mL. In vitro PT and aPTT assays were conducted on normal platelet poor plasma blood samples by a digital coagulation analyzer. The obtained results revealed anticoagulation activity of all investigated plant species with observed variations among them. The aqueous and ethanol extracts of T. spicata as well as the aqueous extract of S. thymbra prolonged PT values significantly (p 0.05). While, all V. fruticulosum extract types have had no significant effect on the PT values. The recorded aPTT data showed that all aqueous extracts have had a significant effect on the blood haemostasis as they increased aPTT values in all plant species under study. Out of which, both the ethanol and methanol extracts of T. spicata and methanol extract of S. thymbra showed similar effect. Of great concern, it was clearly noticed that the aqueous and ethanol extract of T. spicata and the aqueous extract of S. thymbra possess the strongest anticoagulation effect as they increased both PT and aPTT values significantly relative to the control (p 0.05). The variable anticoagulation bioactivity among the studied plant species could be referred to the various solvents degrees of solubility of different phyto-constituents. Thus, the efficacy of the plant species extracts evaluation as anticoagulants or coagulants were related to the plant species and to the solvent of extraction.

Resumo A eficácia hemostática de diferentes tipos de extrato de Satureja thymbra L., Thymbra spicata L. (Lamiaceae) e Verbascum fruticulosum Post. (Scrophulariaceae) foi avaliada neste estudo pelo tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa). Os extratos aquosos, metanólicos e etanólicos das folhas das espécies de plantas examinadas foram preparados para uma concentração final de 50 mg/mL. Os ensaios de TP e TTPa in vitro foram realizados em amostras normais de sangue, pobre em plaquetas, por um analisador de coagulação digital. Os resultados obtidos revelaram atividade anticoagulante de todas as espécies de plantas investigadas, com variações observadas dentre elas. Os extratos aquosos e etanólicos de T. spicata e o extrato aquoso de S. thymbra prolongaram significativamente os valores de TP (p 0,05). Entretanto, todos os tipos de extratos de V. fruticulosum não tiveram efeito significativo sobre os valores de TP. Os dados registrados do TTPa mostraram que todos os extratos aquosos tiveram um efeito significativo na hemostase do sangue, pois aumentaram os valores de TTPa em todas as espécies de plantas em estudo. Dos quais, ambos os extratos etanólicos e metanólicos de T. spicata e o extrato metanólico de S. thymbra mostraram efeito semelhante. De grande preocupação, notou-se claramente que os extratos aquoso e etanólico de T. spicata e o extrato aquoso de S. thymbra apresentam efeito anticoagulante mais forte, aumentando os valores de TP e TTPa significativamente em relação ao controle (p 0,05). A variável bioatividade anticoagulante dentre as espécies vegetais estudadas pôde ser referida aos vários graus de solventes de solubilidade de diferentes fitoconstituintes. Assim, a eficácia da avaliação de extratos de espécies vegetais como anticoagulantes ou coagulantes foi relacionada às espécies vegetais e ao solvente de extração.

Haematological parameters and screening tests of haemostasis in children with sepsis: results from a tertiary care centre in India

Sepsis is a common cause of death in infants and children. Haemostatic abnormalities have been reported in such patients. There is scant information on the nature and frequency of these abnormalities in children especially from India. Our aim was to evaluate the nature and frequency of haematological and haemostatic abnormalities in children with sepsis. Fifty children between 1-10 years of age admitted with sepsis and 50 age-matched, healthy controls were included in the study. Complete blood counts, examination of stained peripheral blood film, prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen, C-reactive protein, liver function tests and serum creatinine were done in all patients and controls. Prolonged PT and APTT were seen in 9 (18%) and 24 (48%) patients respectively. Plasma fibrinogen was decreased in 6% and increased in 8% patients. One or more haemostatic parameter was abnormal in 35 (70%) patients and in all patients who died.

Upper gastrointestinal haemorrhage in severe dengue: To scope or not to scope?

Upper gastrointestinal haemorrhage (UGIH) in severe dengue represents a clinical dilemma in term of management. The recommended treatment in dengue with UGIH involves blood product transfusion support and proton pump inhibitor (PPI) infusion. Despite being the mainstay of treatment in non-dengue UGIH, the role of endoscopic haemostatic intervention in severe dengue remains controversial. In the present report, we present a case of severe dengue complicated with upper gastrointestinal haemorrhage successfully underwent early therapeutic endoscopic intervention in a district hospital.

Effects Of First-Line Anti-Retroviral Therapy On Blood Coagulation Parameters Of HIV-Infected Patients Attending A Tertiary Hospital At Abuja, Nigeria

Background: Blood coagulation abnormalities are common in persons infected with the human immunodeficiency virus (HIV). However, few studies showed the association of these abnormalities with anti-retroviral therapy (ART). Objective: This cross-sectional study investigated the effects of ART on blood coagulation parameters of patients infected with HIV attending HIV special clinics of the University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria. Material and Methods: A total of 191 patients comprising 128 HIV subjects on ART (test subjects) and 63 other HIV patients not on ART (control subjects) were included in the study. CD4+ lymphocyte counts, platelet counts, prothrombin time (PT) and partial thromboplastin time with kaolin (PTTK) of subjects were determined using flow cytometry, automated hematology analyser and Quick one-stage methods respectively. Results: Of the total test subjects, 21 (16.4%) were CD4 lymphopaenic, and the mean CD4+ cell count for the test subjects was statistically higher than that of the control subjects (578 versus 322 cells/ mm3 ) (p = 0.014). Eight (6.3%) of test subjects had prolong PTTK, and the mean values of PT and PTTK were statistically not significant between test subjects and control subjects (p = 0.358 and p= 0.141 respectively). Eight (6.3%) of test subjects had thrombocytopaenia, the mean platelet count was significantly lower than that of the control subjects (238 versus 278.6 x 109 /L, p = 0.001), and also varied significantly with the duration of ART (p = 0.0086). Conclusion: Findings from this study revealed ART decreased platelet counts of HIV-infected individuals, but did not affect the PT and PTTK results.

Biochemical and biological characterisation of lancehead (Bothrops venezuelensis Sandner 1952) snake venom from the Venezuelan Central Coastal range / Caracterización bioquímica y biológica del veneno de la serpiente "tigra mariposa" (Bothrops venezuelensis Sandner 1952) de la región central de la Cordillera de la Costa Venezolana

Se aislaron fracciones del veneno de Bothrops venezuelensis que demuestran ser un espectro abundante de proteínas con actividades variadas (coagulante, hemorrágica, fibrinolítica, proteolítica y de función plaquetaria), para el análisis de sus propiedades físico-químicas y biológicas, el veneno fue fraccionado por cromatografía de exclusión molecular, corrido en una electroforesis en gel y realizada una batería de ensayos biológicos. La DL50 del veneno de B. venezuelensis fue 6,39 mg/kg de peso corporal, fue determinada inyectando intraperitonealmente en ratones, diluciones seriadas de veneno de B. venezuelensis. Se colectaron doce fracciones a partir del veneno de B. venezuelensis mediante cromatografía de exclusión molecular. Las fracciones 1-5 y 7-9 tenían actividad hemorrágica. Todas las fracciones, con la excepción de las fracciones 3 y 6, tenían actividad fibrinolítica. Ninguna de las fracciones tuvo actividad de gelatinasa significativa, y sólo fracciones 4-6 demostraron actividad en polvo azul de ocultamiento. Con la excepción de las fracciones 1 y 4 , todas hidrolizaron la cadena β de la insulina. Cada fracción del veneno, así como el veneno crudo mostraron actividad procoagulante, cuando se probó en un analizador Sonoclot. Las fracciones 1, 3 , 5 y 9 inhibieron la función plaquetaria. En este estudio se señalan actividades biológicas de un veneno poco estudiado (B. venezuelensis) y sus fracciones. Al detectar actividades hemorrágicas, fibrinolíticas, procoagulantes, proteolíticas y de inhibición de la función plaquetaria. Este estudio preliminar abre el camino para la identificación de moléculas específicas que podrían tener potencial terapéutico en hemostasia y cáncer, que vienen siendo estudiados en nuestro grupo.

Venom fractions isolated from Bothrops venezuelensis were shown to contain a broad spectrum of proteins with varied activities. This study describes venom fractions with coagulant, haemorrhagic, fibrinolytic, proteolytic and antiplatelet activities, and analyses their physico-chemical properties and biological activities via molecular exclusion chromatography, gel electrophoresis and a bioassay battery. The LD50, determined by injecting intraperitoneally serial dilutions of B. venezuelensis venom into mice, was 6.39 mg/kg body weight. Twelve fractions were collected from B. venezuelensis venom using molecular exclusion chromatography. Of these, fractions 1-5 and 7-9 showed haemorrhagic activity, and all fractions except 3 and 6 showed fibrinolytic activity. However, none of the fractions had significant gelatinase activity, and only fractions 4-6 demonstrated activity on hide powder azure. With the exception of fractions 1 and 4, all fractions hydrolysed the insulin B-chain. In addition, all fractions as well as the crude venom showed strong procoagulant activity when tested using a Sonoclot Analyzer. Fractions 1, 3, 5 and 9 inhibited platelet function. In this study we have described the activities of the crude venom and its size-fractions from the scarcely studied B. venezuelensis. Haemorrhagic, fibrinolytic, procoagulant and proteolytic activities, and the inhibition of platelet function were detected. This preliminary study paves the way for the identification of specific molecules in B. venezuelensis venom that could have therapeutic potential for cancer and aberrant haemostasis treatment.

Leukocyte, Haemostatic and Inflammatory Biomarkers are Activated in Patients with Cardiovascular Disease (CVD): A Pilot Study.

Background: Cardiovascular disease (CVD) provides a huge economic strain worldwide and is responsible for over 4 million deaths in Europe annually. Atherosclerosis, a key component of CVD, is recognised as an inflammatory process. This clinical pilot-study aimed to compare a range of selective leukocyte, haemostatic and inflammatory biomarkers in patients with CVD to healthy volunteers. Original Research Article British Journal of Medicine & Medical Research, 4(26): 4392-4406, 2014 4393 Patients and Methods: Fifty participants were recruited, 21 patients with CVD (due to atherosclerosis) and 29 healthy volunteers (with no history of CVD or diabetes). All participants for the study provided a non-fasting venous blood sample prior to analysis (n=50). The biomarkers measured included the Cluster of Differentiation 11b (CD11b) cell surface expression in monocytes and neutrophils, neutrophil elastase, fibrinogen, von Willebrand Factor (vWF), protein C and C-Reactive Protein (CRP). Results: vWF levels were significantly raised in CVD patients (186.8±106.6 %vWF:Ag) compared to healthy volunteers (109.9±85.2 %vWF:Ag), (p<0.001). CRP was significantly raised (3mg/dL) in CVD patients compared to healthy volunteers (<3mg/dL), (p=0.036), with the CD11b cell surface expression in monocytes being higher (0.64±0.55 MFI) in CVD patients compared to healthy volunteers (0.37±0.44 MFI), (p<0.005). No differences were observed for protein C, fibrinogen, neutrophil elastase or neutrophil CD11b in CVD patients compared to healthy volunteers (p>0.05). Discussion and Conclusion: Patients with CVD have elevated levels of vWF, CRP and CD11b cell surface expression (monocytes) compared to healthy volunteers. The results of this study support the premise of leukocyte, haemostatic and inflammatory involvement during CVD, and that measuring biomarkers such as vWF and leukocyte CD11b cell surface expression, may aid in the diagnosis and monitoring of patients with CVD. However, further large-scale prospective studies are required to fully understand the relationship between these markers and CVD.

Effect of Alcohol Consumption on Platelet, Prothrombin Time and Activated Partial Thromboplastin Time of Alcoholics in Birnin Kebbi, Kebbi State, Nigeria.

Aims: Alcoholism is a global public health problem with significant socioeconomic implications. The aim was to investigate the effect of alcoholism on the haematological and haemostatic parameters of consecutively recruited alcoholics in Birnin Kebbi, Kebbi State and North Western Nigeria. Study Design and Methodology: This prospective case-control study included one hundred adults alcoholics [≥18 years), aged range (18-60), mean age (38.46 ± 13.26) and made up of 68 males (68%) and 32 females (32%)]. Fifty gender and age matched non-alcoholics were monitored as controls. Ethical approval was obtained from the research and ethics committee in the Faculty of Medical Laboratory Science of the Usmanu Danfodiyo University Sokoto, North Western Nigeria. Written informed consent was obtained from all study subjects after counselling. Place and Duration of Study: This study was carried out at the service laboratory in the Department of Haematology, Faculty of Medical Laboratory Science in Usmanu Danfodiyo University in Sokoto North Western Nigeria between May 2011 to February, 2012. Result: Participants for this study included 50 heavy alcoholics and 50 moderate alcoholics (subjects) and 50 age and gender –matched non-alcoholics (controls). Platelet count of non-alcoholics, moderate and heavy alcoholics was; 260.7 ± 48.17, 253.3 ± 43.16 and 130.6 ± 6.79 respectively. Platelet count was significantly lower among heavy alcoholics compared to non-alcoholics (p=0.0001). Although marginally higher, there was no statistically significant difference in the platelet count of moderate alcoholics and non-alcoholics (p=0.10). We observed a negative correlation between platelet count and duration of alcoholism (r=-0.62). The mean prothrombin time (PT) and activated partial thromboplastin time (APTT) values of non-alcoholics, moderate alcoholics and heavy alcoholics was; (14.46 ± 0.97 and 34.82 ± 13.71), (15.74 ± 1.26 and 35.78 ± 3.50) and (19.46 ± 0.93 and 43.42 ± 5.13) respectively. Prothrombin time and activated partial thromboplastin time values were significantly lower among heavy alcoholics compared to non-alcoholics (p=0.0001). PT and APTT were marginally higher among moderate alcoholics compared to non-alcoholics but the difference however was not statistically significant (p= 0.08 and 0.62 respectively). We observed a positive correlation between duration of alcoholism and prolonged prothrombin time and activated partial thromboplastin time (r = 0.46 and 0.55 respectively). Conclusion: Our study has shown that alcoholism produces a significant adverse effect on some haematological and haemostatic parameters. Evidenced data generated from this study can facilitate the development of a policy on the effective management of haematological and haemostatic complications associated with alcoholism. There is need to enact laws that regulate the production, sales and consumption of various alcoholic beverages to prevent abuse and protect the health of citizens.

Laser - An Innovative Tool In Periodontal Therapy - A Review Paper

Dentistry has entered an exciting era of technological advancements. The advent of newer modalitiesof treatment like the use of laser radiation has heralded a change in the field of Periodontics since itsdevelopment and subsequent applications for dental hard and soft tissue procedures. Extensive researchhas been done on the possible benefits of lasers derived from the adjunctive effects of bacterial controland haemostasis associated with its use. This review attempts to explore the current status of laserapplications in the treatment of periodontal diseases and the emerging concepts in the utilization of laserenergy. The limitations of lasers in periodontal therapy are also briefly discussed.

New Endoscopic Hemostasis Methods

Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension.

Nuevos anticoagulantes orales / New oral anticoagulant drugs

Thromboembolic disease (TED) is the leading cause of morbidity and mortality worldwide. The hallmark of oral long-term anticoagulant therapy has been the use of vitamin K antagonists, whose anticoagulant effect is exerted inhibiting vitamin K epoxide reductase. Warfarin and acenocoumarol are the most commonly used. In the last five years several new drugs for long term anticoagulation have been developed, which can inhibit single clotting factors with the purpose of improving drug therapeutic range and, ideally, minimizing bleeding risks. This review addresses the state of the art on the clinical use of inhibitors of activated factor X and thrombin.