Research Progress of Carboxymethyl Chitosan-Based Haemostatic Materials and Their Haemostatic Mechanism --Review / 中国实验血液学杂志

Effective haemostatic materials can quickly control bleeding and achieve the purpose of saving patients' lives. In recent years, chitosan-based haemostatic materials have shown good haemostatic effects, but their application is limited because chitosan is almost insoluble in water. Carboxymethyl chitosan-based haemostatic materials can promote hemostasis by activating red blood cells and aggregating platelets. In addition, carboxymethyl chitosan can bind with Ca2+ to activate platelets and coagulation factors, and start endogenous coagulation pathways, which can adsorb fibrinogen in plasma to promote haemostasis. In this paper, the latest research progress of carboxymethyl chitosan-based haemostatic materials and their haemostatic mechanism were reviewed, in order to further strengthen the understanding of the haemostatic mechanism of carboxymethyl chitosan-based haemostatic materials, and provide new idea for the research and clinical application of carboxymethyl chitosan-based haemostatic materials.

Formulation of a Topical Tannic Acid and Chitosan Gel Haemostatic Drug Delivery System for Treatment of Wounds and Abrasions

Haemostatic agents accelerate blood clotting and help in wound healing processes for wounds or abrasions. The purpose of this study was to prepare and evaluate a haemostatic gauze impregnated with chitosan andtannic acid as two effective haemostatic agents. The haemostatic gauze was easy to prepare and produce by means of a simple solvent casting method followed by lyophylisation. Nine different concentration combinations of tannic acid and chitosan were impregnated onto a 50mm x 50mm 8 ply gauze strip and were prepared and evaluated for dissolution into simulated body fluid (SBF) and finally tested for in vitroblood clotting ability versus Quikclot©(a commercially imported haemostatic gauze).There was an initial quick release of tannic acid from the haemostatic gauze strips within 60 secs and thereafter a constant release of tannic acid. The invitroblood clotting ability was found to be better in all the formulated haemostatic gauze strips than that of Quikclot©. Best clotting extent was achieved from 0.5% w/vchitosan and 1% w/vtannic acid gauze strips at 180 secs. In conclusion, the combination of tannic acid and chitosan haemostatic gauze strips developed in this study presents an inexpensive and effective alternative to importing haemostatic gauzes and bandages

Synthesis and Pharmacological Activity of Some Pyrazolone Derivatives

A sequence of novel pyrazolone derivative was produced by the reaction of 2, 4-dinitrophenyl hydrazine (0.1 mol) and ethyl acetoacetate with benzaldehydes followed by hydrazine hydrate and finally treated with secondary amine and formaldehyde and the synthesized compounds were characterized by their physical properties (M.P and TLC) and UV, IR, 1HNMR, Mass spectroscopic studies respectively. The entire synthesized complex was tested for their anthelmintic, antimicrobialand haemostatic activity against gram-positive and gram-negative strains of bacteria and Eudrilus eugeniaand human venous blood. The antimicrobial activity of synthesized pyrazolone derivatives was assessed by agar cup method. All the synthesized complexes were screened for the antimicrobial, athelminticand haemostatic activity against some gram (+ve), Gram(-ve) organisms, Eudrilus eugeniaand human venous blood. The complexes exhibited reasonable to upright activity when compared with the standard one.

Haemostatic Alterations after Sildenafil and Tramadol Administration in Rats

Haemostatic parameters constitute measurable indices in the haemostatic system used to assess the functionality of the coagulation system of an individual to establish a state of health or disorder. This studyevaluated haemostatic parameter such as platelets count, mean platelet volume (MPV), platelets distribution width (PDW), prothrombin time (PT) and activated partial thromboplastin time (APTT) in 22 Male Albino Rats grouped and orally treated daily for three weeks with Sildenafil (4mg/200g.bwt), Tramadol(6mg/200g.bwt) and Sildenafil/Tramadol combination (4+6mg/220g.bwt). Rats were sacrificed by cardiac puncture and 5mls of blood collected for the analysis of the parameters using Sysmexhaematologyanalyser and Agape Diagnostic reagents kits. Results obtained shows a statistically significant increase in platelet count, PT and APTT compared with control across the various groups (p<0.05). A statistically significant decrease was observed in MPV, PDW inSildenafil+tramadol group, significant decrease in platelets distribution width for Tramadol group when compared with control (p<0.05). No significant difference was observed in the mean platelets volume and platelet distribution width in Sildenafil group. A comparison of Sildenafil+tramadol and Sildenafil groups shows no statistically significant difference in all the parameters analysed. There was also no significant difference in the mean platelets count, PDW, PT and APTT when Sildenafil+tramadol and Tramadol groups were compared (p<0.05). However, a statistically significant increase was seen in platelets count when Sildenafil+tramadol and tramadol were compared (p<0.05). Sildenafil and tramadol causes significant increase in platelets count, prolonged PT and APTT following single/combined daily administration in rats. Further research on these parameters, assessment of liver function, and measurement of intrinsic and extrinsic pathway coagulation factors in human taking this medication is recommended

Abnormal Changes in Some Haemostatic Parameters in First-ever Stroke Patients in Port Harcourt, Nigeria: A Preliminary Findings

Background and Purpose: Cellular component and clotting factors are involved in thrombotic events such as stroke, but the type and nature of alteration of those haemostatic parameters remain unclear. Our objective was to identify possible abnormal changes in some haemostatic parameters in established stroke patients.Materials and Methods: This was a prospective case-control study conducted at Braithwaite Memorial Specialist Hospital, Port Harcourt, Nigeria. Standard operating procedures were adopted to assayfibrinogen, antithrombin, tissue plasminogen activator, prothrombin time and activated partial thromboplastin time as well as the determination of platelet count and platelet indices.The data were analyzed using Statistical Package for Social Science (SPSS) version 17.0 software Results: A total of 108 individuals comprised of 54 stroke patients aged between 45 and 73 years(mean, 59± 13.04 years), 20 (37.04%) men and 34 (62.96%) women and another 54 age-and sex-matched healthy control subjects were studied. Significantly (p<0.05) higher mean values of mean platelet volume (MPPV), platelet distribution width (PDW), Platelet larger cell ratio (PLCR), antithrombin, tissue plasminogen activator and fibrinogen were observed in the stroke patients when compared to those of the control subjects. Whereas, significantly lower (p<0.05) mean values of platelet count, prothrombin time and activated partial thromboplastin time were observed in the stroke patients than in those of the control subjects. Conclusion: Several haemostatic parameters were found to be altered in stroke patients and have the potential to be risk factors but have not been demonstrated as being causative. Further work is needed to establish where they begin to contribute to stroke prognosis

An experimental study to test the haemostatic effect of Aloe vera

Background: Blood clotting is a process which prevents blood loss during injuries. Blood clots even when it is coming out from the blood vessels. Aloe vera is a perennial plant found all over India. It is commonly used in traditional system of medicine for treatment of wound healing, mouth ulcers, constipation, skin wrinkles and diabetes mellitus It is also used as antioxidant and antimicrobial agent. As it is used in traditional system of medicine for wound healing, this study was under taken to test the possible haemostatic effect of aloe vera.Methods: 12 rats were divided into two groups (control and test) with 6 rats in each group. Determination of Bleeding Time (BT), rat tail was warmed for one minute in water at 40?C and then dried. A small cut was made in the middle of the tail with a scalpel. In test group, a drop of aloe vera leaf extract was applied on the injured area immediately after making the cut in the middle of the tail, where as in the control group nothing was applied, and BT estimated. Determination of Clotting Time (CT), 12 test tubes were arranged in water bath at 37?C. Control Group: 0.4 ml of blood was collected from each rat in the control group and added to 6 test tubes kept in the water bath. Test group: For the remaining 6 test tubes 0.1 ml of aloe vera leaf extract was added. 0.4 ml of blood collected from the test group was added to these test tubes. The CT was estimated for both control group and test group.Results: The results were statistically analyzed by using unpaired t-test. The reduction in BT and CT for test group was statistically highly significant (p<0.001) compared to control group.Conclusions: In this study aloe vera leaf extract significantly reduced both BT and CT in the test group.

Haemostatic abnormalities in solid malignancies

Background: Though the actual symptoms of any haemostatic abnormalities in patients of solid malignancies are not seen commonly screening in all such cases can guide us to correct those abnormalities in time and improve the outcome. The present study is undertaken with an objective to find out coagulation disorders in patients of solid malignancies and compare their levels according to the stage of the cancer.Methods: A prospective study was undertaken in a tertiary care centre in Maharashtra, India from December 2010 to September 2012. Total 102 cases with malignancies diagnosed on histopathology/cytological examination were tested for BT, CT, Platelet count, PT, APTT, TT and D-dimer levels. These tests were repeated on first postoperative or post chemotherapy day wherever possible. Early and advanced stages of cancer were divided according to the spread of the tumor. Results were compared between the two. DIC cases were also noted.Results: Out of 102 cases studied, haemostatic abnormalities were more common in adenocarcinomas that too in mucin secreting adenocarcinomas. The percentage of cases with increased D-dimer values was higher in the advanced disease compared to early disease. The PT, APTT, TT and platelet count showed statistically significant differences between the early and advanced disease groups. Compared to preoperative values, postoperative values were abnormal but the change was not statistically significant.Conclusions: Screening for coagulation profile in all solid malignancies can help to predict the chances of complication and therapeutic interventions can be done.

Effect on Haemostatic Proteins in Plasma Prepared from Fresh and Overnight Stored Whole Blood

@#Introduction: Fresh frozen plasma (FFP) is prepared within 8-10 hours after collection to ensure preservation of coagulation factors however, adherence to this time is a challenge. Extended processing time is an option to overcome it. This study was done to evaluate haemostatic proteins after extended time. Methods: Blood collected from a mobile donation centre was divided into three (3) groups before processed into plasma. Group 1 (n=42) was prepared within 8 hours post collection. Group 2 (n=42) was prepared after overnight and stored at room temperature. Group 3 (n=42) was prepared after overnight but stored at 2-6⁰C. Plasma haemostatic proteins were measured in all groups and mean activity of each level was compared using One-way ANOVA. Results: There was no reduction in all the haemostatic proteins in plasma prepared from overnight storage (Groups 2 and 3) compared to Group 1 except for Factors VIII and V whilst PT was not significantly prolonged. aPTT was significantly prolonged in both Groups 2 and 3 compared to Group 1. There were 25.7% and 35.2% reduction of Factor VIII levels in Groups 2 and 3 respectively, however levels were above 60%. There is 8.7% reduction in Factor V level but the mean factor activity was above 90%. Comparing Groups 2 and 3, there was no significant difference in activity of all haemostatic proteins. Conclusions: Haemostatic proteins are preserved in plasma prepared from blood stored overnight. Prolongation of the APTT is reflected by reduction in Factor VIII activity but still within the normal reference range.

Haemostatic Disorders in Sickle Cell Disease Subjects in Nigeria: A Review of Literature

Background: Sickle cell disease (SCD) is an autosomal recessive disorder that is characterised with chronic anaemia and painful crisis. SCD is associated with hypercoagulability or prothrombotic state that can predispose to thromboembolic complications with increasing morbidity and mortality. Aim: This study aimed to show the various documented haemostatic disorders and possible thromboembolic complications among SCD subjects in Nigeria. Methods: A comprehensive literature search was performed using the internet search engines linked to academic databases including Pubmed, Google Scholar, Ebsco, Hinari, Scopus, etc. Studies involving hemostatic disorders in Nigeria were thoroughly searched, and the references of such articles were also searched for any probable relevant information. Findings and Conclusion: There is a paucity of information on this subject in Nigeria, and there are inconsistencies in the available studies. Haemostatic disorders in sickle cell disease are conditions that are associated with increased mortality and morbidity. Further research on the level of natural anticoagulant is required to verify the correlation between haemostatic disorders and thromboembolic complications in SCD subjects in Nigeria.

Actualización sobre prevención y tratamiento de la pérdida de sangre quirúrgica / Mise à jour sur la prévention et le traitement de la perte de sang en chirurgie / Update on Prevention and Treatment of Surgical Blood Loss

La pérdida de sangre quirúrgica es uno de los mayores retos que enfrentan los cirujanos actualmente. La demanda de cirugías de alta complejidad se ha incrementado por múltiples causas. Se realizó una revisión acerca de los principales factores que inciden en la pérdida de sangre en cada etapa de las intervenciones quirúrgicas, con énfasis en los procedimientos quirúrgicos ortopédicos. Se examinaron y evaluaron los fármacos hemostáticos existentes que contribuyen a prevenir dicha pérdida y evitan el riesgo de transfusión. Diversos factores como la anemia, edad avanzada, la existencia de comorbilidades, el tiempo quirúrgico prolongado, el empleo en el posoperatorio de medicamentos con la finalidad de lograr anticoagulación, favorecen la pérdida sanguínea quirúrgica y elevan los índices de transfusión sanguínea. El empleo de agentes hemostáticos debe estar basado en el sentido clínico de la eficacia terapéutica que se espera, la seguridad frente a posibles complicaciones y los costos económicos de su administración(AU)

Surgical blood loss is one of the biggest challenges facing surgeons today. The demand for highly complex surgeries has increased for multiple reasons. A review was made of the main factors that influence blood loss at each stage of surgery, with emphasis on orthopedic surgical procedures. Existing hemostatic drugs that help prevent such loss and avoid the risk of transfusion were examined and evaluated. Various factors such as anemia, advanced age, the existence of comorbidities, prolonged surgical time, the use in the postoperative of medicines in order to achieve anticoagulation, favor surgical blood loss and elevate blood transfusion rates. The use of hemostatic agents should be based on the clinical sense of the expected therapeutic efficacy, safety against possible complications and the economic costs of its administration(AU)

La perte de sang chirurgicale est l'un des plus grands défis actuels auxquels sont confrontés les chirurgiens. La demande pour les chirurgies très complexes a augmenté de multiples causes. Un examen sur les principaux facteurs qui influent sur la perte de sang à chaque étape de la chirurgie, en mettant l'accent sur les interventions chirurgicales orthopédiques effectuées. Ils ont été examinés et évalués médicaments hémostatiques existants qui aident à prévenir la perte et de prévenir le risque de transfusion. Divers facteurs tels que l'anémie, la vieillesse, la présence de comorbidités, le temps opératoire prolongé, l'utilisation post-opératoire des médicaments afin d'atteindre anticoagulation, promouvoir et élever les taux de transfusion sanguine de chirurgie de perte de sang. L'utilisation d'agents hémostatiques doit être fondée sur le sens clinique de l'efficacité thérapeutique attendu, la sécurité contre les complications potentielles et les coûts économiques de l'administration(AU)

Research progress of haemostatic dressing for traumatic injury prehospital firstaid / 医疗卫生装备

The main species and research status were introduced for the haemostatic dressing of the prehospital first aid in foreign countries and China.The advantages and disadvantages,problems and futural development were analyzed for kinds of haemostatic dressing.It's pointed out that the haemostatic dressing tended to be multi-functional and complicated in the future.Dressing and haemostatic system had to be designed based on traumatic conditions in case multi function could not be realized.

The clinical haemostatic effect of absorbable haemostatic membrane on posterior spinal surgery / 实用医学杂志

Objective The absorbable haemostatic membrane was used to stop bleeding during posterior spinal surgery so as to investigate the therapeutic effect and the security of the absorbable haemostatic membrane. Methods Ninety-four patients were enrolled into the experimental group and the control group. In the experimental group , the decompression wound is handled by using the regular absorbable haemostatic membrane to stop bleeding. In the control group , the conventional surgical methods , such as coagulation , brain cotton and other methods were used to stop bleeding. After the operations , patients in two groups were given indwelling vacuum drainage tube. The post operation vacuum pipe drainage , the drainage tube removing time , the incidence of postoperative complications after removing drainage tubes , the reoperation number , vital signs after 24 hour (temperature, respiration, pulse, blood pressure), and laboratory tests (blood count, coagulation function parameters) were determined and compared between two groups. Results Both the vacuum drainage at 24 hours post operation and the total vacuum drainage post operation were significantly reduced in the experimental group(P < 0.05, respectively). No significant differences in the coagulation function parameters were found between both two groups. Conclusion The absorbable haemostatic membrane may be applicable for spinal surgery.

Damage control resuscitation: A case of thoraco abdominal impalement

Damage Control Resuscitation and Surgery is the concept of controlled hypotension, haemostatic resuscitation and abbreviated surgical procedures following severe trauma; the practice of which has resulted in improved mortality and morbidity. We describe a rare case of thoraco-abdominal impalement successfully managed based on the concept of Damage Control Resuscitation.

Dispositivo para la Hemorragia puerperal (balón hemostático) / Device for Postpartum hemorrhage (haemostatic balloon)

La hemorragia postparto es un importante contribuyente a la morbilidad materna y sigue siendo la principal causa de mortalidad materna a nivel mundial; en la mayoría de los casos aparece en forma espontanea inmediata a la ocurrencia del parto, y el porcentaje mayor se refiere a la hipotonía uterina, que es rebelde a la aplicación de medidas convencionales como el masaje uterino, oxitócicos, prostaglandinas etc. Las pautas para el manejo de la hemorragia postparto implican medidas graduales desde enfoques farmacológicos hasta los quirúrgicos. El método de taponamiento uterino utilizando "balones hemostáticos" se ha añadido recientemente al arsenal de tratamiento de la hemorragia postparto. Hay varios balones disponibles, incluyendo el Balón de Bakri, Foley, Sengstaken-Blakemore, Rusch, entre otros. Este artículo estudia estas tecnologías de taponamiento uterino en el tratamiento de la hemorragia postparto y especialmente el método del Balón intrauterino aplicado en el Hospital Materno Infantil German Urquidi como una alternativa más ante esta complicación.

Postpartum hemorrhage is a major contributor to maternal morbidity and remains the leading cause of maternal mortality worldwide, in most cases appears spontaneously immediately after the childbirth, the highest percentage refers to the hypotonic uterine, which is refractory to the conventional measures such as uterine massage, oxytocin, prostaglandins etc. Guidelines for the management of postpartum hemorrhage involve gradual steps from pharmacological approaches to surgical treatment. The method of uterine tamponed using "hemostatic balls" was recently added to the arsenal of treatment of postpartum hemorrhage. There are several balls available including the Bakri balloon, Foley, Sengstaken-Blakemore, Rusch, among others. This article reviews these uterine tamponed technologies in the treatment of postpartum hemorrhage and especially the intrauterine balloon method applied in the German Urquidi's Maternity Hospital as an alternative to this complication.

Sellantes de fibrina en ginecología laparoscópica, aspectos moleculares y mecanismo de acción: revisión de la literatura / Molecular aspects and mechanism of action regarding the use of fibrin sealants in laparoscopic gynecology: a literature review

Objetivo: hacer una revisión sobre la actividad biológica y mecanismo de acción de los sellantes de fibrina en ginecología laparoscópica. Materiales y métodos: se realizó una búsqueda de la literatura publicada tanto en inglés como en español a través de Medline vía PubMed, Ovid y Cochrane, desde 1993 a 2010. Se analizaron los artículos que incluían el uso de los sellantes en ginecología laparoscópica y se agruparon por temáticas tales como antecedentes, actividad biológica, composición, administración y características biofísicas. Resultados: se encontraron entre 1993 y 2010, 200 artículos de los cuales 49 correspondían a los criterios establecidos siendo objeto de análisis. Los sellantes de fibrina contribuyen al logro de la hemostasia aumentando la expresión en las células peritoneales de los activadores e inhibidores del plasminógeno, afectando el proceso de curación, que puede ser de beneficio en la reducción de las adherencias posoperatorias. Conclusión: el desarrollo de los sellantes de fibrina surge como una alternativa práctica para la reducción de la hemorragia y control de la hemostasia, además de la reducción de las adherencias posoperatorias en la cirugía laparoscópica ginecológica...

Objective: reviewing fibrin sealants’ biological activity and mechanism of action related to laparoscopic gynecology. Materials and methods: a search was made of the literature published in both English and Spanish via PubMed/Medline, OVID and Cochrane from 1993 to 2010. Articles involving the use of sealants in laparoscopic gynecology were analyzed and grouped by topic, such as background, biological activity, composition, administration and biophysical characteristics. Results: 200 articles were found which had been published from 1993 to 2010, 49 of them complied with the established analysis criteria. Fibrin sealants contributed towards achieving hemostasis, increasing plasminogen activator and inhibitor expression in peritoneal cells, thereby affecting curing, which could be beneficial in reducing post-operative adhesion. Conclusion: developing fibrin sealants emerges as a practical alternative for reducing hemorrhage and controlling hemostasia, as well as reducing postoperative adhesion in surgery involving laparoscopic gynecology...

Correlation analysis between hemostatic activity and commercial grades of Panax notoginseng / 中草药

Objective: To explore the correlation between the hemostatic activity and commercial grades of Panax notoginseng. Methods: After treatment with different commercial grades of P. notoginseng, the mice blooding time (BT) and clotting time (CT) were measured. At the same time the prothrombin time (PT), activation part thrombin time (APTT), fibrinogen (FIB), and platelet count (PLT) were also detected by fully automated blood cell analyzer. The contents of dencichine were determined by HPLC. Results: Mice BT, CT, PT, and APTT were decreased and PLT was increased significantly in all the commercial grades of P. notoginseng. Among all the commercial grades, the countless Tou Sanqi Powder has the best hemostatic activity. There is no correlation between the commercial grades and homostatic activity. Different contents of the extracted dencichine were observed among different commercial grades of P. notoginseng. The highest content of dencichine was 0.98% in countless Tou Sanqi and the lowest was 0.52% in 80 Tou Sanqi. There is no statistical correlation between the dencichine and hemostatic activity or dencichine and commercial grades of P. notoginseng. Conclusion: There is no statistical correlation between the commercial grades of P. notoginseng and haemostatic activity or dencichine contents. The dencichine in countless Tou Sanqi which is the cheapest of all displays the better hemostaic activity than those in 13 or 20 Tou Sanqi whose cost is almost as ten times as countless Tou Sanqi's.

Daño endotelial y activación del sistema hemostático asociado al uso crónico de cocaína: estudios ex vivo e in vitro / Endothelial damage and activation of the haemostatic system associated to chronic use of cocaine: an ex vivo and in vitro study

Antecedentes: Usuarios crónicos de cocaína tienen riesgo aumentado de presentar infarto de miocardio, angina,muerte súbita y accidentes cerebrovasculares. Aunque la patogenia del daño vascular es mayormente desconocida, se ha encontrado arterioesclerosis prematura y formación de trombos intravasculares. Objetivo: Demostrar evidencia de daño endotelial y activación del sistema hemostático en usuarios crónicos de cocaína. Métodos: Un grupo de 23 pacientes con criterios de dependencia a cocaína DSM-IV; 19 hombres (edad promedio 32 a), con exposición a la droga dentro de 72 h del estudio. Disfunción endotelial se evaluó por enumeración de las células endoteliales circulantes (CEC) y nivel de sICAM . Para activación del sistema hemostático se incluyó: complejos trombina-antitrombina (TAT) y generación de trombina; NAP-2 y RANTES para activación plaquetaria. In vitro, CE en cultivo (HUVEC), se expusieron a plasma de consumidores o controles. Se midió factor von Willebrand (FVW) en el medio y expresión de FvW y factor tisular (FT) sobre las CE. Adhesión plaquetaria estática se evaluó por microscopía. Resultados: En usuarios de cocaína, con respecto a controles, las CEC estaban significativamente elevadas...

Background: chronic cocaine users have an increased risk of developing myocardial infarction, angina, suddendeath and stroke. Although the pathogenesis of this effect is not completely known, premature atheromatosis and intravascular thrombosis appear to be involved.Aim: to provide evidence for the presence of endothelial damage and activation of the haemostatic system in chronic cocaine users. Methods: 23 subjects (19males, overall mean age 32) with DSM-IV criteria for cocaine dependency and exposure to the drug within 72 hours were studied. Endothelial dysfunction was determined by circulating endothelial cell counts (CEC) and sICAM levels. Thrombin-antithrombin complexes (TAT) and thrombin generation were used to characterize haemostatic status. In vitro, platelet activation was studied by NAP-2 and RANTES. EC in culture (HUVEC) were exposed to plasma from cocaine users and controls. Von Willebrand factor was measured in the culture media as well as its expression along with that of tissue factor in EC. Platelet adhesion was evaluated by microscopy. Results: Compared to controls, EC were significantly increased in cocaine users...

Diseño de un medio de enseñanza, para el estudio de técnicas hemostáticas en sangramientos postonsilectomía / Design of a Teaching Aid in the Study of the Hemostatic Techniques in Post-tonsillectomy Bleeding

Se confeccionó un medio de enseñanza por tres especialistas de Otorrinolaringología del Hospital Pediátrico Provincial Docente "Pepe Portilla" de Pinar del Río en el año 2006. Se lograron mostrar, mediante el uso de esta maqueta, las diferentes estructuras anatómicas de la orofaringe y la conducta a seguir ante el sangramiento en pacientes amigdalectomizados. Se utilizaron materiales desechables y de bajo costo para su diseño. Se obtuvo el 100 % de promoción en los estudiantes de la brigada # 88 con el aprendizaje de la anatomía orofaríngea y el dominio de las técnicas para hacer hemostasia en el sangramiento de pacientes tonsilectomizados.

Three otolaryngologists designed a teaching aid at "Pepe Portilla" Provincial Children Teaching Hospital in Pinar del Rio in 2006. It was shown by means of this model the different anatomical structures of the oro-pharynx and the behavior to be followed in presence of a bleeding in patients underwent a tonsillectomy. Disposal and low cost materials were used for the design . A promotion of 100 percent was attained in students from the Brigade 88 knowing the oropharyngeal anatomy as well as the techniques for the hemostasis in presence of bleeding in patients undergone a tonsillectomy.

Relationship between some coagulation indices with hemorrhage complication in patients undergoing cardiac surgery with cardiopulmonary bypass

Background: Cardiac surgery with cardiopulmonary bypass (CPB) can cause haemostatic abnormalities that increase the risk of postoperative hemorrhage. Objectives: (1) To study changes of coagulation in cardiac patients undergoing surgery with CPB. (2) To research the relationship between duration of cardiopulmonary bypass, coagulation tests and postoperative hemorrhage complications. Subjects and methods: A cross sectional descriptive study was carried out on 252 patients (105 women, 147 men) undergoing cardiac surgery with CPB due to congenital heart disease and acquired heart disease at Viet Duc Hospital from December 2005 to August 2006. Results: After surgery, 54 patients had to transfuse the blood products, accounting for 21.4% rate. 21 cases had abnormal bleeding (8.3%). 12 patients assigned to re-operate due to bleeding (4.8%). There was an inverse correlation between platelet counts after surgery with duration of CPB and duration of aortic clamping. Relationship between rate of prothrombin, APTT, fibrinogen after surgery and duration of CPB and duration of aortic clamping was not seen. Duration of CPB prolonging over 120 minutes related to postoperative hemorrhage complication (OR=2.69 (p<0.5)). Reduced platelet count increased the risk of postoperative hemorrhage but not statistically significant (OR=1.36; p>0.05). Prothrombin ratio of less than 50% associated with the risk of postoperative hemorrhage (OR=4.83; p<0.01). Conclusion: The routine coagulation tests can help monitor clotting in patients after cardiac surgery

Pyrazinamide therapy and severity of haemoptysis.

Background: Pyrazinamide (PZA) has been known to adversely affect the haemostatic mechanisms in our body. Aim: This study aims to find out whether PZA has any influence on the course of haemoptysis. Methods: One hundred and six patients of active pulmonary tuberculosis and haemoptysis, having normal baseline coagulators profile, were included in this prospective study. One half of them were given PZA containing anti-tuberculosis regimens (PZA group) and the other half were prescribed non-PZA containing regimens (non-PZA group). They were managed conservatively and followed up for a period of 7 days. Results: Blood loss during therapy was moderate to massive in amount in majority (56.61%) of patients in the PZA group as compared to non-PZA group (35.84 %). Though the mean duration of haemoptysis was almost similar in both the groups (3.98 days in the PZA group versus 4.12 days in the non-PZA group), but in patients in whom haemoptysis lasted for more than 3 days, in the non-PZA group, majority (62.50 %) had minimal blood loss as compared to the PZA group (48.27 %). Concusion: Although PZA does not alter the mean duration of haemoptysis but omission of PZA can significantly reduce blood loss during therapy.