Postoperative bleeding following preoperative clopidogrel administration in patients with haemoglobin level above 110 g/l undergoing urgent cabg

Abstract Introduction: Patients with acute coronary syndrome usually receive dual antiplatelet therapy (DAPT) (usually clopidogrel + aspirin) prior to coronary catheterization, and approximately 10% of these patients require coronary artery bypass grafting (CABG). DAPT has favorable effects on prevention of thrombus formation, but it can have deleterious effects on surgical hemostasis. Anaemia, if present, gives additional risk to such patients. The aim of this study was to examine if DAPT affects postoperative bleeding in patients with haemoglobin levels above 110 g/L, who underwent urgent or emergent CABG, less than five days after stopping DAPT therapy. Methods: Data were collected prospectively on 122 CABG patients, operated by a surgical team from March 2008 to August 2013. Patients were stratified into two groups: group 1 received DAPT within 5 days of CABG (n=65), and group 2 where DAPT was discontinued for more than 5 days prior to CABG (n=57). All patients were diagnosed with acute coronary syndrome preoperatively, and all of them had haemoglobin levels above 110 g/L. Patients who needed reoperation, combined procedures, or off-pump revascularization were excluded. Results: There was no hospital mortality. Mean chest tube losses after the surgical revascularization did not differ significantly, but group 1 received a higher quantity of transfused red blood cells and platelets. Conclusion: Urgent and emergent surgical revascularization using extracorporeal circulation in patients with acute coronary syndrome whose preoperative haemoglobin levels are above 110 g/L is a safe and effective procedure. We suggest that, where indicative, one may perform CABG in less than 5 days after the clopidogrel discontinuation.

Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss / Uso do ácido tranexâmico em artroplastia total primária de joelho: repercussões na perda sanguínea perioperatória

ABSTRACT BACKGROUND AND OBJECTIVES: The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. METHOD: 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5 g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5 min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24 h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. RESULTS: There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p = 0.925) compared to placebo. Group TA had a decrease of 12.28% (p = 0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35 mL in blood loss (25.32%) compared to group GP (p = 0.027). The number of blood transfusions was higher in Group GP (p = 0.078). Thromboembolic events were not seen in this study. CONCLUSION: Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso do ácido tranexâmico, em cirurgias de artroplastia total primária de joelho, tem sido objeto de constante estudo. As estratégias para redução de sangramento visam à redução da necessidade de transfusão de sangue devido aos riscos que apresentam. Neste estudo, propomos a avaliação do uso do ácido tranexâmico na redução do sangramento, na necessidade de transfusão de sangue e na prevalência de trombose venosa profunda (TVP) pós-operatória em artroplastia total primária de joelho. MÉTODO: Foram estudados 62 pacientes submetidos à artroplastia primária total de joelho, de junho de 2012 a maio de 2013, randomizados para receber ácido tranexâmico 2,5 g endovenoso (grupo AT), em dose única, ou soro fisiológico (grupo GP), cinco minutos antes da abertura do torniquete pneumático, respectivamente. Foram feitas dosagens de hemoglobina e hematócrito e medida a perda sanguínea 24 horas após a cirurgia. A TVP foi pesquisada durante a internação do paciente, 15 e 30 dias após a cirurgia nas consultas de revisão. RESULTADOS: Não houve diferenças demográficas entre os grupos estudados. O grupo GT apresentou queda do hematócrito 13,89% (p = 0,925) comparado com o grupo placebo. O grupo GT apresentou diminuição de 12,28% (p = 0,898) da hemoglobina comparado com o grupo GP. O grupo GT apresentou uma diminuição média de 187,35 ml nas perdas sanguíneas (25,32%) quando comparado com o grupo GP (p = 0,027). O número de transfusões sanguíneas foi maior no grupo GP (p = 0,078). Eventos tromboembólicos não foram evidenciados neste estudo. CONCLUSÕES: O ácido tranexâmico diminuiu o sangramento pós-operatório sem promover eventos tromboembólicos.

Efficacy of Ferric Carboxymaltose in Anaemia of Malignancy - A Pilot Study.

Anaemia is an important problem in malignancy. It may be due to chronic causes like malnutrition, marrow infiltration, associated renal or endocrine disorders and it may be complicated with blood loss. Measures like blood transfusion, erythropoietin injections often pose a logistical problem. Parenteral iron injections have proved to be useful in fighting anaemia in some chronic conditions e.g. patients on hemodialysis. Aims and Objectives: Primarily to see the observable change in hemoglobin (Hb) level with ferric carboxymaltose (FCM) in treating patients of malignancy on anti-cancer treatment. Materials and Methods: Twenty seven patients were enrolled for this study who were suffering from various malignancies. The baseline Hb level was estimated and FCM injection was administered as per the schedule of 500 mg intravenously (IV) weekly once. The overall results of increase in Hb level was noted during the middle of the treatment (chemotherapy or radiotherapy) and later 3-4 weeks after treatment completion. The results were analysed using SPSS and the mean values of initial Hb and after treatment were analysed. Level of significance (p value) was noted using t test. Results: In 27 patients the mean initial Hb level was 8.09 g/dl before treatment which increased to 10.28 g/dl after FCM treatment (p <0.0001). Conclusion: Treatment with FCM definitely led to a significant increase in Hb level in patients of malignancy undergoing treatment. However, further detailed study is needed to establish its definite role in improving the body iron parameters.

Lead induced alterations in hemoglobin content during gestation and lactation in Swiss albino mice

Number of studies in animal models has shown changes in hemoglobin content after lead administration during gestation and lactation, still lead induced hematological changes are not well established. In the present study, hemoglobin content of normal and lead exposed pregnant and lactating Swiss mice were compared. Pregnant females were exposed to heavy metal lead orally on diet containing 4.5% lead nitrate and lead acetate trihydrate during gestation to 3[rd] week of lactation. Hemoglobin content and blood cell counts were examined on 15[th] day of gestation and on 1[st], 11[th] and 21[st] day after birth. The results indicated that in lead intoxicated pregnant females, hemoglobin content decreased. From the results of above study it can be concluded that high levels of lead exposure during gestation and lactation can severely damage heme synthesis

Impact of twice weekly versus daily iron supplementation during pregnancy on maternal and fetal haematological indices: a randomized clinical trial

A randomized clinical trial examined the efficiency and tolerability of twice weekly versus daily iron supplementation during pregnancy. A total of 370 pregnant women were randomly assigned to receive either daily or twice weekly iron supplementation during pregnancy. There were no significant differences in initial and delivery haemoglobin and haematocrit levels between the 2 groups. Ferritin concentrations were significantly lower in the twice weekly group at delivery, but hypoferritinaemia [ferritin < 15 microg/L] was not observed in either group. The frequency of nausea, vomiting and constipation were significantly lower in the twice weekly group. Birth weight and length were significantly higher in the daily supplemented group. In non-anaemic mothers, a smaller dose of iron may be sufficient and also might prevent the complications of iron excess

Disturbance in hemoglobin metabolism and in vivo antimalarial activity of azole antimycotics / Alteración en el metabolismo de la hemoglobina y actividad antimalárica in vivo de azoles antimicóticos

Plasmodium parasites degrade host hemoglobin to obtain free amino acids, essential for protein synthesis. During this event, free toxic heme moieties crystallize spontaneously to produce a non-toxic pigment called hemozoin or ß-hematin. In this context, a group of azole antimycotics, clotrimazole (CTZ), ketoconazole (KTZ) and fluconazole (FCZ), were investigated for their abilities to inhibit ß-hematin synthesis (IßHS) and hemoglobin proteolysis (IHbP) in vitro. The ß-hematin synthesis was recorded by spectrophotometry at 405 nm and the hemoglobin proteolysis was determined by SDS-PAGE 12.5 percent, followed by densitometric analysis. Compounds were also assayed in vivo in a malaria murine model. CTZ and KTZ exhibited the maximal effects inhibiting both biochemical events, showing inhibition of β-hematin synthesis (IC50 values of 12.4 ± 0.9 µM and 14.4 ± 1.4 µM respectively) and inhibition of hemoglobin proteolysis (80.1 ± 2.0 percent and 55.3 ± 3.6 percent, respectively). There is a broad correlation to the in vivo results, especially CTZ, which reduced the parasitemia ( percentP) of infected-mice at 4th day post-infection significantly compared to non-treated controls (12.4 ± 3.0 percent compared to 26.6 ± 3.7 percent, p = 0.014) and prolonged the survival days post-infection. The results indicated that the inhibition of the hemoglobin metabolism by the azole antimycotics could be responsible for their antimalarial effect.

Los parásitos del género Plasmodium degradan la hemoglobina hospedera obteniendo aminoácidos libres para su síntesis proteica. Durante este evento, unidades de hemo libre tóxicas cristalizan espontáneamente formando un pigmento no tóxico denominado ß-hematina. En este trabajo, se investigó la capacidad de un grupo de azoles antimicóticos: clotrimazol (CTZ), ketoconazol (KTZ) y fluconazol (FCZ), en inhibir la síntesis de ß-hematina y la proteólisis de la globina. La síntesis de ß-hematina se registro por espectrofotometría a 405 nm y la proteólisis de la hemoglobina se determino por SDS-PAGE 15 por ciento seguido por análisis densitométrico de las bandas de hemoglobina intactas. Los compuestos fueron también ensayados in vivo en un modelo de malaria murina. CTZ y KTZ inhibieron la síntesis de ß-hematina con CI50 entre 10 y 15 µM y bloquearon la proteólisis de la hemoglobina (80.01 ± 2.04 por ciento y 55.33 ± 3.57 por ciento, respectivamente). En relación directa con los resultados encontrados in vitro, el CTZ redujo la parasitemia de ratones infectados en forma significativa, así como prolongó lo días de sobrevivencia post-infección en comparación con animales controles no tratados. Se sugiere así que la inhibición del metabolismo de la hemoglobina por los antimicóticos azólicos pudiera ser el mecanismo responsable de su actividad antimalárica.

[Evaluation of the influence of intravenous carnitine on hemoglobin and hematocrit levels in end stage chronic renal failure patients under hemodialysis]

Anemia is present in 60-80% of hemodialysis patients. Recombinant erythropoietin is the treatment of choice for anemia in these patients, but it is expensive. Many researchers have shown the effect of carnitine on anemia. Therefore, this work was designed to evaluate the influence of intravenous carnitine on hemoglobin and hematocrit levels in chronic renal disease patients who were under hemodialysis. This study was accomplished on 29 patients who were under hemodilysis for at least one year and did not have other reasons for their anemia. Using balance block randomization method the patients divided in to two groups: placebo group [n=15] and case group [n=14]. After each dialysis session [3 times a week for 3 months] the case group was injected 1 gr intravenous carnitine while the placebo group received 1 gr distilled water. There was no significant difference between the two groups regarding sex and age. The average amount of hemoglobin and hematocrit was equal in two groups before the intervention. But, finally after the intervention the amount of hemoglobin and hematocrit significantly increased in the case group [P=0.001 and P=0.003 respectively]. Findings of this study revealed that carnitine increases the amount of hemoglobin and hematocrit in hemodialysis patients and improves their anemia. However, further studies with more patients are recommended

Ethanol in low chronic dose level attenuates major organic effects in malnourished rats

The aim of the present study was to evaluate the chronic toxicity of ethanol low blood levels in malnourished rats. Female Wistar rats (220 g) were subjected to either an ad libitum diet (W, well-nourished, n=10) or food restriction (M, malnourished, n=10). Water (WW and MW) or ethanol solution (W5 percent and M5 percent) was offered to half of each nutritional group (n=5) as the only fluid source. The treatment was continued for two months. After sacrifice, blood biochemical parameters and macroscopic, histologic and morphometric evaluation of the liver were performed. Results indicated that: Ethanol consumption was higher in malnourished rats and minimized body weight loss in malnourished rats, while it decreased the body weight gain in well-nourished ones. Behavioral ethanol intoxication was more severe in malnourished rats. Malnutrition decreased hematocrit and hemoglobin but, on the other hand, ethanol was a protective factor of that effect (hemoglobin: MW 10.6 mg/dl / ME 13.02 mg/dl, p< 0.05). Ethanol increased the relative liver weight of both well-nourished and malnourished rats. Ethanol intake minimized iron pigment, collagen area and binuclear hepatocyte/ field increased by malnutrition. These data are in accordance with previous reports which showed ethanol as an important source of calories and, even chronically, ethanol still attenuates the effects of malnutrition.

PDpoietin in comparison with eprex in treatment of anemic patients on hemodialysis

PDpoietin is a recombinant erythropoietin alfa that has been introduced by a manufacturer in Iran. We assessed the effectiveness and complications of PDpoietin in comparison with Eprex in anemic patients on hemodialysis. This clinical trial was performed in a multicenter setting. Patients with a hemoglobin level less than 12 g/dL were assigned into 2 groups in order to receive either Eprex [Janssen Cilag] or PDpoietin [Pooyesh Darou] for 3 months. Forty-one and 34 patients completed the study in the PDpoietin and Eprex groups, respectively. The mean hemoglobin levels at baseline were not significantly different between the two groups of patients with PDpoietin and Eprex. In both groups, hemoglobin levels increased significantly, but there were no significant differences between the two groups at months 1, 2, and 3. At the end of the study, the mean hemoglobin levels reached 11.6 +/- 1.7 g/dL and 11.8 +/- 1.9 g/dL, respectively [P = .002; P = .01]. The mean hemoglobin per cumulative of drug dose index [hemoglobin/[erythropoietin dose/1000 x injections per month]] was not significantly different between the two groups at different treatment stages, and it did not change significantly in each group during the course of the study. No serious complications were reported. Eprex and PDpoietin could equally increase the hemoglobin levels with no significant complication. Therefore, PDpoietin can be used for treatment of anemia in patients on dialysis, and the patients will have the advantages of its availability and low price

Hemoglobin response and influence on left ventricular hypertrophy after 24-week treatment of a biosimilar epoetin-alfa in hemodialysis patients with anemia.

BACKGROUND: Anemia is common in end-stage renal disease (ESRD) patients and an important determinant for left ventricular hypertrophy (LVH) in dialysis patients. There are increasing numbers of biosimilar epoetin-alfa entering Thailand. OBJECTIVE: To conduct a prospective trial to evaluate the efficacy and safety of a biosimilar epoetin-alfa (epoetin) (Espogen) in ESRD patients receiving chronic hemodialysis complicated by anemia and to address its impact on the left ventricular mass index (LVMI) and volume index (LVVI) in these patients. MATERIAL AND METHOD: Twenty-two hemodialysis (HD) subjects were recruited from Rajavithi and Huachiew Hospitals. Inclusion criteria were chronic HD, hemoglobin (Hb) < 10 g/dL without preceding treatment (epoetin or transfusion) for 1 month. Echocardiographic baselines were obtained Epoetin-alfa was initially given 4,000 IU subcutaneously twice a week and titrated biweekly to keep the Hb range of 11 to 12 g/dL (titration period 12 weeks). Treatment continued until the end of 24 weeks. Records were made for conventional blood tests, blood pressure, amount of drugs needed to control blood pressure, and adverse events. Echocardiogram was repeated (on observer blinding) at the completion of the present study. RESULTS: After 24-week of epoetin therapy, the predialysis Hb level increased significantly from 8.0 +/- 1.3 g/dL to 11.0 +/- 1.1 g/dL (p < 0.001). The mean dose of epoetin at the present study entry was 143.6 +/- 87.8 IU/kg/ week. At the present study entry, LVH was present in 86.4% of the patients. At the completion of the present study, a decrease in LVMI was observed in 50% of the patients; however, the mean LVMI change was not significantly different. Notably, there were minimal but significant changes in LVEDD (52.8 +/- 7.0 vs. 50.1 +/- 6.9 mm, p < 0.05), LVVI (86.2 +/- 25.2 vs. 75.5 +/- 19.5 mL/m2, p < 0.05) and when subjects were partitioned into tertiles of baseline LVMI, the LVVI change was confined to the highest tertile (103.7 +/- 25.2 vs. 79.6 +/- 21.9 mL/ m2, p < 0.05). The aortic root diameter also significantly decreased despite some increase in blood pressures but without significant change in number of antihypertensive agents. No serious adverse event was observed during the present study period. CONCLUSION: The efficacy of anemia treatment and safety of the biosimilar epoetin-alfa was demonstrated in hemodialysis patients. Significant regression of LVVI and some reduction in LVMI were shown in this 24-week prospective trial.

Antianemic effect of once weekly regimen of epoetin alfa 40,000 units in anemic cancer patients receiving chemotherapy.

BACKGROUND: Anemia is a common problem in the cancer population that is the result of clinical consequences. It also has adverse effects on patients' perceived quality of life. Good management of anemia in the cancer population is therefore essential. A recent published clinical trial has demonstrated statistically significant increases in hemoglobin levels and significantly increased QOL assessment following the administration of recombinant erythropoietin. OBJECTIVE: To evaluate the effectiveness, the safety, and the quality of life by using once weekly dosing of Epoetin alfa (Eprex, Janssen-cilag) 40,000 units in the treatment of anemia in cancer patients receiving chemotherapy. SETTING: Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand. MATERIAL AND METHOD: This was an open label, non-randomized study, in 41 adult male and female anemic cancer patients who had non-myeloid malignancies in the upper area of the body part and hemoglobin ranging from 9-11 g/dL receiving chemotherapy at least 8 weeks with or without concurrent radiotherapy. The subjects were treated with Epoetin alfa 40,000 units once a week subcutaneously. If, the hemoglobin did not increase by > 1.0 g/dl after 4 weeks of treatment, the dose of Epoetin alfa was then increased to 60,000 units per dose subcutaneously at week 5. The Epoetin alfa treatment would continue for a total of 16 weeks. Clinical outcome was evaluated based on quality of life by using the linear analog scale assessment (LASA) and the functional assessment of cancer therapy-anemia (CU-QOL) instrument. Analyses were performed to determine the incremental change in QOL associated with hemoglobin increases. RESULTS: Seventy six percent of patients receiving Epoetin alfa subcutaneously showed good response with hemoglobin increases of > or = 1 g/dL (Hb level before and after = 9.82 +/- 0.78 g/dL and 12.56 +/- 1.49 g/dL, respectively; p < 0. 001). Improvement of all primary cancer- and anemia-specific QOL domains, including energy level and ability to do daily activities evaluated from LASA and fatigue assessed from CU-QOL, were significantly greater (p < 0.01) for week 16 (233.94 +/- 56.01 and 18.45 +/- 13.07) compared to the baseline (202.58 +/- 36.74 and 25.09 +/- 11.00). Epoetin alfa was well tolerated in all patients. CONCLUSION: Once weekly dosing of Epoetin alfa 40,000 units therapy is safe and effective in remodeling anemia and significantly improves the quality of life in cancer patients receiving chemotherapy. Therefore, the physician should maintain hemoglobin concentration of cancer patients in normal level to improve their quality of life through the chemotherapy period.

Changes in haemoglobin, red cell count, red cell indices and reticulocyte count in response to daily versus intermittent oral iron supplementation during pregnancy in local population

To assess and compare the relative effectiveness of different oral iron supplementation regimens on hematological parameters in pregnant anemic women. This study was carried out in the Department of Physiology, Basic Medical Sciences Institute with collaboration of Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre Karachi. Subjects were pregnant women [n=90] showing clinical anemia [Hb<11g /dl] in their 20-24 weeks of gestation. All selected women were randomly assigned to one of the three treatment groups at the time of registration [30 in daily, 30 in TW, 30 in WS] 75 out of 90 enrolled women successfully completed 12 weeks trial. Group-I received 60 mg oral iron daily, Group-2 received 60 mg TW and Group-3 received 120mg once weekly. Haemoglobin, red cell count, red cell indices and reticulocyte count were evaluated by routine methods initially at baseline before iron therapy then at four weeks interval for 12 weeks following iron therapy. There was no significant difference existed in the mean haemoglobin level, RBC count, Red cell indices and Reticulocyte count between three treatment groups at the end of 12 weeks therapy. The increase in reticulocyte count showed effective erythropoiesis following iron therapy. The results within the group were compared from baseline to twelve weeks and all the groups were compared with each other. Intermittent iron supplementation is an equally effective mode of treatment of anemia as it has similar effect on hematological status to those of standard daily supplements

Effect of unadjusted dose of erythropoietin on hemoglobin in chronic renal failure patients

To assess the response of unadjusted dose of erythropoietin with respect to weight in patients on dialysis. Fifty-five patients who previously had three dialysis sittings, had received erythropoietin for at least one month and were coming on regular follow up dialysis in dialysis clinic of Shifa International Hospital, Islamabad were included in this study. Erythropoietin was given subcutaneously twice a week adding to a dose of 4000 units per week. Hemoglobin level was determined at the end of study period. The over all increase in hemoglobin after the administration of erythropoietin was 1.18 +/- 0.06 g/dl. 87.3% patients responded to erythropoietin and showed a rise in their hemoglobin, while 12.7% did not respond. Unadjusted dose of erythropoietin showed increase in hemoglobin but in most of the cases failed to achieve the target hemoglobin. In order to achieve the target hemoglobin, administration of adjusted doses of rHuEPO is required

Inhibition of Heinz body induction in an in vitro model and total antioxidant activity of medicinal Thai plants.

Herbs have been used for medicinal purposes for centuries and known to possess antioxidant properties that may help to reduce the risk of chronic diseases, cardiovascular disease, and cancer. We screen aqueous extracts from 20 medicinal plants in Thailand that were believed to possess anti-tumor activity, help immune-stimulating property and maintain blood stasis. The antioxidant activities were investigated in two bioassays. Firstly, we demonstrated inhibition of Heinz bodies induction caused by oxidants under in vitro condition. The percentages of Heinz body inhibition activity in plant extracts from Terminalia citrina, Cassia timoriensis, and Derris elliptica were the highest followed by Anamirta cocculus, and Oroxylum indicum respectively. In addition, we investigated total antioxidant activity in plant extracts by improved ABTS radical cation decolorization assay. The total antioxidant activity of the extract from Terminalia citrina was also the highest activity followed by Ficus pubigera, Derris elliptica, Anamirta cocculus, Caesalpinia sappan, and Oroxylum indicum respectively. Our results suggest medicinal Thai plants as valuable sources of antioxidants, which may have a potential anti-carcinogenic activity.

Similarity between the in vitro activity and toxicity of two different fungizone™ / lipofundin™ admixtures

OBJETIVO: A anfotericina B é um agente antifúngico de largo espectro bastante empregado na terapia antifúngica. Entretanto, esta molécula apresenta um alto nível de toxicidade que, na maioria das vezes, impede o seu uso contínuo na terapêutica médica. O objetivo deste artigo foi comparar a eficácia e a toxicidade in vitro do Fungizon™ (AmB-D) e de dois sistemas carreadores de AmB. MÉTODOS: Três produtos foram avaliados: o Fungizon™ , e dois sistemas oriundos da mistura entre o Fungizon™ e o Lipofundin™ , uma emulsão de uso parenteral. Tais sistemas foram obtidos por duas técnicas: Na primeira diluiu-se previamanete o Fungizon™ com água para injetáveis e em seguida inseriu-se o Lipofundin™ (AmB-DAL); o segundo método consistiu na diluíção extemporânea do Fungizon™ com a referida emulsão (AmB-DL). Dois modelos celulares foram empregados no estudo: os eritrócitos (RBC) oriundos de doadores humanos e a Candida tropicalis (Ct). A avaliação in vitro (liberação de K+ e hemoglobina, e o índice de sobrevivência celular-CSR) foi realizado com quatro concentrações de AmB (entre 50 e 0.05mg.L-1). RESULTADOS: Os resultados demonstram que a ação da AmB não só foi dependente da concentração como também variou de acordo com o modelo celular e o veículo que diluiu o Fungizon™ . Nas concentrações de 50 mg.L-1, apesar da liberação de hemoglobina ser quase que total para AmB-D (99.51), para a AmB-DAL e AmB-DL este valor tendeu a zero. Um p = 0.000 demonstrou que AmB-D foi significativamente mais hemolítico. CONCLUSÃO: A mistura Fungizon™ -Lipofundin™ aparenta ser um bom sistema para carrear a AmB tendo em vista seu elevado índice terapêutico demonstrado.

Toxic effects of copper and zinc mixtures on some haematological and biochemical parameters in common carp, Cyprinus carpio (Linn).

The effect of heavy metals and mixture were studied on some haematological and biochemical parameters in fish, Cyprinus carpio at sublethal level over the period of 30 days. Heavy metal significantly decreased total RBC count, haemogoblin, heamatocrit (Hct) (except copper after 10 days exposure). The WBC count was increased significantly in all the treated fish. The MCH, MCHC, MVC were increased depending upon the exposure period; declined PVC was noticed at 1% level of significance after 30 days on all the treated fish. Serum level of chloride and calcium content were increased where as serum glucose, cholesterol and total serum protein were decreased significantly. The alteration in haematological and biochemical parameters shows more toxic in mixture after 30 days, showed more than 'addition action' of the individual toxicant.

Efficacy of sulphasalazine plus methotrexate in rheumatoid arthritis.

Early intervention with slow acting anti-rheumatic drugs (SAARDs) has led to improvement in substantial proportion of rheumatoid arthritis (RA) patients. The present open, controlled study was designed to assess whether a combination of SAARDs offer any added benefit. Fifty-four adult RA patients were randomly allocated to methotrexate (MTX) (n = 27) and MTX plus sulphasalazine (SSZ) (n = 27) groups. The subjects were followed-up fortnightly for four weeks then monthly for six months. The disease activity was assessed with the help of 10 clinical and four laboratory indices. The improvement was graded as: minor, mild decreases in indices, non-steroidal anti-inflammatory drugs (NSAIDs) continued, physician's global assessment (PGA) decreased by one; marked, acceptable decreases in indices, NSAIDs being taken sparingly, PGA decreased by at least 2, and complete, all indices normalised and patients discontinued NSAIDs completely. The improvement was considered clinically important when marked or complete improvement occurred. Adverse drug reactions resulted in withdrawal of 4 subjects from the MTX + SSZ group and 1 from the control groups. Four and three subjects in the combined and MTX groups respectively were lost to follow-up. Subjects in both groups showed significant decline in all indices except hemoglobin and neutrophil count. The differences between the two groups in the pre-treatment and post-treatment values were insignificant. Complete, marked, minor and no improvement occurred in 4 (21%), 12 (63%), 3 (16%) & 0 in the MTX and in 11 (48%), 7 (30%), 4 (17%) & 1 (4%) in MTX + SSZ groups respectively. The differences in the rates of complete and clinically important improvement between the two groups were insignificant (P 0.1398 and 0.7092). The incidence of side effects was insignificantly higher in the MTX + SSZ group. Most of them were mild and transient. The combination of SAARDs offered little added advantage in RA. However, the higher rate of complete improvement in the combination group justifies trials including larger samples.

Anemia asociada a cisplatino / Anemia associated to cisplatin

Antecedentes: El cisplatino es efectivo en el tratamiento del cáncer de ovario, testículo, pulmón, cabeza y cuello. Diversos efectos adversos han sido asociados con el empleo de este fármaco, entre ellos insuficiencia renal, neurotoxicidad, mielosupresión y alteraciones metabólicas. La anemia se ha descrito como un efecto frecuente con relación a dosis cumulativas. Objetivo: Evaluar el índice de reducción de la hemoglobina y el impacto de los bajos niveles de hemoglobina sobre el estado funcional de los pacientes oncológicos tratados con cisplatino. Pacientes: Mayores de 20 años con neoplasias avanzadas susceptibles de ser tratadas con esquemas de quimioterapia a base de cisplatino y que recibieron al menos tres ciclos de tratamiento. Sangrado gastrointestinal, enfermedad ósea metastásica, insuficiencia renal, hemoglobina menor a 10 g en la determinación previa al inició del tratamiento, así como terapia con corticosteroides o eritropoyetina recombinante fueron considerados como criterios de exclusión. Métodos: Estudio retrospectivo de enero de 1994 a diciembre de 1997. Se aplicó cisplatino, solo o en combinación, a dosis de 80 a 100 mg/m², en infusión de 8-10 horas, cada 21 días. Se utilizó terapia profiláctica con manitol, solución salina, suplemento de sulfato de magnesio y terapia antiemética con ondansetron 24 mg/día. Los niveles de hemoglobina y la capacidad funcional fueron determinados antes de cada ciclo mediante la escala de karnofsky. También se evaluó edad, sexo, tipo de neoplasia, estadio clínico y número de ciclos de quimioterapia aplicados. El análisis estadistico fue realizado con métodos descriptivos y pruebas de Kruskall-Wallis y de Spearman, Resultados: Treinta pacientes fueron incluidos, edad promedio 55.6 ñ 14.3 años, 17 hombres y 13 mujeres...

Tratamiento preoperatorio de la anemia sin transfusión de sangre en un Testigo de Jehová / Anemia preoperative treatment without blood transfusion in a Jehovah's witness

Introducción. La transfusión de sangre es un acto contrario a las creencias religiosas de los Testigos de Jehová (TJ), lo que en ocasiones constituye una gran limitante para su manejo. Caso clínico. Niño de 6 años y 9 meses de edad que sufrió quemaduras de segundo y tercer grados por ignición de gasolina en 30 por ciento de su superficie corporal. Durante su hospitalización, la hemoglobina (Hb) descendió de 13.3 a 8.2 g/dL por hemorragia profusa a nivel de las lesiones. Se propuso a los padres la transfusión de paquetes globulares, quienes se rehusaron por pertenecer a la religión de TJ; por lo anterior, se administró eritropoyetina humana recombinante (EpoHu-r) 1,000 UI subcutánea 3 veces por semana y hierro parenteral, con lo que aumentó la Hb 2.4 g/dL al séptimo día de tratamiento con un incremento máximo de 4.6 g/dL al vigésimo segundo días, lo que permitió la colocación exitosa de injertos cutáneos. Conclusión. La administración de hierro y EpoHu-r puede ser útil en pacientes anémicos que no pueden recibir transfusión sanguínea

Efectos de la dehidroepiandrosterona sobre las células sanguineas de la rata / Effects of dehydroepiandrosterone on blood cells of the rat

Se estudió el efecto de la dehidroepiandrosterona (DHEA) sobre los niveles de hemoglobina, hematocrito y leucocitos en ratas machos y hembras; en ratas castradas y en hembras preñadas. La administración subcutánea de 80 mg/kg/d de DHEA durante 5 días consecutivos no modificó en ninguno de los grupos los valores de hemoglobina y hematocrito. En las ratas no cadastradas el número de leucocitos circulantes disminuyó en un 40 por ciento con una franca reducción en el número de linfocitos. La castración aumentó en un 14 por ciento el número de leucocitos y la adiministración de la DHEA los redujo al valor inicial. La administración del benzoato de estradiol, a ratas castradas, produjo un efecto similar al inducido por la DHEA. Se concluye que, en ratas, la administración de la DHEA no afecta el número de eritrocitos pero sí modifica el número de leucocitos presentes en sangre periférica.