Antifactor Xa Levels in Critically Ill Korean Patients Receiving Enoxaparin for Thromboprophylaxis: A Prospective Observational Study

The aim of this study was to investigate antifactor Xa (aFXa) levels after once daily dose of 40 mg of enoxaparin and to evaluate factors influencing aFXa levels among Korean intensive care unit (ICU) patients. This prospective observational study was conducted between August and December 2011 in medical ICUs at Samsung Medical Center. AFXa levels between 0.1 and 0.3 U/mL were considered to be effective for antithrombotic activity. Fifty-five patients were included. The median aFXa levels were 0.22 (IQR 0.17-0.26) at 4 hr, 0.06 (IQR 0.02-0.1) at 12 hr, and 0 U/mL (IQR 0-0.03) at 24 hr. The numbers of patients showing effective antithrombotic aFXa levels were 48 (87.3%), 18 (32.7%), and 0 (0%) at 4, 12 and 24 hr, respectively. At 12 hr, higher sequential organ failure assessment (SOFA) scores and hyperbilirubinemia were significantly associated with low aFXa levels (OR, 0.58; 95% CI, 0.36-0.93; P = 0.02 and 0.06; 0.003-0.87; 0.04, respectively). Once daily dose of 40 mg of enoxaparin is inadequate for maintaining effective antithrombotic aFXa levels, and the inadequacy is more salient for patients with high SOFA scores and hyperbilirubinemia.

Transcutaneous bilirubin levels in healthy term and late preterm indian neonates.

Objective. To provide normative data for transcutaneous bilirubin (TcB) measurements in healthy term and late-preterm Indian neonates during first 72 h of age using a multiwavelength reflectance transcutaneous bilimeter. Methods. TcB measurements were performed in healthy neonates (gestation 35 wk), in a well-baby ward, using a multiwavelength transcutaneous bilimeter (BiliCheck®, SpectRx Inc, Norcross, GA). Age-specific percentiles values for each 6- h epoch starting at 0 h of age were calculated and an age-specific TcB nomogram was developed using different percentile values. Diagnostic ability of each percentile curve for prediction of hyperbilirubinemia, defined as requirement of phototherapy, was calculated. Results. We performed 925 TcB measurements on 625 healthy newborn infants (gestation: 35 to 41 wk; age: 0 to 72 h; mean birth weight: 2808±437 g). TcB increased in a linear manner with maximum rate of rise observed during first 24 h of age (50th percentile: 0.22 mg/dL/h). 50th percentile curve of age-specific TcB nomogram had high negative predictive value (99.8%) and acceptable positive predictive value (16.4%) for prediction of hyperbilirubinemia. Conclusion: We provided age-specific nomogram of TcB for first 72 h of age in healthy term and late-preterm Indian neonates. Percentile curves and rate of rise in TcB may help in identification of neonates at low-risk of development of hyperbilirubinemia facilitating their safer discharge from the hospital. Diagnostic utility of this nomogram for predicting hyperbilirubinemia needs to be tested in a separate validation cohort.

Síndrome ictérica / Icteric syndrome

O entendimento do metabolismo das bilirrubinas, desde sua formação quando da degradação das hemácias, passando por sua captação e conjugação nos hepatócitos até sua eliminação pelas vias biliares,é fundamental para os diversos diagnósticosque podem ser realizadosfrente uma síndrome ictérica. Classificando as síndromes ictéricas em dois grandes grupos, temos inicialmente aquelas devidas a hiperbilirrubinemia não-conjugada, como as doenças hemolíticas, as icterícias constitucionais e a icterícia do recém-nascido. Já as síndromes ictéricasdevidas a hiperbilirrubinemia conjugada também podem ser devidas a icterícias constitucionais, mas fundamentalmente a icterícias parenquimatosas com ausência de colestase ou colestases intra-hepáticas e extra-hepáticas. O trabalho clínico de coleta dos dados de história e exame físico é essen- I cial para os diferentes diagnósticos de icterícia, assim como a interpretação de exames laboratoriais e a correta indicação de exames complementares de imagem e/ou endoscópicos. Diferenciação entre as icterícias constitucionais, o diagnóstico etiológico das hepatites virais e os padrões mais freqüentes de icterícia encontrados na clínica são oferecidos em tabelas, assim como um algoritmo para a realização desse importante diagnóstico diferencial.

Abordagem clinica, laboratorial e terapeutica do recém-nascido icterico / Clinical, laboratorial and therapeutic management of the neonatal jaundice

O objetivo desta revisäo/atualizaçäo a respeito da abordagem clinica, laboratorial e terapeutica do recém-nascido icterico foi apresentar um roteiro didático, com a finalidade de se tentar esclarecer algumas dúvidas sobre a conduta na hiperbilirrubinemia neonatal, dando enfase aos pontos polêmicos da terapeutica