Evaluation of febrile neutropenia in patients undergoing hematopoietic stem cell transplantation

The aim of this study was to determine the incidence and causes of fever as a major problem contributing to transplantation related mortality among patients undergoing hematopoietic stem cell transplantation [HSCT] and evaluation of antibiotic use, according to reliable guidelines.We retrospectively reviewed hospital records of 195 adult patients who underwent HSCT between 2009-2011 at hematologyoncology and bone marrow transplantation research center. Baseline information and also data related to fever and neutropenia, patient's outcomes, duration of hospitalization and antibiotic use pattern were documented.A total of 195 patients were analyzed and a total of 268 febrile episodes in 180 patients were recorded [mean 1.5 episodes per patient]. About 222 episodes [82%] were associated with neutropenia which one-fourth of them were without any documented infection sources. Microbiologic documents showed that the relative frequencies of gram positive and gram negative bacteria were 62.5% and 37.5%, respectively. The hospital stay duration was directly related to the numbers of fever episodes [P<0.0001].The rate of febrile episodes in autologous stem cell transplantation was significantly higher compared to allogeneic type [P<0.05].It is necessary to determine not only the local profile of microbiologic pattern, but also antibiotic sensitivities in febrile neutropenic patients following hematopoietic stem cell transplantation, and reassess response to antibiotic treatment to establish any necessity for modifications to treatment guidelines in order to prevent any fatal complications from infection

Effect of oral anticoagulant therapy on coagulation activity and inflammatory markers in patients with atrial fibrillation undergoing ablation: a randomized comparison between dabigatran and warfarin

Atrial fibrillation [AF] is associated with inflammatory and hypercoagulability state. Previous studies evaluated the safety and efficacy of dabigatran and warfarin in prevention of thrombothic complications. This study was intended to assess the influence of these drugs on hemostatic and inflammatory markers among patient underwent pulmonary vein ablation. A total of 100 patients with AF who underwent catheter ablation were randomized to treatment with dabigatran [D] 110 mg twice daily or warfarin [W] adjusted to an * international normalized ratio [INR] of 2.0 to 3.0 for 3 months after ablation procedure. C - reactive protein [CRP], D-dimer, prothrombin fragment Fl + 2 [Fl +2], were measured at baseline before ablation procedures, after 30 days and after 90 days of treatment. After 3 months, the D-dimer was 164.9 +/- 48.9 in Dabigatran and 197.2 +/- 58.6 in warfarin group, Fl + 2 was 0.4 +/- 0.2 in dabigatran and 0.8 +/- 0.2 in warfarin group and CRP level was 1.8 +/- 1.6 in Dabigatran and 5.1 +/- 5 in warfarin group. [All p-values < 0.05] The results showed that treatment with dabigatran made greater changes in the serum level of CRP, D-dimer, Fl + 2. The pattern of changes in serum CRP levels D-dimer, Fl + 2 is much faster and with a greater slope in the dabigatran group

Trifluoperazine-induced cholestatic jaundice

Liver injury occurs with many drugs; therefore, a thorough work up is important for establishing the diagnosis. We report a case of trifluoperazine-induced cholestatic jaundice. A 44-year old male with schizoaffective disorder developed an increase in liver enzymes and jaundice after starting treatment with trifluoperazine .Workup for other potential etiologies was negative