Comparing modified Lee and White method against 20-minute whole blood clotting test as bedside coagulation screening test in snake envenomation victims

Abstract Background: Twenty-minute whole blood clotting test (20WBCT) and Modified Lee and White (MLW) method are the most routinely employed bedside tests for detecting coagulopathic snake envenomation. Our study compared the diagnostic utility of MLW and 20WBCT for snakebite victims at a tertiary care hospital in Central Kerala, South India. Methods: This single-center study recruited 267 patients admitted with snake bites. 20WBCT and MLW were performed simultaneously at admission along with the measurement of Prothrombin Time (PT). The diagnostic utility of 20WBCT and MLW was determined by comparing the sensitivity (Sn), specificity (Sp), positive and negative predictive values, likelihood ratios, and accuracy at admission with an INR value > 1.4. Results: Out of 267 patients, 20 (7.5%) patients had VICC. Amongst those who had venom-induced consumption coagulopathy (VICC), MLW was prolonged for 17 patients, (Sn 85% 95% confidence interval [CI]: 61.1-96.0) whereas 20WBCT was abnormal for 11 patients (Sn 55%, 95% CI: 32.04-76.17). MLW and 20WBCT were falsely positive for the same patient (Sp 99.6%, 95% CI: 97.4-99.9%). Conclusion: MLW is more sensitive than 20WBCT to detect coagulopathy at the bedside amongst snakebite victims. However, further studies are necessary for standardizing bedside coagulation tests in snakebite cases.

El "chaco": arcilla medicinal comestible del altiplano peruano y sus propiedades en la patología digestiva / The "Chaco": eatable medicinal clay in the Peruvian highlands and his properties in digestive diseases

Los pobladores del altiplano peruano-boliviano consumen una sustancia natural conocida como "chaco", muy difundida desde la época precolombina y apreciada por sus propiedades digestivas. El Chaco es una arcilla medicinal comestible que es usada en forma de suspensión con agua para cohibir molestias dispépticas o manifestaciones ácido-pépticas. En esta contribución damos a conocer aspectos físico-químicos de la composición del Chaco, estudios experimentales en animales que evalúan su efecto antiulceroso y una prueba in vitro que estudia su propiedad antiácida. El mecanismo de acción terapéutico propuesto se debe a una acción citoprotectora sobre la mucosa gástrica por mecanismos independientes de la inhibición de la secreción ácida, ya que no posee propiedad antiácida in vitro. Además tiene una capacidad de adsorción a distintas moléculas orgánicas debido a su gran superficie externa y carga tetraédrica que hace que interaccione con sustancias polares como el agua y toxinas. El otro propósito de esta contribución especial, es reconocer la coexistencia de la "Medicina Tradicional" y la "Medicina Occidental", situación que conlleva a la necesidad de la investigación preclínica de diversos recursos naturales.

The inhabitants of the peruvian-bolivian plateau consume a natural substance known as "Chaco", widespread since pre-Columbian era and appreciated for its digestive properties. The Chaco is an edible medicinal clay that is used as slurry with water to restrain dyspeptic discomfort or acid-peptic manifestations. In this contribution we present physicochemical aspects of the composition of the Chaco, experimental animal studies that evaluate its antiulcer effect and in vitro test that studies the antacid property. The proposed mechanism of therapeutic action is due to a cytoprotective effect on the gastric mucosa by independent mechanisms of acid secretion inhibition, as it has no antacid property in vitro. Also it has an adsorptivity to different organic molecules due to their large surface area and tetrahedral charge that makes it to interact with polar substances such as water and toxins. The other purpose of this special contribution is to recognize the coexistence of "Traditional Medicine" and "Western Medicine", a situation which leads to the need for preclinical research of various natural resources.

Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis

OBJECTIVES: Recent guidelines recommend that all cirrhotic patients should undergo endoscopic screening for esophageal varices. That identifying cirrhotic patients with esophageal varices by noninvasive predictors would allow for the restriction of the performance of endoscopy to patients with a high risk of having varices. This study aimed to develop a decision model based on classification and regression tree analysis for the prediction of large esophageal varices in cirrhotic patients. METHODS: 309 cirrhotic patients (training sample, 187 patients; test sample 122 patients) were included. Within the training sample, the classification and regression tree analysis was used to identify predictors and prediction model of large esophageal varices. The prediction model was then further evaluated in the test sample and different Child-Pugh classes. RESULTS: The prevalence of large esophageal varices in cirrhotic patients was 50.8 percent. A tree model that was consisted of spleen width, portal vein diameter and prothrombin time was developed by classification and regression tree analysis achieved a diagnostic accuracy of 84 percent for prediction of large esophageal varices. When reconstructed into two groups, the rate of varices was 83.2 percent for high-risk group and 15.2 percent for low-risk group. Accuracy of the tree model was maintained in the test sample and different Child-Pugh classes. CONCLUSIONS: A decision tree model that consists of spleen width, portal vein diameter and prothrombin time may be useful for prediction of large esophageal varices in cirrhotic patients.

Susceptibility of bromadiolone anticoagulant rodenticide in two rodent species and its haematologic effect

Susceptibility levels of the Norway rat, Rattus norvegicus and the roof rat, Rattus rattus to bromadiolone anticoagulant rodenticide by bioassay and biochemical methods were studied. Animals were trapped from Giza and Qualyobia Governorates in which the anticoagulant rodenticides were used to control rodents for long periods. Complete mortality was obtained for both species and sexes within standard no-choice feeding test period [4 days] indicating bromadiolone susceptibility. Treatment of rats with LD50 showed high prothrombin times which also indicate the susceptibility of the tested animals. In treated rats, bromadiolone caused significant decrease in the total erythrocytic counts and increase in the total leucocytic counts. In survivors, RBCs, WBCs approximately reached the control levels at day 43 post treatment. Also, treatment decreased neutrophils, eosinophils, basophils and monocytes but increased the lymphocytes in dead and survived animals more than in controls

Usefulness of Silica Clotting Time for Detection of Lupus Anticoagulants / 대한진단검사의학회지

BACKGROUND: The presence of lupus anticoagulants (LA) is a strong risk factor for thrombosis in antiphospholipid syndrome. We investigated the usefulness of addition of silica clotting time (SCT) to the pre-existing dilute Russell's viper venom test (dRVVT) for detection of LA. Also, we analyzed differences in the thrombotic features and the characteristics of antiphospholipid antibodies between dRVVT and SCT. METHODS: A total of 167 patients positive for LA or anti-cardiolipin (anti-CL) antibody and 76 healthy controls were enrolled. The dRVVT and SCT were used for detection of LA. Anti-CL, anti-beta2-glycoprotein I (anti-beta2 GPI) and anti-prothrombin (anti-PT) antibodies were measured using commercial ELISA kits. RESULTS: In detection of thrombosis, the sensitivity of the combined test of SCT and dRVVT was 56.4%, which was higher than that of dRVVT alone (46.2%) or SCT alone (23.1%). The specificity of the combined test (80.9%) was comparable to that of dRVVT (81.9%). Also, odds ratio for predicting thrombosis was higher in the combined test than in dRVVT or SCT alone. When normalized LA ratio of the two tests was compared, the group of patients with higher ratio of SCT showed significantly higher prevalence of recurrent abortion and higher positivity of IgG types of anti-CL, anti-beta2 GPI and anti-PT than the group with higher ratio of dRVVT. CONCLUSIONS: Addition of SCT to dRVVT can improve the detection sensitivity of thrombosis in LA test. And the high normalized LA ratio of SCT may be a useful parameter for detection of recurrent abortion.

Adequação de um sistema de hemodiálise em eqüinos / Adequacy of hemodialysis system in horses

Realizou-se a adequação da técnica de hemodiálise com eqüinos, distribuídos em quatro grupos experimentais de seis animais cada. Os animais do grupo I foram submetidos a cateterismo central unilateral (grupo-controle); os do grupo II foram submetidos a cateterismo central unilateral com cateter duplo-lúmen e a uma sessão de hemodiálise de seis horas; os do grupo III a cateterismo central unilateral com cateter duplo-lúmen e duas sessões de hemodiálise de seis horas e os do grupo IV a cateterismo central bilateral com cateter monolúmen e a uma sessão de hemodiálise de seis horas. Empregaram-se xilazina 10 por cento (0,4mg/kg) e acepromazina 2 por cento (0,008mg/kg) via intravenosa para sedação. Foram utilizados dois hemodialisadores conectados em série, do tipo fibras ocas, baixo fluxo, membrana de polissulfona e área de 1,8m². O fluxo sangüíneo médio foi de 319,18±97,41ml/minuto, associado a um fluxo de dialisato de 500ml/min. A anticoagulação foi feita com heparina sódica em 100UI/kg para primming, repetida na dose de 53,86±18,61UI/kg/hora. Foram avaliados: tempo de coagulação, tempo de protrombina, tempo de tromboplastina parcial ativada e contagem plaquetária, e verificado trombocitopenia nos grupos dialisados. O melhor acesso vascular foi proporcionado pelo cateterismo unilateral com cateter lúmen-duplo (Grupos II e III), podendo a técnica de hemodiálise ser empregada na espécie eqüina, com dialisadores de alta eficiência, em sessão de seis horas de diálise.

Hemodialysis adequacy was studied in four groups with six horses in each: the treatments: group I animals were submitted to unilateral central venous catheter (control group); group II animals were submitted to unilateral central venous double lumen catheter and one six-hour session of hemodialysis; group III horses were submitted to unilateral central venous double lumen catheter and to two six-hour session of hemodialysis, and group IV horses were submitted to bilateral central venous mono lumen catheter and to one six-hour session of hemodialysis. Xilazine 10 percent (0.4mg/kg) and acepromazine 2 percent (0.008 mg/kg) were iv administrated for sedation. Two hollow fiber, 1.8m² low flux polyssulfone hemodialysis apparatus were used in a connected serie. The mean blood flux was 319.18±97.41ml/min with a dialisate flux of 500ml/min. Anticoagulation was performed with sodium heparin, 100UI/kg for priming at the dose of 53.86±18.61UI/kg/h. Anticoagulation monitoring was performed by clotting time, protrombin time, tromboplastin activated time, and platelet number. Decrease in platelet number was detected in groups submitted to dialysis. The best vascular access was performed with double lumen catheter and the hemodialysis may be used in equine practice, with high performance dialyze used in six- hour session.

Effect of implementing nursing guidelines on occurrence of deep venous thrombosis for critically iLL patients

Deep venous thrombosis [DVT] is a major health problem that results in significant morbidity and mortality for the critically ill patients in the critical care units. It was documented that DVT occurs in about two million Americans each year, whereas pulmonary embolism [PE] as a complication of DVT causes approximately 50.000 to 60.000 deaths. Moreover, it was revealed by a study done in Assuit University Hospital that out of 220 surgical patients, 12[5%] died with pulmonary embolism as a complication of DVT. Other research done at Alexandria University in El-Hadra Hospital on 50 orthopedic patients revealed that seven patients were detected with DVT, The critical care nurses are the key players in the prevention of DVT and its complications. They are in the ideal position to asses patient risk factors early and ask for DVT prophylaxis. The current study was carried out to evaluate the effect of implementing nursing guidelines on the occurrence of DVT for critically ill patients. Four critical care unites were used to collect the data for this study at Assuit University Hospital, sixty critically ill patients were included in this study, they were divided into two groups G1 [control group] and G2 [interventional group] 30 patients each. Two tools were used to collect the data of this study. Tool one: "Patient's assessment for DVT, and Tool two: the "DVT evaluation sheet". Findings of the current study revealed low incidence of DVT for the global sample, only two patients experienced DVT in the control group, and none of the interventional group experienced DVT. Moreover, it was observed that the preventive measures of DVT done by the critical care nurses for the control group using non-pharmacological and mechanical methods were not adequately performed. In addition, it was found that all the studied patients of control group did not wear the elastic stocking, while small proportion of this group performed leg exercises, changed their position, did deep breathing, and coughing exercises, and transfer on the chair. It was observed that most of the studied patients experienced low percent of DVT manifestations with no statistical significant difference between the both groups. The present study revealed also that nearly half of the studied patients were in moderate and high risk grades for DVT in the both groups. Based on the current study findings it can be recommended that this research should be repeated on a large sample size and in multi centers for generalization. Moreover, training programs should be established to update critical care nurses' knowledge and skills about DVT preventive measures, and how to use the technical skills to assess the occurrence of DVT using the evidence base nursing and medicine

Study of some haemostatic and inflammatory parameters in preeclamptic and normotensive pregnant females

Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy characterized by gestational hypertension and proteinuria. It complicates many pregnancies and is the third common cause of maternal and neonatal mortality and morbidity. The aim of the present work was to elucidate the relationship between serum maternal levels of C-reactive protein [CRP] as an inflammatory marker and coagulation and fibrinolysis as haemostatic markers in preeclamptic and normotensive pregnant females compared to non-pregnant females. Sixty females were enrolled in the study divided into ten non pregnant healthy females as the control group [Group I], twenty five normotensive pregnant females [Group II], twenty five preeclamptic pregnant females [Group III]. The pregnant females all were primigravidae, in the third trimester of pregnancy. For all these females C-reactive protein was measured as an inflammatory marker. Haemostatic parameters included platelet count, prothrombin time, activated partial thromboplastin time and thrombin time as coagulation parameters while fibrinolytic parameter included euglobulin clot lysis time. The results showed a significant negative correlation between CRP and platelet count in preeclamptic group. It also showed a higher positive correlation between CRP and Euglobulin Clot Lysis Time [fibrinolysis parameter] in preeclampsia than in the normotensive and control groups

Controle do tempo de protrombina em sangue capilar e venoso em pacientes com anticoagulação oral: correlação e concordância / Comparative study of a portable system for prothrombin monitoring using capillary blood against venous blood measurements in patients using oral anticoagulants: correlation and concordance

FUNDAMENTO: O uso de anticoagulantes orais (ACO) é comum na prática cardiológica, tendo como principais indicações a fibrilação atrial e próteses valvares. Os pacientes em uso de ACO necessitam de controle freqüente do tempo de protrombina (TP). Novos sistemas portáteis de monitorização, para medida do tempo de protrombina, sem necessidade da coleta de sangue por venopunção, facilitam a rotina desses pacientes. OBJETIVO: Comparar as medidas do TP realizadas pelo sistema Coaguchek S®, em sangue capilar, com o método padrão em sangue venoso. MÉTODOS: Cento e vinte e sete pacientes em acompanhamento no ambulatório de anticoagulação do Instituto de Cardiologia foram submetidos ao método convencional e coleta de sangue capilar da polpa digital para medida com o sistema Coaguchek S®. RESULTADOS: A idade foi de 58±14 anos, 90 por cento eram brancos. As indicações de ACO foram fibrilação atrial 49,6 por cento e próteses valvares 37,0 por cento. O coeficiente de correlação r s foi 0,90 (p<0,0001; IC:95 por cento 0,87-0,93) entre o sistema em estudo e o controle. A medida de concordância entre pacientes com INR <2, entre 2 e 3,5 e > 3,5 foi de Kappa 73,5 por cento. O sistema Coaguchek S® superestimou o INR em 0,15±0,85 unidades. Valores acima de 3,5 unidades de INR mostram discrepância importante entre as duas técnicas. CONCLUSÕES: O sistema Coaguchek S® mostrou boa correlação e bom grau de concordância quando comparado com o controle, com resultados menores que 4. Porém, valores de INR acima de 3,5 ainda necessitam de confirmação com o método padrão.

BACKGROUND: Oral anticoagulants (OAC) are widely used in cardiology and are mainly indicated in cases of atrial fibrillation and prosthetic heart valves. Regular prothrombin time (PT) control is required for patients using OAC. New portable monitoring systems for measuring prothrombin time, eliminate the need to collect blood by venous puncture and facilitate daily life for these patients. OBJECTIVE: To compare PT measurements using the Coaguchek S™ system with capillary blood and the standard method in venous blood. METHODS: One hundred and twenty-seven patients from the Cardiology Institute's anticoagulation clinic underwent conventional blood collection and capillary blood collection via a finger prick for measurements using the Coaguchek S™ system. RESULTS: The mean age was 58 ± 14 years and 90 percent of the patients were white. OAC indications were atrial fibrillation (49.6 percent) and prosthetic heart valves (37.0 percent). The correlation coefficient, r s , was 0.90 (p<0.0001; CI:95 percent 0.87-0.93) between the Coaguchek S™ system and the control method. The Kappa measure of agreement among the patients with INR <2, INR between 2 and 3.5 and INR > 3.5 was 73.5 percent. The Coaguchek S™ system overestimated INR by 0.15±0.85 units. A great deal of discrepancy was found between the two techniques for INR values higher than 3.5 units. CONCLUSION: The Coaguchek S™ system when compared to the control method revealed good correlation and a high degree of agreement for results lower than 4 units. However, confirmation is required for INR values above 3.5 using the standard method.