THE ROLE OF MARKERS OF SYSTEMIC INFLAMMATORY RESPONSE IN PATHOGENESIS OF THROMBOTIC COMPLICATIONS IN MALIGNANCY.

Patients with malignancy have higher risk of developing venous thromboembolism. The incidence among different groups of cancer patients varies considerably depending on clinical factors, the most important being tumor entity and stage. The study was approved by the local ethics committee on human research, and written informed consent was obtained from all the study participants. After written informed consent was obtained, a precise medical history was taken, with particular attention to questions about the presence of thrombotic risk factors at the onset of VTE. We retrospectively enrolled 50 patients with Venous Thromboembolism (DVT and PTE) having malignancy and 50 healthy controls from January 2020 to December 2020. DVT were diagnosed using peripheral vascular duplex ultrasonography while PTE was confirmed in all cases by computed tomography. Patients having treatment with anticoagulant therapy, recent surgery less than 8 days previously, refusal or inability to give informed consent, and inability for ascending contrast venography or inadequate results of the venographic examination were excluded from the study. Biomarkers have been specifically investigated for their capacity of predicting venous thromboembolism (VTE) during the course of disease. The relationships between inflammation markers e.g., IL-6, IL-8 and CRP as indicators of the inflammatory process and clinical venous thromboembolism need to be investigated. We investigated IL-6, IL-8 and CRP in 50 patients with venous thromboembolism having malignancy and reported that patients having venous thromboembolism have increased levels of IL-6, IL-8 and CRP (p value < 0.05). Our study concluded that in cancer patients, inflammatory biomarkers play significant role in developing venous thromboembolism. This supports the hypothesis that, markers of systemic inflammatory response are involved in development of thromboembolism in patients with malignancy.

Bretylium tosylate as initial treatment for cardiopulmonary arrest: randomized comparison with placebo.

To evaluate the therapeutic effectiveness of intravenous bretylium tosylate as a first-line drug for patients in cardiopulmonary arrest, a randomized, double-blind study was conducted, comparing bretylium with a normal saline placebo. Fifty-nine patients presenting to the emergency department with cardiopulmonary arrest due mainly to ventricular fibrillation or asystole initially received either bretylium (10 mg/kg) or placebo in a rapid intravenous bolus and were then otherwise treated according to standard American Heart Association guidelines. If ventricular fibrillation or asystole persisted, a second bolus of bretylium or normal saline was given after 20 minutes. Thirty-five percent of patients presenting with ventricular fibrillation or asystole who received bretylium were successfully resuscitated, whereas 6% of patients who received placebo survived (P less than 0.05). These findings serve to suggest that the early use of bretylium tosylate in cardiopulmonary arrest improves survival.

Massive intravenous bolus bretylium tosylate.

A 30 mg/kg (2-gm) intravenous bolus of bretylium tosylate was administered to a patient with recurrent ventricular tachycardia and fibrillation. After successful defibrillation the patient exhibited marked hypertension followed by protracted refractory hypotension. There was no further ventricular ectopy in spite of a very low cardiac index. A bretylium level of 8,800 ng/ml is the highest reported in man from a single bolus injection. This case demonstrates the exaggerated hemodynamic response to massive intravenous bolus bretylium tosylate.