Rivaroxaban as an Alternative Agent for Heparin-Induced Thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is a high-risk adverse drug reaction because of its associated risk of life- and limb-threatening thrombosis. Rivaroxaban may be considered as an ideal nonheparin anticoagulant alternative for the management of HIT. In this preliminary retrospective study, the efficacy and safety of rivaroxaban to control the clinically suspected HIT (4Ts score 4 points or greater) were evaluated. Patients with chronic kidney disease, hepatic impairment, mechanical heart valves, and active bleeding were excluded. Forty-two eligible patients who received rivaroxaban for clinically suspected HIT were evaluated by medical records review, with 12-month follow-up after the first dose of rivaroxaban. End points included confirmed thrombosis (primary end point), mortality, and adverse treatment-related events. HIT-associated thrombosis was found in 17/42 (40.5%) patients before receiving rivaroxaban. After rivaroxaban therapy, platelet counts normalized in all patients, with only 1/42 (2.3%) patients developing new thrombosis. No hemorrhagic event was recorded in the patients. Twelve patients (28.6%) died, but the cause of death was not related to the thrombosis, hemorrhage, or adverse effects of rivaroxaban. Our findings are consistent with the available emerging data, suggesting that rivaroxaban is a safe and effective drug for the management of clinically suspected HIT. Rivaroxaban is a particularly valuable treatment option in developing countries, where there are issues of cost and availability of approved alternative agents.

Biochemical Methods in Production of Three-Dimensional Scaffolds from Human Skin: A Window in Aesthetic Surgery.

BACKGROUND: Use of matrix-derived biologic scaffolds has become a treatment of choice in several clinical issues. This study assessed biochemical methods in production of three-dimensional scaffolds from human skin. METHODS: Human skin was prepared from circumcisions, washed in phosphate buffer saline (PBS) and kept at -20ºC until use. The skin samples underwent various methods. In group A, NaCl, Triton X100 and EDTA solution were used for removal of epidermis and was subdivided to three subgroups. The solution for removal of epidermis was similar for all subgroups, but decellularization was different. Group B was subdivided into 6 subgroups, NaCl in different concentrations was used for removal of epidermis and decellularization happened using SDS in various concentrations and different time intervals. Group C was subdivided to 3 subgroups, trypsin was used for removal of epidermis and decellularization was conducted applying NaOH or SDS. Washing was performed using only PBS. In group D, decellularization was done applying SDS. Histomorphometric study was conducted to compare the groups. RESULTS: No fibroblast was present in A2, B2, B4, and C3 subgroups after decellularization. Histological photographs from subgroups A1 to A3 revealed several cells and collagen fibers. Dense collagen fibers in pink color were noted in all subgroups; but, epidermis was absent. CONCLUSION: It was shown that 1M NaCl was the best solution for removal of epidermis, 0.5% SDS for 2 h was the most effective solution for decellularization and PBS was the best solution for washing, while the solutions are easily available and cost-effective.

Association between Coping Strategies and Infertility Stress among a Group of Women with Fertility Problem in Shiraz, Iran.

BACKGROUND: Studies have shown that individuals with fertility problems experience psychosocial problems. The use of various coping strategies seems to have different impacts on women with infertility stress. The aim of this study was to examine the role of coping strategies (active-avoidance, passive-avoidance, active confronting and meaning based) in predicting infertility stress among a group of women seeking infertility treatment in Shiraz. METHODS: One hundred twenty infertile women were recruited from several infertility clinics in Shiraz using convenience sampling method. The participants completed research measures including the Infertility Problem Stress Inventory and the Ways of Coping Scale (passive-avoidance, active-avoidance, active-confronting, meaning-based). Multiple regression analysis was used for data analysis. A p-value less than 0.05 was considered as statistically significant. RESULTS: The findings showed that participants had the highest scores on passive-avoidance coping strategies followed by meaning-based coping, active-confronting coping and active-avoidance coping. The findings also indicated that women who utilized more active-avoidance coping strategies reported less infertility stress. Furthermore, the results of regression analysis demonstrated that two coping strategies including active-avoidance (ß=0.35, p<0.001) and meaning-based coping (ß=-0.50, p<0.001) predicted infertility stress significantly. Moreover, meaning-based coping strategy was the strongest predictor of low infertility stress. CONCLUSION: The present study showed that the majority of infertile women used passive-avoidance coping strategy. Furthermore, those who perceived their infertility problem as meaningful had a low infertility stress, while those who used active-avoidance coping strategies had high infertility stress.