Latest Event Updates

Argatroban as an Alternative Anticoagulant in the Case of Heparin-Induced Thrombocytopenia after Pediatric Cardiac Surgery

Posted on Updated on

Heparin-induced thrombocytopenia (HIT) with impending thromboembolic complications presents a major challenge in Fontan patients, especially with the fenestrated Fontan. These patients are particularly prone to thrombosis within the Fontan tunnel due to the low blood flow velocity. In addition, the communication between the Fontan tunnel and the common atrium may become a passageway for systemic embolization and may cause a stroke. Effective on-going anticoagulation without interruption is necessary in every Fontan patient. Given the high risk of arterial and venous thrombosis of HIT, alternate anticoagulation management is essential as soon as HIT is suspected.

The appearance of anti-heparin/PF4 antibodies in childhood is lower than in adult patients. The reason for this may be the immature immune system and lower platelet Factor 4 (PF4) levels. However, after cardiac bypass surgery the number of children developing antibodies is similar to that of adults. Antibody formation has been reported to be 1.7% in neonates and 16% in children after re-operative cardiac surgery on the 5th postoperative day. On the tenth postoperative day even 52% of re-operated children were antibody positive (ELISA) but only 1.3% developed symptoms like thrombosis or skin lesions .

We are reporting on two patients who developed HIT antibodies and thrombocytopenia after re-exposure to heparin during a Fontan procedure.

The first patient, a three-year-old boy had undergone stage one and two palliation for a complex cardiac malformation with a hypo plastic right ventricle. He also had a cardiac catheterization before every surgical step including the preoperative evaluation before the Fontan procedure . A fenestrated lateral tunnel was generated on cardiopulmonary bypass and unfractionated heparin (UFH) was administered to maintain an activated clotting time (ACT) above 480 seconds. In the intensive care unit (ICU) heparin was infused continuously with the intention of keeping the activated partial thromboplastin time (aPTT) at about 60 seconds.

Before surgery the platelet count had been within the normal range. Because of excessive bleeding and thrombocytopenia at the end of the procedure, one unit of platelets was transfused. After an initial recovery to 109 G/l, the platelet count dropped again to a minimum of 31 G/l on the sixth postoperative day. According to the 4T scoring system there was a high risk for ongoing HIT. Heparin was stopped immediately and anticoagulation was continued by a continuous infusion of the direct thrombin inhibitor argatroban. The dosage needed to achieve the targeted aPTT of about 60 seconds varied between 2 and 6.1 μg/kg/min.artcle2

Advertisements

Assessing Self Care Practices of People Living with AIDS attending antiretroviral clinic Kafanchan, Kaduna State, Nigeria

Posted on Updated on

HIV/AIDS is one of the major public-health problems worldwide. With the success of antiretroviral therapy (ART) in improving the quality of life of people living with AIDS (PLWA) and reducing morbidity and mortality, HIV has become a chronic manageable disease. Like all other chronic diseases, it requires lifetime changes in physical health, psychological functioning, social relations, and adoption of disease-specific regimen based on choice and decision making. The shift from acute to chronic illness requires a selfmanagement model in which patients assume an active and informed role in healthcare decision-making to change behaviours and optimize health and wellbeing. There are many risk factors that contribute to the spread of HIV, including prostitution, high-risk practices among itinerant workers, high prevalence of sexually transmitted infections (STIs), clandestine high-risk heterosexual and homosexual practices, international trafficking of women, and irregular blood screening . These individuals have significant roles to play in avoiding the risk behaviors. An estimated 36.9 million people are living with HIV around the world.

The U.S. Department of State [4] observed that epidemic is more concentrated and driven by high-risk behaviors. According to United Nations AIDS (UNAIDS) statistics, Nigeria accounts for about 10% of people living with HIV/AIDS (PLWHA) worldwide. The HIV epidemic varies widely by region . Some States have more generalized epidemics that are sustained primarily by multiple sexual partners than others. Youth and young adults are vulnerable to HIV, with young women at higher risk than young men due to their young age at marriage and higher risk for sexual abuse than their male counterparts.

article14

Application of Ranolazine in Stable Angina Pectoris Therapy (ARETHA): Real-World Data from an Observational Study

Posted on Updated on

Methods

Patients with stable angina pectoris (AP) receiving ranolazine were enrolled in this non-interventional study. Data were documented at baseline and after 3 months of ranolazine treatment. Endpoints included changes in the number of AP attacks per week, frequency of using short-acting nitrates, current status of the CCS classification, overall estimate of quality of life assessed by both, the physician and the patient, and safety.

Results:In total, 1,537 patients were eligible for efficacy evaluation. After 3 months, the mean (±SD) number of AP episodes per week significantly decreased from 4.4 ± 4.0 at baseline to 1.1 ± 1.8 (p<0.0001), and the weekly use of short-acting nitrates was significantly reduced from 3.4 ± 3.4 to 0.8 ± 1.5 (p<0.0001). Improvement occurred independent of diagnosed coronary heart disease (CHD). The CCS classification improved in 69.0% of patients and remained stable in 27.1%. Quality of life, assessed on a numerical analogue scale by physicians and patients, improved significantly by 43.7% and 44.9%, respectively (p<0.0001). Safety analysis was based on 2,726 patients. A total of 63 adverse drug reactions (ADRs) occurred in 37 patients (1.4%) and led to discontinuation in 34 patients (1.2%). By the end of the observation period, all ADRs were resolved or resolving.

Conclusion:

article12The adjuvant therapy with ranolazine is an effective treatment option with a positive benefit-risk balance for patients with angina pectoris of different causes, e.g. small vessel disease, endothelial dysfunction, including those without prior CHD diagnosis.

 

 

The Changing Therapeutic Landscape of Chronic Lymphocytic Leukemia

Posted on Updated on

Chronic lymphocytic leukemia (CLL) is characterized by slow accumulation of mature but functionally incompetent lymphocytes which are monoclonal in origin. The disease course is highly variable– with some patients having long survival times and never requiring treatment and others who live only for a few years even with treatment.

In the past, the treatment of CLL consisted of chemoimmunotherapy, usually with FCR (fludarabine, cyclophosphamide and rituximab), PCR (pentostatin, cyclophosphamide, rituximab) or BR (bendamustine and rituximab). Not all patients with CLL will require treatment. Considering the adverse effects of traditional chemotherapy, only patients with disabling symptoms or cytopenias proven to be secondary to CLL (not autoimmune related) are usually treated. A high white cell count or disfiguring lymphadenopathy are not indications for treatment. article9.jpg

Association between Sickle Cell Disease and Dental Caries among Sudanese Children

Posted on Updated on

Sickle Cell Disease is defined as hereditary autosomal recessive blood disorder characterized by hemoglobin gene mutation caused by amino acid substitution in the gene coding valine is encoded instead of glutamic acid, so that the amino acid results in the production of hemoglobin S rather than hemoglobin A.

Two types of sickle cell disease were recognized; homozygous and heterozygous. Homozygous have S-type haemoglobin (Hb-SS), and sickle-cell disease develops as a result. Heterozygous (Hb-SA) have a sickle cell trait with 40% of S-type haemoglobin (Hb-SS) and the remaining is normal (Hb-AA), which is a mild characteristics disease.

In Sudan, sickle cell disease is following natural extension of West African sub-Saharan belt. The majority of patients clustered in western Sudan (Kordofan and Darfur). The most prevalent variant among the African population is the HbSS variant, which happens to be the most prevalent form among the Sudanese population too.

Dental carries is a worldwide main issue and it considered a common disease affecting people. Caulfield in 2005 defined the dental caries as an infectious and transmissible disease, caused by bacterial colonization of the tooth surface.

Dental caries is currently conceptualized as a multi-factorial disease involving the known biological factors and social modifying factors, although there is growing evidence that genetics contributes to caries.article7

Real-Time Electronic Drug Monitoring for HIV-Positive Adolescents: Promising Acceptability and Feasibility in China

Posted on Updated on

Introduction

The benefits of antiretroviral therapy (ART) have been well documented , but achieving and sustaining high adherence to ART remain vital to treatment success in children and adults. Systematic reviews of adherence in children and adolescents in low and middle income countries have found generally suboptimal adherence levels. In China, where more than 3500 children and adolescents are currently on ART, early reports on the country’s pediatric ART treatment rollout are encouraging. Still, concerns are rising regarding adherence in the adolescent age group.

Given the complexity and interrelatedness of individual, caregiver, clinical, and societal and cultural influences at play, sustaining high adherence to ART in adolescents presents unique challenges. As older children begin to assume responsibility for their own medication, the wide array of emotional and physical changes of adolescence, juxtaposed against powerful social and cultural factors, may present obstacles to a child’s ability to adhere to treatment regimens, although they may also offer potential opportunities for adherence support. How best to monitor and support adherence among adolescents represents a critical area for research.

article4Measuring adherence objectively is a particular challenge in adolescents due to the complex transition of health-care responsibilities, including medication administration, from caregivers to children as children age. Adherence measures have primarily taken the form of selfreport or other proxy indicators such as pill count and pharmacy refill, typically shown to be poor measures of actual adherence in adult. We identified four studies that have used electronic drug monitoring (EDM), considered a more objective adherence measure, in pediatric patient in only one did adolescents themselves use an EDM device.

Myocardial Protective Effect of Exogenous Creatine Phosphate in Children Undergoing Open Heart Surgery

Posted on Updated on

Introduction

 

To obtain a bloodless operating field during open-heart surgery, aortic cross-clamping is deliberately introduced leading to a period of myocardial ischemia. As a consequence, an unbalance between demand and supply of cellular high-energy phosphates is created. This results in a rapid fall of creatine phosphate levels, followed by a decrease in the tissue content of ATP. Low levels of ATP are related to the loss of cellular function and the onset of cell injury and death. The precise mechanism of action is, however, still unclear.

Most protective measures taken during open-heart surgery aimed at the conservation of cardiac high-energy phosphate pools in the ischemic tissues. To this end, commonly electro-mechanical activity is abolished rapidly by intracoronary infusion of an ice-cold crystalloid or sanguineous cardioplegic solution immediately after aortic crossclamping.

The clinical application of creatine phosphate (PCr) for cardioprotection during heart surgery and myocardial ischaemia is based on the results of a series of pharmacological studies in animal models. Its application as a cardioplegic additive and for intravenous infusion leads to significantly better functional recovery following ischaemia, during the postinfarction period and upon reperfusion.

Material and Methods:

Clinical data:From August 2015-February 2016, 63 cases of congenital heart disease (CHD) were performed open heart surgery under CPB, including 39 cases of ventricular septal defect, 24 cases of atrial septal defects. Cases were randomly divided into three groups, each 21 cases. A group of 9 males and 12 females, age (6.4 ± 2.3) years, body mass (13.7 ± 5.3) kg, ejection fraction (63 ± 8)%; group B, 11 males and 10 females, age (6.8 ± 2.4) years, body mass (14.3 ± 5.7) kg, ejection fraction (65 ± 7)%; group C, 11 males and 10 females, age (6.5 ± 2.4) years, body mass (13.9 ± 5.2) kg , ejection fraction (62 ± 5)%. 3 groups were comparable clinical dataarticle2

Material and Methods:Clinical data:From August 2015-February 2016, 63 cases of congenital heart disease (CHD) were performed open heart surgery under CPB, including 39 cases of ventricular septal defect, 24 cases of atrial septal defects. Cases were randomly divided into three groups, each 21 cases. A group of 9 males and 12 females, age (6.4 ± 2.3) years, body mass (13.7 ± 5.3) kg, ejection fraction (63 ± 8)%; group B, 11 males and 10 females, age (6.8 ± 2.4) years, body mass (14.3 ± 5.7) kg, ejection fraction (65 ± 7)%; group C, 11 males and 10 females, age (6.5 ± 2.4) years, body mass (13.9 ± 5.2) kg , ejection fraction (62 ± 5)%. 3 groups were comparable clinical data

 

 

 

 

 

 

 

 

To obtain a bloodless operating field during open-heart surgery, aortic cross-clamping is deliberately introduced leading to a period of myocardial ischemia. As a consequence, an unbalance between demand and supply of cellular high-energy phosphates is created. This results in a rapid fall of creatine phosphate levels, followed by a decrease in the tissue content of ATP. Low levels of ATP are related to the loss of cellular function and the onset of cell injury and death. The precise mechanism of action is, however, still unclear.

Most protective measures taken during open-heart surgery aimed at the conservation of cardiac high-energy phosphate pools in the ischemic tissues. To this end, commonly electro-mechanical activity is abolished rapidly by intracoronary infusion of an ice-cold crystalloid or sanguineous cardioplegic solution immediately after aortic crossclamping.

The clinical application of creatine phosphate (PCr) for cardioprotection during heart surgery and myocardial ischaemia is based on the results of a series of pharmacological studies in animal models. Its application as a cardioplegic additive and for intravenous infusion leads to significantly better functional recovery following ischaemia, during the postinfarction period and upon reperfusion.

Material and Methods

Clinical data

From August 2015-February 2016, 63 cases of congenital heart disease (CHD) were performed open heart surgery under CPB, including 39 cases of ventricular septal defect, 24 cases of atrial septal defects. Cases were randomly divided into three groups, each 21 cases. A group of 9 males and 12 females, age (6.4 ± 2.3) years, body mass (13.7 ± 5.3) kg, ejection fraction (63 ± 8)%; group B, 11 males and 10 females, age (6.8 ± 2.4) years, body mass (14.3 ± 5.7) kg, ejection fraction (65 ± 7)%; group C, 11 males and 10 females, age (6.5 ± 2.4) years, body mass (13.9 ± 5.2) kg , ejection fraction (62 ± 5)%. 3 groups were comparable clinical data