Decrease In Hemoglobin Values Research Articles

Comparison of two different suction curettage methods in cesarean scar pregnancy treatment

BackgroundCesarean scar pregnancy (CSP), the incidence of which is increasing, can lead to life-threatening consequences. In this study, it was aimed to compare the results of two different ultrasound-assisted suction curettage (SC) approaches that we applied to endogenous type CSPs in different time periods.MethodsPatients who were diagnosed with CSP and treated with SC in the early pregnancy service between January 2012 and March 2019 were included in the study. While classical SC was applied until December 2016, patients were treated with SC modified by us after this date. Demographic characteristics, preoperative clinical findings, intraoperative characteristics and postoperative short-term follow-up of these two groups of patients belonging to different time periods were compared.Results34 patients were treated with classic SC (Group 1) and 32 patients with modified SC (Group 2). The amount of decrease in Hemoglobin values measured at the sixth hour postoperatively compared to the preoperative period was found to be less in group 2 (1.01 ± 0.67 g/dl) than in group 1 (1.39 ± 0.85 g/dl) (p = 0.042). The treatment failure rate was found to be lower in group 2 (p = 0.028). According to the results of multiple logistic regression analysis of significant factors associated with treatment outcome, myometrial thickness measurement and the largest gestational diameter measurement were found to be significant independent factors.ConclusionIn CSP cases, SC procedure with abdominal ultrasonography is an effective and reliable approach. At the beginning of this surgical procedure, if the gestational sac is removed from the uterine wall with the curettage cannula before suction, the success of the procedure will increase even more.

An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries.

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ± 11.65 and the DTI group is 44.89 ± 10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.

Tranexamic Acid and Tourniquet: Which Combination Reduces Blood Loss Most Effectively?

Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and decrease transfusion rates in patients undergoing TKA. Tranexamic acid, an antifibrinolytic agent with known efficacy for achieving these goals, is combined with tourniquets to reduce bleeding in arthroplasty surgeries. Our study investigated the effects of various combinations of tranexamic acid and tourniquet use on bleeding in knee arthroplasty in 558 patients. We aimed to determine the method that would provide the least blood loss and transfusion need in knee arthroplasty surgery. Between January 2018 and December 2022, 558 patients aged between 55 and 85 years underwent TKA surgery for grade 4 gonarthrosis in our clinic, and their decrease in hemoglobin value and whether they were transfused or not were analyzed. The patients were divided into four groups based on use of tranexamic acid and tourniquet. Demographic variables and patient data (body mass index, INR values, and preoperative hemoglobin values) were recorded. There were 558 patients with a mean age of 68.19 (67 ± 6.949) years. In group 1, tranexamic acid was not used in 128 patients and tourniquet was used only during cementation; in group 2, in 132 patients, tranexamic acid was not used and tourniquet was used throughout the surgery; in group 3, in 158 patients, tranexamic acid was used and tourniquet was used throughout the surgery; in group 4, in 140 patients, tranexamic acid was used and tourniquet was used only during cementation. The decrease in hemoglobin value and transfusion rate was lowest in group 3 and highest in group 1. Besides, there was a greater decrease in hemoglobin value in group 2 than in group 4 and the transfusion rate was similar. This clinical study showed that using tranexamic acid and a tourniquet throughout surgery significantly reduced the decrease in hemoglobin value and the need for transfusion.

Clinical characteristics and treatment modalities in uremic and non uremic calciphylaxis - a dermatological single-center experience

Calciphylaxis (CP) is a serious, potentially life-threatening disease that presents with medial calcification of small-sized vessels and painful ischemic ulcerations. Although calciphylaxis is frequently seen in patients with end-stage kidney disease on dialysis (calcific uremic arteriolopathy, CUA), there are reported cases of nonuremic calciphylaxis (NUC), which often remain undiagnosed. We conducted a retrospective chart review at our dermatological hospital and evaluated data concerning the epidemiology, comorbidities, medication, laboratory abnormalities, and therapeutic approaches of 60 patients diagnosed with calciphylaxis between 01/2012 and 12/2022. We identified 21 patients diagnosed with NUC and 39 with kidney disease. The predilection sites of skin lesions were the lower legs in 88% (n = 53), followed by the thigh and gluteal regions in 7% (n = 4). Significant differences were identified in comorbidities, such as atrial fibrillation (p < 0.001) and hyperparathyroidism (p < 0.01) accounting for CUA patients. Medication with vitamin K antagonists (p < 0.001), phosphate binders (p < 0.001), and loop diuretics (p < 0.01) was found to be associated with the onset of calciphylaxis. Hyperphosphatemia (p < 0.001), increased parathyroid hormone (p < 0.01) and triglyceride levels (p < 0.01), hypoalbuminemia (p < 0.01) and decreased hemoglobin values (p < 0.001) in the CUA cohort were significantly different from those in the NUC group. All patients with CUA received systemic medication. In contrast, only 38% (n = 8) of patients with NUC received systemic treatment. Striking discrepancies in the treatment of both cohorts were detected. In particular, NUC remains a disease pattern that is still poorly understood and differs from CUA in several important parameters.

Clinical-epidemiological profile of the canine population in a shelter, Minas Gerais, Brazil, 2019-2020

ABSTRACT The aim of this study was to analyze the demographic, clinical, and hematological aspects of the population in a dog shelter located in the municipality of Lavras, Brazil. All animals were microchipped and evaluated by veterinarians. Whole blood samples were obtained from 329 dogs in the months of July–August 2019 and from 310 dogs in the months of January–February 2020. Most of the dogs were of mixed breed, received anti-rabies and polyvalent vaccines (100%), were dewormed (100%), and were spayed/neutered (98.59%), with a predominance of adult (86.51%), short-hair (67.51%), normal body condition (65.57%), medium-size (62.57%), and female (62.36%). The main clinical alterations detected were enlarged lymph nodes (38.69%), skin lesions (31.50%), overweight (23.32%), obesity (6.07%), elevated temperature (17.05%), and ear secretion (15.72%). Regarding hematological alterations, thrombocytopenia (36.31%), leukopenia (15.92%), anemia with decreased hemoglobin values (10.60%), hematocrit (9.70%), and red blood cells (5.14%) were observed. Most of the shelter dogs were apparently healthy, but specific measures for nutritional, dermatological, otological and disease management should be implemented once the health changes are verified, as they impact the general state of the population and adoptions.

Hematological effects of Levosimendan therapy in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Levosimendan is an inotropic drug, acting as calcium sensitizer, used in the management of acute heart failure. Despite its hemodynamic benefits, Levosimendan is associated with several adverse reactions, including hematological effects, with a hemoglobin value decrease, causing anemia. Acute coronary syndromes (ACS) might be a precipitant of acute heart failure, in a substantial proportion of cases. These situations may require the use of inotropic drugs, such as Levosimendan. Antithrombotic therapy is the cornerstone therapy for management of acute coronary syndromes, and the decision of which strategy is determined by the balance of ischemic and hemorrhagic risks. Therefore, in the management of acute heart failure, associated with ACS, the use of Levosimendan might be associated with the increase of hemorrhagic risk, due to hemoglobin decrease, influencing the antithrombotic therapy strategy choice. Purpose This study aims to evaluate the effect of the use of Levosimendan on the hemoglobin value, comparing with Dobutamine, in patients hospitalized for ACS. Methods We analyzed a retrospective, multicenter, observational cohort of 317 patients, admitted for ACS, requiring inotropic therapy. The population was divided into two groups: a group that used Levosimendan and a group that used Dobutamine. The mean decrease in hemoglobin value, and the minimum hemoglobin value, during hospitalization, was compared between both groups. Results Levosimendan sample included 39 patients, of which 40,1% (n=15) were women, with a mean age of 83±12,1 year old, while Dobutamine sample had 278 elements, of which 38% (n=105) were women with a mean age of 82±12,1. There was no statistically significant difference between both samples on age and sex distribution. Levosimendan group had a mean minimum hemoglobin value of 10,7±2,2 g/dL and a mean decrease in hemoglobin value, during hospitalization, of 2,7±1,9 g/dL, while Dobutamine group had a mean minimum hemoglobin value of 10,7±2,2 g/dL and a decrease in hemoglobin value, during hospitalization, 2,1±1,9g/dL. There was no statically significant difference on mean minimum hemoglobin value on both samples (p&amp;gt;0,05), however, there was a statistically significant difference, with a higher decrease in mean hemoglobin value, during hospitalization in patients using Levosimendan, comparing with patients using Dobutamine (2,7±1,9g/dL vs 2,1±1,9g/dL, p=0,04). Conclusion Levosimendan is associated with a higher decrease in hemoglobin value. As heart failure might complicate ACS episode, and might require inotropic therapy, we should be aware that the choice of using Levosimendan in these situations may confer a greater risk of bleeding, associated with the higher decrease in hemoglobin value, in patients who need intense antithrombotic therapy.

Long-Term Outcomes of Patients With Pulmonary Embolism Managed With Endovascular Therapies Compared to Medical Therapy.

Guidelines on the management of acute pulmonary embolism (PE) recommend consideration of endovascular therapies (EVT) for patients at intermediate-high risk. However, long-term data on the outcomes of patients after EVT as compared to medical therapy is lacking. This study aimed to compare outcomes of patients receiving EVT as compared to medical therapy alone at 3 to 6 months. In this single-center, retrospective cohort study, 190 patients with PE underwent evaluation for presence of right ventricular (RV) dysfunction by transthoracic echocardiogram, residual perfusion defects on ventilation-perfusion scanning, and functional capacity by 6-minute walk distance (6MWD) at 3 to 6 month follow-up. Fifty-eight (31%) patients received EVT for the management of their acute PE. At follow-up (median 120 [97-170] days), 71% of patients who received EVT had normalization of RV function compared with only 34% of patients who received medical therapy alone (P < .001). Patients who received EVT had a significantly greater increase in their estimated glomerular filtration rate (P = .001), decrease in N-terminal proB-type natriuretic peptide (P = .003), and decrease in hemoglobin values (P = .018). Patients with intermediate-high to high risk PE who received EVT had significantly greater distance achieved on their 6MWD as compared to those who received medical therapy alone (P = .025). Patients with acute PE who received EVT plus medical therapy were more likely to achieve normalization of RV dysfunction at 3 to 6 month follow-up compared to patients who received medical therapy alone. These data suggest that EVT is an effective therapy option for acute PE in intermediate-high and high risk patients with potential durable long-term benefits.

Laporan Kasus Manajemen Kegawatdaruratan Trauma Jaringan Lunak Wajah Pada Anak Penderita Talasemia

Facial soft tissue trauma is a common case in the emergency department. Handling this case requires special attention because the face is a prominent part and a marker of identity. Thalassemia is a blood disorder that causes the sufferer to experience anemia, where thalassemia patients must undergo blood transfusions for life. This case will describe a 14-year-old girl who came to the Emergency Department of Hasan Sadikin Hospital Bandung with complaints of bleeding on the eyelids due to a motorcycle accident, from the patient's history it is known that the patient is a thalassemia patient who routinely undergoes transfusions every month. As a result of this hemorrhage caused a significant decrease in hemoglobin value in the patient, so that emergency management was carried out, namely suturing the patient's traumatized eyelid and blood transfusion. Emergency management of facial soft tissue trauma in children with thalassemia must be done carefully to control bleeding and restore the function and aesthetics of traumatized facial tissues, besides that we also collaborate with pediatric colleagues for the management of anemia due to thalassemia in this patient.

32700 Association between body lice infestation and decreased hemoglobin values

Background: Pediculus humanus humanus (body lice) survive on blood meals taken from human hosts. Case reports have described profound iron deficiency anemia associated with extensive body lice infestation, but larger epidemiologic studies have not been performed.

Factors influencing surgical outcomes of laparoscopic myomectomy. A propensity-score matched analysis.

IntroductionTo evaluate factors influencing surgical choice in performing uterine myomectomy by comparing laparoscopic and open approach surgery.Material and methodsWe analyzed women undergoing uterine myomectomy in our hospital. Patients were divided into two groups: patients who underwent laparoscopic myomectomy (group A) and patients who underwent laparotomic myomectomy (group B). We matched 1 : 1 women in these two groups to compare the effects of the procedures on each outcome according to a propensity-matched score analysis.Results460 myomectomies were performed in the study period: 361 cases by laparoscopy (group A) and 99 cases by laparotomy (group B). We found lower estimated intraoperative blood loss (200 ml group A vs. 300 ml group B, < 0.0001) and a smaller decrease in hemoglobin value on the first postoperative day (1.7 g/dl group A vs. 2.2 g/dl group B, < 0.0001) with the laparoscopic approach. The propensity score matching estimated that to obtain an equivalent outcome, we required an average of 2 myomas and an average diameter of 8 cm in laparoscopy and 10 cm in laparotomy. Moreover, the variables mostly associated with a laparotomic conversion were the presence of a myoma > 8 cm and association with the presence of more than 2 myomas.ConclusionsDespite some proposals from previous studies, there are no specific guidelines regarding the best surgical procedure for myomectomy. Our data confirm that the choice of surgical technique should consider the patient characteristics and the surgeon experience to reduce longer operating times and more significant blood loss.

Clinical and laboratory studies in correlation to oxidative stress indices in demodicosis affected dogs

Skin diseases are the most common health problem among dogs. Demodicosis is the most important one. The study aimed to detect the clinical effect of demodicosis on dogs that come to the veterinary clinic and the correlation between some blood parameters and some oxidative stress indices. Clinical and laboratory examination of the diseased dogs was carried out. The clinical study was conducted on two groups of dogs. The first one includes seven dogs (7.77%) out of 90 diseased dogs of different ages. In the second group, 14 dogs were clinically healthy used as a control group. Animals were subjected to physical examination followed by a special dermatological examination. Skin scrapings were examined under the microscope for mite detection. Blood samples were taken for hematological examination and biochemical analysis. Hematological parameters of demodicosis-affected dogs showed a highly significant decrease in hemoglobin values. Regarding differential leukocytes, a significant increase in granulocytes absolute number was recorded. The biochemical findings of blood plasma obtained from dogs affected by demodicosis showed a significant increase in plasma SOD when compared with control ones and a highly significant increase in plasma MDA values. Correlation analysis revealed a positive correlation between plasma zinc and copper levels and antioxidant enzymes as SOD, GPx, and a negative correlation between plasma SOD and plasma MDA levels. The study revealed the importance of oxidative stress indicators variations in diagnosis and pathophysiology of demodicosis.

Infections of cats with blood mycoplasmas in various contexts

Haemotropic microorganisms are the most common bacteria that infect erythrocytes and are associated with anaemia of varying severity. The aim of this study was to focus on the occurrence of Mycoplasma haemofelis, Mycoplasma haemominutum, and Mycoplasma turicensis in cats. We followed infected individuals’ breeding conditions, age, sex, basic haematological indices, and co-infection with one of the feline retroviruses. A total of 73 cats were investigated. Haemoplasmas were detected by PCR and verified by sequencing. Haematology examination was performed focusing on the number of erythrocytes, haemoglobin concentrations and haematocrit. A subset of 40 cat blood samples was examined by a rapid immunochromatography test to detect retroviruses. The following was found in our study group: M. haemofelis in 12.3% of individuals, M. haemominutum in 35.6% of individuals and M. turicensis in 17.8% of individuals. A highly significant difference was found between positive evidence of blood mycoplasmas in cats living only at home (15%) and in cats with access to the outside (69.8%). There was also a highly significant difference in the incidence of mycoplasma in cats over 3 years of age compared to 1–3 years of age and up to 1 year of age. There was no difference in the frequency of infections between the sexes. Blood mycoplasma infection in our group was not accompanied by fundamental changes in the haematological indices and was only reflected by a decrease in haemoglobin values in three cases. In a subset of cats that were also examined for the presence of retroviral infection, mycoplasma infection in blood was confirmed in all five positive cases.

The evaluations of ESWL, RIRS and m-PCNL treatments in kidney stones smaller than two centimeters

Objective: The aim of the current study was to compare the outcome of minimal invasive treatment (RIRS, m-PCNL) with the ESWL, Micro-Percutaneous Nephrolithotomy (m-PCNL), and Retrograde intrarenal surgery (RIRS) in patients with renal calculi less than two centimeters in size.&#x0D; Methods: Preoperative renal ureter-bladder (KUB) film and computed tomography (CT) used to imaging stone size and localization in all patients. Ninety consecutive patients were randomized equally to three groups. We evaluated age, gender, stone size, length of hospitalization, stone-free rates, X-ray duration that patients were exposed during the processes, general anesthesia time, Visual Analogue Scale values, Modified Clavien Complication Scale scores after RIRS, mPCNL, and ESWL on renal stones smaller than 2 cm.&#x0D; Results: At the end of the first month, stone-free rate for the lower calyx stones was 33.3% (3 patients out of 10) in ESWL, 83.3% (10 patients out of 12) in RIRS, and 90.9% (10 patients out of 11) in m-PCNL. ESWL's success in the lower-calyx stones was found to be low. Our rates for the stones in renal pelvis, middle, and upper calyx were % 85.7 (18 patients out of 21) in ESWL, % 94.4 (17 patients out of 18) in RIRS and % 94.7 (18 patients out of 19) in m-PCNL. No difference was observed in the duration of hospitalization among patients who underwent RIRS and m-PCNL. The VAS scores in ESWL group were higher than other groups. There were no significant differences for fluoroscopy time between the groups. Decrease in hemoglobin values before and after the procedure were found to be significant in m-PCNL group (p&lt;0.05).&#x0D; Conclusions: We compared three minimal invasive treatments for less than 2 cm renal stones; m-PCNL and RIRS methods were found to be more effective than ESWL, especially aspects of the stone free rates.

Is abdominal wall hemorrhage an avoidable complication of robotic radical prostatectomy?

Aim: We presented the diagnosis and treatment of patients with abdominal wall hemorrhage after robot-assisted laparoscopic radical prostatectomy (RALRP) in a high volume center. Materials and Methods: We retrospectively screened the data of 1950 patient RALRP series performed between June 2010 and December 2019 in our clinic. Patients who developed postoperative abdominal wall hemorrhage were included in the current study. The diagnosis of abdominal wall hemorrhage was established by ultrasonographic and physical examination findings. Results: In our 1950 patient RALRP series, 15 (0.7%) patients developed abdominal wall hemorrhage. The mean decrease in hemoglobin values was 3.9 (2.8-4.7) g/dl at postoperative 6th hour. On the postoperative 2nd day, areas of ecchymosis were observed on the abdominal wall skin. On the postoperative 4th day, hemoglobin level was stabilized. Blood transfusion was required for 8 of 15 patients. None of the patients required surgical exploration. At the postoperative 1st month control visits, we observed that the ecchymosis was completely disappeared. Conclusion: RALRP is a surgical technique that has been increasingly preferred in the treatment of localized prostate cancer. Abdominal wall hemorrhage is a rarely seen complication of RALRP that may be avoided by paying attention to some anatomical landmarks and optimizing the blood level of muscle relaxant medications at an effective dose. As a rerely seen complication of RALRP, abdominal wall hemorrhage can be successfully managed without the need for explorative surgery.

Increased Outdoor PM2.5 Concentration Is Associated with Moderate/Severe Anemia in Children Aged 6-59 Months in Lima, Peru.

Anemia affects 1.62 billion people worldwide. Although iron deficiency is the main cause of anemia, several other factors may explain its high prevalence. In this study, we sought to analyze the association between outdoor particulate matter PM2.5 levels with anemia prevalence in children aged 6–59 months residing in Lima, Peru (n = 139,368), one of the cities with the worst air pollution in Latin America. The study period was from 2012 to 2016. Anemia was defined according to the World Health Organization (Hb < 11 g/dL). PM2.5 values were estimated by a mathematical model that combined data observed from monitors, with satellite and meteorological data. PM2.5 was analyzed by quintiles. Multiple linear and logistic regressions were used to estimate the associations between hemoglobin concentration (beta) and anemia (odds ratio) with PM2.5, after adjusting by covariates. Prevalence of anemia was 39.6% (95% confidence interval (CI): 39.3–39.9). Mild anemia was observed in 30.8% of children and moderate/severe in 8.84% of children. Anemic children compared with nonanemic children are mainly males, have low body weight, higher rate of stunting, and live in an environment with high PM2.5 concentration. A slight decrease in hemoglobin (4Q B: −0.03, 95% CI: −0.05 to −0.02; 5Q B: −0.04, 95% CI: −0.06 to −0.01) and an increase in the probability of moderate/severe anemia (4Q OR: 1.18, 95% CI: 1.10–1.27; 5Q OR: 1.18, 95% CI: 1.08–1.29) were observed with increased exposure to PM2.5. We conclude that outdoor PM2.5 levels were significantly associated with decreased hemoglobin values and an increase in prevalence of moderate/severe anemia in children under 5 years old.

Intravenous Tranexamic Acid Reduces Postoperative Blood Loss After High Tibial Osteotomy

Medial opening wedge high tibial osteotomy (HTO) entails extensive soft tissue release that may lead to substantial perioperative bleeding. Although tranexamic acid (TXA) is a well-established blood-conserving agent in total joint arthroplasty, its potential to reduce blood loss in patients undergoing HTO has not been studied extensively. (1) Does TXA reduce total estimated blood loss in HTO? (2) Does TXA use in HTO affect in-hospital endpoints as measured by visual analog scale (VAS) pain scores at rest the day after surgery, wound complications in the immediate postoperative period, blood transfusions, or symptomatic deep vein thrombosis? Between January 2015 and May 2017, a single surgeon performed 156 HTOs, all of which were done using the medial opening wedge technique. We began using intravenous TXA for all HTOs in June 2016. This left us with 89 patients who were treated during a time when no TXA was used and 67 patients who were treated when all patients received TXA. Two patients in the control group had simultaneous TKA in the contralateral leg and one patient in each group had missing data so these patients were excluded, leaving 86 (97%) patients in the control group and 66 (98.5%) in the TXA group available for analysis in this retrospective study. There were no demographic differences between the groups in terms of age, sex, body mass index, and baseline hemoglobin values. Total estimated blood loss was the primary outcome variable, which was calculated using total blood volume and decrease in hemoglobin values. Secondary outcome variables included pain VAS at rest the day after surgery, wound complications in the immediate postoperative period, allogeneic blood transfusions, and occurrence of symptomatic thromboembolic manifestations. The decision on when to transfuse was based on predetermined criteria. An orthopaedic surgeon not involved in patient care collected the patient data from electronic medical records and did chart review. The TXA group had less total blood loss (372 ± 36 mL versus 635 ± 53 mL, mean difference 263 mL [95% confidence interval, 248-278]; p < 0.001). Between groups, differences in VAS pain scores at rest the day after surgery favored the TXA group but were small and unlikely to be clinically important. There were two wound complications in the control group (one hematoma and one superficial wound infection) and none in the TXA group. No patients in either group received a blood transfusion, and no symptomatic thromboembolic events were detected in either group. This study demonstrates that the systemic administration of TXA reduces postoperative blood loss in medial opening wedge HTO; however, insofar as no transfusions were administered to patients even before the routine use of TXA in this series, and no clinically important differences in pain scores were identified, the clinical benefit of routine use of TXA in patients undergoing HTO is uncertain. Our study was too small to make safety-related claims on rare endpoints such as wound complications or thromboembolic events. Larger, and preferably randomized, trials are needed to help define whether it is important to use TXA in this setting. Our data can help inform sample size calculations for such studies. Level III, therapeutic study.

Safety of uneventful cesarean section in terms of hemorrhage

Objective: Hemorrhage still continues to be reported as one of the leading causes of maternal mortality and morbidity. Intraoperative estimation of the blood loss seems to be complex and misleading as it is impaired by the amount of amniotic fluid and blood from the placenta. The present study was aimed to investigate the safety of intraoperative deciding on an uneventful cesarean section in a low risk patient population. Material and methods: One hundred patients free from hemorrhage risks and experienced an uneventful elective cesarean section, were included to the study. The decline in hemoglobin and hematocrit values, calculated blood loss, transfusion rate and presence of hemorrhage related symptoms and signs were accepted as the main outcomes of the study. Results: The average preoperative and postoperative hemoglobin values were detected as 12.09 ± 0.18 g/dl and 10.72 ± 1.39 g/dl, respectively. The average decrease in hemoglobin was 1.36 ± 1.06 g/dl. The observed decrease in hemoglobin values were less than 10% in 34.4% of the patients. The average blood loss was calculated to be 517.06 ± 417.55 ml. There were no patients with signs and symptoms of hemorrhage. Cross match transfusion ratio, transfusion probability and transfusion index was calculated as zero. Conclusion: The decision of uneventful cesarean section provides obstetricians a safe postoperative and postpartum period after following standardized surgical procedures in terms of hemorrhage and related complications.

Sub Lethal Effects of Copper and Arsenic on Some Biochemical and Hematological Parameters of the Blood in an Air Breathing Fish Heteropneustes fossilis

Study was undertaken to evaluate biochemical and hematological alterations resulting from the exposure of Heteropneustes fossilis to both sub-lethal concentration of copper (1.84 ppm and 1.10ppm) and arsenic (1.10 ppm and 0.78ppm) on various tissues for 15 days, 30 days and 60 days. Three groups of 14 fish were taken as control group, arsenic exposed group and copper exposed group. At the end of experiment periodically blood sample were taken from the control and experimental group of fish. Blood was assayed for selected biochemical and hematological parameters (hematocrit, haemoglobin per cent red blood cell counts, white blood cell counts, MCV, MCH, MCHC, clotting time, plasma protein, plasma glucose, blood plasma GOT, GPT, alkaline phosphatase, cholesterol, triglycerides). The hematological indices of both sub-lethal concentration of both test metal indicated a dose-dependent decrease in hemoglobin values, hematocrit values, red blood counts, MCH, MCHC, which are indication of anemia of the normal chronic type. Clotting time significantly increased in copper exposed fish. A dose-duration dependent increase was observed in MCV and WBC count. Biochemical analysis demonstrated the blood plasma level of protein and glucose was lowered in the exposed fish as compared to the control group, but a significant dose dependent elevation was recorded in all other bio chemical parameters. During exposure time a relative decrease in blood glucose level and an increase in blood serum cholesterol level and SGOT, SGPT, alkaline phosphatase, triglycerides level was increased. The result of present study demonstrates the toxic effect of both test metal in test fish Heteropneustes fossilis and recorded hematological and biochemical parameters can be used as an indicator of copper and arsenic related toxicological stress in fish on been exposed to sublethal concentration of both metal.

Identification of hospital outliers in bleeding complications after percutaneous coronary intervention.

Post-percutaneous coronary intervention (PCI) bleeding complications are an important quality metric. We sought to characterize site-level variation in post-PCI bleeding and explore the influence of patient and procedural factors on hospital bleeding performance. Hospital-level bleeding performance was compared pre- and postadjustment using the newly revised CathPCI Registry(®) bleeding risk model (c-index, 0.77) among 1292 National Cardiovascular Data Registry(®) hospitals performing >50 PCIs from 7/2009 to 9/2012 (n=1,984,998 procedures). Using random effects models, outlier sites were identified based on 95% confidence intervals around the hospital's random intercept. Bleeding 72 hours post-PCI was defined as: arterial access site, retroperitoneal, gastrointestinal, or genitourinary bleeding; intracranial hemorrhage; cardiac tamponade; nonbypass surgery-related blood transfusion with preprocedure hemoglobin ≥ 8 g/dL; or absolute decrease in hemoglobin value ≥ 3 g/dL with preprocedure hemoglobin ≤ 16 g/dL. Overall, the median unadjusted post-PCI bleeding rate was 5.2% and varied among hospitals from 2.6% to 10.4% (5th, 95th percentiles). Center-level bleeding variation persisted after case-mix adjustment (2.8%-9.5%; 5th, 95th percentiles). Although hospitals' observed and risk-adjusted bleeding ranks were correlated (Spearman ρ: 0.88), individual rankings shifted after risk-adjustment (median Δ rank order: ± 91.5; interquartile range: 37.0, 185.5). Outlier classification changed postadjustment for 29.3%, 16.1%, and 26.5% of low-, non-, and high-outlier sites, respectively. Hospital use of bleeding avoidance strategies (bivalirudin, radial access, or vascular closure device) was associated with risk-adjusted bleeding rates. Despite adjustment for patient case-mix, there is wide variation in rates of hospital PCI-related bleeding in the United States. Opportunities may exist for best performers to share practices with other sites.

Small bowel capsule endoscopy in obscure gastrointestinal bleeding: normalcy is not reassuring.

Small bowel capsule endoscopy (SBCE) is currently a fundamental tool in the etiological study of obscure gastrointestinal bleeding (OGIB). However, the impact of a negative exam and the risk of rebleeding are not entirely known. The aim of this study was to evaluate the outcomes of patients with OGIB and a negative SBCE examination in terms of follow-up duration, additional diagnostic studies, and achievement of a diagnosis as well as to assess the incidence of rebleeding and possible associated factors. We retrospectively analyzed 256 patients who consecutively underwent an SBCE examination for the study of OGIB between April 2006 and December 2011, and then selected the 79 whose results excluded potentially bleeding lesions. Eleven patients were lost to follow-up and the remaining 68 were eligible for a nested case-control analysis. Pre-SBCE and post-SBCE information was collected, including follow-up interval and incidence of rebleeding, defined as admission to the hospital for symptomatic anemia, need for blood transfusion, decrease in hemoglobin value of greater than 2 g/dl, or evidence of melena or hematochezia. Univariate analysis included age, sex, OGIB presentation (occult or visible), hemoglobin levels at presentation, and comorbidities. In the 68 patients analyzed, the mean age was 52±18 years and 61.8% were women. The OGIB was occult in 54 patients (79.4%) and overt in 14 patients (20.6%). Patients were followed up for an average of 32 months. Thirty-nine patients (57.4%) underwent further diagnostic investigations during the period of follow-up and a cause for the gastrointestinal bleeding was found in five of them. Rebleeding was documented in 16 (23.5%) patients, occurring on average 15±13.8 months after the SBCE. Male sex was associated significantly with higher incidence of rebleeding (P=0.004). Approximately one quarter of patients with OGIB and negative SBCE examination will experience rebleeding, with higher incidence among men; thus, a negative SBCE in this setting is not reassuring. As the vast majority of rebleeding episodes seem to occur within the following 2 years after SBCE, the maintenance of regular medical surveillance during the above-mentioned period of time after a negative SBCE seems advisable.