Reduction In Hemoglobin Research Articles

A patient with cardiovascular disease and anaemia: fatal combination or consistent pattern?

Anemia is a common clinical and laboratory syndrome, complicating many somatic diseases. Of particular importance is the reduction of hemoglobin in patients with cardiovascular diseases. Anemia increases both the frequency and prognosis of cardiovascular disease. The article presents a typical clinical case of an elderly patient with chronic heart failure and normocytic anemia, presents the algorithm of management and tactics of treatment of anemia.

Influence of high affinity haemoglobin on the response to normoxic and hypoxic exercise.

Theoretical models suggest there is no benefit of high affinity haemoglobin to preserve maximal oxygen uptake in acute hypoxia but the comparative biology literature has many examples of species that are evolutionarily adapted to hypoxia and have high affinity haemoglobin. We studied humans with high affinity haemoglobin and compensatory polycythaemia. These subjects performed maximal exercise tests in normoxia and hypoxia to determine how their altered haemoglobin affinity impacts hypoxic exercise tolerance. The high affinity haemoglobin participants demonstrated an attenuated decline in maximal aerobic capacity in acute hypoxia. Those with high affinity haemoglobin had no worsening of pulmonary gas exchange during hypoxic exercise but had greater lactate and lower pH than controls for all exercise bouts. High affinity haemoglobin and compensatory polycythaemia mitigated the decline in exercise performance in acute hypoxia through a higher arterial oxygen content and an unchanged pulmonary gas exchange. The longstanding dogma is that humans exhibit an acute reduction in haemoglobin (Hb) binding affinity for oxygen that facilitates adaptation to moderate hypoxia. However, many animals have adapted to high altitude through enhanced Hb binding affinity for oxygen. The objective of the study was to determine whether high affinity haemoglobin (HAH) affects maximal and submaximal exercise capacity. To accomplish this, we recruited individuals (n=11, n=8 females) with HAH (P50 =16±1mmHg), had them perform normoxic and acute hypoxic (15% inspired oxygen) maximal exercise tests, and then compared their results to matched controls (P50 =26±1, n=14, n=8 females). Cardiorespiratory and arterial blood gases were collected throughout both exercise tests. Despite no difference in end-exercise arterial oxygen tension in hypoxia (59±6 vs. 59±9mmHg for controls and HAH, respectively), the HAH subjects' oxyhaemoglobin saturation ( ) was ∼7% higher. Those with HAH had an attenuated decline in maximal oxygen uptake ( ) (4±5% vs. 12±%, p<0.001) in hypoxia and the change in between trials was related to the change in (r=-0.75, p<0.0001). Compared to normoxia, the controls' alveolar-to-arterial oxygen gradient significantly increased during hypoxic exercise, whereas pulmonary gas exchange in HAH subjects was unchanged between the two exercise trials. However, arterial lactate was significantly higher and arterial pH significantly lower in the HAH subjects for both exercise trials. We conclude that HAH attenuates the decline in maximal aerobic capacity and preserves pulmonary gas exchange during acute hypoxic exercise. Our data support the comparative biology literature indicating that HAH is a positive adaptation to acute hypoxia.

Inability of Current Dosing to Achieve Carboplatin Therapeutic Targets in People with Advanced Non-Small Cell Lung Cancer: Impact of Systemic Inflammation on Carboplatin Exposure and Clinical Outcomes.

The presence of elevated systemic inflammation in people with advanced non-small cell lung cancer (NSCLC) is associated with significantly shorter survival following carboplatin-based chemotherapy. This study investigated whether novel factors, such as systemic inflammation [platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR)], impact carboplatin pharmacokinetics and drug utilisation. The study also examined the ability of current and alternate dosing regimens to meet therapeutic targets. Seventy-two people with advanced NSCLC treated with carboplatin-based (460-1050 mg) doublet chemotherapy were recruited and pharmacokinetic data (n = 61) were analysed using non-linear mixed modelling. Covariate analysis was performed to investigate the impact of standard and novel patient characteristics of carboplatin pharmacokinetics. A Monte Carlo simulation of 100,000 representative NSCLC patients evaluated the ability of the Calvert formula and novel dosing strategies to achieve the targeted therapeutic range. The associations between systemic inflammation and chemotherapy drug utilisation (cycles received, relative dose intensity (RDI) and second-line uptake) and clinical endpoints were also investigated in the pharmacokinetic cohort, and two independent cohorts of people with advanced NSCLC from the Chemotherapy Dosing in Cancer-Related Inflammation (CDCRI) databasethat were administered carboplatin-paclitaxel (n = 37) or carboplatin-gemcitabine (n = 358). In all cohorts, 25-53% of people had elevated systemic inflammation (NLR > 5 or PLR > 300). In the pharmacokinetic cohort, no patients achieved the desired therapeutic target of carboplatin. Carboplatin exposure was related to renal function, as estimated using the Cockcroft-Gault formula, albumin and inflammation (NLR). In the pharmacokinetic cohort, increasing carboplatin area under the curve (AUC) correlated with greater reductions in red blood cells and haemoglobin. In this cohort, the average measured AUC of partial responders was 2.4mg·min/mL. Also in the pharmacokinetic cohort, only 12% of people with an NLR > 5 received four or more cycles of chemotherapy, compared with 62% of patients with an NLR ≤ 5 (p < 0.001). For people in the CDCRI cohort receiving carboplatin-gemcitabine, those with an NLR > 5 also received less cycles (four or more cycles, 41% vs. 60%; p < 0.01) as well as less second-line chemotherapy (46% vs. 60%; p = 0.02) compared with patients without inflammation. People in the pharmacokinetic cohort with an NLR > 5 had 12months less median survival compared with people with an NLR ≤ 5 (6.5 vs. 18months; p = 0.08). Similarly, overall survival was significantly shortened in people in the CDCRI cohort receiving carboplatin-gemcitabine with an NLR > 5 compared with those with an NLR ≤ 5 (7 vs. 12months; p < 0.001), and Cox regression analysis showed a 1.5-fold (1.3-2.1; p < 0.001) increased hazard of death associated with the increased systemic inflammation. Simulations of the newly developed model-based and Calvert dosing assessed the ability to reach this study's proposed actual target AUC of 2.2-2.6mg·min/mL. These showed current Calvert dosing was predicted to result in substantial overexposure in patients with high systemic inflammation. The newly developed model showed equivalent levels of carboplatin therapeutic target achievement across the spectrum of inflammation observed in the lung cancer population. An alternate model-based dosing strategy for carboplatin was developed and is predicted to result in consistent drug exposure across the population and improve attainment of therapeutic targets. Further studies of this new model are warranted in people with advanced NSCLC.

Optimizing red blood cell protein extraction for biomarker quantitation with mass spectrometry.

Red blood cells (RBC) are the most common cell type found in blood. They might serve as reservoir for biomarker research as they are anuclear and lack the ability to synthesize proteins. Not many biomarker assays, however, have been conducted on RBC because of their large dynamic range of proteins, high abundance of lipids, and hemoglobin interferences. Here, we developed a semiquantitative mass spectrometry-based assay that targeted 144 proteins and compared the efficiency of urea, sodium deoxycholate, acetonitrile, and HemoVoid™ in their extraction of the RBC proteome. Our results indicate that protein extraction with HemoVoid™ led to hemoglobin reduction and increased detection of low abundance proteins. Although hemoglobin interference after deoxycholate and urea extraction was high, there were adequate amounts of low abundance proteins for quantitation. Extraction with acetonitrile led to an overall decrease in protein abundances probably as a result of precipitation. Overall, the best compromise in sensitivity and sample processing time was achieved with the urea-trypsin digestion protocol. This provided the basis for large-scale evaluations of protein targets as potential blood-based biomarkers. As a proof of concept, we applied this assay to determine that alpha-synuclein, a prominent marker in Parkinson's disease, has an average concentration of approximately 40μgmL-1 in RBC. This is important to know as the concentration of alpha-synuclein in plasma, typically in the picogram per milliliter range, might be partially derived from lysed RBC. Utilization of this assay will prove useful for future biomarker studies and provide a more complete analytical toolbox for the measurement of blood-derived proteins. Graphical abstract.

Application of Nano Drug Carrier in the Detection of Human Hemoglobin Content

This paper studies the application of nano drug carrier in the detection of human hemoglobin content. Taking nano modified electrode as nano drug carrier, the application of nano silver particle modified silver electrode and nano poly thionine modified electrode in the detection of human hemoglobin content is studied. Atomic force microscope, UV-Vis and FT-IR are used to characterize the nano poly(thionine), and the electrochemical properties of nano poly(thionine) modified electrode. The silver electrode decorated with nano silver particles is made. The electrochemical behavior of hemoglobin on the modified electrode is studied. The experimental results show that a pair of redox peaks appear in the silver electrode modified by nano silver particles. With the increase of Hb concentration, the redox peak current in the cyclic voltammogram of the silver electrode modified by nano silver particles increases correspondingly, and the hemoglobin has a good current response on the silver electrode modified by nano silver particles, which is a kind of adsorption current. The electrochemical activity of nano poly thionine shows a decreasing tendency with pH value. After adding hemoglobin, there is a significant reduction peak near –0.4 V. With the increase of hemoglobin concentration, the reduction peak current increases accordingly. The nano poly thionine modified electrode has a catalytic effect on the reduction of hemoglobin. The results show that the two nano drug carriers, nano poly thionine modified electrode and nano silver particle modified silver electrode, can effectively analyze and determine human hemoglobin.

The effect of bilateral uterine artery ligation versus intermittent clamping of uterine and ovarian artery on blood loss during abdominal myomectomy : A randomized controlled trial

Background: Myomectomies are more commonly performed than hysterectomies, mainly due to the fact that patients desire to retain their uterus for psychological, reproductive and cultural reasons even after completing their families. The average volume of blood loss during abdominal myomectomy is 200 to 800 mL. Surgical hemorrhage may result in anemia, hypovolemia, and coagulation abnormalities.Aim: To compare between bilateral uterine artery ligation and intermittent clamping of uterine and ovarian artery on amount of blood loss during abdominal myomectomy.Patients and Methods: This study was conducted at Ain-Shams University Maternity Hospital on 90 women with symptomatic myomas in the postmenstrual period presented by abnormal uterine bleeding, dull aching lower abdominal pain, dyspareunia, pressure symptoms, progressive abdominal enlargement or pelvic heaviness, diagnosed based on clinical examination and ultrasound scan with pre-operative hemoglobin level above 10gm/dl.Results: The preoperative Hb was 11.6 gm % and 11.8gm% for both clamping and ligation one respectively, and post-operative Hb for the groups was 9.4 gm% and 9.2 gm% for the 2 groups respectively. There was no significant difference between both groups regarding postoperative drop of hemoglobin which was 0.8 gm % in the clamping group and 1.1 gm% in the ligation group. Estimated inraoperative blood loss start was significantly fewer among clamping group than among ligation group. Hemoglobin reduction was significantly fewer among clamping group than among ligation group.Conclusion: Based on the results obtained by this study, intermittent clamping of uterine and ovarian artery is a preferred approach than bilateral uterine artery ligation on blood loss during abdominal myomectomy.

Comparing Prophylactic Effect of Rivaroxaban and Enoxaparin on Thromboembolism After Total Hip or Knee Arthroplasty

Background: Vascular thromboembolism is one of the major concerns of orthopedic surgeons after hip or knee replacement surgery. Although many thromboprophylactic drugs have been introduced, there is still no consensus over their efficacy and safety. Therefore, this study aimed to compare the efficacy and safety of oral rivaroxaban and aspirin administration and enoxaparin injections in patients undergoing knee or hip replacement. Objectives: Determination and comparison of the side effect and efficacy of Rivaroxaban and Enoxaparin after total hip or knee arthroplasty. Methods: A total of 231 patients undergoing knee or hip replacement surgery were included in the study. Of them, 31 patients were excluded due to missing the follow-up. Of the remaining 200 patients, 42 low-risk and 158 moderate- to high-risk patients were identified, according to Caprini risk assessment model. Then, they were divided into three groups: aspirin (42 patients), enoxaparin (78 patients), and rivaroxaban (80 patients). Severe hemorrhage (hemoglobin reduction of more than 2 g/dL or requiring blood transfusion) was assessed after the first dose of medication until discharge through daily hemoglobin testing. Frequency of other side effects such as wound complications (ecchymosis, hematoma, and wound infection) and gastrointestinal or skin problems was recorded and compared by daily examination during the hospital stay and then in the future visits to the clinic up to 6 months in each group. Follow up visits were performed at weeks 6, 12, and 24. Results: No cases of deep vein thrombosis or pulmonary thromboembolism were observed in any of the study groups. There was no significant difference between the two groups in the number of major bleeding cases (P=0.39). Ecchymosis around the wound was significantly higher in the rivaroxaban group than in the enoxaparin group (33.8% vs. 23%). However, this difference was not statistically significant (P=0.06). Conclusion: The efficacy and safety of rivaroxaban and enoxaparin drugs are comparable. Although ecchymosis was seen after using rivaroxaban rather than enoxaparin, rivaroxaban is orally administered and costs less for the patient and the health system. So, its use as a thromboprophylactic drug of choice following hip and knee arthroplasty surgery is still recommended.

A greater proportion of participants with type 2 diabetes achieve treatment targets with insulin degludec/liraglutide versus insulin glargine 100 units/mL at 26 weeks: DUAL VIII, a randomized trial designed to resemble clinical practice.

This report presents the efficacy and safety of insulin degludec/liraglutide (IDegLira) versus insulin glargine 100 units/mL (IGlar U100) as initial injectable therapy at 26 weeks in the 104‐week DUAL VIII durability trial (NCT02501161). Participants (N = 1012) with type 2 diabetes (T2D) uncontrolled on oral antidiabetic drugs (OADs) were randomized 1:1 to open‐label IDegLira or IGlar U100. Visits were scheduled at weeks 1, 2, 4 and 12, and every 3 months thereafter. After 26 weeks, glycated haemoglobin (HbA1c) reductions were greater with IDegLira versus IGlar U100 (−21.5 vs. –16.4 mmol/mol [−2.0 vs. –1.5%]), as was the percentage of participants achieving HbA1c <53 mmol/mol (78.7% vs. 55.7%) and HbA1c targets without weight gain and/or hypoglycaemia. Estimated treatment differences for insulin dose (−13.01 U) and body weight change (−1.57 kg) significantly favoured IDegLira. The hypoglycaemia rate was 44% lower with IDegLira versus IGlar U100. Safety results were similar. In a trial resembling clinical practice, more participants receiving IDegLira than IGlar U100 met treatment targets, supporting use of IDegLira as an initial injectable therapy for people with T2D uncontrolled on OADs and eligible for insulin initiation.

Comparison of Two Different Vinblastine Dosages for Treatment of Cutaneous Mast Cell Tumor in Dogs

Background: Mast cell tumors (MCT) are among the most common malignant cutaneous neoplasm in dogs with variable biologic behavior and remain a therapeutic challenge in high-grade cases. Surgery remains the primary treatment for canine MCT; however, chemotherapy and radiation therapy are commonly used to treat aggressive cases. The combination of vinblastine (VBL) at a dose of 2 mg/m² and prednisone is the classically described protocol for MCT treatment. Studies have shown the safety of higher VBL doses for dogs with MCT, but there is a lack of information regarding dose intensity and outcome as a goal after chemotherapy. This study aimed to evaluate the impact of a higher dose of VBL on MCT treatment outcome.Materials, Methods &amp; Results: This was an observational and comparative study conducted in two different Veterinary Teaching Hospitals. Client-owned dogs with histopathological diagnosis of grade II or III MCT were selected and underwent at least four chemotherapy sessions with VBL and prednisone. The experimental group (EG) consisted of 18 dogs that received a dose of 3 mg/m² VBL treated in one institution. The control group (CG) included 31 dogs that received a dose of 2 mg/m² VBL treated at the other institution. All dogs treated in both groups had a clinical and complete blood count (CBC) evaluation performed previous the start of chemotherapy (T0) and before each weekly treatment (T1, T2, T3, and T4). After treatment, dogs in both groups were followed-up for the recurrence rate and overall survival time after diagnosis. There was no significant difference in clinical variables between EG and CG. During treatment, dogs of EG showed a significant reduction in erythrocyte, hemoglobin, and hematocrit values between T0 and T1, T2, T3, and T4 (P &lt; 0.001). Comparatively, the CG showed significant reduction in hemoglobin (P = 0.02) and total leucocytes (P = 0.001) values in the same period. Despite these findings, these hematological parameters did not exceed the lower limit for the species in both groups. There was a higher-grade neutropenia one week after the first VBL application (T2) in both groups, with no statistical difference in neutrophil counts at T2 or during the whole treatment. There were discrete and self-limited episodes of anorexia, vomiting, and diarrhea in both groups. After chemotherapy, dogs in EG showed a significantly lower rate of recurrence than dogs in CG (P = 0.02). There was no significant difference in the overall survival time between groups.Discussion: The absence of significant differences in clinical variables (e.g. sex, age, histological grading, and tumor location) between EG and CG suggests that the groups may be similar regarding these parameters. All dogs included in this study had a recommendation for MCT post-operative chemotherapy treatment. VBL action is non-selective and anemia is not a commonly described adverse effect associated with its administration. Despite that, EG dogs exhibited a reduction in erythrocytes, hematocrit, and hemoglobin, and CG dogs in hemoglobin throughout T0 to T4. The highest number of neutropenia episodes occurred during T2, after the first VBL application in both groups with a trend of stabilization after T2, which is compatible with findings described in the literature. Any dog of EG or CG had to interrupt the treatment due to hematological or gastrointestinal toxicity or died during treatment. The role of VBL dose intensity in outcome is still debatable for dogs with MCT, once it is a multifactorial disease with variable presentation. In this study, there was no difference in overall survival time after diagnosis between groups, and EG dogs treated with a higher VBL dose showed significantly less tumor recurrence than CG.

Glossitis by Actinobacillus equuli subsp. equuli in an Equine

Background:Actinobacillosis in adult horses is rare, and is often associated with infection due to Actinobacillus equuli subsp. equuli, which is a commensal organism inhabiting the oral cavity of healthy animals. It is an opportunistic pathogen, and the infection usually occurs secondary to another primary disease or due to predisposing factors such as pre-existing lesions, mainly in the oral cavity. Infection may be associated with peritonitis, bacterial endocarditis, pneumonia, enteritis, infectious periorchitis, abortion, and septicemia. This paper aims to describe the clinical, microbiological, and pathological aspects of actinobacillosis in the oral cavity of a horse.Case:A case of actinobacillosis has been reported in a 22-year-old gelding Quarter Horse. According to the owner, the animal presented with progressive weight loss during the previous three months, and leakage of food from the oral cavity. Examination of the oral cavity revealed sharp enamel overgrowths, which had been corrected during a previous dental procedure. However, five days after the procedure, the animal developed halitosis. Ceftiofur sodium (4.4 mg/kg intramuscularly, every 24 h) was prescribed; two days after the commencement of antimicrobial therapy, the animal presented with sialorrhea, bilateral submandibular lymphadenomegaly, protrusion of the tongue, edema of the base of the tongue, cheeks, and gums, in addition to black-colored sores and scales in the oral mucosa, particularly affecting the base of the tongue and gums. Samples from ulcerative lesions found at the base of the tongue and gums were collected using sterile swabs, and culture and antibiogram were requested. Microbiological culture led to the growth of small colonies measuring less than 5 mm in diameter, that were non-hemolytic, slightly whitish in color but non-opaque, smooth and bright in appearance. These were identified as gram-negative rods on microscopy, and further characterized as Actinobacillus equuli subsp. equuli based on the phenotypic and biochemical findings. The antibiogram revealed sensitivity of the organisms to cephalothin and doxycycline, intermediate sensitivity to amoxicillin, and resistance to florfenicol, metronidazole, clindamycin, and sulfazotrim. The complete blood count revealed anemia with a reduction in hemoglobin (10.1 g/dL) and hematocrit (27.9%), neutrophilia (10.670 x 10³ /mm³), and lymphopenia (330 x 10³ /mm³). Decrease in serum albumin (2.0 g/dL) and alkaline phosphatase (91 IU/L), and increase in globulin (4.9 g/dL), aspartate aminotransferase (361 4 IU/L), and urea (123.8 mg/dL) were noted on biochemical analyses. Two days after the onset of acute clinical signs, the animal died; necropsy revealed severe, subacute, fibronecrotic glossitis associated with myriads of basophilic bacteria.Discussion:This report describes an infection of the oral cavity by Actinobacillus equuli subsp. equuli following a dental procedure, a finding compatible with the opportunistic nature of these bacteria. The presence of enamel overgrowths resulted in the formation of traumatic lesions on the oral mucosa and tongue that favored colonization of the bacteria. The case of equine glossitis reported in this study had a similar clinical presentation to the classic actinobacillosis in cattle, also known as “wooden tongue”, an infection caused by Actinobacillus lignieresii; common symptoms in cattle include oral edema, sialorrhea, and dysphagia.

The Effects of Dextran on Postoperative Thrombosis and Hemodilution in Microvascular Head and Neck Reconstruction.

Free tissue transfer is an integral part of reconstructive head and neck surgery today. Although increased experience and refinements in techniques have minimized flap loss, pharmacological agents have been used to prevent thrombus formation and flap failures, despite their questionable effectiveness. The aim of this study is to investigate the use of dextran 40 in thrombosis prophylaxis, as well as its effects on blood coagulability and flap survival. This is a retrospective analysis of 176 free flaps performed at University Hospital Dubrava, Zagreb, Croatia, during a 4-year period. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols. All patients were treated with low-molecular-weight heparin as deep vein thrombosis prevention, until patient mobilization. Group 1 was on dextran 40 protocol, whereas group 2 did not receive additional treatment. Primary outcome of the study was determined as flap loss rate, whereas secondary outcome was evaluated as the rate of thrombosis or hemorrhage. The hemodilution potential of dextran 40 was examined through blood count laboratory values. Total flap survival rate was 90.34%. There were 16 free flap losses and 1 partial loss overall. Anastomoses were re-explored in a total of 27 cases, of which 17 were salvaged. There were 29 events of hemorrhage or arterial or venous thrombosis: 17 in group 1 and 12 in group 2. A sum of 26 incidences of other postoperative complications was recorded, 13 in each group. Hemodilution status showed a statistically significant reduction in erythrocyte count and hemoglobin and hematocrit levels in the group receiving dextran 40, on postoperative days 1 and 3, but no such effect was observed on postoperative platelet count. Although dextran 40 has been shown to have a valuable effect on hemodilution, which is beneficial in microsurgery, it did not demonstrate better outcomes in terms of flap survival. Because it can cause serious systemic complications, it is better not to administer it routinely. However, its important influence on reduction in erythrocyte count and hemoglobin and hematocrit levels should be further investigated.

Acute and subacute toxicity tests of goat bile in BALB/c mice.

Aim:The aim of this study was to investigate the toxicity of goat bile in BALB/c mice since some Indonesian people consume raw goat gallbladder to treat malaria and increase stamina.Materials and Methods:Acute toxicity test was done in six groups of BALB/c mice using 100%, 50%, 25%, 12.5%, and 6.75% of goat bile and negative control. The death of mice was observed within 14 days. In the subacute toxicity test, the body weight and hematology parameters on day 0 and day 4 post-treatment were evaluated. The mice were closely observed for 28 days before plasma collection for the blood biochemistry evaluation.Results:Mild diarrhea was observed in acute and subacute toxicity tests. No death of mice was observed in acute test. Goat bile did not inhibit the increase of the body weight of mice. A slight reduction in hemoglobin and hematocrit levels in mice treated with 25% and 50% goat bile, however, remained normal in mice treated with 100% goat bile. The red and white blood cell count were not affected. Liver and kidney functions were not affected by goat bile treatment as revealed by the plasma level of aspartate aminotransferase and alanine aminotransferase, blood urea nitrogen, and creatinine, which remained in the normal range.Conclusion:Goat bile treatment in BALB/c mice caused mild toxicity in mice. Hydrophobic bile acids may cause the toxicity of goat bile in mice; therefore, it is recommended that goat bile consumption not to be taken oftenly to avoid its harmful effect.

Antimalarial Activities of Hydromethanolic Crude Extract and Chloroform Fraction of Gardenia ternifolia Leaves in Plasmodium berghei Infected Mice.

Background Gardenia ternifolia is utilized in traditional medicine of Ethiopia for malaria treatment and possessing in vitro antimalarial activity. However, no in vivo study was conducted to substantiate the claim. The aim of this study was to judge the antimalarial activity of Gardenia ternifolia extract in vivo in Plasmodium berghei-infected mice. Methods Plasmodium berghei was inoculated to healthy mice, and hydromethanolic crude extract and chloroform fraction of G. ternifolia leaves at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day were administered. Percent parasitemia inhibition, percent change in bodyweight, hemoglobin level, and mean survival time were determined. Data were analyzed using one-way ANOVA followed by post hoc Tukey HSD test with IBM SPSS software version 20.0 statistical package and P < 0.05 considered as statistically significant. Results The chemosuppressive test of hydromethanolic crude extract at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day ranged from 27.09% to 67.72%, and chloroform fraction had 35.21%–78.19% parasitemia suppression, respectively. For curative test on day 5, hydromethanolic crude extract at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day ranged from 25.58% to 48.76%, chloroform fraction at 100 mg/kg/day, 200 mg/kg/day, and 400 mg/kg/day and chloroquine base at 10 mg/kg showed 46.36%–74.42% and 92.87% percent parasitemia inhibition, respectively, and also the results to both tests were highly significant (P < 0.001) compared to the negative control. Maximum effects on chemosuppressive, curative, prevention of weight loss, and reduction in hemoglobin were observed at higher doses of the hydromethanolic crude extract and chloroform fraction. Conclusion From this study, hydromethanolic crude extract and chloroform fraction of G. ternifolia leaves have shown promising antimalarial activity. The findings support the traditional claim of G. ternifolia leaves for malaria treatment; however, species variation could also limit such a straightforward extrapolation of the findings of this study in humans.

Anemia and Associated Factors Among Under Five Children at AsellaTeachingand Referral Hospital, Ethiopia

Anemia is a condition which results from a reduction in hemoglobin concentration or reduction in red blood cell number or both which resulting in lower ability of oxygen delivery to support the body’s activities. It is a wide spread public health problem and has a significant cause of childhood mortality and (WHO) considers anemia prevalence over 40% as a major public health problem, between 20 and 40% as a moderate public health problem, and between 5 and 20% as a mild public health problem. The high prevalence of anemia has its negative consequences for children’s health, especially for their growth and development of their mental, physical and social development. It also causes negative behavioral and cognitive effects which resulting in poor school performance and work capacity in later years as different studies indicated. The Objectives of the study is to assess the prevalence of anemia and associated factor among under five children attending pediatrics outpatient department in Asella teaching and referral Hospital June 2018 to September 30 2018. Institutional based cross sectional study was conducted by non- probability convenience sampling technique, 338 children was selected. The results of the study showed that, the overall prevalence of anemia among under five children were 36.3%, around 21 (6.2%) of them were found to be severely anemic, whereas 37 (10.9%) were moderately anemic. Factors like child’s age [AOR=2.00, 95%CI (1.15, 2.61)], birth intervals [AOR=2.25, 95%CI (1.91, 6.94)], sex of the children, being stunting [AOR=2.50, 95%CI (2.00, 3.10)] and wasting [AOR=1.52, 95%CI (1.40, 3.66)], infected with malaria parasites [AOR=1.12, 95%CI (1.00, 1.40)], were associated with anemia. Anemia remains a common health problem in the study area among under five children and further studies are needed to focus on etiologies and interventions.

Effects of Aspiration and Re-transfusion Technique with Carotid Artery Stenting.

Embolic stroke is the most serious complication after carotid artery stenting (CAS). The incidence rate of embolic stroke is reduced by the use of embolic protection devices (EPDs); however, there is no consensus on which EPD is the most effective. The aspiration and re-transfusion technique (ART) with CAS under distal balloon protection was adopted at our center to reduce the incidence of embolic complications. This retrospective study investigated the effects of ART. From November 2010, 243 consecutive patients treated by CAS under distal balloon protection were included. ART was performed on 202 patients (ART group) and the other 40 patients only received distal balloon protection (non-ART group). In ART, the blood from the aspiration catheter was continuously returned through a filter to the femoral vein. The amount of debris was assessed intermittently using a small blood sample and the rest was returned. We investigated the diffusion-weighted imaging (DWI)-positive rate and symptomatic ischemic stroke one day after CAS. Compared with the non-ART group, the incidence of DWI-positive lesions (22.7% vs 37.5%, P = 0.07) and frequency of symptomatic ischemic stroke (0.9% vs 5.0%, P = 0.12) were reduced in the ART group. The hemoglobin reduction rate was significantly reduced by ART (11.1% vs 14.9%, P <0.01). In the ART group, the frequency of multiple lesions (more than 5) and large lesions (more than 10 mm) was lower than that in the non-ART group (P <0.01, P = 0.14). CAS under distal balloon protection with ART was effective at reducing the incidence of DWI-positive lesions and may be useful to reduce the incidence of symptomatic ischemic stroke.

Daily blood loss transition after total knee arthroplasty with topical administration of tranexamic acid: Paradoxical blood loss after action of tranexamic acid.

The purpose of this study was to compare the daily blood loss transition between groups with and without topical administration of tranexamic acid (TXA) after cruciate retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA). A total of 220 patients undergoing unilateral TKA were enrolled in CR and PS TKAs, which were divided into groups that received topical administration of TXA (TXA group) or without TXA (non-TXA group). Each group in both types of TKA included 55 patients. The daily transition of blood loss was compared between the TXA and the non-TXA groups in CR and PS TKAs. The blood loss was calculated through Nadler formula using the patient's blood volume and hemoglobin reduction rate. Total blood loss was significantly lower in the TXA group in both CR and PS TKAs (p < 0.001, respectively). The blood loss was lower for 0-24 h and 24-48 h after TKA. However, from 48 h to 72 h, it was greater in the TXA group (253.1 vs. 34.6 mL; p < 0.001) in CR TKAs. These tendencies were similar in PS TKAs after 48 h (186.2 vs. 134.9 mL, p = 0.223). Topical administration of TXA for reduction of blood loss seemed to be effective up to 48 h after both CR and PS TKAs. The blood loss after 48 h tended to be even greater in the TXA group. Future studies will be required to identify the pharmacokinetic evidence for this clinical finding. Level II.

Dissection and ligation of the lateral circumflex femoral artery is not necessary when using the direct anterior approach for total hip arthroplasty.

BACKGROUNDBranches of the lateral circumflex femoral artery (LCFA) stretch across the surgical field during a direct anterior total hip arthroplasty. It is an anatomical marker in direct anterior approach. As an important vessel around the hip joint, this vessel was ligated in most situations. Although ligation of the vascular pedicle of the LCFA is a common, traditional procedure used to decrease bleeding, the ligation of the pedicle of the vessel is tedious and time-consuming.AIMTo explore whether this ligation is truly necessary in a direct anterior approach to total hip arthroplasty.METHODSThis single-center, single-surgeon, prospective study was performed to compare patients’ bleeding undergoing ligation of the branches of the LCFA pedicle (group A) vs those treated with electrocautery from the branches of the LCFA (group B). In both groups, the pedicles were identified in the intermuscular plane between the tensor fasciae lata and the rectus femoris muscles. In group A, the pedicles were ligated with a silk ligature. In group B, the branches coming off the LCFA were controlled with electrocautery. We compared preoperative vs postoperative changes in blood hemoglobin levels, intraoperative blood loss, operative time, rates of transfusion, re-bleeding, and hematoma between the two groups.RESULTSThe reduction of hemoglobin in group A was 20.9 ± 7.0, and in group B it was 21.2 ± 4.9. There was no statistically significant difference between the two groups (P > 0.05). The actual calculated blood loss in group A was 784 ± 125 mL, and in group B it was 722 ± 153 mL. There was a trend in group A having more blood loss (P = 0.078). The estimated blood loss in group A was 344 ± 88 mL, and in group B it was 346 ± 73 mL. There was no statistically significant difference between the two groups (P = 0.883). In addition, there were no significant differences in the rates of postoperative transfusion (10% vs 6.7%, P > 0.05), postoperative hematomas (6.7% vs 13.3%, P > 0.05), or re-bleeding (13.3% vs 20%, P > 0.05) between the two groups.CONCLUSIONLigation of the pedicle of the LCFA has no advantage in preventing or decreasing bleeding during or after a total hip arthroplasty using the direct anterior approach. Ligation of the pedicle of the vessel is a cumbersome, unnecessary procedure and can be replaced by electrocautery control of the branches off this artery that course through the surgical field.

Continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia: A retrospective study of 13 cases.

This study aimed to evaluate the clinical effects of continuous veno-venous hemofiltration in the treatment of severely burned patients with acute hypernatremia. A total of 13 severely burned patients with acute hypernatremia admitted to Xijing Hospital were included in this study. All patients received continuous veno-venous hemofiltration treatment in addition to conventional treatment. The original sodium level in the replacement fluid was set to be lower than the serum sodium level by 8 mmol/L and subsequently undergoes a reduction rate of 2.16 ± 0.18 mmol/L every 4 h. Patients' clinical features, serum laboratory tests, hemodynamic variables, changes in sodium levels in serum, and replacement fluid during continuous veno-venous hemofiltration treatment were monitored. Patients had an average total burn surface area of 66.69% ± 20.28%. Two patients died of systematic Pseudomonas aeruginosa infections, and 11 patients survived. After continuous veno-venous hemofiltration treatment, patients showed a significant reduction in the serum sodium level (168.91 ± 4.88 mmol/L vs 144.62 ± 2.98 mmol/L, p < 0.01). Likewise, the serum levels of urea and creatinine decreased from 24.8 ± 6.5 mmol/L to 14.9 ± 8.3 mmol/L and from 278.6 ± 155.3 μmol/L to 152.6 ± 29.7 μmol/L, respectively (p < 0.05). The patients also displayed improvements in the Acute Physiology and Chronic Health Evaluation II and Glasgow scores (p < 0.05) and showed a significant reduction in hemoglobin and serum albumin levels (p < 0.05), but no obvious change in levels of platelets, alanine aminotransferase, and aspartate aminotransferase (p > 0.05). Our results indicate that continuous veno-venous hemofiltration with gradient sodium replacement fluid is effective in treating hypernatremia in severely burned patients with the controllable sodium reduction rate and satisfactory clinical outcomes.

Cost-effectiveness of a mobile-phone text messaging intervention on type 2 diabetes—A randomized-controlled trial

AimsTo evaluate the cost-effectiveness of a mobile phone text messaging program for people with type 2 diabetes mellitus. MethodsWe performed a generalized cost-effectiveness analysis in a randomized controlled trial in Bangladesh. Patients with type 2 diabetes were randomized (1:1) to a text messaging intervention plus standard-care or standard-care alone. Intervention participants received a text message daily for 6 months encouraging healthy lifestyles. Costs to users and the health systems were measured. The EQ-5D-3L was used to measure improvements in health-related quality-adjusted life years (QALYs). Intervention costs were expressed as average cost-effectiveness ratios (cost-per 1% unit-reduction in glycated haemoglobin HbA1c and cost per QALY gained), based on the World Health Organization cost effectiveness and strategic planning (WHO-CHOICE) method. ResultsIn 236 patients [mean age 48 (SD9.6) years] the adjusted difference in accumulated QALYs between the intervention and the control group over the 6-month period was 0.010 (95%CI: 0.000; 0.021). Additional costs per-patient averaged 24 international dollars (Intl.$), resulting in incremental cost-effectiveness ratios of 38 Intl.$ per % glycated haemoglobin (HbA1c) reduction and 2406 Intl.$ per QALY gained. The total intervention costs for the mobile phone text messaging program was 2842 Int.$. ConclusionText messaging might be a valuable addition to standard treatment for diabetes care in low-resource settings and predicted to lead an overall saving in health systems costs. Studies with longer follow-up and larger samples are needed to draw reliable conclusions.

Holmium laser enucleation of the prostate in Jehovah's Witness patients.

To evaluate if HoLEP is a viable option for male patients with medication-refractory urinary symptoms due to an enlarged prostate who are surgical candidates, but do not accept blood product transfusion. Between August 2008 and March 2019, nine Jehovah's Witness patients were undergoing HoLEP for relief of lower urinary tract symptoms and urinary retention. We described change in hemoglobin, change in PSA, enucleated prostate weight, enucleation and morcellation times, length of stay, and postoperative retention rate. The average age was 71.4years (range 53-87). Urinary retention requiring catheterization was present in seven patients (78%). Two patients had a known diagnosis of prostate cancer preoperatively. The mean preoperative PSA on average was 21.6ng/dL. Patients had a wide range of gland sizes, with a mean enucleated weight of 141g (range 18-344g). Mean reduction in hemoglobin was 16.9% following HoLEP. All patients managed to void postoperatively. All but one patient went home on postoperative day 1, and this patient went home on postoperative day 2. No patients required blood product transfusion or return to the operating room for clot irrigation postoperatively. HoLEP is a reasonable option for Jehovah's Witness and other patients with contraindications to blood product transfusion requiring surgical management of urinary symptoms due to enlarged prostate.