Hemorrhagic Ones Research Articles

The Immature Reticulocyte Fraction (IRF) in the Sysmex XN-1000V Analyzer Can Differentiate between Causes of Regenerative and Non-Regenerative Anemia in Dogs and Cats.

The Sysmex XN-1000V analyzer can identify those reticulocytes with high RNA content and fluorescence, providing the immature reticulocyte fraction (IRF). While this parameter has been used in human medicine to identify the cause of anemia, few studies have focused on its use in veterinary medicine. In this study, we determined the IRF and related reticulocyte parameters in a large population of non-anemic and anemic dogs and cats (subclassified depending on the origin of their anemia). The IRF was significantly higher in hemolytic anemias compared to hemorrhagic ones in both species. Moreover, the IRF was significantly lower in dogs and cats with bone marrow failure than in other non-regenerative anemias and in both groups compared to pre-regenerative anemias. The accurate cut-off values for the differential in regenerative anemias and reference ranges for both species using the Sysmex XN-1000V are also reported. The measurement of the IRF in this analyzer can help clinicians to further classify the type of anemia in both species.

Complications of ultrasound-guided percutaneous native kidney biopsies in children: A single center experience

Introduction: Percutaneous kidney biopsy is a necessary tool to diagnose many kidney diseases. However, major complications were reported in adults, including bleeding in the kidney or around it, creation of arteriovenous fistula, wound infection, damage to adjacent organs, or even loss of the kidney. Such complications can rapidly develop serious consequences. Exploring risk factors might help in preventing them. Objective: The current study aims to evaluate and explore the complications that happened after percutaneous kidney biopsy in children and associated risk factors. Methodology: A retrospective record-based study was conducted by reviewing the medical records of children with post-ultrasound-guided percutaneous kidney biopsy complications at King Saud Medical City, a tertiary hospital in Riyadh, Saudi Arabia during the period from May 2014 to June 2021. Data were extracted using pre-structured data collection sheet. Data collected included children’s age, gender, primary disease, laboratory findings, and kidney complications with needed management. Results: The study identified 76 children who had undergone 86 ultrasound-guided percutaneous kidney biopsies in the study period and fulfil the inclusion criteria. Children’s ages ranged from 1 years to 15 years with a mean age of 7.3 ± 4.0 years old. Most of the study children had nephrotic syndrome (61.6%; 53), followed by glomerulonephritis (25.6%; 22). Thirty-five (40.7%) children developed at least one of the complications. The most-reported complication was microscopic haematuria (32.6%; 28), followed by gross haematuria (3.5%; 3), Flank pain was reported among 3 (3.5%) children also and hematoma (1 child), only 2 children (3.9%) among those who had no complications recorded Haemoglobin drop > 2 g/dl compared to 3 of those who had complications with no statistical significance (p = .365). Prothrombin time was significantly higher among children who had renal complications than others who had not (11.7 ± 1.8 vs. 10.8 ± 1.2 seconds; p = .022). Conclusion: Suggestive by the low need to intervene in complications, ultrasound-guided percutaneous kidney biopsy is a relatively safe procedure in children. Even in the most commonly observed complication, i.e. hemorrhagic ones, blood transfusion is rarely needed.

Differences in Clinical Characteristics and Surgical Outcomes of Patients with Ischemic and Hemorrhagic Pituitary Adenomas

Ischemia and hemorrhage of pituitary adenomas (PA) caused important clinical syndrome. However, the differences on clinical characteristics and surgical outcomes between these two kinds apoplexy were less reported. A retrospective analysis was made of patients with pituitary apoplexy between January 2013 and June 2018. Baseline and clinical characteristics before surgery were reviewed. All patients underwent transsphenoidal surgery and were followed up at least 1 year. Total 67 cases (5.8%) among 1147 pituitary tumor patients were enrolled, which consisted of 28 (~2.4%) ischemic PA and 39 (~3.4%) hemorrhagic PA. There were more male patients in the ischemic group compared with hemorrhagic group (78.6% vs 53.8%, p=0.043). However, the mean age, tumor size and functional tumor ratio were significant higher in the hemorrhagic group. Headache was more common in ischemic PA (82.1%) than that of hemorrhagic PA (51.3%, p=0.011). Magnetic resonance imaging findings found that mucosal thickening and enhancement of the sphenoid sinus was observed in 15 ischemic PA patients (n=27, 55.6%), but none in patients with hemorrhagic PA (n=38, p<0.0001). It was worth noting that the rate of pre-surgical hypopituitarism in ischemic PA patients were seemed higher than that in hemorrhagic PA patients, but not significant. The two groups got a total tumor resection rate at 94.1% and 92.9%, independently. No significant difference on the operative time, blood loss in operation and complications in perioperative period was observed in two groups. After operation, cranial nerve symptoms recovered to normal at 81.8% of ischemic PA patients and 82.6% of hemorrhagic PA patients. Importantly, the incidence of postoperative hypopituitarism partially decreased in both groups, among which the rate of hypothyroidism in ischemic PA patients significantly decreased from 46.4% to 18.5% (p=0.044). Patients with ischemic PA presented different clinical characteristics to the hemorrhagic ones. Transsphenoidal surgery should be considered for the patients with neuro-ophthalmic deficits and might benefit for pituitary function recovery of the apoplectic adenoma patients, especially pituitary thyroid axis in ischemic PA patients.

Association between Use of Spironolactone and Risk of Stroke in Hypertensive Patients: A Cohort Study.

Objective: to investigate the relationship between the use of spironolactone and the risk of stroke in hypertensive patients. Methods: a total of 2464 spironolactone users and 12,928 non-users were identified (unmatched original cohort), and 1:1 matched pairs of 2461 spironolactone users and 2461 non-users based on propensity scores were created (propensity-score-matched cohort). Results: In the unmatched original cohort, the unadjusted analysis showed that the use of spironolactone was associated with a lower risk of total stroke (HR, 0.71; 95% CI, 0.61−0.84; p < 0.001), which was sustained in the adjusted analysis. According to stroke type, the association was with ischemic strokes (propensity-score-adjusted HR, 0.71; 95% CI, 0.59−0.85; p < 0.001) and hemorrhagic ones (propensity-score-adjusted HR, 0.63; 95% CI, 0.45−0.88; p = 0.008). Similar results were shown in the propensity-score-matched cohort. The results of the subgroup and sensitivity analyses were consistent with those of the primary analysis. The dose−response analysis demonstrated a dose-dependent association of spironolactone with a lower risk of stroke in hypertensive patients. Conclusions: The use of spironolactone was associated with a significantly lower risk of stroke events in hypertensive patients. Further research, including prospective randomized clinical trials, is needed to validate our findings.

OPTIMIZATION OF SURGICAL TACTICS IN PATIENTS WITH POSTNECROTIC PANCREATIC CYSTS

Summary. The predominance of people of working age (21–60 years) among patients with pancreatic necrosis, the occurrence of permanent disability in a significant part of patients, high overall and postoperative mortality (20–85 %), due to various complications, turns the treatment of pancreatic necrosis into an important social problem. The frequency of formation of false cysts in acute pancreatitis is 5–16 %, and in destructive forms it increases to 60–80 %.&#x0D; Materials and methods. The scope of endoscopic interventions in the treatment of 16 patients with pancreatic cysts of the pancreas directly depended on the preoperative findings and, first of all, on the presence of the connection of the cyst with the pancreatic ducts. Favorable conditions for endoscopic correction in the treatment of pancreatic pseudocysts were a small (less than 10 mm) distance between their cavity and the lumen of the gastrointestinal tract, minimal thickness of the capsule (no more than 2 mm), large dimensions (over 6 cm), as well as localization in the projection body and isthmus of the pancreas.&#x0D; Research results. When analyzing the results of the treatment of complications of pancreatic necrosis, we formulated an algorithm for the rational choice of operative interventions. We believe that rational treatment is based on early diagnosis of PN complications, including hemorrhagic ones.&#x0D; Conclusions. The use of the developed algorithm allowed us to reliably reduce postoperative mortality among patients of this category.

OPTIMIZATION OF SURGICAL TACTICS IN PATIENTS WITH POSTNECROTIC PANCREATIC CYSTS

Summary. The predominance of people of working age (21-60 years) among patients with pancreatic necrosis, the occurrence of permanent disability in a significant part of patients, high overall and postoperative mortality (20-85 %), due to various complications, turns the treatment of pancreatic necrosis into an important social problem. The frequency of formation of false cysts in acute pancreatitis is 5-16 %, and in destructive forms it increases to 60-80 %.&#x0D; Materials and methods. The scope of endoscopic interventions in the treatment of 16 patients with pancreatic cysts of the pancreas directly depended on the preoperative findings and, first of all, on the presence of the connection of the cyst with the pancreatic ducts. Favorable conditions for endoscopic correction in the treatment of pancreatic pseudocysts were a small (less than 10 mm) distance between their cavity and the lumen of the gastrointestinal tract, minimal thickness of the capsule (no more than 2 mm), large dimensions (over 6 cm), as well as localization in the projection body and isthmus of the pancreas.&#x0D; Research results. When analyzing the results of the treatment of complications of pancreatic necrosis, we formulated an algorithm for the rational choice of operative interventions. We believe that rational treatment is based on early diagnosis of PN complications, including hemorrhagic ones.&#x0D; Conclusions. The use of the developed algorithm allowed us to reliably reduce postoperative mortality among patients of this category.

Eficacia de la tromboprofilaxis con heparina de bajo peso molecular en pacientes críticos con COVID-19: estudio observacional, prospectivo y multicéntrico

IntroductionCOVID-19 induces coagulopathy associated with an increase of thromboembolic events. Due to the lack of agreement on recommendations for thromboprophylactic management, the aim of this study was to study the dosages of LMWH used in critically ill COVID-19 patients assessing the effect on their outcome. MetohdsWe evaluated data of the Reg-COVID19. According to LMWH dose two groups were analyzed: prophylaxis and treatment. Primary outcome was the relationship of LMWH dosage with mortality. Secondary outcomes included the incidence of thrombotic and bleeding events, length of ICU stay, invasive mechanical ventilation, and thrombotic and inflammatory parameters. ResultsData of 720 patients were analyzed, 258 in the prophylaxis group and 462 in the treatment group. C Reactive Protein, invasive mechanical ventilation, tocilizumab and corticosteroid treatments were related with the choice of LMWH dose. Hemorrhagic events (66/720, 9.2%) and thrombotic complications (69/720, 9.6%) were similar in both groups (P=.819 and P=.265), as was the time course of the thrombotic events, earlier than hemorrhagic ones (9 [3-18] and 12 [6-19] days respectively). Mortality was lower in prophylaxis group (25.2% versus 35.1%), but once an inverse probability weighting model was applied, we found no effect of LMWH dose. ConclusionWe found no benefit or harm with the administration of therapeutic or prophylactic LMWH dose in COVID19 critically ill patients. With a similar rate of hemorrhagic or thrombotic events, the LMWH dose had no influence on mortality. More studies are needed to determine the optimal thromboprophylaxis protocol for critically ill patients.

Timing and Spectrum of Neurological Complications After Flow Diverter Implantation for Intracranial Aneurysms.

Background and Purpose: The aim of this study was to characterize neurological complications after flow diverter (FD) treatment on a long follow-up cohort and identify predictive factors associated with these complications.Methods: This study was conducted on a monocentric cohort of patients treated for intracranial aneurysms by FD.Results: Between September 2008 and July 2018, 413 patients were treated for 514 aneurysms: 18% of the patients presented with at least one neurological complication during a median follow-up of 446 days (IQR 186–1,210). Sixty-one patients presented with ischemic complications, 13 with hemorrhagic ones and 10 with compressive processes. Among 89 neurological complications 64.5% were peri-operative (occurring within the 30 days following the procedure) and 35.5% were delayed after 1 month.Conclusions: Overall, neurological complications after FD implantation were overrepresented by cerebrovascular ischemic events occurring during the peri-operative period, but also in a delayed manner after 1 year. Long-term follow-up is relevant after aneurysm intervention using FD.

Risk Factors for Stroke in Patients with Chronic Kidney Disease

Abstract Stroke is a public health problem especially in developed countries, being an important cause of death and disability. The prevalence of chronic kidney disease (CKD) in the general population varies from country to country. The percentage of afflicted patients is on the rise, mainly due to the high incidence of diabetes mellitus (DM) complicated with diabetic nephropathy (DN) and of the kidney vascular diseases (hypertensive nephroangiosclerosis and ischemic nephropathy). In patients with CKD, strokes are relatively frequent, especially hemorrhagic ones, due to a host of risk factors, both modifiable and unmodifiable. Cardiovascular complications (which may be prevented by risk factors control) are the main culprit for the relatively high mortality rate of CKD patients, frequently leading to their death before the initiation of renal replacement treatment (dialysis, kidney transplant).

Evaluation of clopidogrel response with light transmission aggregometry before extra- intracranial stenting

Objective – to study the result of light transmission aggregometry with ADP for platelet reactivity before and after clopidogrel administration before extra-intracranial stenting.Materials and methods. Between January and October 2019 36 patients (19 males and 17 females, the average age was 41 years (25–69 years)) who underwent extra or intracranial stenting for atherosclerotic stenosis, endovascular aneurysm coiling with stent-assistance, or implantation of flow diverter were examined. Determination of the aggregation curve with ADP (concentration – 5 mmol/L) was performed before antiplatelet therapy and 5–7 days after before the procedure. Clopidogrel resistance was determined with a maximum aggregation &gt; 50 % on the aggregation curve. In case of clopidogrel resistance, the daily and loading doses were increased to 150 and 450 mg respectively.Results. The maximum ADP-induced aggregation before clopidogrel admission was 77.50 % [63.0–99.0] and 43 % [33.0–61.0] after admission (p &lt; 0.0001). Clopidogrel resistance was detected in 6 (16.7 %) patients. All patients with low sensitivity to clopidogrel underwent extra or intracranial stenting without peri-procedural complications. Thromboembolic complications occurred in 2 patients with a normal response in the early postoperative period after stent implantation, and in 1 case there was a hemorrhagic complication on standard dual antiplatelet therapy in the form of recurrent bleeding from the femoral artery puncture site.Conclusions. Light transmission aggregatometry with ADP is an effective and relatively cheap method of determination the clopidogrel response before neurovascular stenting. Platelet response to clopidogrel therapy significantly varies among patients. Maximum ADP-induced aggregation on the standard dose of clopidogrel before stenting is an important prognostic factor for deciding the optimal clopidogrel dosage. Therapeutic approaches to reduce platelet aggregation in patients with low response on a standard clopidogrel therapy require further study with the aim to determine the optimal drug and its dose for reducing thrombembolic complications rate, without additional risk of hemorrhagic ones.

Association of serum magnesium levels with risk factors, severity and prognosis in ischemic and hemorrhagic stroke patients.

Background:Stroke is the third leading cause of mortality worldwide. One of the factors that affect the occurrence of stroke can be attributed to changes in the levels of trace elements. Accumulating evidence has been shown that magnesium, as an important element, is a new predictor of stroke. We aimed to determine the levels of Mg in ischemic stroke patients in comparison with those having the hemorrhagic type.Methods:This study was conducted on 447 stroke patients. Demographic characteristics of patients, stroke severity, and risk factors such as hypertension, ischemic heart disease, diabetes mellitus, and hyperlipidemia were recorded. Stroke was diagnosed based on the neurological examination and neuroimaging findings e.g. computed tomography (CT) or magnetic resonance imaging (MRI). The colorimetric technique was used to determine the concentration of Mg at 450 nm according to the commercial kit.Results:The mean of magnesium levels in ischemic patients was significantly higher than that in the hemorrhagic patients (P=0.001). Difference in magnesium status was associated with gender in thrombotic patients (P<0.05), while hyperlipidemia was associated with the status of magnesium in embolic patients (P=0.012). Furthermore, magnesium levels were correlated with ischemic heart disease in embolic (P=0.011) and sub-arachnoid hemorrhagic (SAH) patients (P=0.012), and with diabetes mellitus in thrombotic patients (P=0.012). Magnesium status was associated with the severity of ischemic stroke at the time of discharge in ischemic patients (P<0.001). Mg levels had the best area under curve (AUC) for the discrimination of ischemic patients from hemorrhagic ones.Conclusion:Magnesium levels were higher in ischemic patients compared to hemorrhagic ones, and these levels were associated with many risk factors contributing to a stroke. Magnesium may be used as a new predictor of stroke in ischemic patients as opposed to hemorrhagic ones.

Animal models of acute gastric mucosal injury: Macroscopic and microscopic evaluation.

Acute gastric mucosal injury is a common disorder of the gastrointestinal tract and the search for new therapeutics is ongoing. The aim of this study is to update and expand the information related to the most widely used rat models of acute gastric ulcer, the ethanol‐induced ulcer and the indomethacin‐induced ulcer. These two models are compared in terms of macroscopic and microscopic features. Experimentally, ethanol was given orally in a single dose and indomethacin was subcutaneously injected into male Wistar rats. After ulcerative challenges, the stomachs were removed and visually inspected. Anti‐ulcerative drugs were used to validate the models. Histological analysis of the stomachs determined the microscopic score. The methodology used for model evaluation applied to macroscopic and microscopic gastric lesions. With these methods it was possible to induce lesions in the gastric mucosa. Microscopic evaluation permitted assessment of the inflammatory and apoptotic impact in the mucosa not observable by macroscopic evaluation. Groups of animals were treated with two standard drugs: sulcralfate suspension or lansoprazole solution. Both drugs reduced macroscopic and microscopic lesions, particularly the hemorrhagic ones. Both models induced acute gastric mucosal injury and no single evaluation method can address all the aspects of the pathology of gastric lesions. As a complement to macroscopic evaluation, microscopy appears to be a relevant tool to selectively identify specific aspects of the development of mucosal injury, quantify the extent of lesions, and contribute to an appropriate interpretation of results. The score systems established here offer a reliable method for testing antiulcer drugs.

Approach to Classification of Cavitary Effusion and Comparison between Manual and Automatic Methods for Total Nucleated Cell Count

Background: Two classifications are used to categorize cavitary effusions using total nucleated cell count (TNCC): protein concentration and pathophysiology of its formation. The aims of the present study were to evaluate the correlation between the TNCC values of cavitary effusions obtained in the automatic and the manual method, and also evaluating the classification methodology. Materials, Methods &amp; Results: Cavitary effusions were analyzed for physical, chemical and cytological aspects, as well as manual and automatic cell counts for the correlation between the traditional methods and those suggested by Stockham &amp; Scott. Bland-Altman regression and Spearman correlation analysis were performed. Of the total, 44 were abdominal effusions (73.3%), 15 thoracic (25%) and 1 pericardial (1.7%). According to the traditional classification, most of the effusions were classified as modified transudates (40%) and according to the classification of Stockham and Scott, as transudates poor in protein (31.7%). The correlation between cell counting techniques between pure, modified and exudate transudates was 0.94, 0.97 and 0.94, respectively, indicating an excellent correlation between the parameters (p = 0.95%).Discussion: Considering the concentration of proteins and CCNT, the effusions classified as modified transudate were mainly caused by neoplastic processes (carcinomas/adenocarcinomas), since there are several mechanisms of their formation, such as large variation of protein concentration. According to the Stockham &amp; Scott classification a unique classification is considered for exfoliative neoplastic effusions, the variation of the protein concentration of the effusion does not alter its classification. In neoplastic effusions, classified as exudates, lymphomas were the most prevalent, and hypercellularity (approximately 150,000 cells / μL) allowed this classification. When considering low-protein transudates, the findings related to low concentrations did not differ much from the traditional classification. In the ruptures of viscera and vessels, the hemorrhagic ones were the most frequent, thus, the cytological diagnosis is essential, since it can give information about the contamination with blood during the collection. Most of these were due to neoplasia as the underlying cause. A case of chylotorax was diagnosed by comparing cholesterol and triglyceride values of effusion and serum. In cases of uroperitoneum, the presence of urine in the abdominal cavity promotes the dilution of the fluid from the cavity, being initially classified as pure transudate and, with its permanence in the cavity, increasing the CCNT, becomes an exudate. As in cases of exfoliative neoplastic effusions, the classification of the uroperitoneum, according to Stockham &amp; Scott, is classified directly into effusion due to rupture of the viscera, giving a quick and clear diagnosis. According to Stockham &amp; Scott, cases classified as nonseptic exudates (n = 3), two of which resulted from feline infectious peritonitis (PIF). The effusive form of PIF presents with accumulations of fluid in the abdomen, having an inflammatory character, but according to the traditional classification, they enter the category of modified transudates, because, despite containing protein concentrations close to or above the serum level, they present a CCNT lower than an exudate. Cavitary effusions were classified as septic exudates when intracellular bacteria were present and in the present study, two effusions were classified as such in two patients, one with septic peritonitis and in the other the final diagnosis was not found. The high values of Spearman correlation coefficients found when comparing the automatic counts with the manual demonstrate that there is an excellent correlation between the methods and, the Bland-Altman test showed significant agreement between them.

Reduction in High-Sensitivity C-Reactive Protein Levels in Patients with Ischemic Stroke by Statin Treatment: Hs-CRP Sub-Study in J-STARS.

Aims: The pleiotropic effects of statins on recurrent stroke remain unclear. We investigated the effects of pravastatin on high-sensitivity C-reactive proteins (Hs-CRP) in ischemic stroke, and explored the impact of Hs-CRP on recurrent stroke and vascular events.Methods: This randomized open-label trial was ancillary to the J-STARS trial. One thousand and ninety-five patients with non-cardiogenic ischemic stroke were assigned to the pravastatin (n = 545) or control groups (n = 550). The primary and secondary endpoints were serum Hs-CRP reduction and stroke recurrence, including both ischemic and hemorrhagic ones, respectively. Onset of vascular events and each stroke subtype in relation to Hs-CRP levels were also determined.Results: In the pravastatin treatment group, Hs-CRP levels (median 711 µg/L, IQR 344–1500) significantly decreased 2 months later (median 592 µg/L, IQR 301–1390), and they remained significantly lower until the end of the study. However, in the control group, baseline Hs-CRP levels were similar to those 2 months later. The reduction of Hs-CRP levels from the baseline to 2 months in the pravastatin group was statistically significant compared with the control (p = 0.007). One SD increase in log-transformed Hs-CRP increased the risk of stroke recurrence (HR 1.17, 95% CI 0.97–1.40) and vascular events (HR 1.30, 95% CI 1.12–1.51). With an Hs-CRP cut-off of 1000 µg/L, higher Hs-CRP significantly increased the risk of recurrent stroke (HR 1.50, 95% CI 1.03–2.17) and vascular events (HR 1.68, 95% CI 1.23–2.29).Conclusion: In non-cardiogenic ischemic stroke, pravastatin treatment may reduce vascular inflammation as assessed by Hs-CRP, and higher Hs-CRP levels appeared to increase the risk of recurrent stroke and vascular events.

Neonatal Hypoxic-Ischemic Encephalopathy and Hypothermia Therapy: Solving Questions about Monitoring and Prognosis

Introduction: The hypoxic-ischemic encephalopathy is a significant cause of neurologic morbidity and mortality in the newborn. One of the standards of management is the hypothermia therapy that allows a reduction in the brain injury extension, making important to define the settings involving the admission to such therapy. The hypothermia therapy protocol demands an strict compliance of the inclusion criteria, one of them, the APGAR score at a determinate moment, no protocol includes its score at different times, the APGAR score helps the clinician to decide the therapeutic approach of this patients, and the tenth minute score has received priority over the other minute’s score, nevertheless many patients will lose the opportunity to be admitted for hypothermia therapy when this score is taken, although the ACOG has determined that it is the minute 5 APGAR that has the value to define neonatal asphyxia, most European and American protocols take the 10 minute APGAR score; besides it is possible that the newborn in the first 6 hours does not demonstrate the secondary damage, or energy failure that are generated up to 48 hours later, in which the use of hypothermia therapy has truly a therapeutic effect. Then it is imperative to analyze the early outcomes according to the APGAR in the minute 5 and 10 in patients admitted for hypothermia therapy. Methods: A descriptive study, and retrospective analysis of a cohort of 62 patients born in term with hypoxic ischemic encephalopathy, admitted at the intensive care unit of Clinica Universitaria Bolivariana, Medellin, Colombia, between 2014-2016. Results: The cohort of newborns exhibits a mortality of 8.1%, which was significantly associated with the presence of complications during hypothermia. The most frequent pattern found in the electroencephalographic line during the first day was suppression burst 45.2%, and heading to the end of the protocol, 51.6% achieved normalization; imaging findings such as the subcortical ischemia was the mostly found in 25.8%, but the hemorrhagic ones were only found in 12.9%. During a bivariate analysis a correlation between different outcomes were found, the most important of them, was the one among the presence of status during the electroencephalographic monitoring with an APGAR score under 5 at the fifth minute. Conclusions: It is important to take on consideration the five-minute APGAR score because of its relation with epileptic status development, which in our cohort was more frequent without clinical manifestation than with it during monitoring. This is important because of the negative prognosis that this implies in the short term, in addition the patients that presented epileptic status post medication had correlation with persistent abnormalities at the discharge, that is why the five-minute APGAR score under five can predict the neurological examination at the discharge and the epileptic status development as a predictive marker. This also creates a suspect that the recommendation to use hypothermia therapy without electroencephalographic monitoring is a dangerous practice, and makes it difficult to assess the response to it.

Secondary prevention of systemic arterial and recurrent venous thromboembolic events, through extended time anticoagulation with apixaban, in an elderly patient with multiple comorbidities

The clinical case illustrates the daily practice with an individualized, adjusted thromboprophylactic dose of apixaban (2.5 mg twice-daily, follow-up for 20 months), mandatory indicated as a continuous therapy for secondary prevention of systemic arterial embolism and recurrent venous thromboembolic events, in an elderly obese patient, associating multiple pathological conditions (chronically anticoagulated for non valvular atrial fibrillation and stroke sequelae, multiple metabolic comorbidities such as type 2 diabetes mellitus , hyperuricemia, moderate renal insufficiency, hyperuricemia), who submitted a severe “unprovoked” phlegmasia alba dolens in the sound (left) lower limb, a decade after a (most possible) iatrogenic deep vein thrombosis at the paralyzed (right) limb. Thromboprophylaxis for an extended time, without any medical complications (neither systemic or venous thrombotic events, nor hemorrhagic ones) confirmed the product`s efficacy and safety profile. Physiopathological considerations and essential pharmacological considerations were discussed, focused on the individualized safe therapeutic approach.

Aggravation by Clopidogrel, An Antiplatelet Drug, of Antral Damage Induced by NSAID in Rats: A Prophylactic Effect of Antiulcer Drugs

Recent studies suggested a risk of gastric adverse reaction on the concomitant use of antithrombotic drugs with NSAIDs. We investigated whether clopidogrel, a P2Y12 receptor antagonist, aggravates antral damage induced in rats by indomethacin and examined the effects of several antiulcer drugs on these lesions. Male SD rats fasted for 24 h were refed for 1 h, and then administered indomethacin (30 mg/kg) s.c. 1 h after refeeding, and the stomachs were examined for lesions 6 h thereafter. Clopidogrel (3‐30 mg/kg) was given p.o. 3 times, 48, 24 h and 30 min before indomethacin. Famotidine or teprenone was given p.o. 1 h before indomethacin. Indomethacin alone produced damages, mostly nonhemorrhagic lesions, in the antrum of refed rats. Clopidogrel dose‐dependently worsened these lesions with convertion of nonhemorrhagic damages into hemorrhagic ones. The ulcerogenic response to indomethacin plus clopidogrel (30 mg/kg) was significantly suppressed by pretreatment with famotidine with a decrease in hemorrhagic lesions. The aggravating effect of clopidogrel was also attenuated by teprenone, though the effect was less pronounced than that of famotidine. These results suggest that 1) clopidogrel aggravates NSAID‐induced antral lesions, converting from nonhemorrhagic into hemorrhagic damage, and 2) these lesions are effectively prevented by both antisecretory and mucosal protective drugs.

Assessment of the histopathological prototypes of the pleural fluid and granulomatous tissue reaction associated with pleural tuberculosis

PurposeThe aim of this study is to differentiate between the histopathological features of pleural tuberculosis both free and encysted forms of pleural effusion as regards pleural fluid cytology and pleural tissue granulomatous tissue reaction and assess the effects of combined microbial infection on histopathological and clinical residuals. Patients and methodsOne hundred and ninety patients were confirmed to be tuberculous by pleural tissue biopsy. Pleural fluid cytopathology and TB granulomatous tissue biopsy samples were studied. ResultsWithin histopathological features in TB pleural effusion is typical granulomatous TB reaction that was prevalent in both free and encysted forms of pleural effusion with high percentage (97% and 87.5% respectively). On the other hand, lymphocytic exudative smear was predominant in the free TB effusion group than both inflammatory and hemorrhagic ones (74.7% versus 23.5% and 1.8% respectively) while the encysted effusion group presented higher predominance to inflammatory exudative smear than other types (54.2% versus 41.7% and 4.2% respectively). Moderate cellularity was higher in percentage in both free and encysted groups 77.7% and 62.5% respectively. Also, langerhans cells prevailed in both effusion types. Lastly, non TB culture was present in all cases of encysted pleural effusions but accounted only for 3% of free effusion cases. ConclusionDifferentiation between free and encysted forms of pleural tuberculous effusion as regards effusion cytopathological criteria and pleural tissue histopathological patterns represent an important support in understanding the pathogenesis of pleural tuberculous tissue reactions and other positive cultural diagnosis can aggravate TB granulomatous reactions.

A foldable intraocular lens implantation into the ciliary body sulcus with scleral suturing in patients with inadequate capsular support

There are different methods of IOL fixation in case of inadequate capsular support, one of them being IOL implantation into the ciliary body sulcus. Foldable aspheric Akreos IOLs produced by BauchLomb were implanted in 212 patients, who had had a dystrophic or traumatic crystalline lens subluxation of 3rd degree, luxation into the anterior chamber, post-traumatic aphakia and in those in whom a posterior capsule rupture occurred as a phacoemulsification complication. A method of IOL suturing in the ciliary body sulcus in the absence of capsular support for the foldable IOL implanted through a small incision was worked out. A visual acuity analysis revealed high functional results, in particular in cases of small incision implantations. Among postoperative complications, hemorrhagic ones were observed most often. It was shown that IOL Akre-os AO implantation into the ciliary body sulcus could be used in case of inadequate capsular support.

Renal Cell Carcinoma with venous neoplastic thrombosis: A ten years review

To review the 10-year experience of our urological unit in the surgical management of renal cell carcinoma (RCC) with neoplastic tumor thrombosis focusing on postoperative survival. We underwent a retrospective analysis of the patients treated for this pathology during the last decade 2002-2012, stratifying them by tumor thrombus level and histological subtype. Kaplan-Meyer curves were used to assess survival. Overall, 67 patients underwent surgery for RCC with neoplastic tumoral thrombosis in the period under review. 60 were clear cell RCC, 4 were urothelial papillary tumors of the renal pelvis and 3 were rare histotypes, as a nefroblastoma, a spinocellular tumor of the renal pelvis and an unclassifiable renal carcinoma. Thrombus level was I in 40 cases, II in 17, III in 2 and IV in 8 patients. We report the main postoperative complications and our survival data, with mean follow up of 36 months. Tumor stage is the most important variable in predicting survival. Patients with N0M0 disease had 70% survival at 36 months, instead of 20% for those with primitive metastatic tumor. Our survival results fit with the main reports in literature and our surgical management was completely in keeping with international guidelines. We did not observe relevany post-operative complications, except of hemorrhagic ones that occurred in 6 patients (9% of total) and were always successfully managed. Eighteen patients (26.87% of total) underwent caval filter positioning, without evidence of complications during its positioning or removal. Life expectancy was particularly low for the cases of RCC without clear cell histotype (7 cases in our series, 10.4% of total) that always was less than one year from surgery.