Decrease In Mean Hemoglobin Level Research Articles

Evaluation of Epidemiological Risk Features and Hematological Parameters in the Lymphoma Patients in the Larkana Region

Background: Hodgkin lymphoma (HL) is a type of lymphatic cancer that is distinctly characterized and classified into various subtypes, with varying prognoses based on the stage at diagnosis and treatment modalities. Despite advances in treatment, the specific demographic and clinical factors influencing treatment outcomes and the incidence of side effects, such as chemotherapy-induced anemia and neutropenia, remain under-explored, particularly in diverse regional settings. Objective: This study aims to evaluate the epidemiological risk features and hematological parameters of lymphoma patients in the Larkana region, with a focus on the impact of chemotherapy on these parameters. Methods: A case-control study was conducted over twelve months at Linar Hospital in Larkana, involving 40 participants aged between 10 and 70 years. Informed consent was obtained, aligning with ethical standards akin to the Declaration of Helsinki. Two types of blood samples were collected pre- and post-chemotherapy for hematological analysis including total leukocyte count, hemoglobin, and platelet levels, which were assessed using Complete Blood Count (CBC) containers with EDTA. Statistical analysis was performed using Microsoft Excel 2010 and SPSS Version 23, utilizing descriptive statistics and the Student's t-test. Results: The study documented a decrease in mean hemoglobin levels from 11.42 ± 1.74 g/dL before chemotherapy to 10.65 ± 1.55 g/dL after (p = 0.001), mean white blood cell count from 7.30 ± 2.6 × 10^3/uL to 5.71 ± 2.1 × 10^3/uL (p = 0.003), and platelet count from 297.52 ± 116.2 × 10^3/uL to 230.2 ± 72.6 × 10^3/uL (p = 0.001). These findings indicate a significant hematological impact associated with chemotherapy. Conclusion: The significant reduction in critical hematological parameters among lymphoma patients’ post-chemotherapy highlights the need for rigorous monitoring and tailored management strategies to mitigate treatment side effects. The findings emphasize the importance of comprehensive patient care and support in improving treatment outcomes in lymphoma.

Effect of Heparin on the Formation and Healing of Gastric Ulcers Induced by Acetic Acid Application on the Gastric Mucosa in Rats

The key factor in maintaining the integrity of the gastric mucosa is its normal blood supply, respectively, the use of drugs that improve it, including through a positive effect on the rheological properties of blood, is in demand for the treatment of gastric ulcer. These drugs include the anticoagulant heparin. The aim of the work is to study the effect of heparin on the formation and healing of gastric ulcers induced by the application of 60% acetic acid to the gastric mucosa in rats, while assessing the possible risk of bleeding. After application of acetic acid (day 0), the area of gastric ulcers was assessed on the 4th day (formation of the ulcers) and the 7th day (healing of the ulcers). To assess the effect on ulcer formation, heparin (1000 IU/kg/day, subcutaneously) was administered from days 0 to 3, and on the healing from days 4 to 6 after acid application. To check for possible bleeding under the influence of heparin, the level of hemoglobin in the blood was tested before acid application (basal), on the 4th and 7th days after application. The degree of bleeding was assessed based on the relative decrease in hemoglobin levels. The administration of heparin led to a decrease in the average area of ulcers both on the 4th and on the 7th day compared with that in control rats (heparin vehicle). In control rats, both on the 4th and on the 7th day, the hemoglobin level was reduced compared to the corresponding basal level. Heparin had no effect on the hemoglobin level at day 4, but potentiated the decrease in mean hemoglobin level at day 7, increasing the number of animals having a greater relative decrease in hemoglobin level compared to the corresponding control group. Thus, heparin may have a gastroprotective effect, manifested both in the weakening of the formation of an ulcer and in the acceleration of its healing, however, there is a risk of bleeding when the ulcer heals.

High Prevalence of Anemia and Poor Compliance with Preventive Strategies among Pregnant Women in Mwanza City, Northwest Tanzania: A Hospital-Based Cross-Sectional Study

Anemia in pregnancy is prevalent in Tanzania despite the implementation of existing prevention strategies. This study aims to determine the level of compliance with anemia preventive strategies among pregnant women and the factors associated with poor compliance. A cross sectional study was conducted among 768 pregnant women who attended the Bugando Medical Center, Sekou-Toure Regional Hospital, Nyamagana District Hospital, and Buzuruga Health Center in Mwanza, Northwest Tanzania. The prevalence of anemia at term was 68.8% (95% CI, 65.5–72.0%). The average hemoglobin level at term was 10.0 g/dL (95% CI, 9.8–10.1). Only 10.9% of pregnant women complied fully with anemia-preventive strategies. A decrease in mean hemoglobin level was observed across levels of compliance, with women who were non-compliant displaying a significantly lower mean hemoglobin level (8.3 g/dL) compared to women who were fully compliant (11.0 g/dL). Poor compliance was associated with no formal or primary education and initiating antenatal care in the 2nd or 3rd trimester. Anemia in pregnancy was commonly associated with lack of compliance with preventive strategies among participants. There is a need for community-based health education on the importance of complying with anemia-preventive strategies in order to reduce the burden during pregnancy and the consequences of anemia to the unborn baby.

Reduction in Blood Loss with Tranexamic Acid use in Dynamic Hip Screw Surgery for Intertrochanteric Fractures

Aim: To compare the mean decrease in hemoglobin levels in fixation of intertrochanteric fractures with or without use of Tranexamic acid. Methods: This study was conducted at Orthopedics Unit II, Mayo Hospital Lahore, Pakistan. Total 78 patients were included in the study. Duration of study was from 15-07-2017 till 15-01-2018.Study was approved by hospital ethical committee. A written informed consent was taken. Diagnosis was made clinically and with help of radiology. Patients were randomly divided into two groups. Patients in intervention Tranexamic acid (TXA) group received 15 mg/kg of Tranexamic acid at the time of induction of anesthesia and repeated after three hours, while those in the control group received placebo which is normal saline, intravenously. Results: There were 16(41%) males and 23(59%) females in group-A. There were 15(38.5%) males and 24(61.5%) females in group-B. Mean age in group A (control) with standard deviation was 44.2051±9.64141. Mean age in group B (TXA) was 45.9744±9.03061. p value 0.0046. Mean BMI in group A was 25.65±5.136. Mean BMI in group B was 24.307±2.153. p value 0.233. In group A 13(33.3%) patients had hypertension and 26(66.67%) did not have hypertension in group-A. In group B 16 (46.2%) patients had hypertension and 21 (53.8%) did not have hypertension in group-B. Mean fall in Hb in Group A was 9.47±1.054. Mean fall in Hb in group B was 9.547±0.9402. p value 0.001. Statistically significant difference was present in Group B (TXA) in term of mean fall in Hb ( p value 0.001). Conclusion: We in our study concluded that the patients in TXA group who were given tranexamic acid 1g intravenously before start of surgery had a lesser fall in mean Hb for the operative treatment of per trochanteric fractures with dynamic hip screw. Hence injecting tranexamic acid intravenously can effectively reduce the blood loss during DHS surgery for the intertrochanteric fractures. Keywords: Interochanteric fracture, tanexamic acid, blood loss

Hemoglobin Levels in Patients with Human Immunodeficiency Virus Naïve Therapy Containing Zidovudine in the First Three Months

Background: Zidovudine, one of the combination antiretroviral used to treat HIV/AIDS, is the most common cause of anemia in HIV patients. Anemia related to zidovudine in HIV can worsen HIV infection. This study determined the hemoglobin level and effect of zidovudine therapy on HIV naive patients in the first three months initiation therapy. Methods: Observational analytic study with longitudinal prospective approach was carried out all new HIV patients who received zidovudine therapy. Hemoglobin examination was done at the beginning of the examination and every month for the first three months of zidovudine therapy. Results: Thirteen (38.23%) subjects developed a decrease in hemoglobin levels. The highest incidence of decreased hemoglobin levels in month 2 was in 11 (84.6%) subjects. The mean hemoglobin levels before the initiation of zidovudine ARV and after 3rd month therapy were 12.75±1.57 and 11.94±2.23 g/dl, respectively. The mean decrease in hemoglobin levels of zidovudine therapy was 2.24±1.99 g/dl. There was an effect of three months of zidovudine therapy on decreasing hemoglobin levels in HIV naive patients with a statistical significance (p = 0.006). Conclusion: There was an effect of zidovudine therapy on decreasing hemoglobin levels in the first three months of ARV therapy HIV naive patients.

The visual percutaneous nephrolithotomy versus the conventional percutaneous nephrolithotomy in treatment for renal stone

To report our initial experience using a self-made optical system to visually identify the quality of the chosen access before the operating tract dilation. We retrospectively reviewed the data on patients with renal stones treated by percutaneous nephrolithotomy (PCNL) in our hospital. The patients were divided into Groups A and B, according to those who received treatment by visual PCNL and conventional PCNL modalities, respectively. Based on the degree of hydronephrosis, the patients in each group were further divided into two subgroups, the patients with mild hydronephrosis (subgroup 1) and the patients with moderate or severe hydronephrosis (subgroup 2). The demographics and perioperative parameters were analyzed. The study included 124 patients who underwent PCNL. Group A (N.=62): 47 patients were assigned to subgroup 1 and 15 to subgroup 2; group B (N.=62): 40 patients were assigned to r subgroup 1 and 22 to subgroup 2. The demographics were not significantly different between Group A and Group B (P>0.05). The puncture times were shorter in Group A and in subgroups (P<0.01), whereas the access loss rates were not significantly different (P>0.05). The mean decrease in hemoglobin levels, repuncture rates, blood transfusions and hospitalization times in Group A and Group A subgroup 1 were significantly lower than in Group B and Group B subgroup 1, respectively, (P<0.05), but no significant differences in subgroup 2 (P>0.05). When the complications were compared, the collecting system injury rates were significantly different between the two groups and in subgroup 1 (P<0.05). However the rates of fever and urinary sepsis were not statistically different in the two groups and in the subgroups (P>0.05). We found that visual PCNL was a safe and efficacious treatment for renal stones that may be considered as an alternative to conventional PCNL, especially in patients with mild hydronephrosis. Further prospective randomized controlled trials are needed to confirm the results of this study.

Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones

ObjectivesThe present study compared the safety and efficacy of combined laparoscopic ureterolithotomy (LU) and flexible ureteroscopy with percutaneous nephrolithotomy (PCNL) for removing large impacted upper ureteral stones with concurrent renal stones. MethodsThis study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones (group A) or PCNL (group B) for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016. Patient demographics, stone characteristics, and procedure-related parameters including stone-free rate, operation time, hospital stay after surgery, mean decrease in hemoglobin levels, visual analog scale (VAS) score, auxiliary procedure rate, and complication rate were compared between groups A and B. ResultsResults of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones. The stone-free rate after a single procedure was 95.7% in group A and 89.7% in group B (p = 0.62). The operation time was longer in group A than in group B (112.2 ± 23.3 min versus 96.2 ± 16.4 min, p = 0.006). However, no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery (5 days versus 6 days, p = 0.06). The decrease in hemoglobin levels was significantly higher in group B than in group A (−0.64 ± 0.36 g/dL versus −1.44 ± 0.65 g/dL, p < 0.0001). The mean VAS scores obtained at 24 hours (2.91 ± 1.08 versus 5.10 ± 1.01, p < 0.0001) and 48 hours after the surgery (1.09 ± 0.73 versus 2.28 ± 0.96, p < 0.0001) were significantly higher for group B than for group A. Moreover, the auxiliary procedure rate was higher in group B than in group A (6.9% versus 0%). ConclusionThese results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards. Despite the longer operation time, the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications. However, the choice of treatment depends on the preferences of surgeons and patients.

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

The aim of study was to compare the efficiency and safety of standard percutaneous nephrolithotomy (sPNL) and miniaturized percutaneous nephrolithotomy (mPNL) in lower calyx and/or pelvic stones smaller than three centimeters. From October 2010 to August 2015, 108 mPNL and 176 sPNL procedures were performed for renal stones smaller than three cm and located in the lower calyx and/or renal pelvis. All patients were evaluated preoperatively with intravenous pyelography and/or computed tomography. Intraoperative parameters, post-operative results and complications were recorded. Postoperative success was defined as complete stone clearance and/or clinically insignificant residual fragments at 3rd month. Preoperative characteristics were similar between sPNL and mPNL groups except previous renal stone operation history and gender. The mean operation time was significantly shorter in the sPNL group (p<0.001). The mean hemoglobin drop was significantly less in the mPNL group (p=0.001), we found a 1.27±1.4 and 0.5±1.3 decrease in mean hemoglobin levels (mg/dL) in the sPNL and mPNL groups, respectively. Transfusion rate was 1.9% in mPNL and 5.6% in sPNL groups, and the difference was statistically significant (p=0.048). Only one patient in the sPNL group needed angiography and embolization. Postoperative JJ stent insertion rate was significantly higher in the mPNL group (p=0.03). Both sPNL and mPNL are safe and effective surgical procedures for lower calyx and/or pelvis stones smaller than 3 cm. However, use of smaller caliber instruments was associated with a lesser hemoglobin drop and need for transfusion.

Impact of Rare Bleeding Disorders during Pregnancy on Maternal and Fetal Outcomes: Review of 29 Pregnancies at a Single Center.

Objective This study aims to give information about the relationship between different types of factor deficiencies and maternal/obstetric outcomes. Methods We retrospectively reviewed the medical records of eight women with factor deficiency disorders. The demographic and clinical features of the patients after their last pregnancies were registered retrospectively. Results There were 29 pregnancies among the 8 patients. The spontaneous abortion rate was relatively high in two patients with factor XIII deficiency (80% and 57.1%) compared with the other factor deficiency groups. There were 16 births, which included 1 set of twins, and 2 deaths (1 stillbirth and 1 postpartum exitus occurred in the same patient). Intrauterine growth restriction was noted in five cases; four of these occurred in factor X deficiency cases. The mean decrease in hemoglobin level of all patients after birth was 1.7 g/dL (range, 0.2-3.6 g/dL). Red blood cell transfusion was required only in one case of factor XIII deficiency. Conclusions There is currently no consensus on the pregnancy management of women with factor deficiencies because of the limited knowledge due to the rarity of such disorders. Labor should be managed in a dedicated unit with a team consisting of an obstetrician, a hematologist, an anesthesiologist, a midwife, and a pediatrician to minimalize the complications.

PD23-04 EFFICACY OF REAL-TIME VIRTUAL SONOGRAPHY-GUIDED RENAL ACCESS FOR ENDOSCOPIC COMBINED INTRARENAL SURGERY

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-04 EFFICACY OF REAL-TIME VIRTUAL SONOGRAPHY-GUIDED RENAL ACCESS FOR ENDOSCOPIC COMBINED INTRARENAL SURGERY Shuzo Hamamoto, Rei Unno, Kazumi Taguchi, Ryosuke Ando, Atsushi Okada, Keiichi Tozawa, Kenjiro Kohri, and Takahiro Yasui Shuzo HamamotoShuzo Hamamoto More articles by this author , Rei UnnoRei Unno More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , Kenjiro KohriKenjiro Kohri More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Real-time virtual sonography (RVS) is a diagnostic imaging support system that can be synchronized with real-time ultrasonography in conjunction with computed tomography (CT) using a magnetic navigation system. The application of RVS for percutaneous nephrolithotomy has not yet been reported. This study aimed to examine the effect of RVS-guided renal access during endoscopic combined intrarenal surgery (ECIRS) for large renal calculi. METHODS We retrospectively evaluated 12 patients with large renal calculi (35.1 ± 3.3 mm) who underwent ECIRS in our center between April 2014 and January 2015. The Digital Imaging and Communication in Medicine volume data from preoperative CT performed in the prone position were loaded in the RVS unit. The operation was performed as follows: 1) All of the patients were oriented in the prone split-leg position to allow for retrograde and antegrade access; 2) One urologist performed retrograde intrarenal surgery by using a Holmium-YAG laser with a ureteroscope through a ureteral access sheath, while the other performed renal puncture using the RVS system (Figure); and 3) After inserting the percutaneous tract, each urologist worked simultaneously to fragment the renal calculi. RESULTS All of the procedures were successfully performed using a single tract. The mean number of renal punctures until gaining renal access through the calyx, which provides the best access to the calculus, was 1.6. The mean surgical duration was 107.0 ± 10.5 minutes, and the mean length of hospital stay was 5.3 ±0.5 days. The mean decrease in hemoglobin level was 0.76 ± 0.15 g/dL. Complete stone clearance after a single ECIRS treatment session was achieved in 7 patients (87.5%). None of the patients required a blood transfusion and had a Clavien grade ≥ 2. CONCLUSIONS RVS-guided renal access improved the precision of the calyceal puncture, which decreased the incidence of bleeding complications and improved the stone clearance rates during ECIRS. This is the first report to evaluate the efficacy of the RVS system for renal access. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e507 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shuzo Hamamoto More articles by this author Rei Unno More articles by this author Kazumi Taguchi More articles by this author Ryosuke Ando More articles by this author Atsushi Okada More articles by this author Keiichi Tozawa More articles by this author Kenjiro Kohri More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effects of in utero cord blood collection on post-cesarean hemoglobin levels

ObjectiveTo assess effects of in utero cord blood collection on postoperative hemoglobin, hematocrit levels. Study designElective cesarean deliveries in which cord blood was collected were compared with match paired elective cesarean deliveries without cord blood collection. Pre–post-operative hemoglobin and hematocrit level differences were compared between study groups with Student's t test. Multivariate regression models were used to address confounders. Correlation between volume of collected UCB and mean decrease in blood count parameters was analyzed. ResultsA total of 399 cesarean deliveries during a 12 months period were included in the analysis. Mean decrease in hemoglobin levels was 1.08g/dL (SD=1.0) in UCB collected group compared to 0.84g/dL (SD=1.0) in control group (p=0.002). Mean decrease in hematocrit levels was 3.1% (SD=3.4) in cord blood collected cesarean delivery group compared to 1.9% (SD=2.4) in control group (p=0.002). Univariate analysis has shown the collected UCB volume to be uncorrelated with the change in hemoglobin levels (r=0.013). Multivariate regression models, after adjusting for birth weight, age and number of prior cesarean, have shown the UCB collection to be significantly associated with the mean decrease in blood count parameters (estimate=0.23g/dL, t=−2.23, p=0.02). ConclusionIn utero UCB collection is associated with a small increase in bleeding of little clinical importance. Amount of UCB is not associated with amount of change in hemoglobin and hematocrit levels. In utero UCB collection seems to be safe for expectant mothers scheduled for low-risk cesarean delivery.

Safety of Robot-Assisted Radical Prostatectomy with Pneumoperitoneum of 20 mm Hg: A Study of 751 Patients.

Early studies describing robot-assisted radical prostatectomy (RARP) reported the use of pneumoperitoneum at a pressure of 15 mm Hg. While higher insufflation pressures (20 mm Hg) may reduce venous oozing and improve visualization, the safety of this method has not been confirmed. This study evaluates the short-term perioperative outcomes of patients undergoing RARP with insufflation pressures of 20 mm Hg. A single-surgeon, prospectively maintained database of patients undergoing RARP was retrospectively analyzed. Patients who underwent RARP with a pneumoperitoneum pressure of 15 and 20 mm Hg for the entire procedure were analyzed. Preoperative and postoperative hemoglobin levels and estimated glomerular filtration rate (eGFR) were compared. Complications, operative time, and estimated blood loss were also examined. The number of patients in the experimental (20 mm Hg) and control (15 mm Hg) groups were 550 and 201, respectively. The groups were well matched with respect to age and operative time. The experimental group had a significantly smaller decrease in mean hemoglobin levels after surgery (-1.18 vs-2.13 mg/dL, P<0.0001). There was no significant difference in the eGFR on the first day after surgery (postoperative day [POD]1) (88.4 vs 85.0 mL/min/1.73m(2), P=0.11) or in the change in eGFR from preoperative to POD1 levels (-0.49 vs 1.54 mL/min/1.73m(2), P=0.18). The complication rate in the experimental group was 8.55% vs 8.46% in the control group. Pneumoperitoneum using a pressure of 20 mm Hg for RARP is safe and has no significant short-term effects on renal function and hemoglobin. Increased insufflation pressure was not associated with a higher complication rate.

FIRST CASES OF ANTEROPOSTERIOR DISSECTION TUEB (TRANSURETHRAL ENUCLEATION WITH BIPOLAR)

We examined the efficacy of anteroposterior dissection transurethral enucleation with bipolar (TUEB) for benign prostate hyperplasia (BPH). We performed anteroposterior dissection TUEB on 21 patients with BPH between October 2012 and June 2013. In anteroposterior dissection TUEB, the lateral lobes are anteroposteriorly dissected from the 12 o'clock position to the 6 o'clock position after enucleation of the middle lobe. Mean age was 73 years, mean estimated prostate volume was 62.8 ml, mean estimated transition zone volume was 44.5 ml, mean International Prostate Symptom Score (IPSS) score was 15.5, mean quality of life (QOL) score was 4.1, peak flow rate (Qmax) was 8.6 ml/s, and mean residual urine volume was 42.4 ml. The mean operation time was 69 min, the mean weight of removed prostate tissue was 27.3 g, and the mean decrease in hemoglobin level was 1.8 g/dl. Three months after surgery, mean IPSS score was 5.9, mean QOL score was 1.9, mean Qmax was 28 ml/s, and mean residual urine volume was 1.0 ml, values which were significantly improved over pre-surgery data. No complications such as perforation or bladder injury occurred during surgery, but 1 case (4.7%) of stress urinary incontinence and 1 case (4.7%) of urethral stricture were reported after surgery. Of note, urethral stricture was determined using a flexible cytoscope at 1 week, 1 month, and 3 months post-surgery. Anteroposterior dissection TUEB can be conducted safely and may be useful in reducing frequency of urethral stricture post-surgery.

Safety and efficiency of thulium laser prostate resection for the treatment of benign prostatic hyperplasia in large prostates

Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) dissects whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of TmLRP-TT for older symptomatic benign prostatic hyperplasia patients with large prostates during 18 months of follow-up. A prospective analysis of 95 consecutive patients with large prostates (>80 ml) who underwent surgical treatment using TmLRP-TT was carried out. All patients were evaluated preoperatively and at 1, 6, 12, and 18 months postoperatively by the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Q max), postvoid residual urine volume (PVR), International Index of Erectile Function 5 (IIEF-5), urine analysis, and urine culture. Perioperative complications were recorded and graded by the modified Clavien classification system (CCS). Mean preoperative prostate volume was 106.81 ± 24.79 ml. TmLRP-TT was successfully completed in all patients. The mean operative duration, catheterization time, and hospital stay were 95.36 ± 27.06 min, 2.25 ± 0.9 days, and 5.39 ± 1.18 days, respectively. The decrease in mean hemoglobin level was 1.23 ± 0.72 g/dl, and that in mean serum sodium level was 0.71 ± 2.56 mmol/l. Within the observation period of 18 months, the patients showed an improvement in IPSS (20.01 ± 7.08 vs. 4.96 ± 3.68), QoL (4.10 ± 1.16 vs. 1.23 ± 1.30), Q max (8.14 ± 3.81 ml/s vs. 18.33 ± 2.56 ml/s) and PVR (102.70 ± 70.64 ml vs. 20.28 ± 30.02 ml), compared with baseline values (P < 0.001). IIEF-5 remained stable. Minor complications occurred in 10 (10.52 %) of 95 patients (Clavien grade 1, 9.47 % and grade 2, 1.05 %). There were no severe complications requiring reintervention (Clavien grade 3, 0 % and grade 4, 0 %). TmLRP-TT is a safe and effective surgical endoscopic technique associated with a low complication rate in large prostates as assessed during an 18-month follow-up period. It is a promising technology, which may be considered as one of the alternatives to open simple prostatectomy (OP) for large prostates in the future.

Peginesatide for Maintenance Treatment of Anemia in Hemodialysis and Nondialysis Patients Previously Treated with Darbepoetin Alfa

Peginesatide (Omontys) is a novel, synthetic, PEGylated, peptide-based erythropoiesis-stimulating agent (ESA) that is designed to specifically stimulate the erythropoietin receptor. This study evaluated maintenance of hemoglobin levels in patients after conversion from darbepoetin alfa to once-monthly peginesatide. This open-label, multicenter study included 101 CKD patients, 52 of whom were receiving dialysis. The duration of the study was 24 weeks. The primary endpoint was the mean change in hemoglobin from baseline to the evaluation period (weeks 19-24). The study was conducted during the period from September 22, 2008 to December 24, 2009. The mean change among hemodialysis patients was -0.42 g/dl (95% confidence interval, -0.65 to -0.19) and the mean change among CKD nondialysis patients was 0.49 g/dl (95% confidence interval, 0.26-0.71). The percentages of patients who maintained hemoglobin levels within ±1.0 g/dl of baseline values were as follows: 80.0% for hemodialysis and 68.1% for nondialysis, and73.3% for hemodialysis and 68.1% for nondialysis within the target range of 10.0-12.0 g/dl. Few patients received red blood cell transfusions (hemodialysis, 5.8%; nondialysis, 2.0%). Seventy-nine patients experienced adverse events, the majority of which were mild or moderate in severity. There were 40 serious adverse events and 2 deaths reported. In this study, once-monthly peginesatide resulted in a slight decrease in mean hemoglobin levels in individuals on hemodialysis and a small increase in individuals with CKD who were not on dialysis.

A pediatric case series of acute hemolysis after administration of intravenous immunoglobulin

Intravenous immunoglobulin (IVIG) is commonly used as an immune-modulatory treatment for patients with autoimmune and inflammatory diseases [1]. Antibody-mediated hemolysis of red blood cells (RBCs) after IVIG infusion is a recognized but rare side effect [2]. This retrospective case series describes four pediatric patients at a single institution who developed significant hemolytic reactions after treatment with IVIG for either Kawasaki disease or acute inflammatory demyelinating polyradiculoneuropathy. Patients ranged in age from 5 months to 14 years. The mean decrease in hemoglobin level after IVIG was 5.1 ± 0.36 g/dL (mean ± SD). Three of the four patients required RBC transfusion, and all the patients recovered spontaneously within 1 month of IVIG infusion. This case series illustrates a relatively uncommon, but potentially severe side effect of IVIG treatment, and demonstrates the importance of monitoring hemoglobin levels after IVIG therapy.

Past, Present, and Future of Chronic Kidney Disease Anemia Management in the United States

The management of anemia in the United States during the past 2 decades and since the introduction of erythropoietin (EPO) has continuously evolved, shaped by the interplay of reimbursement, evidence, clinical performance measurement, and, most recently, risk management. A fee-for-service reimbursement system has driven average EPO doses higher than anywhere else in the world, despite opportunities to decrease such dosing through more effective iron management and subcutaneous administration. Calls by Congress for Medicare to constrain ESA costs and FDA relabeling of erythropoietic-stimulating agents (ESAs), in the wake of The Correction of Hemoglobin and Outcomes in Renal Insufficiency and The Cardiovascular risk Reduction by Early Anemia Treatment with Epoetin Beta trials, have in 2007 led to the first decrease in mean hemoglobin levels in US hemodialysis patients since EPO was introduced in 1989. The implementation of a case-mixed adjusted bundled payment system for ESRD services in 2011 will turn ESAs from a profit center to a cost center for dialysis providers. This is likely to have profound implications regarding anemia management directed at curtailing ESA dosing, including subcutaneous administration, more aggressive iron therapy, and decreased target hemoglobin levels. Medicare has developed a third generation of clinical performance measures (CPMs) for ESRD providers (facilities and physicians) to ensure that quality is maintained in the new fiscal environment. Unlike the previous generations, these new CPMs emphasize an upper limit of hemoglobin as well as a lower one. Payment for performance based on these CPMs will likely be a key driver of future practice patterns for anemia management.

Sym001, the First Recombinant Polyclonal Rhesus-D Specific Antibody Product, Was Safe and Well-Tolerated in a Placebo-Controlled Randomized Phase I Trial.

Sym001 is the first compound in a new class of biopharmaceuticals in clinical development for the treatment of Immune Thrombocytopenic Purpura (ITP), and the prevention of hemolytic disease of the newborn by anti-D prophylaxis (ADP). Sym001 is a recombinant polyclonal antibody product consisting of 25 different anti-Rhesus D specific (RhD) antibodies. The primary objective of this clinical study was to assess the safety of Sym001 following a single intravenous (iv) dose in RhD+ and RhD− healthy male volunteers. Secondary objectives were to assess the potential immunogenicity and pharmacokinetic (PK) profile of Sym001. Fifty-nine RhD+ subjects and 18 RhD− subjects were randomized to receive up to 12.5 μg/kg or 75 μg/kg, respectively, in seven dose cohorts as shown below:Number of SubjectsCohortDose (μg/kg)RhD+ Sym001RhD+ PlaceboRhD− Sym001RhD− Placebo10.25520021.0520034.07272412.57272525720065072007757200Treatment with Sym001 was well tolerated and there were no serious adverse events (SAEs), no AEs of severe intensity and no AEs that resulted in discontinuation of the study in either the RhD+ or RhD− population. The frequencies of treatment-emergent AEs (TEAE), i.e. AEs occurring after drug administration, were similar among Sym001 and placebo treated subjects and there was no dose-dependent pattern of TEAEs. No significant decrease in mean hemoglobin level compared to baseline was observed at any dose level during the study, and no decrease in hemoglobin > 2 g/dL in any subject was seen. No other laboratory findings were suggestive of clinically significant hemolysis. In addition, no clinically significant changes in vital signs or electrocardiograms (ECGs) were observed, and there were no significant changes in clinical chemistry variables that did translate into SAEs or were assessed as being related to study medication. No immunogenicity to Sym001 was detected and analysis of PK is in progress. In conclusion, Sym001 was found to be safe and well-tolerated in healthy volunteers in doses up to 75 μg/ kg. Sym001 is now being evaluated in a red blood cell (RBC) challenge trial for the ADP indication and in a Phase II trial for treatment of patients with ITP.

Efectividad de ácido tranexámico en prótesis total de rodilla en la práctica clínica habitual

To evaluate the effectiveness of treatment with tranexamic acid, compared to absence of antifibrinolytic treatment, in reducing transfusion rates and the number of units of packed red blood cells required in patients undergoing total knee replacement surgery. We reviewed the medical records of all patients who underwent total knee replacement surgery in a general hospital in 2006. Information was recorded on treatment with tranexamic acid, use of other antifibrinolytic drugs, hemoglobin and hematocrit levels before surgery and 3 days after surgery, patients requiring transfusions, units of packed red blood cells administered, and whether or not drains were clamped within 4 hours. Complications attributable to tranexamic acid (thromboembolic or systemic complications) and preoperative treatment with erythropoietin were also recorded. Data for 166 patients were analyzed. Of these, 120 (72.3%) received tranexamic acid, 15 (9%) received epsilon-aminocaproic acid, and 31 (18.7%) received no antifibrinolytic treatment. Transfusions were given to 17 patients, of whom 6 (5.0%) had received tranexamic acid, 2 (133%) had received epsilon-aminocaproic acid, and 9 (29.0%) had received no antifibrinolytic treatment. The mean numbers of packed red blood cell units transfused in each group were as follows: 0.075 in the tranexamic acid group, 0.200 in the epsilon-aminocaproic acid group, and 0.645 in the group with no antifibrinolytic treatment (P < .001). The mean decrease in hemoglobin levels 5 days after surgery was 3.04 g/dL in the tranexamic acid group, 3.55 g/dL in the epsilon-aminocaproic acid group and 3.76 g/dL in the group with no antifibrinolytic treatment (P < .001). Tranexamic acid is effective in reducing the percentage of patients requiring transfusions and in the number of units of packed red blood cells required in total knee replacement surgery. No complications attributable to this treatment were found.

Safety and Feasibility of Elective High-Risk Percutaneous Coronary Intervention Procedures With Left Ventricular Support of the Impella Recover LP 2.5

Currently, the most used left ventricular (LV) support device is intra-aortic balloon counterpulsation. The percutaneous implantable Impella Recover LP 2.5 system is a novel LV (unloading) assist device. We studied the feasibility and safety of LV support with the percutaneous implantable Impella Recover LP 2.5 system in 19 consecutive high-risk patients with percutaneous coronary intervention. Procedural success using the device and percutaneous coronary intervention was achieved in all 19 patients, who were very poor candidates for surgery. The patients were elderly (84% were >60 years of age), 74% had previous myocardial infarction, 63% had LV ejection fractions of < or =25%, and all had LV ejection fractions of < or =40%. There were no procedural deaths and 2 device-unrelated in-hospital late deaths. Mean decrease in hemoglobin level was 0.7 +/- 0.4 mmol/L. The device did not induce or increase aortic valve regurgitation. There were no important device-related adverse events during LV support with the Impella Recover LP 2.5 system. However, these encouraging findings must be confirmed by larger studies, longer assist times, and in other patient categories.