Mucosal Bleeding Research Articles

Safety profile of repeated infusion of platelet-like nanoparticles in healthy dogs.

To assess the safety and efficacy of the platelet-like nanoparticle (PLN), and to assess its safety in repeated administration. 6 purpose-bred dogs. The PLN was administered IV at 3 different doses using a randomized crossover design. Each dog received a full dose of 8 X 1010 particles/10 kg, half dose, and 10 times the dose, with a 14-day washout period between doses. Biochemical, prothrombin time, partial thromboplastin time, and fibrinogen analyses were performed at baseline and 96 hours postinfusion. A CBC, kaolin-activated thromboelastography, platelet function assay closure time, and buccal mucosal bleeding time were performed at baseline and 1, 6, 24, 48, 72, and 96 hours postinfusion. No significant changes were observed over time in the thromboelastography parameters, closure time, and buccal mucosal bleeding time. After the administration of the half dose, hematocrit levels decreased significantly at 1, 6, 24, 48, and 96 hours, with all values within the reference range. The platelet count was decreased significantly at hours 1, 6, 24, 48, and 72 after administration of the half dose, with values less than the reference range at all hours but hour 72. No significant changes in serum biochemistry, coagulation panel, and fibrinogen were observed for all doses. No adverse events were noted during the first infusion. Three dogs experienced transient sedation and nausea after repeat infusion. The PLN resulted in a dilution of hematocrit and platelets, and did not significantly alter hemostasis negatively. The safety of repeated doses should be investigated further in dogs.

Humidified versus nonhumidified low-flow oxygen therapy in children with Pierre-Robin syndrome: A randomized controlled trial.

Background:Humidification is an important process in clinical oxygen therapy. We aimed to evaluate the effects and safety of humidified versus nonhumidified low-flow oxygen therapy in children with Pierre-Robin syndrome.Methods:This study was an open-label, single-centered randomized controlled trial (RCT) with a parallel group design. The study protocol has been registered in Chinese Clinical Trial Registry (ChiCTR1900021584). The children were randomized to the humidified versus nonhumidified groups. Average arterial oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), incidence of ventilator-associated pneumonia (VAP), nasal cavity dryness, nasal mucosal bleeding and bacterial contamination of the humidified bottle, the cost of nasal oxygen therapy and duration of intensive care unit (ICU) stay were analyzed.Results:A total of 213 children with Pierre-Robin syndrome were included. There were no significant differences in the gender, age, weight, prematurity, duration of anesthesia and surgery duration of mandibular traction between humidified group and nonhumidified group (all P > .05). No significant differences in the average arterial PaO2 and PaCO2 level on the postoperative day 1, 2, and ICU discharge between humidified group and nonhumidified group were found (all P > .05). There were no significant differences in the incidence of nasal cavity dryness, nasal mucosal bleeding, bacterial contamination and VAP, the duration of ICU stay between humidified group and nonhumidified group (all P > .05). The cost of nasal oxygen therapy in the humidified group was significantly less than that of nonhumidified group (P = .013).Conclusions:Humidifying the oxygen with cold sterile water in the low-flow oxygen therapy in children may be not necessary. Future RCTs with lager sample size and rigorous design are warranted to further elucidate the effects and safety of humidified versus nonhumidified low-flow oxygen therapy.

A Prospective, Randomized, Double-Blind Study on the Efficacy of Different Modes of Topical Application of Nasal Anesthetics in the Diagnostic Nasal Endoscopy Procedure.

IntroductionIn the current otorhinolaryngology practice, technology has always been an essential part. Therefore, diagnostic nasal endoscopy (DNE) has become a vital examination in today’s practice. In order to visualize the nasal cavity in a systematic manner without any discomfort to both patient and doctor, the nose should be well anesthetized and decongested.ObjectiveThe study is to compare and evaluate the efficacy of 4% lignocaine-oxymetazoline cotton pledget packing versus topical sprays in the preparation of nasal cavities for DNE.MethodologyThe prospective, randomized, double-blind study was conducted among 246 patients and was divided into two groups. In the first group, the nose was packed with cotton pledgets containing 4% lignocaine-oxymetazoline and another group with 4% lignocaine-oxymetazoline spray. Following DNE, patients and surgeons were questioned on a pre-formed questionnaire to evaluate their experience during the procedure.ResultsIt was observed that the time taken for the pre-endoscopic preparation of the packing group was more than the spray group. A total of 91.9% of the spray group had pain during the pre-endoscopic preparation and more burning and tingling sensation than in the nasal pack (75.6%). A total of 69.9% of the patients among the spray group participants compared to 32.5% of the packing group patients experienced more throat discomfort. In addition, 12% of the packing group had mucosal bleeding during the preparation. A total of 32.5% of the spray group experienced severe pain when compared to 12.2% of the packing group during the endoscopic procedure. Most of the participants from both groups had difficulty visualizing the superior turbinate and sphenoethmoidal recess during the procedure. There was a significant difference seen between both the groups with respect to pain during the pre-endoscopic procedure (p=0.0005), burning/tingling sensation (p<0.0001), throat pain (<0.0001), mucosal bleed (p=0.0003), pain during the procedure (p=0.0001), and discomfort after the procedure (p<0.0001).ConclusionBoth methods of nasal preparation have merits and demerits in terms of discomfort, pain, and visualization of structures. Still, the packing of the nasal cavity with cotton pledgets is better when compared to spraying with 4% lignocaine-oxymetazoline. However, 4% lignocaine-oxymetazoline spray can be used during an emergency situation and with sensitive patients.

A retrospective analysis of transanal surgical management of 291 cases with rectal foreign bodies.

Rectal foreign bodies (RFB) are quite uncommon except in very busy hospitals. Because of their rarity, it is seldom that the treating physicians have a standard approach to the diagnosis, technique of extraction, and post-extraction evaluation. This can be further complicated by the rather extreme variability of size, shape, and texture of the foreign bodies, as well as the potential extent of trauma to the rectum or distal colon. The objectives of this study were to delineate the demographics, classification of cause, and injury patterns of RFB and to present the results of the transanal surgical management of a large series of RFB. We retrospectively collected extensive data from the hospital medical records of the 291 patients who presented with RFB to the emergency department of Shenyang Proctological Hospital (Shenyang, China) from 2012 July to 2020 December. Specifically, demographics, origins and circumstance of the RFB, complications, injuries, anesthesia method, and the results of the transanal surgical management were recorded and analyzed. Of the 291 RFB cases, 225 (77.3%) were male and 66 (22.7%) were female, with a mean age of 53.8 ± 15.5years (range, 1 ~ 88years). The circumstances of the RFB were categorized as swallowed, 199 cases (68.4%); self-inserted, 87 (29.9%); and iatrogenic, 5 (1.7%). The proportion of males in the self-inserted RFB group was significantly greater than the swallowed RFB group (t = 31.114, p = 0.000). In the swallowed RFB group, the most common anorectal injuries and pathological changes were the following: penetration into the mucosa (75 cases, 37.7%), perianal or submucosal abscess (27 cases, 13.6%), and penetration into the anal canal (18 cases, 9.0%). In the self-inserted RFB group, 64 (73.6%) of the 87 cases had an intact rectum, whereas 8 (9.2%) had rectal mucosal ulcers and bleeding, and 7 (8%) had rectal lacerations. In the iatrogenic RFB group, 3 cases (60%) had rectal mucosal ulcers and bleeding, and 2 cases (40%) had inflammation of the rectal mucosa. Regarding extraction procedures, in the swallowed group, 187(187/199; 94%) patients underwent a transanal surgical procedure, and all were successful. In the self-inserted group, 82 patients underwent the transanal surgical procedure, and 74 (74/82; 90.2%) were successful whereas it was unsuccessful in the remaining 8 patients (8/82, 9.8%). Three (3/4, 75%) patients with iatrogenic RFB were resolved by the transanal surgical procedure. Men were markedly more likely than women to have swallowed RFBs and self-inserted RFBs. No serious damage to the rectum and anus was found in cases of swallowed RFB. Moreover, most surgical operations to remove foreign bodies via the anus were successful in this category of RFB. In contrast, rectal injury was more severe in patients with self-inserted RFB, such as rectal laceration, rectal mucosal ulcer, and bleeding. Moreover, the transanal removal operation in patients with self-inserted RFB had a failure rate of nearly 10%. Thick, long, hard foreign bodies did present a great challenge to the operator. Therefore, if necessary, patients with foreign bodies may need to be promptly referred for transabdominal removal.

Role of Endotracheal Tube Cuff Deflation in Facilitating Passage of Nasogastric Tube.

BackgroundNasogastric tube insertion is a routinely performed technique in anesthetized and intubated patients. However, failure leads to repeated insertion attempts causing injury, which makes the situation cumbersome. Therefore, we introduce a simple technique of deflating endotracheal tube cuff for nasogastric tube insertion in such patients.MethodsEighty adult patients scheduled for elective abdominal surgeries were randomly allocated into two groups, Group A (nasogastric tube insertion without endotracheal cuff deflation) and Group B (nasogastric tube insertion with endotracheal tube cuff deflation) along with lateral pressure application at cricoid in both groups. The number of attempts required, overall success rate, the time taken, rescue maneuvers, and incidence of complications were compared between the groups.ResultsIn Group B, the total success rate for nasogastric tube placement was significantly higher than in Group A (80% vs 55%, p=0.016). Group B had a 55% first attempt success rate, but only 25% of patients in Group A had a first attempt success rate (p=0.014). The overall time for successful nasogastric tube placement was longer in Group A than in Group B (65.4 ± 28.72 seconds vs 43.5 ± 25.37 seconds, p=0.0005). The differences in nasogastric tube kinking and coiling between Group B and Group A were not statistically significant (20% vs 22.5%, 10% vs 27.5%, p = 0.78 and 0.08, respectively). Mucosal bleeding was substantially higher in Group A than in Group B (30% vs 10%, p=0.025, respectively).ConclusionsThis study showed that endotracheal tube deflation significantly increased the first-attempt success rate, overall successful placement of the nasogastric tube in intubated patients, and incidence of complications like mucosal bleeding decreased.

Predictive correlation of adverse clinical outcomes with thrombocytopenia in dengue fever

Background: Dengue fever is the most widely distributed viral infection in the world with more than 100 million people affected. In this study we attempt to study the co-relation between the nadir of the plateletcount and the onset of warning signs (persistent pain abdomen and vomiting, mucocutaneous bleed or clinical fluid accumulations). A positive co-relation in between these two elements could help predict onset of shock and third spacing and facilitate prognostication and early intervention. Methods: We studied 82 patients with a diagnosis of dengue fever, the basis of which was clinical signs and symptoms with a positive NS1 antigen test. The nadir of thrombocytopenia and rise in transaminases were studied along with onset of various warning signs. Results: The nadir of thrombocytopenia correlates with onset of warning signs such as clinical fluid accumulation (two tailed P value &lt;0.002) and mucosal bleed (two tailed P value &lt;0.001). However, the rising value of transaminases does not co-relate statistically with onset of warning signs in Dengue fever. Conclusions: The age of patients ranged from 18 to 60 with 23 out of 83 (27.7%) being in the 30-40 years age group.

The Preventive and Therapeutic Effects of Ajwa Date Fruit Extract Against Acute Diclofenac Toxicity-Induced Colopathy: An Experimental Study.

BackgroundStudies regarding treatment of acute toxicity with diclofenac (ATD) are quite few. Diclofenac is commonly prescribed in neurology, psychiatry, and general medicine practice. This study investigated possible colon-protective effects exerted by Ajwa date fruit extract (ADFE), a prophetic medicine remedy native to Al-Madinah, Saudi Arabia against ATD. Phytochemicals in ADFE as gallic acid and quercetin have reported protective effects against ATD.MethodsTotal phenols and flavonoids in ADFE were estimated as equivalents to gallic acid and quercetin. Four experimental groups were allocated each of six rats: control group, ATD group received a single dose of 150 mg diclofenac intraperitoneally, toxicity prevention group received a single dose of ADFE orally followed 4 hours later by diclofenac injection, and toxicity treatment group received a similar diclofenac dose followed 4 hours later by a single dose of ADFE. Four days later, animals were sacrificed. Histological and biochemical examinations were done.ResultsADFE has a total phenolic content of 331.7 gallic acid equivalent/gram extract and a total flavonoid content of 70.23 quercetin equivalent/gram. ATD significantly increased oxidative stress markers as serum malondialdehyde (MDA) and hydrogen peroxide (H2O2). Serum MDA and H2O2 were significantly scavenged by ADFE. ATD significantly (p<0.001) decreased antioxidant power as serum total antioxidant capacity and catalase activity. That was reversed by ADFE in both prevention and treatment groups. Histologically, ATD caused complete destruction of colonic crypts architecture, patchy loss of the crypts, loss of the surface epithelium, absent goblet cells and submucosal exudate, heavy infiltration of the lamina propria and submucosa with inflammatory cells, mainly lymphocytes and eosinophils. There were mucosal haemorrhages and submucosal dilated congested blood vessels. All that was prevented and treated using ADFE.ConclusionADFE is rich in quercetin and gallic acid equivalents that exert potent antitoxic effects. ADFE is strongly recommended for preventive and therapeutic colon effects against ATD.

Carbon Nanoparticles in Mongolian Medicine Alleviate Acute Gastric Ulcer Induced by Ethanol by Regulating Fas/FasL Pathway.

The consumption of large amounts of ethanol can directly lead to acute gastric mucosal bleeding, edema, and erosion, while long-term drinking has been associated with gastric ulcers. Previous research has demonstrated that Har Gabur, a traditional Mongolian medicine, alleviates gastric ulcers through the physical adsorption of its carbon components. It is well known that the immune response has an important role in gastric ulceration. In the present study, we used an ethanol-induced injury cell and mice model to investigate whether Har Gabur can inhibit the immune response stimulated by ethanol and identify the active constituents of Har Gabur involved in this process. We found that Har Gabur significantly repressed the activated Fas/FasL signal pathway and endogenous Bax/Bcl-2 apoptosis pathway. The molecular mechanism of the protective effect most likely involved the transcription or mRNA stability, as Har Gabur remarkably reversed the change in mRNA level of apoptosis-related genes induced by ethanol. Har Gabur operated in a cell-state-specific manner in vivo without inducing adverse effects in normal mice. Importantly, GO was identified as the main active ingredient of Har Gabur for gastric ulcers.

Renal pelvis mucosal artery hemorrhage after percutaneous nephrolithotomy: a rare case report and literature review

BackgroundFollowing a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients with postoperative bleeding can be treated conservatively, causing the perirenal hematoma to resolve spontaneously. The major causes of severe postoperative bleeding are pseudoaneurysms, arteriovenous fistula, and segmental arterial injury. Typically, the first choice of treatment to manage severe bleeding complications is selective angioembolization (SAE) because of the very high success rate associated with this procedure.Case presentationThis clinical case involves a 56-year-old man who underwent dual-channel PCNL treatment after diagnosing a left kidney staghorn stone and urinary tract infection. The operation was successful, with no apparent signs of bleeding. Tests revealed continued decreasing hemoglobin levels following the procedure. After the conservative treatment failed, renal angiography was performed immediately, indicating renal pelvis mucosal artery hemorrhage. In the three hours post-surgery, the SAE still failed to prevent bleeding. Further discussions led to formulating a new surgical plan using a nephroscope to enter the initial channel where hemostasis began. The hemostasis origin was found precisely in the mucosal artery next to the channel during the operation and was successfully controlled.ConclusionsThis case reveals there is poor communication and inadequate discussions about the potential failures of an SAE procedure. Swift clinical decision-making is imperative when dealing with high-level renal trauma to prevent delays in surgery that can threaten the safety of patients.

Clinical Presentations of Idiopathic Thrombocytopenic Purpura

Back Ground: ITP is the most common cause of thrombocytopenia in children and is a result of immunologically mediated increased platelet destruction, which is usually acute and self-limiting but may be a recurrent or chronic disorder. Aim of Study: Assessment of clinical manifestation of ITP in children. Patient and Methods: A prospective study was performed on 60 patients diagnosed as idiopathic thrombocytopenic purpura admitted to central child teaching hospital from 1st of January to 3o September 2011. Diagnosis was based on clinical and laboratory tests including bone marrow aspiration. Results: The age ranged from 6 months to 13 years and majority of cases were between 1-5 years, 68.3 % were males and 31.7 % were females, male to female ratio 2.1 : 1 . History of upper respiratory tract infection preceded the onset of illness in 71.7 % of patients. Where the Duration between Preceding URTI and ITP Up to 1 week in 30.2 % and &gt; 1 week in 79.8 % Concerning the distribution of cases according to the season of the year: One case (1.7%) found during January, four cases (6.7%) during February, six cases (10.0%) during March, five cases (8.3%) during April, ten cases (16.7%) during May, eight cases (13.3%) during June, 14 cases (23.3%) during July , five cases (8.3%) during August, and seven cases (11. 7%) during September. This distribution was significant (P less than 0.05). The commonest presentation was cutaneous bleeding in 60 %, Mucous Membrane bleeding 1.7 %, both 38.3 % , Splenomegaly with bleeding 6.7 % , Hepatomegaly with bleeding 8.3 %, Lymphadeno-pathy with bleeding 5 % . In 69 % of cases the initial platelet count was less than 20.000 /mm³. 37.9 % had anemia. Bone marrow examination done in 56 case and all were normal. In this study, one case die due to intracranial hemo – rrhage . we didn’t include the management because the patients receive different types of treatments ( mostly by steroid , some by IVIG and anti-D ) , most of patients examined by bone marrow aspiration which was normal , and also we didn’t include the follow up because of most of the patients didn’t come for follow up. Conclusion: The disease is self-limited , most cases at age of 1-5 years , male affected more than female , most cases preceded by upper respiratory tract infections , most cases presented by skin bleeding.

Evaluation of paediatric immune thrombocytopenia patients with clinical and laboratory findings: emphasizing the role of monocytosis.

We aimed to investigate the relationship between demographics, clinical features, laboratory findings including monocytosis and clinical course in children with immune thrombocytopenia (ITP). Data of 100 ITP patients were analysed. Complete blood count findings of the patients at certain time points were evaluated to classify the disease as acute, persistent and chronic. An effect of sex on chronicity was not observed ( P = 0.166). Of the patients enrolled in the study, 38% ( n = 38) had chronic course. The mean age of patients with the chronic course was 7 ± 4.1 years, which was significantly higher than the other groups ( P = 0.007). Sixty-five percent ( n = 13) of the patients presenting with mucosal bleeding and 27.4% ( n = 20) of the patients presenting with skin bleeding became chronic ( P = 0.008). MPV was found to be significantly high in chronic ITP patients ( P = 0.049). Monocytosis was noted in 80% of the patients at diagnosis. Intravenous immunoglobulin was used in 84% of the patients with acute ITP; 33% of them developed chronic ITP. The age at diagnosis, presence of mucosal bleeding and increased MPV on admission were high-risk factors for the development of the chronic course. Monocytosis was detected in 80% of the patients on admission, and it may play a role in the pathogenesis of ITP.

Dengue Haemorrhagic Fever (Dhf)

Dengue fever frequencies have been on the ascent during the most recent couple of years. In 2012, there were a sum of 21,900 cases revealed, with 35 passing’s. This likened to around 76 occasions for each 100,000 people. Dengue fever is characterized with prominent signs such as stomach pain, mucosal bleeding, liver enlargement, hematocrit with diminishing platelets, plasma leakage, organ failure etc. Patients who recuperated rapidly were to have contracted dengue fever but with fewer symptoms. These patients reacted well to indicative treatment and liquid transfusions. In any case, extra disintegration of platelets was marked as extreme dengue, while recuperation was conceivable with legitimate and fast treatment

PB2299: CLINICAL AND LABORATORY CHARACTERISTICS OF CHILDREN WITH INHERITED THROMBOCYTOPENIA IN A SINGLE EGYPTIAN UNIVERSITY HOSPITAL

Background: Inherited thrombocytopenias (IT) are rare bleeding disorders, which cause a deficiency of platelets in early infancy. This group of disorders is sometimes associated with abnormal phenotypes. ITs are being recognized with increasing frequency. The study of IT in children is difficult due to the heterogeneity of the patients and the rarity of each disease. To the best of our knowledge, the study of the epidemiology of such a hematological finding in our area has not been previously published. Aims: To report the clinical and laboratory characteristics of children with inherited thrombocytopenia. Methods: The files of all children with thrombocytopenia followed at the Hematology clinic of Alexandria University Children’s Hospital, Alexandria, Egypt, were retrospectively analysed. Patients who joined the clinic until the 31st of December 2021 were included. IT was considered in patients with suggestive clinical features as young age of presentation, abnormal physical features, positive family history, no response to ITP drugs. The blood film was revised for assesment of platelet size and morphology. Flowcytometry of platelet glycoproteins was perfromed. Results: Forty patients were identified as suspected IT. The median age of patients was 65 months, ranging from 9 months to 17 years at the time of the study. Thrombocytopenia was first discovered at a median age of 20 months. Fifty-five percent were males. In 55% of patients, there was a history of thrombocytopenia in a family member, and 42% had consanguineous parents (first-degree cousins). The most common bleeding symptoms were purpura and ecchymoses, followed by mucosal bleeding. The median platelet count at diagnosis was 30 ×103 cell/uL, while the lowest was 9 ×103 cell/uL. The initial recorded diagnosis was ITP in 65% of patients, followed by Glanzmann thrombasthenia (7.5%), CAMT and WAS (5% each). After revision of the diagnosis, BSS was confirmed in 20% of patients, WAS in 12.5%; some rare disorders were identified like MYH9-RD and Glanzmann thromboasthenia with macrothrombocytopenia. In 35% of patients the diagnosis was not defined yet. Seven patients were missing for further workup, and seven patients were sent for genetic testing. Summary/Conclusion: Inherited thrombocytopenias are rare disorders that are frequently overlooked. A detailed family and disease history, examination of the blood film by an expert, and assessment of the response to usual ITP treatments are all simple methods that help pick up suspected cases. Simple tests like platelet glycoprotein flowcytometry or MYH9 staining can confirm the diagnosis in a substantial number of patients. Genetic tetsing is the final step for undiagnosed cases.

PB2301: PEDIATRIC IMMUNE THROMBOCYTOPENIA; A GLANCE AT PATIENTS AND CURRENT THERAPEUTIC CHALLENGES

Background: Immune thrombocytopenia (ITP) during childhood is usually characterized by acute onset of thrombocytopenia with around 75% of children having spontaneous remission within 6 months. Most children experience only mild bleeding in the form of bruising and Petechiae, with severe bleeding being rare even in children with persistent disease Aims: To study demography, clinical, laboratory and treatment options of patients who were newly registered cases of immune thrombocytopenia referred to Children Welfare Teaching Hospital, Medical City, Baghdad. Methods: A retro-prospective descriptive study was done on pediatric patients with ITP who were referred to Children’s Welfare Teaching Hospital (CWTH) / Medical City / Baghdad from January 1, 2020 to August 31, 2021. The period of data collection and follow up started in May 2020 till October 2021. Results: A total of 138 patients were identified as having a presumptive newly diagnosed Immune Thrombocytopenia. Sixteen patients were excluded after being diagnosed as secondary ITP or other causes of thrombocytopenia during observation period. The analysis was limited to 122 patients. The mean age was 4.75 years (range 2 months-13.1 years). There were 63 (51.6%) boys and 59 (48.4%) girls, with a M:F ratio was 1.06:1. The mean duration of symptoms is 13.6 days. Seventy-five (61.5%) patients were managed as an outpatient only. Sole cutaneous bleeding was reported in 57 (46.7%) patients while epistaxis was the leading cause of mucosal bleeding occur in 30 (25%) patients followed by gum bleeding in 15 (12.5%) patients. According to grading, grade I/II was seen in 57 (46.7%). The mean platelet count was 20.2x109/L, Platelet’s count of <30 x109/L in 95 (77.8%) patients. Ninety-three patients (76.2%) reached CWTH without receiving any treatment while 29 (23.8%) patients received treatment elsewhere. The total number of patients kept under watchful waiting strategy was 56 (45.9%). The mean and median platelets count at both time of diagnosis and time of last contact in the observation group were higher than that of the treatment group at time of diagnosis (26 vs 15.4 x 109/L) with a significant statistical correlation, and comparable at time of last follow up (200.7 vs 210.4 x 109/L) with negligible statistical correlation. There was a significant statistical correlation between both groups of patients in regard to the grades of bleeding, the observed group showed grade I\II as the major type of bleeding while the treated group showed grade III as the major type of bleeding. Summary/Conclusion: The result of this study confirms the result of two previous studies in the same center which encourages the successful management of ITP by observation only and support the consensus that ITP is a benign and self-limited condition for the majority of affected children. The incidence of intracranial bleeding was 0.8%. The study observations support the emerging trend toward reserving drug therapy for ITP patients with major bleeding manifestations or troublesome impairment of quality of life.

Coagulation Factor VII: Genetic, Molecular, and Clinical Characteristics

: Coagulation factor VII (FVII) is a vitamin K-dependent serine protease that plays a pivotal role in normal hemostasis. Mature FVII is a glycoprotein comprised γ-carboxyglutamic acid-rich (Gla) domain, two epidermal growth factor (EGF)-like domains, an activation domain, and a serine protease domain. FVII requires proteolytic activation followed by tissue factor (TF) binding for maximal activity. The F7 gene (14.8 kb) is located on 13q34, composed of nine exons and eight introns. The congenital FVII deficiency is a rare coagulopathy with an autosomal recessive pattern of inheritance that occurs due to mutation in the F7 gene. A considerable number of mutations of different types have been identified throughout this gene affecting the expression, structure, and post-translational alterations of the protein. FVII deficiency is the most frequently recessively inherited bleeding disorder. Subjects with FVII deficiency show a wide range of symptoms, including cutaneous hemorrhage, mucosal hemorrhage, gastrointestinal bleeding, joint bleeding, and central nervous system (CNS) hemorrhage. Unlike other coagulation factor deficiencies, serum levels of FVII do not demonstrate the severity of the disease, and there is no direct correlation between serum levels and clinical complications. Replacement therapy is the treatment of choice for FVII deficiency. Various therapeutic products such as prothrombin complex concentrate, plasma-derived FVII concentrate, fresh frozen plasma, and activated recombinant FVII are available to treat FVII deficient individuals. This review aims to provide information on molecular, biochemical, and clinical aspects of coagulation FVII, its role in hemostasis, and the consequences of its deficiency.

Gastrointestinal Complications Associated With Non-steroidal Anti-inflammatory Drug Use Among Adults: A Retrospective, Single-Center Study.

BackgroundTraditional non-steroidal anti-inflammatory drugs (NSAIDs) are recognized to injure the upper gastrointestinal tract (GIT) mucosa. For example, gastric mucosal hemorrhages can be caused by a single dose of 650 mg of aspirin. Nearly 30% to 50% of NSAID users showed endoscopic lesions including subepithelial hemorrhages, erosions, and ulcerations. These lesions are often asymptomatic and are mostly found in the gastric antrum. With the chronic exposure, the mucosa adapts to the aggression of the NSAIDs, whereby these lesions slowly lessen or fade.AimThe aim of this study is to detect the association between NSAIDs and gastrointestinal complications among the general population in the Aseer region, Saudi Arabia.MethodologyA record-based retrospective study was conducted targeting people with GIT complications who were 20 years old and above. We reviewed patients' records from the GIT clinic in the Aseer region of Saudi Arabia. We reviewed specifically patients who had GIT complications like gastritis, abdominal pain, GIT bleeding, heartburn, nausea, vomiting, peptic ulcer, and diarrhea. Then we contacted those patients individually to fill out a questionnaire. Participants less than 18 years, those who refused to complete the questionnaire, or any patients with no history of GIT complications were excluded. An online questionnaire was sent to the patients with GIT complications. The questionnaire included participant's personal data, NSAID use, and associated GIT complications. The questionnaire was uploaded online using social media platforms by the researchers and their relatives and friends during the period from March 2012 to May 2022.ResultsA total of 211 participants with GIT complications completed the study questionnaire. Participant ages ranged from 20-59 years with a mean age of 31.2 ± 12.9 years old. A total of 140 (66.4%) were males and 175 (82.9%) were from urban areas. A total of 156 (73.9%) were non-smokers. A total of 103 (48.8%) participants used NSAIDs. As for complications, the most reported were peptic ulcer (37.9%), GIT bleeding (5.8%), GIT erosions (4.9%), and intestinal obstruction (3.9%) while 59.2% had no complications.ConclusionsThe current study revealed that nearly one out of every two participants in the Aseer region mainly used NSAIDs as tablets for pain. Regarding high utilization rates, less than half of them developed GIT complications, mainly peptic ulcers.

Description and Clinical Management of Patients With Glanzmann's Thrombasthenia in a University Hospital, a Referral Center Specialized in Hemostasis, in Bogotá, Colombia.

IntroductionGlanzmann's thrombasthenia (GT) is an autosomal recessive disorder of platelets caused by a deficiency in the glycoprotein IIb-IIIa. Bleeding from the skin, mucous membranes, and ecchymosis are symptoms manifested starting in early childhood. There may also be major bleeding conditions as a result of surgical procedures or trauma. The treatment is based on platelet transfusions, antifibrinolytic agents, and recombinant activated factor VII (rFVIIa).ObjectiveTo describe the demographic and clinical characteristics as well as the main treatment strategies used during bleeding events or procedures for patients diagnosed with GT that required inpatient attention at a university hospital, a referral center specialized in hemostasis, in the city of Bogota.Materials and methodsA descriptive retrospective cohort study was done over a period of 10 years that included nine patients over 18 years of age diagnosed with GT.ResultsA total of 34 admissions were reported, 23 due to bleeding and 11 for scheduled surgery. Some of the admissions for bleeding (38%) (n=13) required surgical procedures. Overall, 23 surgical procedures were done, six of which were classified as major. Seventy-seven percent of the patients were women with a median age of 37. Their most common symptoms were mucosal and genitourinary bleeding. The use of antifibrinolytics was registered in 28 events, followed by the use of platelet transfusion in 19, and the use of rFVIIa in 17. The average hospital stay was eight days.ConclusionThe characteristics registered and the treatments established for this cohort of Colombian patients with GT are similar to those reported in other hospitals around the world. GT presents diagnostic and therapeutic challenges and, therefore, acquiring more knowledge about this pathology is needed within this context.

Effect of Preoperative Alpha-Blocker in Ureteroscopy for Ureteral Stones: A Case-Control Study

Background: Urothethiasis is the most common urinary tract disease with a global prevalencerate of 2-20%. Alfa-blocker has a relaxation effect on the smooth muscles of the ureter making theremoval of ureteric stone easier during the ureteroscopic procedure.Objectives: To evaluate the effect of preoperative -adrenoreceptor antagonists therapy (tamsulosin) in the treatment of ureteral stone using a ureteroscope regarding operative time, access tothe ureter, and the complication rate.Materials and methods: A prospective case-control study was conducted at Al-JamhoryTeaching Hospital, Mosul, Iraq. During the period from June 2019 to August 2020. Subjectts withureteral stones (7-15 mm) scheduled for ureteroscopic intervention were enrolled in the study. Thepatients were classified into two groups, the first group was received a pre-operative alpha-blocker(tamsulosin 0.4 mg capsule per day for 7 days), and the second group (Control) did not receivefurther medication. The operative time, uretric access, and intra- and postoperative complicationswere registered for both groups.Results: There was a matching between the two groups regarding the age, gender, and side, size,and location of the ureteric stones. There was a statistically significant difference between the twogroups regarding the operative time (23.2 ± 4.569 minute in the treated group vs. 25.48 ± 4.904minute in the control group) (P-value = 0.009). Besides, the ureteroscopic operation was easier(P-value = 0.031) in treated group (n = 51 easy case, 85%) than the control group (n=41, 68.33%easy case). The intraoperative and postoperative complications were mucosal injury, perforation,bleeding, pain, hematuria, and fever. The total number of complicated cases was 14 (23.33%) inthe treated group and 25 (41.66%) in the control group, and there was a significant differencebetween the two groups (P-value = 0.032).Conclusion: The study revealed that the preoperative alpha-blocker tamsulosin was improved theoutcome of ureteroscopy (shorter operative time, easier access to the ureter, and low complicationrate).

Acute promyelocytic leukemia: A single institution's experience.

e19001 Background: Acute Promyelocytic Leukemia (APL) is highly curable but carries high risk of early morbidity and mortality, including hemostatic abnormalities, differentiation syndrome and infection. Induction regimens include all-trans-retinoic acid (ATRA) to promote promyelocyte differentiation and arsenic trioxide (ATO), with chemotherapy added for high-risk patients. Our objective was to characterize clinical characteristics and complications during APL induction. Methods: Electronic medical records were screened for ATRA, ATO, or idarubicin from 2011-2021. APL induction hospitalization records were reviewed for: demographics, white blood cell (WBC) and platelet count at presentation, fibrinogen at presentation, time to ATRA administration, time to complete remission (CR), infection, thrombohemorrhagic complications, ATO related QT interval prolongation, incidence of and time to differentiation syndrome. Results: 56 patients (pts) (median age 50) were analyzed. Mean time from initial presentation at our institution to ATRA administration was 1.5 days (range 0-6 days). Findings upon arrival: median WBC 1.7 K/UL (range 0.3-134.9), median platelets 32 K/UL (range 7-373), hypofibrinogenemia in 39.2% (N = 22) (median 161 MG/DL, range 35-473). 80.3% had documented thrombohemorrhagic complications during induction hospitalization: DIC (N = 24), venous thromboembolism (N = 12), gastrointestinal bleed (N = 6), oral mucosal bleeding (N = 5), vaginal bleeding (N = 3), gross hematuria (N = 3), intracranial hemorrhage (N = 3), epistaxis (N = 2), intraocular hemorrhage (N = 1), cerebral vascular accident (CVA) (N = 1). 21% (N = 12) developed differentiation syndrome with mean time of onset of 8.8 days (range 1-23 days). 55% (N = 31) had clinically significant infections most commonly neutropenic fever (N = 13), bacterial pneumonia (N = 10), skin (N = 5) and bacteremia (N = 5). 48 pts were given ATO during induction and 31% (N = 15) developed QT interval prolongation with no arrhythmias in the cohort. Among 8 pts who did not receive ATO, one died prior to therapy initiation and 7 were treated prior to ATO as standard of care. Among evaluable patients (N = 51): 98% (N = 50) achieved complete remission (CR) or complete remission with incomplete count recovery (CRi). Median time to CR was 35 days (range 27-50). 6 pts did not achieve CR or had unknown status: 1 patient died during induction (CVA) and 5 had post-induction bone marrow evaluations at outside facilities. Conclusions: Thrombohemorrhagic complications, infection and differentiation syndrome are critical to be mindful of during the early phase of treatment in APL. Our data adds to the landscape of knowledge regarding the incidence and timeline of complications. Although we observed prolonged QTc in pts on ATO, there were no arrhythmias detected and all pts were able to quickly resume therapy.

Hémophilie acquise et grossesse : une approche forcément multidisciplinaire

The occurrence of acquired hemophilia during pregnancy or postpartum is rare (2 to 10 % in series). It is generally suspected in the presence of haemorrhagic manifestations (especially subcutataneous or mucosal bleeding) associated with an isolated prolongation of the activated partial thromboplastin time (APTT). The diagnosis is confirmed by the association of a low level of factor VIII (FVIII) and the presence of an anti-FVIII inhibitor. Postpartum management is similar to that of other acquired haemophilias: correction of a severe haemorrhagic syndrome by “bypassing” agents, eradication of the inhibitor by corticosteroids alone or in combination with another immunosuppressive agent depending on the residual level of FVIII and the titer of the inhibitor. Management of the forms occurring during pregnancy is based on rare experiences or expert opinions. The management of childbirth is particularly delicate in terms of haemorrhage, especially if the anti-FVIII inhibitor is still present, and must be prepared in a multidisciplinary manner. Finally, as with any acquired hemophilia, a relapse is possible, especially in the year following remission. During a subsequent pregnancy, the risk of recurrence is possible but should not be a contraindication to a new pregnancy.