Prothrombin Rate Research Articles

Role of Anticoagulation in Nonagenarian Patients with Acute Limb Ischemia

Preoperative anticoagulant therapy is known to have a positive impact on the prognosis of patients with acute limb ischemia (ALI). However, little is known about its efficacy in elderly patients. We aimed to investigate the potential effect of anticoagulation in nonagenarian patients managed for ALI. Between January 2015 and December 2021, we identified all nonagenarian patients managed for ALI at a single center. Long-term anticoagulation and hemostasis parameters (prothrombin rate, activated partial thromboplastin time [APTT], platelet count) measured on admission were reviewed. The primary end point was mortality at 30-day mortality (D30) in patients with or without long-term anticoagulation therapy. We also studied the effect of these factors on the occurrence of revascularization failure in operated patients (initial failure, ischemic recurrence during hospitalization, necrosis requiring major amputation). A total of 68 nonagenarian patients were managed for ALI, with a mean age of 93.8years (from 90-107years), 76.5% of whom were women. Of these patients, 47 (69%) were managed surgically. Long-term anticoagulation therapy was associated with better survival at D30, both in nonoperated (P<0.01) and operated (P<0.05) patients. In operated patients, the absence of long-term anticoagulation therapy was associated with the occurrence of revascularization failure (P<0.05). In operated patients, survival to D30 and successful revascularization were associated with a longer APTT (P<0,05). We were able to observe the survival of 4 patients contraindicated for surgery and treated with a single medical therapy (intravenous unfractionated heparin). Anticoagulation appears to have an impact on the survival and postoperative prognosis of nonagenarian patients with ALI. In addition, curative anticoagulation therapy may be an alternative treatment when surgery is contraindicated in this frail population.

A Preoperative Evaluation Revealing a Rare Coagulation Factor Deficiency

Constitutional factor II deficiency is a rare coagulation disorder. The autosomal recessive form has an estimated prevalence of 1-2 million. Clinical symptoms depend on the rate of factor II deficiency. We report a fortuitous discovery of an isolated factor II deficiency in a 9-year-old girl of 1st degree consanguineous parents, following a preoperative assessment of drainage of her abundant pericardial effusion, the biological assessment showed a factor II rate &lt; 1%, a prothrombin rate at 3% and a TCA &gt; 120 sec, the dosage of the other coagulation factors are without anomalies. Through this observation we recall the rarity of this deficit and thought about it in the face of unusual bleeding in newborns of consanguineous parents, as well as the necessity of collaboration with international registries to establish codified diagnostic and therapeutic guidelines. Keywords: Factor II; Congenital Hemorrhagic Diseases; Rare Coagulation Factor Deficiency Abbreviations: FFP: Fresh Frozen Plasma

Stomorrhagia Revealing Hemophilia in an Infant: About a Case Treated at CHUOwendo

Introduction: Persistent oral bleeding in a child may be a sign of a bleeding disorder. The objective of this work is to describe the diagnostic and therapeutic aspects of hemophilia. Observation: We report the case of an 11-month-old male infant who had been admitted to the maxillofacial surgery department for persistent post-traumatic gingivorrhagia in a patient with no particular history. The clinical examination noted a wound with a layer of gingival bleeding, hematomas in the two upper limbs. Biological exploration revealed normochromic microcytic anemia at 6.5 g/dl; 97% prothrombin rate. The treatment consisted of gingival suture with tranexamic acid compression dressing, vitamin k injection and transfusion of 2 iso-group, iso-rhesus blood bags. The persistence of bleeding led to a search for coagulation factors, with factor VIII returning to less than 1%, concluding with the diagnosis of hemophilia A. Transfusion of an iso-group iso-rhesus blood bag to stop the bleeding. Transfer of the patient to the hematology department for specialized care. Discussion: Any unusual bleeding from the cephalic and bucco-facial sphere in an infant should raise the question of hemophilia. Conclusion: Stomatorrhagia is the evocative sign and the suture accompanied by blood transfusion a means of treatment.

Effect of Methionine and Age of Rat on the Occurrence of Hemorrhagic Diathesis in Rats Fed a Ration Containing Irradiated Beef

There was no mortality in weanling Sprague-Dawley rats fed non-irradiated beef. A significant (P < 0.01) number of deaths occurred in the group fed the irradiated-beef ration. Methionine reduced the mortality rate linearly (P < 0.01). The prothrombin rate (reciprocal of prothrombin time × 1000) of rats fed an irradiated-beef ration was lower (P < 0.01) than that for rats fed a ration containing nonirradiated beef. The prothrombin rate increased (P < 0.01) when the ration was supplemented with methionine. Growth was depressed (P < 0.01) by dietary methionine. Some adult Sprague-Dawley rats died of internal hemorrhages when fed a ration containing nonirradiated beef, indicating adults were more susceptible than weanling rats to hemorrhagic diathesis. Feeding irradiated beef increased the mortality (P < 0.01), but it was decreased (P < 0.01) by supplemental methionine. The methionine required to prevent hemorrhagic disease in adult rats fed nonirradiated-beef diet was less (P < 0.01) than that of rats fed irradiated beef. Feeding irradiated beef decreased the prothrombin rate (P < 0.01) and supplementation with methionine increased the rate (P < 0.01). There was a linear (P < 0.01) decrease of body weight gain with increasing supplemental methionine, which was less (P < 0.05) for rats fed non-irradiated beef than for those fed irradiated-beef rations.

An In-vitro Study of the Effect of Hydroethanol Extract of Annona senegalensis Leaves on Bitis rhinoceros (Viperidae) Venom Induced Coagulopathy

Bites of Bitis Rhinoceros (Viperidae) usually cause a hemorrhagic syndrome in the victims. This is a medical emergency. Antivenom immunotherapy remains effective. However, its availability and cost still limiting its use in Africa in general and in Côte d'Ivoire particularly. The roots of a plant of the Annonaceae family (Annona senegalensis) are used in Côte d'Ivoire to treat cases of envenomations by Viperidae. The objective of this work is to study the modulation of the effect of Bitis rhinoceros venom on coagulation parameters by the hydroethanol extract of Annona senegalensis leaves.&#x0D; The phytochemical study of the plant was carried out by monitoring effect of the venom on three blood coagulation parameters (PT, APTT, Fibrinogen) from healthy individuals in the presence and absence of the hydro-ethanolic extract. Phytochemistry revealed the presence of saponins, tannins, and polyphenolic compounds including flavonoids in this plant.&#x0D; The study of the effect of the venom showed that at the concentration of 10-2 mg/mL the venom of Bitis rhinoceros modifies some coagulation parameters by the decrease of half of the prothrombin rate, the increase of the coagulation time. It has no effect on the fibrinogen level.&#x0D; The effect of this venom is inhibited by 1 mg/mL of the hydroethanol extract. The leaves of Annona senegalensis contain molecules that could neutralize the action of the venom in the coagulation disorder.

Prevalence and Clinical Aspects of Hemophilia in the Western Region of Cameroon

Introduction: Hemophilia is a constitutional defect in blood clotting related to a clotting factor deficiency. Its remains a major public health problem, mainly due to ignorance of the disease, limited screening capacities and access to treatment in sub-Saharan Africa and particularly in Cameroon. It causes heavy bleeding in the absence of adequate management. Few reports are available about the disease in countries with limited resources. This study assess the occurrence of hemophilia in the Western region of Cameroon and clinical aspects with the aim of raising public awareness of the disease.&#x0D; Methods: A cross-sectional and descriptive study was carried out over a period of 04 months in 5 departments of the Western region of Cameroon, in particular Mifi, Ndé, Bamboutos, Haut Nkam and Menoua. The individuals were selected in their houses on the basis of clinical arguments, i.e. bleeding from the gums, traumatic wounds, hematomas. The blood samples taken from the latter were analyzed in the hemostasis laboratory of the Regional Hospital of Bafoussam. The epidemiological characteristics of hemophiliacs identified and suspects hemophiliacs were analyzed. The results obtained were analysed using statistical software R version 4.1.1.&#x0D; Results: Out of 5995 people selected, 13 (0.22%) cases of hemophilia were identified, 09 confirmed cases and 04 new cases. The mean age of the patients was 14.85 years old (1.5-49). The disease was discovered mainly during circumcision in the months following birth (9/13, 69.23%), and by bleeding of the gums (9/13, 69.23%). Clinical signs were pain of the joints (46%), hematoma and swelling of the joints (38%). Platelets counts and prothrombin rate were normal in all. However, a prolonged Cephalin + Activator Time was found; it was corrected by supplying normal control plasma.&#x0D; Conclusion: Hemophilia is a pathology little known for the general public. For this, with the help of public authorithies, continuing education sessions must be set up to raise awareness among the population in order to limit the transmission of the disease and to eradicate this scourge which constitutes a real public health problem.

Proposing a Sex-Adjusted Sodium-Adjusted MELD Score for Liver Transplant Allocation

Liver allocation is determined by the model for end-stage liver disease (MELD), a scoring system based on 4 laboratory measurements. During the MELD era, sex disparities in liver transplant have increased and there are no modifications to MELD based on sex. To use laboratory values stored in electronic health records to describe population-level sex differences in all MELD laboratory values (in healthy individuals and patients with liver disease) and propose a sex adjustment. A retrospective cohort study was conducted from March 2019 to April 2020 to evaluate sex differences in laboratory values in liver transplant patients, patients with liver disease who did not undergo transplant, and healthy controls. Primary analyses were conducted in Vanderbilt University Medical Center (VUMC)'s deidentified electronic health record system. Replication analyses were conducted in the All of Us Research Program. Simulations of a sex-adjusted sodium-adjusted MELD (MELDNa) score were completed using liver transplant waiting list data from the liver simulated allocation modeling system. Patients who regularly used VUMC with measurements for any MELDNa component laboratory were included in the analyses. Analysis took place from November 2019 to March 2021. Electronic health record-reported sex. Creatinine, bilirubin, international normalized ratio, and sodium levels. The VUMC sample was composed of 623 931 individuals (359 976 [57.7%] female) with a median (IQR) age of 44 (23-61) years. All component MELDNa laboratory values and calculated MELDNa scores yielded significant sex differences within VUMC (mean [SD] creatinine: male, 0.99 [0.39] mg/dL; female, 0.79 [0.30] mg/dL; P < .001; bilirubin: male, 0.76 [0.83] mg/dL; female, 0.58 [0.64] mg/dL; P < .001; international normalized ratio of prothrombin rate: male, 1.24 [0.42]; female, 1.20 [0.40]; P < .001; sodium: male, 139.00 [2.36] mEq/L; female, 139.03 [2.28] mEq/L; P < .001), resulting in MELDNa scoring that disadvantaged female individuals. This pattern persisted when the sample was divided into healthy controls, individuals with liver disease who did not undergo transplant, and patients who did undergo liver transplant. Female transplant patients had a greater number of decompensation traits (mean [SD]: male, 1.34 [1.11]; female, 1.60 [1.09]; P = .005), despite having lower MELDNa scores (mean [SD]: male, 21.72 [6.11]; female, 20.21 [6.15]; P = .005), indicating MELDNa scores are not accurately representing disease severity in female individuals. In simulations, the sex-adjusted MELDNa score modestly increased female transplant rate and decreased overall death. These results demonstrate pervasive sex differences in all laboratory values used in MELDNa scoring and highlight the need and utility of a sex-adjustment to the MELDNa protocol.

Prognostic Factors in Non-occlusive mesenteric ischemia: A pragmatic pre-operative score for the prediction of 28-day mortality

BackgroundThe prognosis of critical ill patients with non-occlusive mesenteric ischemia (NOMI) is poor and not fully understood. We aimed to determine preoperative factors associated with 28-day mortality in NOMI. MethodsVariables associated with 28-day mortality were entered into a multivariate cox regression model and were used to compute a NOMI mortality score. Results154 patients were included. The 28-day mortality rate was 56%. Multivariable analyses including variables at the time of the CT identified three variables (i.e. lactates > 7 mmoL/l, prothrombin rate <60% and kidney infarction), included in a simple score. Among the study population, the probability of 28-day mortality was 26% (11/42), 54% (26/48), 77% (23/30) and 100% (21/21) for a survival score of 0, 1, 2 and 3, respectively. ConclusionA simple score combining these three variables, calculated preoperatively, was able to accurately predict 28-day mortality and might help to avoid futile laparotomies.

Complication of an Adult Oesophageal Foreign Body: Place of Cervicotomy

<i>Objectives</i>: Our work was aimed at exposing the methods of extraction of a foreign body enclosed in the cervical esophagus and specifying the place of cervicotomy in its management. <i>Observation:</i> We report the case of a 76-year-old patient admitted to the ENT emergency department for sudden onset dysphagia following the ingestion of a foreign body of dental prosthesis type (two teeth). The face and profile cervicothoracic radiography revealed a thickening of the oesophageal lumen associated with a prevertebral hyperclarity at the height of the C8 and D1 vertebrae. After two endoscopic extraction attempts to the rigid tube we performed a cervicothoracic CT that showed the dental prosthesis at the height of C8-D1 associated with a peripheral hyperclarity and a left pneumothorax. The hemoglobin level was 14 g/dl, the prothrombin rate was 84%, the activated partial thromboplastin time was 35 seconds. The cervicotomy allowed us to note a perforation of the esophagus at the height of C8-D1. We made an oesophagofissure that allowed us to extract the prosthesis. The reconstruction of the oesophageal lesion was done in two planes. <i>Conclusion:</i> Denture type foreign bodies carry a risk of perforation, especially when endoscopic extraction is difficult. This risk is all the more important when the extraction time is long, when there is a pre-existing oesophageal pathology and by forced extraction maneuvers. Standard surgery is the best way to prevent perforation and septic complications.

Making an Equal System Equitable: Proposing a Sex-Adjusted MELDNa Score for Liver Transplantation Allocation

Background: Liver allocation is determined by the model for end-stage liver disease (MELD), a scoring system based on four laboratory measurements. During the MELD era, sex disparities in liver transplant have increased and there are no modifications to MELD based on sex. We use data from electronic health records (EHRs) to describe sex differences in MELD labs and propose a sex adjustment. Methods: We extracted lab values for creatinine, International Normalized Ratio of prothrombin rate (INR), bilirubin, and sodium from EHRs at Vanderbilt University Medical Center (VUMC) and the All of Us Research Project to determine sex differences in lab traits. We calculated MELDNa scores within liver transplant recipients, non-transplanted liver disease cases, and non-liver disease controls separately. To account for sex differences in lab traits in MELDNa scoring, we created a sex-adjusted MELDNa map which outputs adjusted female scores mapped to male scores of equal liver disease severity. Using waitlist data from the Liver Simulated Allocation Modeling, we conducted simulations to determine if the sex-adjusted scores reduced sex disparities. Findings: In VUMC (n=623,931), all component MELDNa lab values yielded significant sex differences that disadvantage females in MELDNa scoring (creatinine: p<2.22x10 -308 ; bilirubin: p<2.22x10 -308 ; INR: p<2.22x10 -308 ; sodium: p<2.22x10 -308 ). This pattern persisted when the sample was divided into healthy controls, non-transplanted liver disease patients, and liver transplant patients, and in the All of Us cohort (n=56,715). Female transplant patients had a greater number of decompensation traits (p=0.005), despite having lower MELDNa scores (p=0.005), indicating MELDNa scores are not accurately representing disease severity in females. In simulations, the sex-adjusted MELDNa score modestly increased female transplantation rate and decreased overall death. Interpretation: Our results demonstrate pervasive sex differences in all labs used in MELDNa scoring and highlight the need and utility of a sex-adjustment to the MELDNa protocol. Funding: The National Institutes of Health. Declaration of Interest: None to declare. Ethical Approval: This protocol was approved by the Vanderbilt University Medical Center institutional review board (#172020) and was deemed non-human subjects research because all information is de-identified.

Evaluating the Risk of Irreversible Intestinal Necrosis Among Critically Ill Patients With Nonocclusive Mesenteric Ischemia.

To identify factors associated with irreversible transmural necrosis (ITN) among critically ill patients experiencing nonocclusive mesenteric ischemia (NOMI) and to compare the predictive value regarding ITN risk stratification with that of the previously described Clichy score. All consecutive patients admitted to the intensive care unit between 2009 and 2019 who underwent exploratory laparotomy for NOMI and who had an available contrast-enhanced computed tomography with at least 1 portal venous phase were evaluated for inclusion. Clinical, laboratory, and radiological variables were collected. ITN was assessed on pathological reports of surgical specimens and/or on laparotomy findings in cases of open-close surgery. Factors associated with ITN were identified by univariate and multivariate analysis to derive a NOMI-ITN score. This score was further compared with the Clichy score. We identified 4 factors associated with ITN in the context of NOMI: absence of bowel enhancement, bowel thinning, plasma bicarbonate concentration ≤15 mmol/L, and prothrombin rate <40%. These factors were included in a new NOMI-ITN score, with 1 point attributed for each variable. ITN was observed in 6%, 38%, 65%, 88%, and 100% of patients with NOMI-ITN score ranging from 0 to 4, respectively. The NOMI-ITN score outperformed the Clichy score for the prediction of ITN (area under the receiver operating characteristics curve 0.882 [95% confidence interval 0.826-0.938] vs 0.674 [95% confidence interval 0.582-0.766], respectively, P < 0.001). We propose a new 4-point score aimed at stratifying risk of ITN in patients with NOMI. The Clichy score should be applied to patients with occlusive acute mesenteric ischemia only.

Predictive factors of toxicity of TPF induction chemotherapy for locally advanced head and neck cancers

BackgroundThe rate of toxic deaths related to induction chemotherapy in the treatment of locally advanced head and neck cancers is unacceptable and calls into question this therapeutic strategy, which is however highly effective in terms of rate and speed of response. The purpose of the study was to investigate predictive factors of toxicity of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (TPF) in locally advanced head and neck cancers (LAHNC).MethodsBetween June 2009 and December 2017, 113 patients treated consecutively with TPF were included retrospectively. Patients were receiving induction chemotherapy for either an inoperable cancer or laryngeal preservation. For inoperable cancer, induction chemotherapy was proposed to patients presenting either a large tumor with strong symptoms (dyspnea, dysphagia, pain) or a tumor with rapid progression. Risk factors were chosen among the initial patient and tumour characteristics and chemotherapy modalities.ResultsEighty-nine patients (79%) were male; the median age was 58 years [32–71]. Sixty-nine (61%) patients were treated for inoperable cancer and 44 (39%) for laryngeal preservation. 45% had stage IVa cancer, 28% stage III and 25% stage IVb. Sixty percent of patients had a partial response after TPF, 22% had a complete response, 12% were stable, 5% were progressing, and 1% had a discordant response. Thirty-four patients (30%) received enteral feeding during induction chemotherapy with TPF. The possibility of oral feeding without a tube was predictive of a better response (p = 0.003). Seven (6%) patients died during TPF. There was an increased risk of death with preexisting liver dysfunction (liver dysmorphia on imaging or decrease prothrombin rate) (p = 0.032). There was an increased risk of grade ≥ 3 infection if an enteral feeding occurred during the period of induction chemotherapy (p = 0.03).ConclusionsTPF induction chemotherapy had an 82% objective response rate with 6% toxic deaths. Nutritional status and the presence of hepatic dysfunction are significant risk factors to be taken into account in therapeutic decisions.

Assessment of Haemostasis in Anaesthesia for Surgery at the Sylvanus Olympio University Hospital Center in Lom&amp;#233;

Title: Assessment of haemostasis in anaesthesia for surgery at the Sylvanus Olympio University Hospital Center in Lomé. Objectives: Evaluate the prescription of the preoperative haemostasis assessment. Methodology: This was a prospective descriptive and observational study which had taken place in the central operating room and in the operating room of the ENT department at UHC SO of Lomé from January 1 to June 31, 2016. It had concerned all patients who had anaesthesia for scheduled surgery after pre-anesthetic consultation and the haemostasis assessment carried out according to the anaesthesia technique and the type of surgery. Results: Two hundred and sixty (260) patients underwent anaesthesia during the study period. The male sex predominated (60%), the age group 18 - 40 years predominated (50.4%). GA was more practiced (62.7%) followed by spinal anaesthesia (30.3%). Minor ENT surgery was more performed (28%). ASA1 patients predominated (48.5%). The pre-anesthetic haemostasis assessment including platelet count, prothrombin rate, activated partial thromboplastin time and bleeding time was almost always done. The platelet count was achieved in all patients followed by the activated partial thromboplastin time (94%). No haemorrhagic complication related to a haemostasis disorder was observed in the perioperative period in anaesthesia than in surgery. Conclusion: The prescription of the pre-anesthetic haemostasis assessment should not be systematic. It must take into account the clinical history, the patient’s bleeding history during the anaesthesia consultation, the type of anaesthesia, the surgery planned and the age.

The effectiveness of essential oil extracted from alfalfa seeds for blood clotting

The experiment was conducted on alfalfa seeds that were brought from Marjajah in the city of Touggourt. After the traditional extraction process, some of its physical properties were measured, including, refractive index, pH, with a yellowish green color, odor, prick, and transport value of 363 cm/S and on blood clotting. The results showed that the seed extract of alfalfa has an effect on blood clotting on the internal and external pathway by the prothrombin rate (TP) obtained that sample 1 has the largest clotting time of 22 seconds and by the time of cefalin kaolin (TCK), the highest coagulation time for sample 2 by 46 seconds. The prothrombin rate and the time of cefalin kaolin chronometer tests also show that alfalfa seed extract exercises an important anticoagulant activity compared to the two coagulation methods, because this activity is more pronounced towards the internal pathway that the external pathway passes, that is, the alfalfa seed extract is better than the normal witness and less than the positive witness heparin.

Failure of a Mexican antivenom on recovery from snakebite-related coagulopathy in French Guiana

Introduction In French Guiana, most snakebites are caused by crotalids, with the main signs being tissue damage and bleeding due to venom-induced coagulopathy. Since December 2014 the Western Guiana Hospital (WGH) has used Antivipmyn Tri TM, a Mexican polyvalent antivenom. The aim of the study was to assess its benefit on the correction of snakebite-related coagulopathy. Methods This retrospective study included patients hospitalized at the WGH with snakebite and a coagulopathy defined by: a prothrombin rate (PR) lower than 45%, an activated partial thromboplastin time ratio (aPTTr) greater than 2 or a fibrinogen lower than 100 mg.dL−1. The antivenom group included patients receiving Antivipmyn Tri TM from December 2014 to September 2017. The control group included patients admitted between January 2013 and November 2014 (when antivenom was unavailable) or admitted between December 2014 and September 2017 during times of antivenom shortage. We graphically compared the time courses of PR, aPTTr and fibrinogen between groups. Other endpoints were the length of hospital stay and the need for surgery or dialysis. Results 84 patients were included: 42 in the antivenom group, 42 in the control group. Both groups were similar for age, sex-ratio, proportion of bleedings, necrosis, and severity. Most patients in the antivenom group received 3 vials. There were no significant differences in recovery of PR, aPTTr and fibrinogen through the first 24 h. Fibrinogen declined again in the control group at 30 h and showed a slower rise to normal concentration. There were no significant differences in any secondary endpoint. Conclusion Antivipmyn Tri TM as currently used did not show any benefit in recovery from coagulopathy.

Epidemio-Clinical, Therapeutic and Evolutive Aspects of Pulmonary Embolism in Young Subject in the Cardiology Department in Point “G” Hospital University Center Bamako

Objective: The purpose of this work was to determine the epidemiological, clinical and evolutionary aspects of the pulmonary embolism of the young person in the cardiology department of the University Hospital Center (CHU) Point G in Bamako-Mali. Methodology: This was an analytical study from January 01, 2018 to December 31, 2018 in the CHU Point G cardiology department, including all patients hospitalized during this period. Results: Of 1379 hospitalized patients, 19 patients were concerned by pulmonary embolism of the young person. The prevalence of pulmonary embolism of the young person was 1.37%. The most affected age group was 21 - 30 (47.4%) of patients. The predominance was female (89.47%) with a gender ratio of 0.11 in favour of women. The average age in the series was 29.79 years with extremes of 16 years and 40 years. Factors predisposing to pulmonary embolism were dominated by peri partum, cardiomyopathy and obesity with 47.3%, 31.57% and 21.1%, respectively. The dominant signs were chest pain and dyspnea in 94.7% and 89.5% of cases respectively. Pulmonary embolism was unlikely in 60.52% according to the Geneva and Wells score simplified. At the thoracic angioscanner, the embolism was bilateral in 52.6% of cases and distal in 36.8% of patients; in 10 patients who performed cardiac ultrasound, pulmonary arterial hypertension (70%), dilation of the right ventricle (20%) and left ventricular dilation (40%). Hyper leucocytosis (47.4%), anemia and low prothrombin rate (TP) (22.2%) were the most found biological abnormalities. More than 2/3 (68.5%) our patients had an intermediate mortality risk according to the PESI (Pulmonary Embolism Severity Index) score. The average hospital stay was 10 days. Hospital mortality was 10.5%. Conclusion: The pulmonary embolism of the young person is a frequent, serious and multifactorial pathology and the female sex is most affected especially during peri partum periods, hence the need for preventive measures. Clinical signs are not specific and based on the assessment of clinical probability. Pulmonary angioscanner remains the confirmation review in our context.

EFFECT OF TRIDAXPROCUMBENS EXTRACTS ON BLOOD CLOTTING

Objective: The present work has focused on evaluating the effect of tridaxprocumbens on blood clotting.Methods: in the course of our study we have therefore carried out a Hydro ethanol extraction (50/50), Liquid-Solid extraction, and phytochemical screening. Thereafter our study was carried out on nine (09) male and female Wistar type rats aged from 10 to 12 w and weighing between 100 and 200 g. These animals were raised at the laboratory of Biomembranes Laboratory and Cell Signaling from FAST to UAC under standard environmental conditions. Animals have free access to water and food. 09 rats are experienced, divided in three batches of 3 rats each, submitted respectively to the following treatment: fed with distilled water, fed with 100 mg/kg P. C tridax extract procumbens, fed at 300 mg/kg P. C tridax extract procumbens. Evolution of the weight of rats during treatment was measured. After 7 d of treatment, the blood of the rats is taken for an experience of bleeding time, experience of coagulation time, and dosage of some blood parameters (platelet, partial thromboplastin, prothrombin).Results: Phytochemical screening carried out on the leaf and stem powder of Tridaxprocumbens revealed the presence of phenolic compounds, flavonoids, reducing sugar, mucilage, terpene and sterol, but at varying proportions. After 7 d of treatment, evaluation of the effect of the extractions on the body weight of the rats gave interesting conclusions. The weight of the control rats did indeed increase while that of the rats treated with the dose of (100 and 300 mg/kg) dropped. In addition, the effect of the hydroethanolic extract of the leaves and stems of Tridaxprocumbens on the coagulation of blood has been studied in order to verify the alleged property that the said extract can be used to manage bleeding. This was done by examining the effect of the extract on bleeding time, coagulation time, platelet count, activated partial thromboplastin time and prothrombin rate. These were carried out using the Duke method and the Lee and White method. In the bleeding time experiment, the mean time without adding the extract was 2.58±0.31 min, while the mean bleeding time after treatment with the extract was 1.61±0.70 min at a dose of 100 mg/kg PC and 1.77±0.69 min at a dose of 300 mg/kg PC, achieving 57% of the decrease in normal bleeding time. Thus the extract significantly lowers the bleeding time.When the extract was used for the coagulation time, it was found that the extract promotes blood clotting. In addition, this study reveals that Tridaxprocumbens significantly influences TCA, TP and platelet count at varying doses.Conclusion: The plant material studied in this study is, therefore, a credible alternative for an effective fight against bleeding and also promotes the coagulation of blood.

Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved.

Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved.

Impact of Obliterative Portal Venopathy Associated With Human Immunodeficiency Virus.

HIV-associated obstructive portopathy (HIVOP) is an obstruction of the hepatic microvasculature of unknown origin. The purpose of this study was to describe the clinical and paraclinical presentation of the disease and its impact in terms of morbidity.Twenty-nine HIV1-infected patients (average 12 years of infection, nadir of CD4 210/mm3, including 7 patients with a history of opportunistic infection) with a biopsy-proven or likely HIVOP have been followed up for an average of 6.1 years.Modes of revelation of the HIVOP were: cytolysis and/or cholestasis (60%), occult (14%) or symptomatic (37%) portal hypertension (esophageal varices 17%, ascites 10%, cytopenia 10%), or fortuitous (8%). Hypoalbuminemia (≤35 g/L) was present in (31%), thrombocytopenia (<150,000 platelets) in 52% and prothrombin rate <70% in 10%. Esophageal varices were detected in 71%. Thrombophilia was present in 23 patients (80%): in head, protein S deficiency (87%). MRI showed in 82% at least 1 morphological abnormality. The average value of the liver stiffness by Fibroscan was 8.3 kPa. During follow-up, there was no radiological improvement, 15 (52%) patients presented with variceal hemorrhage, 10 patients (34%) ascites, 10 (34%) portal vein thrombosis, 7 (24%) an iron deficiency, and 2 (7%) with a protein-losing enteropathy, including 14 patients (48%) with several events. Four patients (14%) were transplanted, 1 (25%) recurred the HIVOP on the graft, and 1 patient is waiting for a transplant.HIVOP is a severe disease associated with high morbidity related to symptomatic portal hypertension, which occurred in 50% and required liver transplantation in 14%.

Treatment of Chronic Hepatitis B with Tenofovir Disoproxil Fumarate in Ivory Coast

Little data exist on patients treated with tenofovir in Sub-Saharan Africa. Objective: To describe the clinical and laboratory characteristics of patients with viral hepatitis B treated with tenofovir. Material and methods: A descriptive single-center retrospective study, on chronic viral hepatitis B mono-infected, followed in the hepatogastroenterology department of the University Hospital of Yopougon and treated with tenofovir from February 2012 to February 2015. The studied parameters were demographic, clinical, biochemical, serological, virological, abdominal ultrasound. Liver fibrosis was assessed either by liver biopsy or non-invasive tests. Results: 110 patients were treated with tenofovir disoproxil fumarate with a mean age of 40.4 years and a male predominance. Clinical examination revealed jaundice in 9% of cases, hepatomegaly in 7.3% of cases, splenomegaly in 9.1% of cases and ascites in 15.5% of cases. The AST averaged 77.3 IU/l, the ALT 76.8 IU/l, prothrombin rate at 76.6% , albumin level at 32.3 g/l, total bilirubin at 29.9 g/l, alpha fetoprotein rate at 15.3 ng/ml. HBe antigen was negative in 76.2% of cases. The average rate of DNA at baseline was 7.4 log10 IU/l. 27.5% was cirrhotic. The average time of starting treatment was 23.7 months. Conclusion: TDF is the first-line treatment for chronic hepatitis B in our country, because it is a well-tolerated, potent therapy with a high threshold for resistance development. Our study population had an average age of 40.4 years. Virological profile was dominated by HBe antigen negative patients and high viral load of HVB DNA. One third of patients were at the stage of cirrhosis. This treatment must be delivered free of charge in all the country hospitals, which is going to improve significantly the natural evolution of the disease and to decrease the incidence of the HCC.