Significant Decrease In Hemoglobin Levels Research Articles

Investigating Alterations in Blood Parameters Pre-lipolysis and Post-lipolysis Surgical Intervention

Background: Laser lipolysis is one of the most prevalent liposuction techniques and is widely preferred in cosmetic surgical procedures globally. Compared to traditional liposuction, some investigations have demonstrated a reduction in complications when using the laser lipolysis technique. However, the amount of research in this area remains limited. Objectives: This study aims to investigate changes in pre- and post-operative blood parameters, including hemoglobin level, hematocrit, WBC count, and platelet level. Additionally, the research explores potential complications following laser lipolysis. Methods: This retrospective study, conducted at the Isfahan Clinical Center (Najaf Abad Branch), included 100 patients (without previous hematological disorders) who underwent laser lipolysis. Demographic information about the patients was collected. Blood parameters (hemoglobin, hematocrit, WBC, and platelets) were measured before and 24 hours after the operation. Laser liposuction was performed using a 1064-nm Nd laser. Postoperative care instructions were provided. Statistical analysis included t-tests and mixed linear regression using SPSS 20 software for data analysis, with a significance level of P < 0.005. Results: Significant alterations were observed in hemoglobin, WBC, and platelet levels. Hemoglobin and platelet levels showed a notable reduction of 16.9% and 7.9%, respectively. Conversely, the WBC count increased by 100.5%. Conclusions: Our study found a significant decrease in hemoglobin levels following laser lipolysis surgery, likely due to intraoperative bleeding. Further research is recommended to compare hemoglobin level changes using different laser types.

Analysis of the Role of Age Factors on Hemoglobin, Leukocyte and Platelet Levels in Breast Cancer Patients Post Chemotherapy 3 Cycles at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction: Breast cancer is one of the most common cancers in women. Chemotherapy is one of the main modalities in the treatment of breast cancer, but it can cause hematological side effects such as anemia, leukopenia, and thrombocytopenia. Age is one factor that is thought to influence these side effects.
 Methods: This study used an analytical observational design with data collected from medical records of breast cancer patients who had undergone 3 cycles of chemotherapy at Dr. Mohammad Hoesin General Hospital Palembang. Data on hemoglobin, leukocyte, and platelet levels before and after chemotherapy were analyzed using the t-test and ANOVA.
 Results: A significant decrease in hemoglobin levels was observed in patients aged > 60 years after chemotherapy (p < 0.05). Leukocyte levels showed fluctuations, especially in patients aged <40 years, while platelet levels fluctuated more in patients aged <40 years and decreased in the age group 40-60 years after chemotherapy.
 Conclusion: Age does not significantly influence the decrease in hemoglobin, leukocyte, and platelet levels in breast cancer patients after chemotherapy.

The Relationship Between Endoscopic Findings and Laboratory Results in Inflammatory Bowel Diseases

Objective: The aim of this study was to determine the relationship between routine laboratory indicators (including hemoglobin, white blood cells, platelets, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)) and the extent of endoscopic involvement in individuals with inflammatory bowel disease (IBD). Additionally, it sought to examine the applicability of these less invasive parameters for monitoring patients in the follow-up. Material and Method: The medical records of patients who were diagnosed with Ulcerative Colitis (UC) and Crohn's Disease (CD) between 2009 and 2015 were retrospectively examined. Endoscopic findings and hemoglobin, white blood cell, platelet, ESR, and CRP values at the time of colonoscopy were analyzed. An exploratory multinomial regression model was created to examine the association of laboratory parameters and endoscopic involvement localization. Results: In UC, a significant decrease in hemoglobin levels was present in cases with extensive colitis/pancolitis compared to distal type colitis (p=0.02), while no significant difference was found between left-sided colitis and distal type colitis. Elevated ESR values were notably found in left-sided colitis (p=0.007) and extensive colitis/pancolitis (p=0.043) compared to distal type colitis. CRP levels were significantly higher in cases with extensive colitis/pancolitis (p=0.015). No relationship was identified between laboratory parameters and the endoscopis location of involvement in CD. Conclusion: Although hemoglobin value, ESR and CRP levels are helpful in determining the location of involvement in UC, their effects have not been observed in CD. In addition to these basic laboratory values, other parameters should also be taken into consideration in the evaluation of patients.

Acquired Hemophilia A: Bleeding Pattern and Hemostatic Therapeutic Strategies.

Acquired Hemophilia A (AHA) is a rare autoimmune disorder characterized by the onset of a sudden and unexpected bleeding episode in a patient with no personal or family history of bleeding diathesis, and with a typical laboratory feature, i.e., a prolonged activated partial thromboplastin time that is not otherwise explained. This bleeding disorder is caused by autoantibodies directed against the coagulation factor VIII (FVIII). AHA is idiopathic in 50% of cases and is secondary to well-defined diseases in the remaining 50%. AHA affects elderly patients although it has also been observed in the post-partum period. Bleeding manifestations are heterogeneous, ranging from mild to life-threatening bleeds involving limbs and organs. Severe bleeding with a significant decrease in hemoglobin levels must be promptly and adequately treated in order to avoid a worsening of the hemorrhages and their complications. According to international recommendations, the bypass agents (i.e., activated prothrombin complex concentrate and activated recombinant factor VII) and the replacement therapy with recombinant porcine FVIII are considered as the first-line therapy for bleeding control, due to their proven clinical efficacy. Plasma-derived or recombinant FVIII concentrates could be used as second-line treatments. Emicizumab may represent a valid and interesting therapeutic option for prophylaxis of bleeding recurrences.

Correlation of Circulating Cathelcidin Level and Inflammatory Bowel Disease Activity

Abstract Background Inflammatory bowel diseases (IBDs), which include Crohn’s disease (CD) and ulcerative colitis (UC), are a group of idiopathic, chronic and relapsing inflammatory disorders of the gastrointestinal tract, whose incidence and prevalence has been increasing in the last decade. Objective To correlate circulating cathelicidin levels with mucosal disease activity in patients with IBD. Patients and Methods This case control cross sectional study was conducted on 45 adult subjects referred to Gastrointestinal Endoscopy and Liver Unit, EL-Haram Hospital.40 of the patients had IBD, the other 40 were non IBD patients studied as case control. All subjects were submitted to complete medical history, physical examination, laboratory investigations, colonoscopic examination and cathelicidin serum level. Results Our results showed that there was no statistically significant difference between both studied groups regarding both age and sex distribution. In this study we found highly significant decrease in Hemoglobin level in cases group compared to control group (p value < 0.001). Also, there was significant increase in platelets level among cases group compared to control (p value < 0.05). Also, we found that serum albumin was decreased among IBD patients compared to control. Conclusion Serum Cathelicidin has shown significant increase in patients with IBD activity. Serum cathelicidin levels showed statistically significant reverse correlation with Partial Mayo Scores of severity in UC patients. Serum cathelicidin levels showed Non-statistically significant correlation with Harvey Bradshaw Indices of severity in CD patients. Co-evaluation of LL-37 and CRP levels was more accurate than CRP alone or LL-37 alone in the correlation with Mayo Endoscopic Score of UC patients.

Comparison between Size of OV, Fibroscan in Chronic Hepatitis C Patients before & after Treatment with DAAs

Abstract Background HCV infection is a global health issue and one of the major causes of chronic liver diseases, Egypt on the top of the countries with heavy HCV burden, HCV genotype 4 is the most common in Egypt and represents 92% of total infections. Objective To asses changes on the size of esophageal varices and liver stiffness after treatment of HCV with DAAs. Patients and Methods The study was carried out at Gastroenterology and hepatology Department, Ain-Shams Hospital and Kobry-Elkoba Military Hospital and included 60 patients with chronic infection of hepatitis c virus diagnosed by (HCV Ab by ELISA positive and HCV RNA by PCR positive) and was divided into 3 groups: Group I: 20 patients chronically infected with HCV received sofosbuvir (one 400 mg tablet taken once daily) & Ribavirin (weight –related dose, 75 kg or less: 400 mg orally in the morning and 600 mg in the evening, Greater than 75 g: 600 mg orally twice daily and decrease the dose in case of anaemia) for 6 months. Group II: 20 Patients chronically infected with HCV received sofosbuvir (one 400 mg tablet taken once daily) & simeprevir (one 150 mg tab taken once daily) for 3 months. Group III: 20 patients chronically infected with HCV received sofosbuvir (one 400 mg tablet taken once daily with or without food) & daclatasvir (one 60 mg tab taken once daily) for 3 months. Results In the study, patients achieved high rates of SVR 12 (98.3%) only one patient at group II relapsed after finishing the treatment and did not reach SVR12. In the study, there was decrease in fibroscan stages after treatment with different regmins of DAAs, but it was significant with group III (HCV patients who received sofosbuvir & daclatasvir for 3 months). In the study, There is significant improvement in liver enzymes (AST&ALT) and significant increase at platelet count after treatment in all the 3 groups, Also there was significant decrease in hemoglobin level in group I (SOF/RIB) in comparison to other groups. In the study, there was no significant change in OV grading in group I before and after treatment, and also in group II & III only one patient in each group had changes in OV grading after treatment from OV grade III to OV grade II. Conclusion High rates of SVR achieved after DAAs therapy associated with significant improvement of the liver function and fibrosis regression estimated by (LSM by fibroscan) but with no improvement of the degree of esophageal varices at least in short term follow up after therapy.

Clinical and Biochemical Profile of Children with Chronic Kidney Disease in a Tertiary Care Hospital of Bangladesh

Background: Chronic kidney disease (CKD) is an insidious and irreversible condition that eventually progresses to end stage renal failure and important cause of morbidity and mortality in children worldwide. However, the care of these patients represents a challenge for health care providers, which must pay attention not only to renal disease, but also to the various extra renal manifestations that affect growth and development. Evaluation of clinical and biochemical profile of children with chronic kidney disease can help to meet up this challenge. Methods: This cross-sectional observational cohort study evaluated clinical, anthropometric and biochemical variables of children with chronic kidney disease aged 2 to 16 years in the department of Pediatric Nephrology, Dhaka Shishu (Children) Hospital, Bangladesh, during July’ 2018 to December’ 2018. A total of thirty-six children with chronic kidney disease with creatinine clearance <60ml/min/1.73 m2 and on supportive treatment and haemodialysis were included. In control group, equal number of age and sex matched healthy children without any preexisting chronic diseases were included. Both study group and control group were assessed for sociodemographic data, nutritional status, clinical and biochemical parameters. Results: The mean age was 9.09±3.01 years in case group and 7.85±3.69 years in control group. In case group, 22 patients (61.1%) were male and 14 (38.9%) were female and the ratio was 1.5:1. In this study we found that a statistically significant decrease in Z-score for (Weight, Height and Body Mass Index) in the CKD patients’ group than control. In terms of blood pressure, 66.7% of patients in the cases group were hypertensive (P = 0.001). There was no significant difference of hypertension among CKD stages in this study. CKD Patients were found anemic with significant decrease in hemoglobin level. Anemia found in 35 patients (97.2%) in the case group than control (P=0.001). CKD stage 5 children had significantly lower hemoglobin level. Serum phosphate and potassium were significantly higher while serum calcium was significantly lower and parathyroid level was higher in case group than control. Conclusion: The present study stated that CKD patients had significantly lower BMI and hemoglobin but hypertensive in comparison to case group. Serum potassium, phosphate and parathyroid higher but serum calcium level was lower in case group. J Bangladesh Coll Phys Surg 2023; 41: 120-125

COMPARATIVE ANALYSIS OF TOXICITY OF BIS[BIS(3,5-DIMETHYLPYRAZOL-1-YL)ACETATO]COPPER AND CU2(3,5-DIPS)4(H2O)3 COPPER(II)-BASED COMPLEXES

One of the priority tasks of modern medicine is the search for new effective means of facilitating the treatment of injuries of various nature. Besides the stability, ease of use and prolonged action, the requirements for such compounds also include low toxicity. In this regard, copper-based complexes with high antioxidant activity are of particular interest. The aim of this work is to determine and compare the toxicity of bis[bis(3,5-dimethylpyrazol-1-yl)acetato]copper(II) complex, (Cu[HC(COO)(pzMe2)2]2 (complex 1) and Cu2(3,5-DIPS)4(H2O)3 (complex 2) by evaluating the survival, life expectancy and several blood parameters. According to the obtained data, complexes 1 and 2 proved to be low-toxic compounds. According to the test results: in case of complex 1 at a dose of 1450 mg/kg, we received a survival rate of 87,5%, and an average life expectancy of 26,8 days, and in the case of complex 2 at the same dose, the survival rate was 75% and the average life expectancy was 22,9 days, which indicates the low toxicity of these compounds (complex 2 has however a higher toxicity, since an identical result is achieved with a lower dose). Using the method of integration according to Behrens in experiments on rats, an average lethal dose of LD50/7 was found, which is more than 2000 mg/kg. Regarding the blood parameters: in case of complex 1, on the 3rd day of the experiment, an increase in the level of all studied blood parameters was observed. This was followed by a decrease, and on the 7th day there was a normalization of all blood parameters except for the number of platelets. Nevertheless, a trend towards normalization was observed in this indicator as well, which led to the normal value of platelet levels by the 21st day. When complex 2 was administered subcutaneously, a significant decrease in hemoglobin level was observed, which was restored by the 7th day; a significant decrease in blood clotting time (BCT), which persisted until the end of the study. By the 7th day, a significant decrease in the levels of platelets and erythrocytes was also noted. The results of haematological studies also confirmed the lowest toxicity of complex 1

THE LEVEL OF LEUKOTRIENE B4 IN PATIENTS WITH ARTERIAL HYPERTENSION AND CORONAVIRUS DISEASE

Relevance. Patients with comorbid pathology, including arterial hypertension (AH), coronary artery disease, type 2 diabetes, and cerebrovascular disease have been shown to be at risk for coronavirus disease (COVID-19). Currently, among the pathogenetic mechanisms of vascular endothelial damage are considered direct effects of SARS-COV-2 virus, as well as proinflammatory cytokines, which lead to a «cytokine storm» with unpredictable consequences for the patient. In this aspect, the role of leukotriene B4 (LTB4) – one of the first candidates to provoke a hyperimmune inflammatory response in the progression of COVID-19 – was insufficiently elucidated.
 Objective: to investigate the level of leukotriene B4 (LTB4) in patients with AH with and without coronavirus disease 2019.
 Methods. 78 people with AH and overweight or obesity who were treated at the Lviv Emergency Hospital were examined. All patients were divided into 2 groups: group 1 (n=37) – persons with AH (stage І-ІІІ, grade 1-3); group 2 (n=41) – patients with AH (stage І-ІІІ, grade 1-3), COVID -19 and interstitial lung disease.
 Anthropometric measurements with a determination of body mass index (BMI), echocardiography, a blood test, biochemical blood test with determination of glucose, alanine aminotransferase, aspartate aminotransferase, creatinine, and urea were performed. Serum blood samples for the examination of LTB4 (Elabscience Elisa Kit) were taken and processed using ELISA method.
 Results. Saturation was significantly lower in patients of group 2, while heart rate and body temperature were higher (p < 0,01) compared to group 1. There was a significant decrease in hemoglobin level, increase in ESR, glucose, and LTB4 in individuals with AH and COVID-19, which is probably due to the presence of inflammation in the lung tissue in coronavirus infection. The concentration of LTB4 ranged from 370 to 3600 pg/l in patients of group 2. 19 individuals (46,3%) of group 2 had a higher level of LTB4 than the median value, which is probably associated with a more severe course of coronavirus infection. A positive correlation between LTB4 and BMI (rs= 0,369; p < 0,05) was found in individuals with AH.
 Conclusions. The level of LTB4 is higher in patients with AH and COVID – 19 than in individuals with AH, due to the severity of the inflammation process in this comorbid pathology.

Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy for proximal gastric cancer with stage cT1-2.

This study aimed to evaluate the feasibility and nutritional benefits of laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) in comparison with laparoscopic total gastrectomy (LTG).The demographic, clinical, and pathological data and postoperative nutritional status of patients undergoing LPG with DTR (n = 21) or LTG (n = 26) at Sir Run Run Shaw Hospital between January 2016 and January 2019 were retrospectively reviewed and compared.The operative time in the LPG group was slightly longer than that in the LTG group; however, the difference was not statistically significant. Blood loss was not significantly different between groups. The mean number of retrieved lymph nodes was higher in the LTG group than in the LPG group (P = .02). The time to first flatus, postoperative hospital stay, and postoperative complications were comparable between the groups. During the 3-year postoperative follow-up, a statistically significant decrease in hemoglobin level was observed in the LTG group. There were no differences between the two groups of patients before and after the operation regarding albumin levels. The mean vitamin B12 level was higher in the LPG group than in the LTG group from 12 to 18 months postoperatively.LPG with DTR is an acceptable procedure for patients with upper gastric cancer. LPG with DTR has numerous potential advantages in preserving the physiological and nutritional functions of the remnant stomach and the conservation of the gastric reservoir.

Bisphenol A mediated histopathological, hemato-biochemical and oxidative stress in rabbits (Oryctolagus cuniculus)

Bisphenol A (BPA) is a ubiquitous environmental contaminant and is commonly known as an endocrine disrupting chemical (EDC). BPA is widely used in production of numerous products including polycarbonate plastics, cans, drinking water bottles and dental sealants. Therefore, the current study was designed to investigate deleterious effects of BPA on blood, serum biochemistry, antioxidant enzymes and histopathological changes in different visceral organs of exposed rabbits. For this reason a total of 16 male rabbits were randomly divided and kept in four different groups (A-D). Rabbits in control group A received no treatment and were kept on normal feed while the rabbits in groups B, C and D were administered BPA @ 10, 50 and 100 mg/kg/day respectively by oral gavage for 28 days. The results showed significant decrease in hemoglobin level, total proteins, lymphocytes, packed cell volume (PCV), red blood cells (RBC) and monocytes in treated rabbits compared to control group. The total white blood cell count and neutrophil (%) significantly increased in treated rabbits. The serum biochemistry analysis showed that the concentrations of glucose, cholesterol, triglycerides, high density lipoprotein (HDL) and low density lipoprotein (LDL) were significantly (p<0.05) higher in the treated rabbits. Results revealed that the levels of various antioxidant enzymes such as peroxidase (POD), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) were significantly decreased (p<0.05) in rabbits exposed to BPA. The quantity of oxidative stress biomarker such as malondialdehyde (MDA) significantly increased in all treated animals compared to control group. Microscopic observation of different visceral tissues like liver, kidneys, lungs and heart exhibited necrotic and degenerative lesions in treated rabbits. In conclusion, the results of our experimental study suggested that BPA induces hemato-biochemical, histopathological and oxidative stress in male rabbits.

Effect of Direct-Acting Antiviral Therapy on Thrombocytopenic Patients with Hepatitis C Virus-Related Chronic Liver Disease.

Background and Aims Thrombocytopenia is a common complication in patients with chronic hepatitis C virus (HCV) that increases the risk of bleeding. We aimed to analyze the hematologic effects of the new direct-acting antiviral (DAA) therapy, particularly on the platelet count in chronic HCV-infected patients with thrombocytopenia. Patients and Methods. One hundred thrombocytopenic patients chronically infected with HCV were included in a prospective study. All patients were eligible for receiving anti-HCV treatment with sofosbuvir-based regimens for 12 weeks, according to the protocol of the National Program for treatment of HCV in Egypt sponsored by the Ministry of Health. Results At the end of treatment (EOT), there was a highly significant increase in platelet count (p < 0.001), a significant increase in white blood cells (WBCs) count (p ≤ 0.032), and a highly significant decrease in hemoglobin level (p < 0.001) as compared to pretreatment levels. Patients with mild to moderate hepatic fibrosis had significantly higher median and interquartile range (IQR) platelet count at baseline and EOT than those with advanced fibrosis and cirrhosis (p ≤ 0.023 and p < 0.001, respectively). There was more elevation in platelet count at EOT in patients with mild to moderate fibrosis than those with advanced fibrosis and cirrhosis. Out of the hundred patients, 73% showed improvement of platelet count, while 27% showed no improvement or even decrease in the platelet count. Conclusion Sofosbuvir-based DAA therapy is a highly effective and safe treatment regimen that results in the improvement of platelet count in thrombocytopenic patients, particularly in mild to moderate stages of hepatic fibrosis.

Study the Effect of Sofosbuvir, Daclatasvir and Ribavirin on Hematologic Profile, ‎Vitamin B12 and Folic Acid Levels in HCV-Related Cirrhotic Patients‎

Background and study aim: The real life effect of anti-HCV direct acting agents (DAAs) on the hematologic profile and serum ‎levels of vitamin B12 and folic acid was not yet fully studied‎. Patients and Methods: Between March 2018 and March 2019, a prospective study was designed at El-Rajhi University ‎Hospital, Egypt, to randomly select HCV-related child A cirrhosis that were eligible for DAAs. All ‎patients received oral sofosbuvir (SOF; 400 mg) plus daclatasvir (DCV; 60 mg) once daily plus weight ‎based ribavirin (RBV): 1,000 mg/day if < 75 kg and 1,200 mg/day if ≥75 kg; regimen for 12 weeks. ‎Hematologic profile, folic acid and B12 levels were assessed twice; before the start of therapy and at ‎the end of week12 by electrochemiluminescence immune-assay. Results: A total of 25 patients were enrolled (age 50.11 ± 7.89 years, 15 males). The majority had no ‎co morbidities. Hematologic profile in pre and post therapy showed significant decrease in hemoglobin ‎levels after treatment (13.1 ± 0.93 Vs 11.15 ± 0.90, respectively; p=0.02). Folic acid level showed a ‎significant decrease (14.56 ± 4.45 Vs 9.06 ± 2.11; respectively, p=0.01) and vitamin B12 levels showed ‎a minor increase (345.09 ± 55.98 Vs 355.19 ± 33.45; respectively, p=0.08)‎. Conclusion: Significant changes in the kinetics of B12 and folic acid were reported during the course of DAAs in ‎management of chronic HCV with cirrhosis. Further large cohort and randomized controlled trial ‎needed to study the effect of add-on these vitamins on the response rates‎.

Mean Platelet Volume and Platelet Function in Neonatal Sepsis

Background: Neonatal sepsis is a clinical disorder developed by bacterial blood stream infections in neonates. CBC indices, such as platelet count, mean platelet volume (MPV), PDW have been used as markers of systemic inflammation in children and adults. Objective: To assess MPV and platelets function in neonatal sepsis. Patients and Methods: This study was a case control, which included 50 cases and 50 controls. All participants were subjected to history taking, clinical examination, CBC, C-reactive protein, blood cultures and assessment of mean platelets volume. Results: There was a significant decrease in haemoglobin level, RBCs count, and platelet count. While, there was significant increase in WBCs count and MPV in the patient group than in the control group. Mean value of platelet count was statistically significantly lower among cases than in control. MPV was significantly higher in patients than controls. PDW was statistically significantly lower among cases than in controls. MPV showed significant negative correlation with gestational age, birth weight and platelet count. While it showed statistically significant positive correlation with CRP. Conclusion: Mean value of platelet count and PDW were statistically significant lower among cases than in control while MPV was significantly higher in patients than in controls. So, platelet function could be a useful early diagnostic marker in neonatal sepsis.

Mean Platelet Volume and Platelet Function in Neonatal Sepsis

Background: Neonatal sepsis is a clinical disorder developed by bacterial blood stream infections in neonates. CBC indices, such as platelet count, mean platelet volume (MPV), PDW have been used as markers of systemic inflammation in children and adults. Objective: To assess MPV and platelets function in neonatal sepsis. Patients and Methods: This study was a case control, which included 50 cases and 50 controls. All participants were subjected to history taking, clinical examination, CBC, C-reactive protein, blood cultures and assessment of mean platelets volume. Results: There was a significant decrease in haemoglobin level, RBCs count, and platelet count. While, there was significant increase in WBCs count and MPV in the patient group than in the control group. Mean value of platelet count was statistically significantly lower among cases than in control. MPV was significantly higher in patients than controls. PDW was statistically significantly lower among cases than in controls. MPV showed significant negative correlation with gestational age, birth weight and platelet count. While it showed statistically significant positive correlation with CRP. Conclusion: Mean value of platelet count and PDW were statistically significant lower among cases than in control while MPV was significantly higher in patients than in controls. So, platelet function could be a useful early diagnostic marker in neonatal sepsis.

Efficacy and Safety of Ombitasvir/Paritaprevir/Ritonavir ± Dasabuvir Regimen in Haemodialysis Patients With Hepatitis C Virus Infection

Background: Hepatitis C virus (HCV) infection is common among patients on haemodialysis (HD) therapy and is an important cause of morbidity and mortality. In patients with chronic kidney disease (CKD), the risks for negative outcomes are significantly higher in HCV-infected patients than in those without HCV infection, including progression to cirrhosis, hepatocellular carcinoma and liver-related mortality. Ombitasvir (OBV), paritaprevir (PTV), ritonavir (r), and dasabuvir (DSV) are all hepatically metabolized and, therefore, require no dose adjustment in patients with any degree of renal impairment. Aims: We studied the safety and efficacy of OBV/PTV/r + DSV in a small group of HCV infected patients on haemodialysis therapy. Methods: Treatment course with ombitasvir/paritaprevir/ritonavir and dasabuvir; (3-DAA regimen of OBV/PTV/r+DSV±RBV) was analysed. Pre-treatment evaluation of HCV infection included HCV RNA, genotype, and liver fibrosis assed by transient fibroelastography (FibroScan). The stage 5 CKD was defined as an eGFR of &amp;lt;15 mL/min/1.73 m2, respectively; those on haemodialysis were considered to have stage 5 CKD or end-stage renal disease (ESRD). Demographic data and concomitant medication were retrieved from patients’ records. The primary endpoint was sustained virologic response at post-treatment week 12 (SVR12). We collected data on on-treatment adverse events (AEs), serious AEs, and laboratory abnormalities. Results: Among 7 treated patients, 6 were male and 1 female, all were infected with genotype 1 (5 GT1b, 2 GT1a). Patient had compensated liver cirrhosis and six patients did not have liver cirrhosis, none were liver transplant recipients. All of seven patients completed 12 weeks of treatment and achieved SVR12. Concomitant medication had to be modified with the treatment initiation in 5 out of 7 patients. One of the patients presented with a significant decrease in haemoglobin level, white blood cell and platelet count during the treatment period. The most frequent adverse events were nausea, diarrhoea. Adverse events were primarily mild, and no patient discontinued treatment due to an AE. Conclusions: Treatment with OBV/PTV/r +DSV ± RBV was well-tolerated and resulted in high rates of SVR12 (100%) for patients with HCV GT1b/1a on haemodialysis.

Efficacy of intravenous tranexamic acid in reducing blood loss during and after elective cesarean section

Background Tranexamic acid (TXA) is one of the prominent amino acid lysine synthetic derivatives having its antifibrinolytic effect through the reversible blockade of the lysine-binding sites on plasminogen molecules. It is regularly administered intravenously to treat and avoid bleeding, with good results. Objective This study was carried out to evaluate the effectiveness, safety, and complications of using TXA in elective cesarean section (CS). Patients and methods This was a prospective study that was conducted at Al-Zahraa University Hospital and El Sahel Teaching Hospital on 200 patients planned for elective CS: 100 patients were given 1 g/10 ml TXA (group A) diluted with 20 ml of 5% glucose, whereas another 100 patients received 30 ml of 5% glucose (group B) 10 min before CS. Following the delivery, patients in both groups received a 5 IU intravenous bolus of pre-prepared oxytocin followed by 30 IU oxytocin in 500-ml lactated Ringer's solution, infused at a rate of 125 ml/h. An antibiotic, 1 g cefazolin, was diluted in normal saline of 20 ml, and it was administered over a duration of 5 min. Estimated blood loss was measured by comparing the hematocrit values before and after the procedure. Results The study revealed a statistically significant decrease in hemoglobin level in group B (placebo group) compared with group A (TXA group), which indicates that there was a significant reduction in the amount of intraoperative and postoperative blood loss in CS in TXA group. Conclusion The use of TXA before CS shows positive effects and can be used as a prophylaxis against postpartum hemorrhage, as revealed by the findings of this study.

Хроническая сердечная недостаточность на фоне ревматоидного артрита: роль воспаления в изменении уровня предсердного натрийуретического пептида и показателей липидограммы

The aim of the research is the analysis of basic clinical laboratory and instrumental parameters of patients suffering from CHF with intermediate left ventricular ejection fraction (LEF), developed as a result of ischemic heart disease and arterial hypertension associated with RA compared to patients without RA; assessment of indicators of morphological and functional parameters of myocardium and possible associations with indicators of RA inflammation activity. Material and methods. The study group included 134 patients with HFFV associated with RA; the comparison group was of 122 patients with HFFV without RA. CHF functional class of patients who took part in the study according to NYHA I-II. RA was diagnosed based on X-ray and serological studies, which included determination of rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), C - reactive protein (CRP). Inflammatory process activity was assessed by DAS28 index and visual analogue pain scale (VAS). X-ray RA stage included the studied I-III patients according to Steinbrocker classofication. CHF treatment medications were compared in groups. The basic anti-inflammatory medication for RA treatment is methotrexate. Patients who did not take methotrexate due to side effects and / or individual intolerance took leflunomide at a dosage of 20 mg per day. Moreover, NSAIDs were used (enterally, parenterally, locally). Hematological, biochemical and instrumental studies were carried out. The processing was carried out in STATISTICA 10.0 program. The work presents statistically significant results. The critical level of significance when testing statistical hypotheses is p &lt;0.05. Results. Comparative analysis revealed statistically significant differences in the levels of ESR and CRP, with a predominance of values in the study group, which naturally reflects the intensity of inflammatory process. Furthermore, statistically significant differences in the levels of creatinine and GFR were revealed. It can be due to the influence of chronic inflammation and regular intake of NSAIDs. In the group of patients with CHF on the background of RA, statistically significant decrease in hemoglobin level was found. Statistically significant predominance of TG, LDL-C concentration, as well as a decrease in HDL-C in the study group in relation to the comparison group were obtained. Statistically significant predominance of atherogenic coefficient was revealed in the study group. NT-proBNP concentration in the study groups differed significante: in the group of patients with CHF associated with RA, the level was 306.7 (225; 391) pg / ml; in the CHF group without RA - 488.7 (355; 638) (p = 0.02). A direct association of the DAS28 index and NT-proBNP was found (r = 0.04; p = 0.02). Conclusion. Patients with CHF associated with RA are reasonably recommended to increase the dosage of statins with more frequent monitoring of lipid profile. An assessment of NT-proBNP level is required for more detailed assessment of morphological and functional parameters of myocardium.

Intrauterine Instillation of Tranexamic Acid in Hysteroscopic Myomectomy: A Double-Blind, Placebo-Controlled, Parallel-Group Randomized Clinical Trial

To evaluate the hemostatic effect of intrauterine instillation of tranexamic acid (TXA) with the distention medium during hysteroscopic myomectomy. Prospective, parallel-group, double-blind, placebo-controlled randomized clinical trial. Early Cancer Detection Unit in Ain Shams University Maternity Hospital, Cairo, Egypt. Eighty women with type 0 or I submucous myoma undergoing hysteroscopic myomectomy using unipolar resectoscope. The participants were randomly assigned to receive either 1 g of TXA for every 1000 mL of the distending medium (intervention group) or 10 mL of placebo (10 mL of 1.5% glycine) in the same form inside every 1000 mL of the distention medium. The primary outcome was a change in hemoglobin level 24 hours after surgery compared with preoperative values, and the secondary outcomes were the surgeon's rating of intraoperative bleeding and the quality of operative view, the duration of surgery, the volume of injected media, intraoperative complications, and the completion of myomectomy in 1 procedure. The mean difference in hemoglobin level was 1.11 ±.58 g/dL in the TXA group and 1.46 ± 0.61 g/dL in the placebo group (p = .015). The quality of hysteroscopic view was better in the TXA group (p = .001), with good operative view in 23 (60.5%) cases in TXA vs 8 (20.5%) in the placebo group. The surgeon's rating of bleeding as excessive was reported in 1 (2.6%) case in the TXA group and in 9 (23.1%) cases in the placebo group. There was no difference between the groups regarding the duration of surgery, the volume of injected media, completion of myoma resection in 1 session, and intraoperative complications. Three cases of uterine perforation with the thermal loop were reported, and all were associated with poor operative field in the placebo group. Intrauterine instillation of TXA with the distention medium during hysteroscopic myomectomy resulted in a statistically significant decrease in hemoglobin level 24 hours after surgery, albeit with minimal clinical significance. TXA resulted in better visualization of the field throughout the procedure.

Hematological Parameters Throughout the First Month of Direct-Acting Antivirus (DAA) Plus Ribavirin for HCV

Abstract Introduction Hematological complications such as neutropenia, thrombocytopenia, and anemia of DAAs/ribavirin in HCV can result in suboptimal outcomes. This study was aimed to investigate the frequency of hematological variations and their impact on the response to DAA therapy. Patients were defined as having hematological abnormalities if they had the presence of either/or a combination of the following hematological parameters at least once during the first month of treatment: drop in (Hb) level, TLC, and PLT count. Pretreatment, Hb, WBC count, and PLT count were not statistically related to the treatment response. However, lower count of all parameters was associated with moderate or advanced hepatic fibrosis stages according to the METAVIR scoring (P &lt; .001). Static analysis showed that drop in Hb, TLC, and PLT count was significantly associated with response to treatment; P &lt; .001, .21, and .41, respectively. Methods Fifty-eight patients for treatment of chronic hepatitis were studied. Their hematological parameters including TLC, Hb, and platelet counts were recorded before starting antiviral therapy and then at 3 monthly intervals. All the patients were given DAAS/ribavirin as antiviral therapy. Data were collected over a period of 3 months. Results Fifty-eight patients with mean (SD) age of 54.38 (12.67) years were studied. There was a mean hemoglobin (Hb) fall of 1.5 g/dL at the first 4 weeks of antiviral therapy. Mean TLC fell to 1.03 × 10⁹/L in the first month. A similar downward trend was noted in platelet values with a mean fall of 12.3 × 10⁹/mm in the first month of the antiviral therapy. Of the cases, 41.4% developed clinically significant anemia as evidenced by hemoglobin 11 g/dL after 4 weeks of antiviral therapy; this fall was noted only in first 4 weeks of treatment. Conclusion Significant hematological abnormalities occurred within the first 4 weeks of antiretroviral therapy. There was significant decrease in hemoglobin level.