scholarly journals Non-tuberculous mycobacterial pulmonary diseases in France: an 8 years nationwide study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicolas Veziris ◽  
Claire Andréjak ◽  
Stéphane Bouée ◽  
Corinne Emery ◽  
Marko Obradovic ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Charlson Comorbidity Index Score ◽  
Control Group ◽  
Treatment Regimens ◽  
Main Driver ◽  
Icd 10 ◽  
History Of ◽  
Study Population ◽  
Annual Total ◽  
Lower Respiratory Disease

Abstract Background The objective of the study was to describe the epidemiology, management and cost of non-tuberculous mycobacteria pulmonary disease (NTM-PD) in France. Methods A retrospective analysis was performed using the SNDS (“Système national des données de santé”) database over 2010–2017. Patients with NTM-PD were identified based on the ICD10 codes during hospitalizations and/or specific antibiotics treatment regimens. The study population was matched (age, sex and region) to a control group (1:3) without NTM-PD. Results 5628 patients with NTM-PD (men: 52.9%, mean age = 60.9 years) were identified over the study period and 1433 (25.5%) were treated with antibiotics. The proportion of patients still receiving treatment at 6 and 12 months was 40% and 22%, respectively. The prevalence of NTM-PD was estimated at 5.92 per 100,000 inhabitants and the incidence rate of NTM-PD remained stable over time between 1.025/100,000 in 2010 and 1.096/100,000 in 2017. Patients with NTM-PD had more co-morbidities compared to controls: corticoids (57.3% vs. 33.8%), chronic lower respiratory disease (34.4% vs. 2.7%), other infectious pneumonia (24.4% vs. 1.4%), malnutrition (based on hospitalization with the ICD-10 code reported during a hospital stay as a main or secondary diagnosis) (22.0% vs. 2.0%), history of tuberculosis (14.1% vs. 0.1%), HIV (8.7% vs. 0.2%), lung cancer and lung graft (5.7% vs. 0.4%), cystic fibrosis (3.2% vs. 0.0%), gastro-esophageal reflux disease (2.9% vs. 0.9%) and bone marrow transplant (1.3% vs. 0.0%) (p < 0.0001). The mean Charlson comorbidity index score was 1.6 (vs. 0.2 for controls; p < 0.0001). NTM-PD was independently associated with an increased mortality rate with a hazard ratio of 2.8 (95% CI: 2.53; 3.11). Mortality was lower for patients treated with antibiotics compared to untreated patients (HR = 0.772 (95% CI [0.628; 0.949]). Annual total expenses the year following the infection in a societal perspective were € 24,083 (SD: 29,358) in NTM-PD subjects vs. € 3402 (SD: 8575) in controls (p < 0.0001). Main driver of the total expense for NTM-PD patients was hospital expense (> 50% of the total expense). Conclusion Patients with NTM-PD in France were shown to have many comorbidities, their mortality risk is high and mainly driven by NTM-PD, and their management costly. Only a minority of patients got treated with antibiotics and of those patients treated, many stopped their therapy prematurely. These results underline the high burden associated with NTM-PD and the need for improvement of NTM-PD management in France.

scholarly journals Non-tuberculous Mycobacterial Pulmonary Diseases in France: An 8 Years Nationwide Study

2021 ◽  
Author(s):  
Nicolas Veziris ◽  
Claire Andréjak ◽  
Stéphane Bouée ◽  
Corinne Emery ◽  
Marko Obradovic ◽  
...  
Keyword(s):  
Marrow Transplant ◽  
Charlson Comorbidity Index Score ◽  
Control Group ◽  
Treatment Regimens ◽  
Main Driver ◽  
Study Population ◽  
Annual Total ◽  
Comorbidity Index ◽  
The Mean ◽  
Lower Respiratory Disease

Abstract Background: The objective of the study was to describe the epidemiology, management and cost of non-tuberculous mycobacteria lung disease (NTM-PD) in France.Methods: A retrospective analysis was performed using the SNDS database over 2010-2017. Patients with NTM-PD were identified based on the ICD10 codes during hospitalizations and/or specific antibiotics treatment regimens. The study population was matched (age, gender and region) to a control group (1: 3) without NTM-PD.Results: 5,628 patients with NTM-PD (men: 52.9%, mean age=60.9 years) were identified over the study period and 1,433 (25.5%) were treated with antibiotics. The proportion of patients still receiving treatment at 6 and 12 months was 40% and 22%, respectively.Patients with NTM-PD had more co-morbidities compared to controls: corticoids (57.3% versus 33.8%), chronic lower respiratory disease (34.4% vs. 2.7%), other infectious pneumonia (24.4% vs. 1.4%), malnutrition (22.0% vs. 2.0%), tuberculosis (14.1% vs. 0.1%), HIV (8.7% vs 0.2%), lung cancer and graft (5.7% vs 0.4%), cystic fibrosis (3.2% vs 0.0%), gastro-esophageal reflux disease (2.9% vs 0.9%) and bone marrow transplant (1.3% vs 0.0%) (p<0.0001). The mean Charlson comorbidity index score was 1.6 (versus 0.2 for controls; p <0.0001). NTM-PD was independently associated with an increased mortality rate with a hazard ratio of 2.8 (95% CI: 2.53; 3.11). Mortality was lower for patients treated with antibiotics compared to untreated patients (HR=0.772 (95% CI [0.628; 0.949]).Annual total expenses the year following the infection in a societal perspective were € 24,083 (SD: 29,358) in NTM-PD subjects versus € 3,402 (SD: 8,575) in controls (p<0.0001). Main driver of the total expense for NTM-PD patients was hospital expense (>50% of the total expense).Conclusion: Patients with NTM-PD in France were shown to have many comorbidities, their mortality risk is high and mainly driven by NTM-PD, and their management costly. Only a minority of patients got treated with antibiotics and of those patients treated, many stopped their therapy prematurely. These results underline the high burden associated with NTM-PD and the need for improvement of NTM-PD management in France.

scholarly journals Short-term outcome in acute and transient psychotic disorder and its correlate to various sociobiological factors

2017 ◽  
Vol 4 (2) ◽  
pp. 350
Author(s):  
Sumit Chandak ◽  
Sunil N. Gowda
Keyword(s):  
Treatment Adherence ◽  
Psychotic Disorder ◽  
Sleep Disturbances ◽  
Significant Proportion ◽  
Term Outcome ◽  
Population Average ◽  
Icd 10 ◽  
History Of ◽  
Study Population ◽  
Made In

Background: There is a higher incidence of acute and transient psychotic disorder, however there are not much data on the course of disease and its association with sociobiological factors. We assessed the outcome in patients who met the ICD 10 DCR criteria for acute and transient psychotic disorder, at a follow up period of 6 months.Methods: We conducted a prospective observational study conducted at out-patient department of the Institute of Psychiatry and Human Behaviour, Bambolim, Goa. Fifty-seven patients were enrolled and were followed up for a period of 6 months from the day of enrollment. The outcome was ‘review of diagnosis and ‘no review of diagnosis at the end of 6 months.Results: The mean age of the study sample was 32.25 years. In three-fourth of the patients, there was no change in the diagnosis. Nearly 65% of the patients were women and 35% of them were men. No review in diagnosis was made in significant proportion of the population. Average duration of education was 7.35 years. Most of them were unskilled laborers and homemakers. A significant number of the study population was migrants. Two-third of the population did not have any family history of psychiatric disorder. The onset was acute in majority of the patients. Suicidal thoughts were present at the time of diagnosis in certain patients. The treatment adherence was lower in those whose diagnoses did not change at the end of 6 months. Sleep disturbances, ideas of persecution, and concentration difficulties were the frequently reported symptoms.No repeat episodes were noted in our study.Conclusions: No review in diagnosis was made in significant proportion of the population. The treatment adherence was lower in those whose diagnoses did not change at the end of 6 months.

scholarly journals Polycystic ovarian syndrome: rs1799752 polymorphism of ACE gene

2018 ◽  
Vol 64 (11) ◽  
pp. 1017-1022
Author(s):  
Mariangela Torreglosa Ruiz Cintra ◽  
Marly Aparecida Spadotto Balarin ◽  
Sarah Cristina Sato Vaz Tanaka ◽  
Vanessa Iorrana Mota da Silva ◽  
Alessandra Bernadete Trovó de Marqui ◽  
...  
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Descriptive Analysis ◽  
Univariate Analysis ◽  
Control Group ◽  
Genotypic Frequency ◽  
Significance Level ◽  
Ace Gene ◽  
History Of ◽  
Study Population ◽  
Ovarian Syndrome

SUMMARY PURPOSE: To investigate the contribution of the deletion polymorphism and insertion (rs1799752) of the angiotensin converting enzyme (ACE) gene in the aetiology of Polycystic Ovarian Syndrome (PCOS). METHODOLOGY: 97 women diagnosed with PCOS who received care at the Gynaecology and Obstetrics clinic of the Hospital das Clínicas of UFTM, participated in this study. The control group consisted of 94 women. All participants were submitted to the collection of 10 mL of whole blood and the genomic DNA was obtained by the saline extraction method. The genotyping of the samples was performed by means of the Polymerase Chain Reaction (PCR). The statistics analyses were performed by descriptive analysis, univariate analysis and logistic regression model. The results were presented in odds ratio (OR) and confidence interval of 95% (CI-95%), with a significance level of 5% (p≤0.05). RESULTS: There were no statistical differences between patients and controls for the genotypic (χ2 = 1.52, p = 0.47) and allelic frequencies (χ2 = 0.21, p = 0.76). The distribution of the genotypic frequency is not in HWE for patients (χ2 = 18.80, p <0.05) and for controls (χ2 = 6.85, p <0.05). In relation to the risk factors for the syndrome, the history of familial PCOS is more frequent between women with the syndrome. CONCLUSION: In the study population, there was no association between I/D polymorphism of the ACE gene and PCOS.

Abstract 225: Healthcare Burden Associated with Dyspepsia Among Nonvalvular Atrial Fibrillation Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Michael H Kim ◽  
Kelly F Bell ◽  
Dinara Makenbaeva ◽  
Daniel Wiederkehr ◽  
Jay Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Baseline Period ◽  
Charlson Comorbidity Index Score ◽  
Prior History ◽  
Nonvalvular Atrial Fibrillation ◽  
Entire Study ◽  
Healthcare Burden ◽  
History Of ◽  
Study Population

Objective: To evaluate the annual healthcare burden associated with dyspepsia among nonvalvular atrial fibrillation (NVAF) patients Methods: NVAF patients ≥18 years of age with continuous medical/prescription coverage were identified (1/1/2007-12/31/2009) from the MarketScan ® Commercial and Medicare Research Databases. Patients with at least 1 inpatient or 2 outpatient dyspepsia diagnoses within 12 months following any NVAF diagnosis were grouped into the dyspeptic cohort, with patients without any dyspepsia diagnosis during the entire study period grouped into the non-dyspeptic cohort. The date of first dyspepsia diagnosis after NVAF diagnosis and a random date within 12 months after NVAF diagnosis were selected as the index dates for dyspeptic and non-dyspeptic patients, respectively. Baseline and follow-up periods were each 12 months. Of the overall dyspeptic and non-dyspeptic cohorts, patients were matched (1:1) by key patient characteristics. The dyspeptic cohort was further categorized as having a prior history of dyspepsia (chronic) or no dyspepsia (non-chronic) during the baseline period. Healthcare utilization and costs were evaluated and compared during the follow-up for matched cohorts. Results: Of 142,322 NVAF patients included in the overall study population (mean age: dyspeptic: 73.68, non-dyspeptic: 72.09 years, p<0.001), 10.2% were diagnosed with dyspepsia, with 67% of them having no history of prior dyspepsia during the baseline. Among the matched study population (N=28,172), patients had similar baseline characteristics: mean Charlson Comorbidity Index score of 2.3 in both cohorts and mean CHADS 2 scores of 1.9 and 1.8 for the non-dyspeptic and dyspeptic cohort, respectively. During the follow-up period, healthcare resource utilization and related costs were significantly greater for the dyspeptic cohort vs. the non-dyspeptic cohort (Table). Patients with chronic dyspepsia were the least likely to receive warfarin in the follow-up period (non-dyspeptic: 57.2%, non-chronic: 50.4%, chronic: 46.6%, p<0.001). Conclusions: NVAF patients with dyspepsia used healthcare resources to a greater extent and had greater healthcare costs than NVAF patients without dyspepsia. Warfarin usage appeared to be lower among NVAF patients with dyspepsia.

A 2- TO 3-YEAR OUTCOME AFTER BRONCHIOLITIS

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 254-254
Author(s):  
Nancy Ostrom
Keyword(s):  
Family History ◽  
Positive Family History ◽  
Control Group ◽  
Short Term ◽  
Term Outcome ◽  
Significant Difference ◽  
Socioeconomic Diversity ◽  
History Of ◽  
Study Population ◽  
Viral Etiologies

Purpose of the Study. To evaluate risk factors and short term outcome for subsequent wheezing in children with early bronchiolitis or pneumonia. Study Population. One hundred twenty-seven children (0 to 2 years old) hospitalized for wheezing (83) or pneumonia in a 1-year period in two hospitals in Finland. Methods. Patients with a history of hospitalization for wheezing with respiratory infection (including bronchiolitis) versus pneumonia were examined, and their parents were interviewed at 1 month, 1.5 to 2 years, and 2.5 to 3 years. Family history of atopy, environmental factors, breast feeding history, and other atopy (eczema, elevated IgE) were noted using a standardized questionnaire and physician-documented wheezing episodes were quantified. Statistical χ2 tests were analyzed comparing the wheezing group to the control group of patients with pneumonia not associated with wheezing. Findings. There was no significant difference between the groups in bacterial versus viral etiology of their lower respiratory symptoms. Subsequent wheezing after bronchiolitis occurred in 76% of children 1-2 years of age and 58% of children at 2-3 years of age. This compares with 9% and 16% (respectively by age) of the group with "non-wheezing" pneumonia. Atopic diathesis, particularly a positive family history of asthma was the host factor best associated with initial wheezing. Parenthetically, parental smoking was found in 61% of the wheezing group and 45% of the pneumonia group. Reviewer's Comments. This is a sound study, perhaps limited, in its comparability to our clinical populations with wider racial and socioeconomic diversity. Of note is the finding of no differences between the wheezing and nonwheezing groups in bacterial and viral etiologies.

Amphotericin B Infusion-Related Toxicity: Comparison of Two- and Four-Hour Infusions

1995 ◽  
Vol 29 (11) ◽  
pp. 1081-1087 ◽  
Author(s):  
Tessa A Nicholl ◽  
Cindy Reesor Nimmo ◽  
John D Shepherd ◽  
Peter Phillips ◽  
Peter J Jewesson
Keyword(s):  
Amphotericin B ◽  
Tertiary Care ◽  
Central Line ◽  
Marrow Transplant ◽  
Prophylactic Regimen ◽  
Double Blind ◽  
Treatment Regimens ◽  
Study Population ◽  
Collection Form ◽  
Infusion Duration

Objective: To investigate the influence of infusion duration on infusion-related adverse effects (IRAEs) associated with prophylactic or treatment regimens of amphotericin B in patients with leukemia/bone marrow transplant (BMT). Design: Randomized, double-blind, 2-arm, complete crossover, prospective clinical trial. Setting: A university-affiliated tertiary care teaching hospital. Participants: The study population consisted of 25 consecutive patients with leukemia/BMT who received 162 prophylactic regimen infusions and 169 treatment regimen infusions of amphotericin B via a central line. Prior to each infusion all patients received a parenteral IRAE prophylaxis regimen of diphenhydramine 25 mg and hydrocortisone 25 mg. No test doses or incremental amphotericin B doses were administered. Patients were monitored closely for IRAEs, which were documented by using a standardized data collection form. Main Outcome Measures: The incidence and nature of IRAEs during a 6-hour monitoring period following the initiation of each infusion was measured. Patients served as their own controls. IRAEs were compared according to infusion duration and therapeutic indication. Results: Three hundred and thirty-one 2- and 4-hour amphotericin B infusions were administered. We found no difference between 2- and 4-hour infusions in the incidence and severity of IRAEs, including overall events (29% of 166 2-hour infusions vs. 25% of 165 4-hour infusions), chill scores (8% of 166 2-hour infusions vs. 7% of 165 4-hour infusions; highest score 7 vs. 6), nausea and vomiting (7% vs. 12%; highest score 4 in both groups), fever (3% vs. 2%), highest temperature increase (2.4 vs. 1.6 °C), systolic hypotension (6% vs. 2%), greatest decrease from baseline (40 vs. 62 mm Hg), diastolic hypotension (5% vs. 3%), and greatest decrease (30 vs. 28 mm Hg) (p > 0.05). Overall, IRAEs were less common in prophylactic treatment regimens (35 events [22%] in 162 infusions) than in treatment regimens (55 events [32%] in 169 infusions) (p < 0.05). Conclusions: This study demonstrates that patients with leukemia/BMT without myocardial or renal dysfunction who receive hydrocortisone and diphenhydramine as premedications can tolerate 2-hour central line infusions of prophylactic or treatment regimens of amphotericin B as well as 4-hour infusions.

scholarly journals Application of an Artificial Intelligence/Machine Learning Model for Estimating Potential US Prevalence of WHIM Syndrome, a Rare Immunodeficiency, from Insurance Claims Data

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4305-4305
Author(s):  
Cathy Garabedian ◽  
Lori Neri ◽  
Jan Seng ◽  
Graham K Jones ◽  
Jonathan Woodring
Keyword(s):  
Claims Data ◽  
Severe Disease ◽  
Control Group ◽  
Insurance Claims ◽  
Claims Database ◽  
Whim Syndrome ◽  
The Us ◽  
Icd 10 ◽  
Insurance Claims Data ◽  
History Of

Abstract Introduction: WHIM (Warts, Hypogammaglobulinemia, Infections, and Myelokathexis) syndrome is an inborn error of immunity characterized as a primary immunodeficiency with neutropenia-but the acronym does not reflect the broad spectrum of disease manifestations that patients may experience. A WHIM syndrome diagnosis may be confirmed clinically by the presence of myelokathexis, the retention of white blood cells in the bone marrow, or by identification of a known pathogenic gain-of-function mutation in the CXCR4 gene coding for the CXCR4 receptor. Diagnosis of WHIM syndrome is thought to be frequently missed because of low disease awareness, missed identification of myelokathexis, and lack of routine genetic testing (Al Ustwani O, et al. Br J Haematol. 2014:164;15-23; Dotta L, et al. Curr Mol Med. 2011;11:317-325; Heusinkveld L, et al. Exp Opin Orphan Drugs. 2017;5(10):813-825). The prevalence of WHIM syndrome has never been systematically studied and is unknown. Determination of prevalence via insurance claims data is hindered by the absence of an International Classification of Diseases (ICD)-10 code for WHIM syndrome as well as inconsistent coding for key symptoms of WHIM syndrome, which are variably penetrant. This study applied an artificial intelligence (AI)/machine learning (ML) model to estimate the potential prevalence of WHIM syndrome using a large US insurance claims database. Methods: A deidentified, longitudinal, patient-level US claims database of &gt;300 million lives was used for this study. Thirty-two patients with genetically confirmed WHIM syndrome were identified from the claims database by linking deidentified patients to known physicians and matching clinical and demographic features. Using this group as a positive training class, an AI/ML model was deployed to identify patients with WHIM look-alike clinical phenotypes in the database. Patients were further filtered based on clinical features to generate low (presence of warts, history of infections, and hypogammaglobulinemia) and high (presence of warts, history of infections, and coding associated with immunodeficiency) prevalence estimates; a final prevalence number for the US was projected to account for incomplete coverage of the US population in the claims database. Finally, insurance codes for disease symptoms, treatments, and management were analyzed to investigate the burden of disease in patients identified by the model. Results: The model showed a high predictive value for distinguishing patients with known WHIM syndrome from a random sample of age-matched patients in the database (area under the curve [AUC] of receiver operating characteristic [ROC] plot, &gt;0.99) as well as a control group of patients with ICD-10 codes defining immunodeficiency conditions (AUC of ROC plot, 0.99). The model generated estimates ranging from 1803 (low) to 3718 (high) patients with WHIM look-alike phenotype in the US. Analysis of medical history in the high-estimate WHIM look-alike group revealed symptomatic and severe disease, as evidenced by ≥1 instance of use of granulocyte colony-stimulating factor (41%) or intravenous immunoglobulin (46%) therapy (both &lt;1% in control group), need for respiratory services (82% vs 8% in control group), presence of hearing loss (18% vs 1% in control group), and high annual utilization of emergency (51%) and hospital (44%) services (vs 8% and 1%, respectively, in control group). Conclusions: The methodology used here provides an approach to explore the prevalence of rare diseases that are often mis- or under-diagnosed and are not captured with a unique ICD-10 code. This study estimates a prevalence of 1803 to 3718 WHIM look-alike patients in the US, supporting the possibility that there may be ≤~3700 patients with either diagnosed or undiagnosed WHIM syndrome in the US. An analysis of the medical history of the WHIM look-alike patients revealed a history of symptomatic and severe disease and a high unmet medical need. Since it is not feasible to definitively confirm a WHIM diagnosis in the look-alike group, it is possible that some of these look-alike patients may have diagnosed or undiagnosed WHIM syndrome, while others may have a clinical phenotype consistent with WHIM syndrome without meeting its classic diagnostic criteria. Disclosures Garabedian: X4 Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company. Neri: X4 Pharmaceuticals: Current Employment. Seng: X4 Pharmaceuticals: Current Employment. Jones: Real Chemistry (Formerly Swoop/IPM): Current Employment, Other: I was paid salary to perform secondary research project work for client "X4" which resulted in this publication.

Screening for haemorrhagic disorders in paediatric patients by means of a questionnaire

2009 ◽  
Vol 29 (S 01) ◽  
pp. S87-S89 ◽  
Author(s):  
I. Music ◽  
M. Novak ◽  
B. Acham-Roschitz ◽  
W. Muntean
Keyword(s):  
Predictive Value ◽  
Laboratory Diagnosis ◽  
Von Willebrand Disease ◽  
Control Group ◽  
Older Children ◽  
Mild Disease ◽  
History Of ◽  
Von Willebrand ◽  
Specific Symptoms ◽  
Infants And Young Children

SummaryAim: In children, screening for haemorrhagic disorders is further complicated by the fact that infants and young children with mild disease in many cases most likely will not have a significant history of easy bruising or bleeding making the efficacy of a questionnaire even more questionable. Patients, methods: We compared the questionnaires of a group of 88 children in whom a haemorrhagic disorder was ruled out by rigorous laboratory investigation to a group of 38 children with mild von Willebrand disease (VWD). Questionnaires about child, mother and father were obtained prior to the laboratory diagnosis on the occasion of routine preoperative screening. Results: 23/38 children with mild VWD showed at least one positive question in the questionnaire, while 21/88 without laboratory signs showed at least one positive question. There was a trend to more specific symptoms in older children. Three or more positive questions were found only in VWD patients, but only in a few of the control group. The question about menstrual bleeding in mothers did not differ significantly. Sensitivity of the questionnaire for a hemostatic disorder was 0.60, while specifity was 0.76. The negative predictive value was 0.82, but the positive predictive value was only 0.52. Conclusions: Our small study shows, that a questionnaire yields good results to exclude a haemostatic disorder, but is not a sensitive tool to identify such a disorder.

Natural Oestrogen in the Female Climacteric - Influence on Blood Coagulation and Fibrinolysis

1978 ◽  
Vol 40 (02) ◽  
pp. 532-541 ◽  
Author(s):  
Anders Lagrelius ◽  
Nils-Olov Lunell ◽  
Margareta Blombäck
Keyword(s):  
Blood Coagulation ◽  
Antithrombin Iii ◽  
Coagulation Factors ◽  
Control Group ◽  
Blood Coagulation Factors ◽  
Excessive Bleeding ◽  
Oestrone Sulphate ◽  
Menopausal Women ◽  
History Of ◽  
Coagulation And Fibrinolysis

SummaryThe aim of the present study was to investigate the effect on blood coagulation and fibrinolysis of a natural oestrogen preparation, piperazine oestrone sulphate, prospectively in menopausal women. Scopolamine was given to the control group.The women were investigated before and during treatment with regard to factors VIII, VII, X, V, fibrinopeptide A, antithrombin III, plasminogen, rapid antiplasmin and α1-antitrypsin. There was no significant change towards hypercoagulability or decreased fibrinolysis in any group. In the oestrogen group, however, a tendency towards an increased level of plasminogen and a decreased level of antiplasmin was demonstrated. In the scopolamine group there was an unexpected fall in factors X and V and also in plasminogen and α1,-antitrypsin. A low level of some blood coagulation factors in some of the women before treatment is somewhat astonishing; none of them had any history of excessive bleeding.

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