scholarly journals Idarucizumab for the Reversal of Dabigatran-induced Anticoagulation in the Treatment of Gastric Bleeding: a Case Report

2021 ◽  
Author(s):  
Yu Jia ◽  
Shaohua Wang ◽  
Najuan Cui ◽  
Quanxi Liu ◽  
Wei Wang ◽  
...  
Keyword(s):  
Renal Function ◽  
Bleeding Risk ◽  
Thrombin Time ◽  
Gastric Bleeding ◽  
Laboratory Findings ◽  
Transfusion Therapy ◽  
Abnormal Accumulation ◽  
Life Threatening ◽  
History Of ◽  
Short Time

Abstract BACKGROUND:The drug instruction for dabigatran recommends the does adjustment 110 mg twice-a-day for the patient with bleeding risk, and at least 1 time of renal function test per year for moderate renal impairment. However, dabigatran still can be abnormal accumulation due to the chronic insidiously progressive renal insufficiency, which requiring idarucizumab to reverse the anticoagulation on account of acute erosive gastritis with extensive gastric mucosal bleeding.CASE SUMMARY: A 76-year-old female, with a history of Atrial Fibrillation (AF), took dabigatran 110 mg twice-a-day as recommended does adjustment to reduce the risk of stroke, and admitted to the hospital for the main complaints of hematemesis and melena. The laboratory findings showed severe life-threatening blood-loss anemia with hemoglobin (Hb) 41.0g/L, and significant coagulation abnormalities with thrombin time (TT) > 180s, most likely caused by dabigatran metabolic disorder. Aggressive acid suppressive, hemostatic and blood transfusion therapy brought out a short-time bleed-controlled misconception, which situation was exactly confirmed by re-bleeding. Idarucizumab was given timely to reverse the anticoagulation effect of dabigatran. 12 hours later, TT was tested as 17.4s which belonged to the normal range. Finally, she had no active bleeding signs, with labs showing Hb 104g/L and TT 17.7s.CONCLUSION:It is recommended to monitor renal function regularly, even coagulation function and dabigatran concentration, for the elder. There is at present no general agreement on the use of Proton Pump Inhibitor (PPI)–dabigatran coadministration to prevent upper gastrointestinal bleeding.

scholarly journals Clinico-radiological profile of COVID-19 in a tertiary care hospital of western Rajasthan

2021 ◽  
Vol 6 (3) ◽  
pp. 152-155
Author(s):  
Priyanka Soni ◽  
Laxman Kumar Soni ◽  
K.C Agarwal
Keyword(s):  
Tertiary Care ◽  
Left Lung ◽  
Care Hospital ◽  
Lung Involvement ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Radiological Data ◽  
Life Threatening ◽  
History Of ◽  
Novel Coronavirus

Coronavirus disease 2019 (COVID-19) is a pandemic infectious disease caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection by COVID-19 can result in a range of clinical outcomes, from asymptomatic to severe life-threatening course or death. The purpose of our research was to evaluate the presentation of COVID19 disease based on the clinical and radiological characteristics of our population. 100 COVID19 patients recorded by RTPCR. Clinical, biochemical and radiological data from April-May, 2021. Of the 100 patients, in our study 66% were males and 26% patients had history of recent travel. Majority of patients were asymptomatic and don’t have comorbid illness. Thrombocytopenia and lymphopenia, increased levels of lactate dehydrogenase (LDH) and serum ferritin and C-reactive protein were common in these patients. CT finding were 63% had normal CT chest. Among the 37% patients who had CT chest findings, 25% had bilateral diseases, 8% patients had right lung involvement while 4% patients have left lung involvement.  COVID-19 disease has a relatively mild course in this part of the subcontinent. Clinical and laboratory findings are similar to those found in viral diseases. Studies involving larger sample size and interventional trials are need of the hour.

scholarly journals SNAKE BITE

2010 ◽  
Vol 17 (02) ◽  
pp. 263-268
Author(s):  
KAMRAN ZAHEER BUTT ◽  
FAHEEM ANWAR ◽  
MOHAMMAD RIZWAN
Keyword(s):  
First Aid ◽  
Snake Bite ◽  
Clinical Effects ◽  
Field Hospital ◽  
Laboratory Findings ◽  
Life Threatening ◽  
History Of ◽  
Male Patients ◽  
Age Range ◽  
Study Setting

Introduction: 15 percent of the snakes are poisonous and present a potential life threatening risk to human lives. Objectives: (1) To review the demographic, epidemiological, clinical and laboratory findings of 48 patients of snake bite treated in a field hospital. (2) To evaluate the treatment and outcome of these patients. Design: A retrospective study. Setting: Field hospital in rural Sindh. Period: From January 2002 to December 2003. Material & Methods: All patients diagnosed with snake bite had first aid treatment by a either a nursing staff close to the place of bite or by a quack and later on transferred to field hospital. The first aid treatment consisted of pain relief (injectable diclofenac, oral acetaminophen), application of bandage or tourniquet proximal to the bite, antihistamine (oral or injectable chlorpheniramine) anti- inflammatory (injection hydrocortisone) and immobilization of the affected limb with a splint. Results: We are treated 48 patients with snake bite. There were 45(94%) male patients and 3(6%) female patients. Age range was 18 to 56 years with a mean age of 29.8 years. 35(73%) patients suffered from snake bite between the months of May and September. The timing of the bite was also peculiar with 36(75%) patients bitten between 8pm and 8am whereas only 12(25%) patients during other times of the day. 38(79%) patients gave history of seeing the snake themselves and 10(21%) patients were not able to see the snake mainly because of darkness. Conclusion It should be remembered that not all snakes are poisonous and that they are more afraid of humans than we are of them. Psychological effects of the bite are at times more devastating than the clinical effects, therefore patient reassurance forms part of the treatment.

scholarly journals Studies on a Novel Circulating Anticoagulant in a Female with Bleeding Diathesis

1977 ◽  
Author(s):  
Harry L. Messmore ◽  
J. Fareed ◽  
Roberta L. Chang ◽  
Gerald M. Gawlik ◽  
Gerald F. Kozuh
Keyword(s):  
Serine Proteases ◽  
Anticoagulant Activity ◽  
Factor Xa ◽  
Surgical Trauma ◽  
Thrombin Time ◽  
At Iii ◽  
Life Threatening ◽  
History Of ◽  
Induced Aggregation ◽  
Hydrolysis Of

A 42 year old Caucasian female has had a history of bleeding from surgical trauma since the age of 3. She has bled massively from surgical trauma and has had life threatening postpartum hemorrhages. Laboratory tests showed marked prolongation of thrombin time, prothrombin time, partial thromboplastin time, low α1 antitrypsin and lipoprotein lipase activity. Fibrinogen level was normal. Mixing of patient’s plasma and serum with citrated normal plasma suggested the presence of a potent antithrombin (AT) substance. Heating of both the plasma and serum at 56°C for 2 hours failed to destroy the AT activity. The AT activity of the patient’s plasma was quantitated to be equivalent to 0.75–0.9 u/ml heparin. Platelets aggregated normally with ADP, collagen, epinephrine, but not with Ristocetin and thrombin (0.5–5.0 u/ml). Her plasma and serum blocked thrombin induced aggregation of normal platelets. Her plasma also inhibited the factor Xa induced hydrolysis of S-2222 (Bz-Ile-Glu-[γ-OR]-Gly-Arg-pNA) and the action of thrombin on S-2160 (Bz-Phe-val-Arg-pNA). The inhibitor was not adsorbed with barium sulfate or reduced in activity by protamine sulfate, toluidine blue or heparinase. It was chromatographed on Sephadex G-100 and G-50, and eluted in the void volume and a low molecular (10–20,000) fraction. Incubation of the patient’s plasma with chymotrypsin and trypsin destroyed the anticoagulant activity. Although anti-AT-III serum totally neutralized the anticoagulant activity of heparin-ized plasma, it failed to neutralize the patient’s plasma anticoagulant activity. Albumin partially neutralized the anticoagulant activity. These studies suggest that this AT substance is a potent inhibitor of serine proteases and behaves as activated AT-III.

scholarly journals DIABETIC RETINOPATHY

2010 ◽  
Vol 17 (02) ◽  
pp. 257-262
Author(s):  
NAUMAN AYUB SHAIKH ◽  
FAROOQ AHMAD
Keyword(s):  
First Aid ◽  
Snake Bite ◽  
Clinical Effects ◽  
Field Hospital ◽  
Laboratory Findings ◽  
Life Threatening ◽  
History Of ◽  
Male Patients ◽  
Age Range ◽  
Study Setting

Introduction: 15 percent of the snakes are poisonous and present a potential life threatening risk to human lives. Objectives: (1) To review the demographic, epidemiological, clinical and laboratory findings of 48 patients of snake bite treated in a field hospital. (2) To evaluate the treatment and outcome of these patients. Design: A retrospective study. Setting: Field hospital in rural Sindh. Period: From January 2002 to December 2003. Material & Methods: All patients diagnosed with snake bite had first aid treatment by a either a nursing staff close to the place of bite or by a quack and later on transferred to field hospital. The first aid treatment consisted of pain relief (injectable diclofenac, oral acetaminophen), application of bandage or tourniquet proximal to the bite, antihistamine (oral or injectable chlorpheniramine) anti- inflammatory (injection hydrocortisone) and immobilization of the affected limb with a splint. Results: We are treated 48 patients with snake bite. There were 45(94%) male patients and 3(6%) female patients. Age range was 18 to 56 years with a mean age of 29.8 years. 35(73%) patients suffered from snake bite between the months of May and September. The timing of the bite was also peculiar with 36(75%) patients bitten between 8pm and 8am whereas only 12(25%) patients during other times of the day. 38(79%) patients gave history of seeing the snake themselves and 10(21%) patients were not able to see the snake mainly because of darkness. Conclusion It should be remembered that not all snakes are poisonous and that they are more afraid of humans than we are of them. Psychological effects of the bite are at times more devastating than the clinical effects, therefore patient reassurance forms part of the treatment. 

The Venous Antithrombotic Profile of Naroparcil in the Rabbit

1994 ◽  
Vol 72 (06) ◽  
pp. 874-879 ◽  
Author(s):  
Jean Millet ◽  
Jocelyne Theveniaux ◽  
Neil L Brown
Keyword(s):  
Oral Administration ◽  
Bleeding Time ◽  
Dermatan Sulfate ◽  
Factor Xa ◽  
Bleeding Risk ◽  
Thrombin Time ◽  
Heparin Cofactor Ii ◽  
Antithrombotic Activity ◽  
Thrombin Inhibition ◽  
Maximal Reduction

SummaryThe venous antithrombotic profile of naroparcil or (4-[4-cyanoben-zoyl]-phenyl)-1.5-dithio-β-D-xylopyranoside was investigated in the rabbit following single i. v. and oral administration. Naroparcil attenuated thrombus development in a Wessler stasis model of venous thrombosis (jugular vein) employing bovine factor Xa as a thrombogenic stimulus giving ED50 values of 21.9 mg/kg and 36.0 mg/kg after respectively i. v. and oral administration. Venous antithrombotic activity was maximal 2-3 h after i. v. administration and 4-8 h after oral administration. Four hours after the oral administration of maximal antithrombotic (Wessler model, factor Xa) doses (100 and 400 mg/kg), naroparcil had no significant effect on bleeding time. In platelet poor plasma obtained from animals treated 4 h previously with various doses (25 to 400 mg/kg) of naroparcil, there was no detectable anti-factor Xa nor antithrombin activity. Similarly, naroparcil had no effect on APTT nor on thrombin time. A sensitized thrombin time (to about 35 s) was modestly but significantly increased following oral administration of the compound at 400 mg/kg. However, thrombin generation by the intrinsic pathway was reduced in a dose-related manner, maximal reduction being 65% at 400 mg/kg. The same doses of naroparcil enhanced the formation of thrombin/heparin cofactor II complexes at the expense of thrombin/antithrombin III complexes in plasma incubated with (125I)-human a-thrombin and induced the appearance of dermatan sulfate-like material in the plasma of treated rabbits, as measured by a heparin cofactor II-mediated thrombin inhibition assay. The results suggest that naroparcil could have a safe venous antithrombotic profile following oral administration (antithrombotic effect compared to bleeding risk). It is probable that part of the mechanism of action of the β-D-xyloside, naroparcil, is due to the induction of chondroitin sulfate-like glycosaminoglycan biosynthesis, this material being detectable in the plasma.

Hepatic brucelloma: a rare complication of a common zoonotic disease

2020 ◽  
Vol 13 (12) ◽  
pp. e237076
Author(s):  
George Vatidis ◽  
Eirini I Rigopoulou ◽  
Konstantinos Tepetes ◽  
George N Dalekos
Keyword(s):  
Rare Complication ◽  
Surgical Excision ◽  
Coombs Test ◽  
Inflammation Markers ◽  
Laboratory Findings ◽  
Ct Guided ◽  
Rare Manifestation ◽  
Bone Marrow Cultures ◽  
History Of ◽  
The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

scholarly journals Right Heart Thrombus and Pulmonary Embolism in Patients with Life-Threatening Bleeding: Management of a Complex Condition

2021 ◽  
Author(s):  
Enrico Bentivegna ◽  
Michelangelo Luciani ◽  
Valerio Spuntarelli ◽  
Giorgio Sesti ◽  
Flavia Del Porto ◽  
...  
Keyword(s):  
Therapeutic Strategy ◽  
Bleeding Risk ◽  
Right Heart ◽  
Bleeding Management ◽  
Critical Situation ◽  
Haemodynamic Parameters ◽  
Complex Patients ◽  
Life Threatening ◽  
Uncommon Condition ◽  
In Transit

AbstractRight heart thrombus (RHT) in transit is an uncommon condition associated with high mortality. Increased use of echocardiography has allowed an easier detection of RHT; however, there is no consensus about the most appropriate management of this critical situation. Therapeutic strategy should be decided according to patient’s haemodynamic parameters, clinical data, and bleeding risk. This paper, referring to the most current evidences, underlines the difficulty to establish the best therapeutic strategies in RHT among complex patients as there are no relevant guidelines. In some conditions, multidisciplinary management is the best way to find the most correct therapy despite the bad prognosis.

scholarly journals Euglycemic Diabetic Ketoacidosis after a Single Dose of Empagliflozin in a Patient with Pancreatitis

2021 ◽  
Vol 11 (2) ◽  
pp. 216-218
Author(s):  
Marta Brandão Calçada ◽  
Luís Fernandes ◽  
Rita Soares Costa ◽  
Sara Montezinho ◽  
Filipa Martins Duarte ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Drug Class ◽  
Clinical Suspicion ◽  
Laboratory Findings ◽  
Sodium Glucose Cotransporter ◽  
History Of ◽  
High Degree ◽  
Euglycemic Diabetic Ketoacidosis

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved drug class for the treatment of type 2 diabetes mellitus (T2D). Although they are largely well-tolerated, their intake has been associated with euglycemic diabetic ketoacidosis (DKA) in some rare cases. We report the case of a 70-year-old male with type 2 diabetes and no history of DKA, who started therapy with empagliflozin one day before presenting with acute pancreatitis and laboratory findings consistent with euglycemic DKA. SGLT2i can induce euglycemic DKA from the first dose. Given the atypical presentation, a high degree of clinical suspicion is required to recognize this complication.

scholarly journals On the Short Time Scale Evolutionary History of the Contact Binary VW Cephei

1998 ◽  
Vol 11 (1) ◽  
pp. 396-396
Author(s):  
I. Pustylnik
Keyword(s):  
Evolutionary History ◽  
Light Curves ◽  
Published Data ◽  
Short Time Scale ◽  
Flare Activity ◽  
Considerable Portion ◽  
History Of ◽  
Contact Binary ◽  
Elongation Phase ◽  
Short Time

We study the short-time evolutionary history of the well-known contact binary VW Cep. Our analysis is based partly on the numerous UBV lightcurves obtained at Tartu Observatory, IUE spectra, and samples from the published data. Special attention is given to the effects of asymmetry of the light curves. A higher degree of asymmetry outside the eclipses along with the significant displacements of the brightness maxima in respect to the elongation phase is interpreted as evidence that a considerable portion of the flaring source is concentrated close to the neck connecting the components. We discuss the nature of asymmetry in terms of possible mass exchange and the flare activity and compare the results of our model computations with the record of orbital period variations over the last 60 years.

scholarly journals Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 205
Author(s):  
Nicola Tarantino ◽  
Domenico G. Della Rocca ◽  
Nicole S. De Leon De La Cruz ◽  
Eric D. Manheimer ◽  
Michele Magnocavallo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Individual Factors ◽  
Substantial Part ◽  
Arrhythmogenic Substrate ◽  
Life Threatening ◽  
History Of ◽  
Anatomic Distribution ◽  
Artery Disease ◽  
Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

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