Spectrum of Non-Traumatic Bleeding Complaints among women with Bleeding Disorders

2021 ◽  
Vol 15 (9) ◽  
pp. 2955-2957
Author(s):  
Muhammad Sarwar Khan ◽  
Kiran Aamir ◽  
Aamir Ramzan ◽  
Aasma Naz ◽  
Khalil Ahmed Memon ◽  
...  
Keyword(s):  
Urban Areas ◽  
University Hospital ◽  
Common Finding ◽  
Bleeding Disorders ◽  
Early Referral ◽  
Patient Interviews ◽  
Appropriate Treatment ◽  
Probable Presence ◽  
Traumatic Bleeding ◽  
Laboratory Investigations

Objective: To study the spectrum of bleeding complaints among women with bleeding disorders. Methodology: This observational study was done at Dept. of Pathology – Liaquat University Hospital, Hyderabad from January 2019 to July 2019 upon a sample of 121 women, selected via non-probability, consecutive sampling). Women presenting to study setting with complaints of non-traumatic bleeding were included in the study. After taking written informed consent, the data was obtained from patient interviews and laboratory investigations was. The data obtained was analyzed using SPSS v. 21.0. Results: The mean age of the women was 28.13 years (±5.21 SD). Among the 121 women studied, 73.55% hailed from urban areas, while 26.45% were from rural residential background. The most common presenting complaint was menorrhagia (30.58%), followed by bruising (17.36%) and epistaxis (15.7%). Among the underlying hemostatic pathologies, VWD was the most common (15.7%), followed by other platelet dysfunctions comprising the second most common finding (6.6%). Mean duration of presence of symptoms was 34 months (±17 SD). Conclusion: As per the findings of this study, menorrhagia, occasional bruising and epistaxis are reported to be the most common non-traumatic bleeding complaints among women with bleeding disorders. The presence of these symptoms may serve as potential indicators of the probable presence such as bleeding disorders and help in early referral, timely diagnosis and appropriate treatment. Keywords: menorrhagia, epistaxis, Hemostatic Dysfunction, Bleeding Disorder, Non traumatic bleeding complaints

Bleeding Disorders among women Presenting with Menorrhagia at Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 2851-2853
Author(s):  
Muhammad Sarwar Khan ◽  
Kiran Aamir ◽  
Aamir Ramzan ◽  
Aasma Naz ◽  
Khalil Ahmed Memon ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Cross Sectional Study ◽  
Von Willebrand Disease ◽  
University Hospital ◽  
Common Finding ◽  
Initial Contact ◽  
Care Hospital ◽  
Bleeding Disorders ◽  
Cross Sectional ◽  
Early Management

Objective: To study the spectrum of bleeding disorders among women, presenting to the study setting with complaints of menorrhagia. Methodology: This observational cross-sectional study was conducted up on 121 women, during a period of 6 months, who were approached via non-probability, consecutive sampling, presenting to the Dept. of Gyneacology & Pathology – Liaquat University Hospital, Hyderabad with menorrhagia. Data obtained from patient interviews and laboratory investigations were recorded into a self-structured questionnaire after taking written informed consent. The data obtained was analyzed using SPSS v. 21.0. Results: The mean age of the women was 28.13 years (±5.21 SD). Among the underlying hemostatic pathologies, VWD was the most common i.e. 21 (65.6%), followed by other platelet dysfunctions (Glanzman Thrombasthenia (n=5, 15.6%) and Berard Soulier Syndrome i.e. n=3, 9.4%) comprised the second most common finding. A cause of hemostatic pathology among a minority of patients remained unidentified i.e. n=3 (9.4%). Conclusion: Keeping in view of hemostatic defects, the study concludes that VWD is the commonest bleeding disorder among women presenting with menorrhagia. A routine screening of females with menorrhagia on their initial contact with the hospital can save years of suffering and lead to early management and probable recovery. Keywords: Von Willebrand Disease, Hemostatic Dysfunction, Bleeding Disorders, Platelet Dysfunction, Menorrhagia & Bleeding Complaints among Women

scholarly journals Evaluation of a shortened course of tranexamic acid for patients with inherited bleeding disorders following dental procedures

2018 ◽  
Vol 5 (1) ◽  
pp. 42-49
Author(s):  
Allison Greig
Keyword(s):  
Tranexamic Acid ◽  
Cost Savings ◽  
Bleeding Risk ◽  
Service Evaluation ◽  
University Hospital ◽  
Bleeding Complications ◽  
Bleeding Disorders ◽  
Telephone Interviews ◽  
Patient Interviews ◽  
Dental Procedures

Abstract People with Inherited Bleeding Disorders (IBD) are often prescribed a course of Tranexamic Acid (TXA) mouthwash for five to seven days following dental procedures to reduce the risk of bleeding. Informal discussions with patients suggested that many do not complete the prescribed course of treatment. A literature review indicated that TXA was prescribed inappropriately for procedures with a low bleeding risk, and that there are inconsistencies in the recommended dose, mode of administration and duration of TXA for this patient group. A new protocol was implemented in the haemophilia centre at St George’s University Hospital NHS Foundation Trust, London, to rationalise the prescribing of TXA in dental procedures. A study was conducted to explore patients’ experience of this new guideline in the form of a service evaluation. Structured telephone interviews were completed following 39 dental procedures to collect data on concerns about bleeding; whether TXA was taken as prescribed and reasons for non-adherence; and any unplanned post-operative treatment. The financial impact of the new guideline was also explored. Patients were supportive of the new regimen, although almost half (46%) did not complete the prescribed course of TXA. The majority (37/39) were prescribed tablets rather than mouthwash. No patients required additional unplanned haemostasis support to control haemorrhage. Cost savings were made by replacing a five- to seven-day course of TXA mouthwash with a three-day course of TXA tablets. Although the data collected from patient interviews supports the new guideline, patients appear to be making decisions about taking TXA based on their own experience rather than following the prescribed regimen. Prescribers should support patients to make informed decisions about their medicines and incorporate patient experience into individualised regimens. Given the lack of bleeding complications experienced in this cohort of patients, it is possible that TXA is being overprescribed. Further work exploring how patients with IBDs make decisions about taking medicines is needed.

P062 Vasculitis in children: epidemiological, clinical and Para clinical profile in the oriental region of Morocco—about 33 cases

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
A Hamami ◽  
A Babakhouya ◽  
A El Ouali ◽  
A Ghannam ◽  
M Rkain ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Kawasaki Disease ◽  
Early Diagnosis ◽  
Renal Insufficiency ◽  
Clinical Profile ◽  
Lower Limbs ◽  
University Hospital ◽  
Age Group ◽  
Abdominal Symptoms ◽  
Appropriate Treatment

Abstract Background Vasculitis in children constitute a heterogeneous group of pathologies considered as a rarity in our context and therefore deserves to be better known. Despite their individualization for more than forty years throughout the world, they continue to be a challenging condition both in terms of diagnosis and treatment. The objective of our study is to report the epidemiological profiles of vasculitis and to assess the clinical and Para clinical profile of our patients, in order to contribute to a better knowledge of these conditions in our context, whose early diagnosis allows the starting of an appropriate treatment and the improvement of the prognosis. Material and methods This is a retrospective study, in which we collected data of all children in whom the diagnosis of vasculitis was confirmed, and who were hospitalized in the pediatric department of the University Hospital Center (CHU) Mohamed VI of Oujda over a period of 3 years from July 2014 to July 2017. Results Thirty-three patients were selected; 25 boys (76%) and 8 girls (24%), including 16 patients with Kawasaki disease; 14 patients with Henoch-Schonlein purpura (HSP); 2 patients with Polyarteritis nodosa (PAN); and 1 patient with Takayasu. A male predominance was noted with a sex ratio of 3.16. HSP represented 42.42% of the cases, the most affected age group was between 5 and 9 years in 45% of cases. Purpura was the most frequent symptom (100%) with petechial appearance in 77% of cases and localized in the lower limbs in all cases (100%). Joints were affected in 13 cases (93%), abdominal symptoms were found in 81.82% of cases, with one case of melena and 3 cases of rectal bleeding. The renal symptoms were mainly biological and were dominated by urinary proteinuria (45%), microscopic hematuria in one case, macroscopic hematuria in 3 cases, hypertension in one case and nephrotic syndrome in one case. Five patients developed renal insufficiency, two children had moderate renal insufficiency and three had severe renal insufficiency. Kawasaki disease represented the majority of cases: 16 cases (48.48%), affecting children between 4 and 41 months of age with an average age of 22 months, with most affected age group was between 12 and 24 months in 55%. The appeal signs were multiple dominated by fever which represents 100% of cases, skin rash in 82%, ocular redness in 45%, enanthema in 45%, oedema of the extremities in 45%, and adenopathy in 6% (one case). The inflammatory syndrome was present in all patients. Cardiac Doppler ultrasound was performed in 14 patients. It was abnormal in 22% of cases. 11 patients received a course of IGIV (54.54%), at a dose of 2 g/Kg in a single 12-h infusion. Aspirin was administered in all patients. The evolution was favorable in 15 patients, only one case was complicated by giant aneurysms of both coronaries, which evolved to a slight decrease in size and disappearance of the pericardial effusion. Valvular abnormality was noted in one case and minimal pericardial effusion in one case. Conclusion This study confirmed that incidence of vasculitis in children in our context is average, this can be seen on the non-negligible number of cases (33 cases) collected over a period of 3 years. Early diagnosis of this condition key to allow an initiation of an appropriate treatment and improvement of the prognosis.

HOMOZYGOUS FACTOR XII CONGENITAL DEFICIENCY: STUDY OF 10 NEW FAMILIES.

1987 ◽  
Author(s):  
G Castaman ◽  
F Rodeghiero ◽  
M Ruggeri
Keyword(s):  
Fibrinolytic Activity ◽  
Normal Values ◽  
Common Finding ◽  
Factor Xii ◽  
Normal Range ◽  
Congenital Deficiency ◽  
Fibrin Plate ◽  
Sporadic Cases ◽  
Laboratory Investigations ◽  
Normal Controls

Sporadic cases of thromboembolic events have been reported in patients with congenital factor XII deficiency and a relationship with a reduced intrinsic fibrinolysis has been suggested.We report here the results of clinical and laboratory investigations in 10 new families comprising 15 homozygotes (age 16-72) and 14 heterozygotes (age 18-65).In homozygotes, kaolin-activated-PTT was indefinitely prolonged and F XII activity and antigen were undetectable, whereas functional assays . of high molecular weight kininogen ahd kallikrein yielded normal values. Intrinsic fibrinolytic activity - assayed on fibrin plate by measuring lysis zones determined i. by euglobulin fraction, obtained in presence of dextran sulphate and flufenamate (Blood activator inventory test, Kluft 1979) - was reduced in all homozygous pts. to about 50% of normal (range 15-70%; normal range 80-120%); normal values were observed in all heterozygotes. Basal extrinsic fibrinolytic activity (measured after addition of Cl-inhibitor) was absent or minimal as in normal controls. None of our patients showed evidence of thrombotic diathesis.In conclusion, our study demonstrates that a reduced intrinsic fibrinolysis, as assayed by blood activator inventory test, is a common finding in F XII deficiency. The absence of thrombotic diathesis in our cases suggests that, this defect is probably devoid of any clinical significance.

scholarly journals Frequency Of Post-operative Hypocalcaemia Following Thyroid Surgery At A Tertiary Care Hospital Of Sindh

2017 ◽  
Vol 08 (01) ◽  
pp. 07-10
Author(s):  
Summaya Qazi ◽  
Khalil ahmed Almani ◽  
Rizwanullah Junaid Bhanbhro ◽  
Diya Ram Khatri
Keyword(s):  
Serum Calcium ◽  
Thyroid Surgery ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Long Duration ◽  
Symptomatic Hypocalcemia ◽  
Laboratory Investigations

Objective: The present study was conducted to determine the frequency of post-operative hypocalcaemia following thyroid surgery at a tertiary care hospital of Sindh Study design: Observational study Place and Duration: Department of surgery, Isra University Hospital from December 2014 to July 2017. Materials and Methods: 100 cases of thyroid swellings were selected according to inclusion and exclusion criteria. Pre- operative patient history, physical examination, thyroid gland examination and laboratory investigations were performed. A serum calcium levels <8 mg/dl was taken as hypocalcemia. Data was analyzed on SPSS 21 version and P value (P< 0.05) was considered significant. Results: Of 100 patients, 67% were female and 33% were male (P=0.0001). Female dominancy was noted with female to male ratio of 2.03:1. Age (mean± SD) was noted as 37.5 ± 9.5 years (19 – 48 years). Frequency of symptomatic hypocalcaemia was noted in 23% subjects post operatively. Mean± SD serum calcium and phosphate in post operative hypocalcemia subjects was noted as 7.31 ± 0.38 mg/dl and 2.95 ± 0.63 mg/dl respectively. Majority of symptomatic hypocalcemia were noted within 72 hours post operatively. Conclusion: The present study reports 23% frequency of post thyroidectomy hypocalcemia noted within 72 hours post operatively. Goiters of long duration, recurrent goiters, hyperthyroidism and goiters with retro sternal extensions were found risk factors for the post thyroidectomy hypocalcemia.

scholarly journals Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

2020 ◽  
Author(s):  
Andrea Strada ◽  
Niccolò Bolognesi ◽  
Lamberto Manzoli ◽  
Giorgia Valpiani ◽  
Chiara Morotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Abdominal Pain ◽  
Chest Pain ◽  
Length Of Stay ◽  
Diagnostic Algorithm ◽  
University Hospital ◽  
Blood Tests ◽  
Traumatic Bleeding ◽  
Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

scholarly journals Analysis of socio-demographic and microbiological profile of vaginal discharge in patients attending Kathmandu University Hospital, Nepal

2015 ◽  
Vol 14 (4) ◽  
pp. 323-326
Author(s):  
Abha Shrestha ◽  
Nuche Ratna Tuladhar ◽  
Chander Dev Chawla
Keyword(s):  
Vaginal Discharge ◽  
Public Awareness ◽  
Randomized Study ◽  
Medical Science ◽  
University Hospital ◽  
Factors Affecting ◽  
Microbiological Profile ◽  
Appropriate Treatment ◽  
Socio Demographic Factors

Background: Vaginal discharge and associated vaginal symptoms is very common amongst women of South East Asia, hence it is necessary to make accurate diagnosis and also for appropriate treatment by identifying the causative microorganisms. Objectives: To analyze the socio-demographic and microbiological profile of vaginal discharge. Methodology: This is a prospective, non-randomized study performed in one hundred and ninety three patients attending in Department of Obstetrics and Gynecology in Kathmandu University Hospital, Dhulikhel, Nepal. The patients with vaginal discharge and age of ?16 years included. Vaginal discharge was taken from the posterior and lateral fornices. The swab was cultured on blood, chocolate and Mac Conkey’s agar and incubated at 37°C for 24-48 hours. Fungus when isolated was subcultured onto Sabouraud dextrose agar. The data were analyzed using the SPSS 11.5 software. Result: The frequency of vaginal discharge was 1.67%. Most of the patients fell within 16-25 years. 50.3% patients were illiterate whereas only 3.1% was having master degree. 50.3% patients were having class V socioeconomic status where as only 2.6% had class I status. Housewife accounted for 67.9% whereas other occupation (petty business) accounted for only 5.2%. Most of the patients with vaginal discharge were from Newar and Tamang ethnic group. Bacterial vaginosis was isolated in 36.3% and normal flora accounted for 20.7%. Conclusion: There is still lack of awareness about the vaginal discharge be it abnormal discharge or physiological leucorrhea and related problems. So, it is worthwhile to create public awareness and also to find out the socio-demographic factors affecting the pattern of microbiological flora variation in vaginal discharge, as it gives us the clue regarding the use of appropriate antimicrobial therapy and the changes that can be made to the quality of life of the women.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.323-326

scholarly journals The Problematics of Transferred Parturient Women in Guinean Urban Areas: The Case of the Donka Maternity Ward at the University Hospital Centre (Chu) Conakry

2019 ◽  
Vol 09 (03) ◽  
pp. 343-352
Author(s):  
Mamadou Hady Diallo ◽  
Ibrahima Sory Baldé ◽  
Abdourahmane Diallo ◽  
Ousmane Baldé ◽  
Boubacar Siddi Diallo ◽  
...  
Keyword(s):  
Urban Areas ◽  
University Hospital ◽  
Maternity Ward ◽  
The University

scholarly journals Features on cardiac magnetic resonance imaging and accuracy of echocardiographic findings for diagnosing constrictive pericarditis

2021 ◽  
Vol 71 (11) ◽  
pp. 2652-2655
Author(s):  
Salik ur Rehman Iqbal ◽  
Fateh Ali Tipoo Sultan
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Constrictive Pericarditis ◽  
University Hospital ◽  
Common Finding ◽  
Imaging Data ◽  
High Surgical Risk ◽  
The Mean ◽  
Echocardiographic Findings

Constrictive pericarditis is a rare disease with a difficult diagnosis. Cardiac magnetic resonance (CMR) imaging data of Aga Khan University Hospital, from January 2011 to March 2020 was retrospectively reviewed and patients with the diagnosis of constrictive pericarditis were included. A total of 22 patients were included with the mean age of 46 + 16 years and majority (77%, n=17) being male. The most common findings on transthoracic echo were significant respiratory variation in mitral and tricuspid inflow velocities (91%, n=20) and septal annular e’>9 (86%, n=19). Most common finding on CMR was respiratory septal shift in 100% (n=22) followed by septal bounce in 95% (n=21), and thickened pericardium in 82% (n=18). Nearly two-third patients (n=15) were considered for pericardiectomy but it was deferred in 5 patients due to high surgical risk. Ten patients underwent pericardiectomy with no mortality on a mean follow up of 4 + 2 years. Continuous...

scholarly journals Clopidogrel resistance in stroke patients (The CRISP Trial)

2020 ◽  
Vol 11 (1) ◽  
pp. 1-5
Author(s):  
E Qazi, ◽  
Syed AH Zaidi ◽  
Olukolade O Owojori ◽  
LJ Bonnett ◽  
PR Fitzsimmons ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Acute Ischaemic Stroke ◽  
University Hospital ◽  
P Value ◽  
Clopidogrel Resistance ◽  
Appropriate Treatment ◽  
Unit Increase ◽  
Acute Stroke Unit

Objective: To investigate the incidence of clopidogrel resistance in patients with acute ischaemic stroke and to evaluate whether there is an association between clopidogrel resistance and the occurrence of a further cerebrovascular ischaemic event using the vasodilator-stimulated phosphoprotein (VASP) index as a marker of clopidogrel resistance. Methods: It is a prospective cohort study that recruited 120 patients from the acute stroke unit at the Royal Liverpool University Hospital. All patients with confirmed acute ischaemic stroke had clopidogrel 75mg/day at discharge or after 14 days of acute stroke if deemed by the direct clinical team to be the most appropriate treatment. After at least 7 days of clopidogrel 75mg/day, all those patients fulfilling inclusion/exclusion criteria had phosphorylation of vasodilator-stimulated phosphoprotein (VASP) measured. If VASP measured ≥50% after ≥7 days of clopidogrel maintenance, these patients were deemed as ‘clopidogrel resistant’, while those with VASP <50% were deemed as ‘clopidogrel responder’. Statistical analysis was by univariable analysis which considered the association of each variable – diagnosis, age, duration of clopidogrel, VASP, days to VASP, and number of comorbidities – with the outcome. Risk of second stroke after a first at 6, 12 and 24 months was estimated using logistic regression. Results: No variables were significantly associated with risk of stroke at 6 months with clopidogrel resistance having no significant effect on likelihood of a further stroke compared to the no clopiodgrel resistance cohort (p value= 0.39). Results were similar at 12 months follow up. However, at 24 months VASP index was significantly associated with risk of a further stroke; each one unit increase in VASP was associated with a 3% increase in risk of stroke at 24 months (p value = 0.05, CI Interval of 1.00- 1.06). Conclusion: No variables were significantly associated with risk of further stroke at 6 months and 12 months after a first stroke. However, VASP was significantly associated with risk of further stroke at 24 months with increasing VASP leading to a higher risk of further stroke.

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