Risk factors of death among children with Dengue Hemorrhagic fever

Background: Dengue hemorrhagic fever (DHF) is still periodically around developing countries including Indonesia. Morbidity and mortality of DHF can be reduced if early diagnosis and appropriate management. Objective: Our study evaluate risk factors of death in pediatric DHF patients hospitalized in Wahidin Sudirohusodo Hospital Makassar. Methods: we review the medical records of patients aged ≤ 18 years from January 2016 to December 2018 with confirmed DHF based on WHO criteria and serologically positive anti-dengue Ig M or positive anti-dengue IgM and Ig G. Results: During the study period, 70 patients aged 1-17 years with the complete medical records enrolled in this study. The DHF severity consisted of 37 cases (52,9%) with shock(DSS) and 33 cases (41,7%) without shock and mostly of them was admitted to the hospital on > 3 days of fever (63 cases /90,0%). Boys were predominantly (39/55,7%) found than girls (31/44,3%) and the majority of cases above 5 years (50/71,4%) with well-nourished patients in 46 cases (65,7%). The hematocrit level ≥ 40 mg/dl, platelets ≤ 40.000/mm3, and leukocyte ≤ 4000 mm3/l were observed in 41 cases (58,6%), 36 cases (51,4%), and 48 cases (68,6%); respectively. Death was observed in four girls (5.7%) (p 0,034/OR 1,148/ 95% CI 1,003 - 1,315) with DSS because of severe condition on admission. Conclusions: Girl was an independent risk factor of death among children with DHF.

The Effect of Intravenous Tranexamic Acid on Hemoglobin and Hematocrit Levels After Cesarean Delivery: a Randomized Controlled Clinical Trial

Background: During a cesarean section, the mother loses a lot of blood. This bleeding can cause a drop in hemoglobin and hematocrit. Tranexamic acid, an anti-fibrinolytic agent, is a novel approach in an attempt to prevent this dreadful complication. This study aims to explore the effect of intravenous tranexamic acid on hemoglobin and hematocrit level after cesarean section(CS) in women who were low risk in postpartum hemorrhage.Methods: This prospective randomised placebo-controlled clinical trial was carried out on 50 pregnant women referred to Izadi hospital, Qom, Iran, 2017. women were divided into two groups of 25 cases using block randomization. The study group, 25 women, received tranexamic acid 10 minutes before CS whereas the control group, 25 women received distilled water. Hemoglobin and hematocrit levels were measured before and 12-24 hours after delivery. Results: There was no significant difference in pre-operative and 12-24 h post-operative hemoglobin and hematocrit levels between the two groups(p>0.05). Conclusions: Pre-operative prescription of 1gr tranexamic acid was not associated with improvement of post-operative hemoglobin and hematocrit.Trial registration: IRCT20091010002558N7.

Spontaneously Ruptured Hepatocellular Carcinoma Treated by Transarterial Embolization Compared with Conservative Treatment: Survival Outcome and Prognostic Factors

Objective: To report the survival outcome and prognostic factors in the patients with spontaneously ruptured hepatocellular carcinoma treated by transarterial embolization compared with conservative treatment.Materials and Methods: A retrospective review of 89 patients who had spontaneous rupture of hepatocellular carcinoma (HCC) at Siriraj Hospital between January 2011 and February 2017 were enrolled. Ruptured HCC patients are diagnosed by clinical presentations of abdominal pain/distension, anemia/shock with dynamic liver computed tomography findings as: hemoperitoneum, focal discontinuity or tumor protrusion of the hepatic surface and/or active contrast material extravasation. We compared the survival outcome and prognostic factors of the ruptured HCC patients who received two treatment methods; conservative treatment and transarterial embolization (TAE). Results: The cumulative median survival time of the ruptured HCC patients was significantly higher in the TAE group (81 days) than in the conservative treatment group (29 days) with p-value = 0.006. There were two significant predictors for post-treatment mortality. First, treatment modality in the TAE group showed a significantly lower mortality rate than in the conservative treatment group with a hazard ratio (HR) 0.454 (p-value = 0.003). Second, a pre-treatment high hematocrit level was a significant predictive factor for lower mortality than a low hematocrit level with a hazard ratio (HR) 0.946 (p-value = 0.016). Conclusion: TAE results in a good clinical outcome and increased survival rate in the patients with ruptured HCC. A pre-treatment high hematocrit level was a good prognostic factor for the survival in ruptured HCC patients.

Post-Malaria Anemia Is Rare in Malawian Children with Cerebral Malaria

Artesunate therapy for severe malaria syndromes has been associated with post-treatment hemolysis and anemia. We defined post-malaria anemia as any decrease in hematocrit between the index hospitalization for severe malaria and 1 month after. We determined the incidence and severity of post-malaria anemia in Malawian children surviving cerebral malaria (CM) by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Children enrolled before 2014 and treated with quinine (N = 258) were compared with those admitted in 2014 and after, and treated with artesunate (N = 235). The last hematocrit value obtained during hospitalization was compared with the 1-month post-hospitalization hematocrit value. The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (11 of 235 or 4.7% for quinine, 15 of 258 or 5.8% for artesunate; odds ratio, 3.23 [0.88, 18.38]); no patients with a decrease in hematocrit were symptomatic, and none required transfusion after hospitalization. Of the 26 children who had a decrease in hematocrit 1 month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit level on admission, lower quantitative histidine-rich protein level, and splenomegaly were associated independently with post-malaria anemia. In African survivors of CM, post-malaria anemia is rare, mild, and unassociated with the anti-malarial treatment received.

The Effect of Dialectic Behavioral Counseling on Depression, Anxiety, and Postpartum Hematocrit Level

Objective Childbirth is a biological, psychological, and sociological event that can be a positive or negative experience, and, without support, this period may be potentially damaging. Parturition may distort maternal emotions and lead to short- or long-term disorders such as postpartum depression and anxiety. The present research aims to study the effects of dialectic behavioral therapy-based counseling on depression, anxiety symptoms, and postpartum hematocrit level. Methods The current research is a clinical trial study, and the sample was selected using parturients who were referred to the Health General Center with a diagnosis of postpartum depression and anxiety. The sample size consisted of 116 subjects who agreed to participate in the study. The patients in intervention group underwent group dialectic behavioral counseling (10 sessions/one session per week) and the control group did not receive any type of intervention. The patients were assessed in the first and last sessions as well as 2 months after the end of the sessions, using the Beck depression scale and Spielberg anxiety scale as well as the results of hematocrit tests. Data were analyzed using the IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA) Results The results implied the effectiveness of dialectic behavioral therapy on reduction of the depression score, anxiety symptoms (p-value ≤ 0.0001), and hematocrit level (p-value = 0.04). The participants' depression, anxiety, and hematocrit levels decreased in the experiment group compared to the control group, and this decrease has remained until the 2-month follow-up. Conclusion It seems that dialectic behavioral counseling reduces the levels of postpartum depression, anxiety, and hematocrits.

The influence of pistia powder (Pistia stratiotes L.) in ration on the performance index and red blood cell profile of male Magelang duck

The research aims at studying the influence of pistia powder (Pistia stratiotes L.) as feed material on the performance index and red blood cell profile of male Magelang duck. The materials used were 100 heads of 4-week old male Magelang duck. The treatments were: T0 (basal), pistia powder in T1, T2 and T3 of ration for male Magelang duck at 6%, 12% and 18%. The parameters observed were Performance Index (PI), number of erythrocytes, amount of hemoglobin, hematocrit level, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Hemoglobin) and MCHC (Mean Corpuscular Hemoglobin Concentration). The research results showed that using pistia powder up to 18% significantly (P≤0.05) increased performance index (PI) and generally insignificantly (P>0.05) influenced the number of erythrocytes, amount of hemoglobin, hematocrit level, MCV and MCHC, but significantly decreased (P<0.05) MCH. The research concludes that pistia powder may be used up to 18% in ration to increase the performance index without influencing the red blood cell profile of male Magelang duck.

Specificities in mechanism of erythrocyte deformability disorders in various diseases

Введение. Нарушение текучести крови, обусловленное повышением ее вязкости и снижением эластичности эритроцитов, может привести к столь значительным расстройствам центральной гемодинамики и микроциркуляции, что возникает дисфункция органов. Цель исследования: изучение доминирующих специфических механизмов, вызывающих нарушение деформируемости эритроцитов при различных заболеваниях. Материалы и методы. Обследован 121 пациент: с геморрагическим панкреонекрозом (n = 16) без острой сопутствующей сердечно-сосудистой патологии (группа 1); с тромбоэмболией магистральных артерий нижних конечностей (n = 37) с локализацией в подвздошной, бедренной и подколенной артериях, со сроком заболевания от 2 до 3 сут (группа 2); с острым тромбозом магистральных артерий нижних конечностей (n = 32) с ишемией II степени и длительностью заболевания от нескольких недель до нескольких месяцев (группа 3); с острым венозным тромбозом (n = 36), срок заболевания варьировал от 24 ч до 30 сут (группа 4). Для контроля изучены показатели 26 практически здоровых лиц (группа 5). Проведено исследование деформируемости эритроцитов методом фильтруемости, изучали распределение эритроцитов по диаметру, определяли показатель гематокрита и механическую резистентность эритроцитов, исследование белкового состава плазмы проводили спектрофотометрическим способом, измеряли содержание сиаловой кислоты в плазме и в эритроцитах. Результаты. Самые тяжелые нарушения морфологических и физико-химических свойств эритроцитов выявлены у больных геморрагическим панкреонекрозом (группа 1): скорость фильтрации эритроцитов была в 1,8 раза меньше, чем у здоровых людей; диаметр эритроцитов в 1,2 раза, а уровень гематокрита на 9% превышали норму; механическая резистентность была в 2 раза ниже нормальной. По сравнению с нормальными значениями у больных группы 2 диаметр эритроцитов был увеличен на 18%, гематокрит — на 7%, механическая резистентность была снижена на 27%. У пациентов группы 3 деформируемость была снижена на 14%, диаметр эритроцитов превышал норму на 11%, гематокрит — на 5%, механическая резистентность была снижена на 18%. У больных группы 4 деформируемость эритроцитов была практически не нарушена, все остальные параметры эритроцитов также не отличались от нормальных. Заключение. Существуют как специфические факторы, обусловливающие нарушение деформируемости эритроцитов и присущие только конкретному заболеванию, так и общие факторы, изменяющие деформационные свойства эритроцитов, которые сопровождают практически любую патологию. Общими факторами, снижающими деформационные свойства эритроцитов при исследованных нами заболеваниях, являются выраженная диспротеинемия и ацидоз. Background. Blood flow disorders due to its viscosity increasing and erythrocytes elasticity decreasing, may cause significant disturbances of central hemodynamics and microcirculation that lead to organ dysfunction. Objectives: to studythe basic specific mechanisms of erythrocyte deformability impairment in various diseases. Patients/Methods. We examined 16 patients: with hemorrhagic pancreonecrosis (n = 16) without acute comorbid cardiovascular pathology (group 1); with thrombembolia of the main arteries (iliac, femoral and popliteal) of lower extremities (n = 37), and disease duration of 2 to 3 days (group 2); with acute thrombosis (II degree ischemia) of the main arteries in the lower extremities (n = 32), and disease duration from several weeks to several months (group 3); with acute venous thrombosis (n = 36) and disease duration from 24 hours to 30 days (group 4). Group 5 consisted of 26 practically healthy individuals. We measured erythrocytes deformability (by filterability method), erythrocytes diameter distribution, hematocrit and erythrocytes mechanical resistance, plasma proteins composition (spectrophotometrically), sialic acid concentration in plasma and erythrocytes. Results. The most expressive disorders of erythrocytes morphological and physicochemical properties were found in patients with hemorrhagic pancreonecrosis (group 1): erythrocytes filtration rate was 1.8 times less than in healthy people; erythrocytes diameter was 1.2 times and the hematocrit level was 9% above normal; mechanical resistance was 2 times lower than normal. In patients of group 2 erythrocytes diameter was increased by 18%, hematocrit level — by 7%, mechanical resistance was reduced by 27% compared with normal values. In patients of group 3, deformability was reduced by 14%, erythrocytes diameter exceeded the norm by 11%, the hematocrit was by 5% above the norm, mechanical resistance was reduced by 18%. In patients of group 4, erythrocyte deformability practically was not impaired; all other erythrocytes parameters also did not differ from normal values. Conclusions. Erythrocyte deformability impairment caused by both specific factors that are attributable only for specific disease and by common factors that exists in almost any disease. Expressed dysproteinemia and acidosis are common factors that reduce erythrocyte deformability in examined diseases.