Knowledge and attitude of dental students in treating patients on antiplatelet and/ or anticoagulant medications

Background: Antiplatelet and anticoagulant medications are widely prescribed for the prevention of thromboembolic events. Dental management of patients taking such medications can be troublesome because of the possibility of excessive bleeding during surgical procedures. On the other hand, stopping these medications will increase the risk of thromboembolic complications. This study aimed to evaluate the level of knowledge and attitude of dental students and internship trainees at King Saud university in treating patients on antiplatelet and/or anticoagulant medications.Methods: A 17-question survey was distributed among dental students in third, fourth, and fifth (seniors) academic year levels, as well as internship trainees. The survey included questions aiming to evaluate participants’ knowledge in treating patients on antiplatelet and/or anticoagulant medications. A total of 281 surveys were returned complete.Results: In our study, most participants were aware of aspirin (86.1%) and warfarin (92.2%) but only a few were aware of newer medications like rivaroxaban (10.7%) or apixaban (8.2%). The majority of participants would consult with the patient’s physician (76.9%) before stopping any medications and/or would rely on local hemostatic techniques to control bleeding (70.8%).Conclusions: In this study, we concluded that only a small percentage of participants were aware of and following the latest guidelines. The findings of the present study suggest a need for educational programs and workshops regarding this topic.

Impacts of Commonly Used Edible Plants on the Modulation of Platelet Function

Cardiovascular diseases (CVDs) are a primary cause of deaths worldwide. Thrombotic diseases, specifically stroke and coronary heart diseases, account for around 85% of CVDs-induced deaths. Platelets (small circulating blood cells) are responsible for the prevention of excessive bleeding upon vascular injury, through blood clotting (haemostasis). However, unnecessary activation of platelets under pathological conditions, such as upon the rupture of atherosclerotic plaques, results in thrombus formation (thrombosis), which can cause life threatening conditions such as stroke or heart attack. Therefore, antiplatelet medications are usually prescribed for people who are at a high risk of thrombotic diseases. The currently used antiplatelet drugs are associated with major side effects such as excessive bleeding, and some patients are resistant to these drugs. Therefore, numerous studies have been conducted to develop new antiplatelet agents and notably, to establish the relationship between edible plants, specifically fruits, vegetables and spices, and cardiovascular health. Indeed, healthy and balanced diets have proven to be effective for the prevention of CVDs in diverse settings. A high intake of fruits and vegetables in regular diet is associated with lower risks for stroke and coronary heart diseases because of their plethora of phytochemical constituents. In this review, we discuss the impacts of commonly used selected edible plants (specifically vegetables, fruits and spices) and/or their isolated compounds on the modulation of platelet function, haemostasis and thrombosis.

Preparation of Tablet from Naagdon Plant by Wet Granulation Method for Treatment of Excessive Bleeding in Piles

The objective of present study was to formulate and evaluate the tablets for piles with different combination of herbal drugs. Material and Method: The tablet for piles containing lactose and mannitol as diluent and containing natural drugs like naagdon which was prepared by wet granulation method. The wet and compressed formulations were subject to several evaluation parameters like appearance, thickness, weight variation, hardness and friability. Results: The results of all evaluation parameters of piles tablet were within the acceptable limit. Pre-compression studies of piles tablet show satisfactory results. The thickness, hardness, weight variation, and friability of pilestablet were found to in acceptable range. The in-vitro drug release of eugenol from optimised for treatment piles formulation was found to be 90.23%. Significant results were obtained from present study. Discussion: The finding of current investigation clearly found that the health promotion of the body could be done by piles

A Case Report on Ayurvedic Management of Perimenopausal Bleeding

Perimenopausal period is the transitional period where a woman passes from the reproductive to the non-reproductive stage. Abnormal uterine bleeding in the perimenopausal period accounts for 70% of all gynecological problems. Most of the abnormal uterine bleeding in this period is due to endometrial abnormalities. In Ayurveda the condition can be correlated to Asrigdhara. This is the case report of a 54 year aged lady who presented with complaints of excessive bleeding and frequent menstrual cycles since three months. Investigations were done to rule out malignancy. USG report showed endometrial hyperplasia of 17mm with bulky uterus. Pap smear and Colposcopy reports showed inflammatory and CIN I changes with HPV flat lesions respectively. Bleeding stopped after two weeks of internal medication. USG done after six months showed significant reduction in endometrial thickness. Pronounced changes were also seen in Pap smear and Colposcopy findings.

Case Report Postoperative Case of Explore Laparotomy for Ruptured Ectopic Pregnancy with Septicemia

Introduction: Ectopic pregnancy is a pregnancy problem when the embryo attaches itself outside the uterus. Signs and symptoms include abdominal pain and vaginal bleeding, but less than 50 percent of affected women have both. it happened. Excessive bleeding may lead to a rapid heartbeat, fainting, or panic attack. Without abnormalities, the fetus can no longer survive. Obstetricians and gynaecologists face various obstacles in dealing with Jehovah's Witnesses. Main Symptoms and/or Important Clinical Findings: A 20-year-old man with a post-operative case of Explore Laparotomy For Ruptured Ectopic Pregnancy with pyosalpinx with septicemia underwent surgery on 14/02/2021 investigating Laparotomy under GA. His diagnostic ultrasonography was performed. Complete the blood test. She had not dropped down before 8 days she was a primigravida at 2 months of pregnancy and then had abdominal pain as she grew stronger over time. The Main Diagnoses, Therapeutic Interventions, and Outcomes: A 20-year-old man with a post-operative case of Explore Laparotomy for Ruptured Ectopic Pregnancy with pyosalpinx withsepticemia, with a complaint of abdominal pain, Treatment began on the day he received V fluids, Antibiotics Injectable. Initiated, Zonac suppository PR consulted. TPR Charting treatment interventions, I / O Charting, abortion chart, Nursing Perspectives: Laboratory techniques are urgently required. To limit the development of treatments to enhance the outcome. Conclusion: Although it is not uncommon for an ectopic pregnancy to exceed the first trimester, it does occur occasionally. As a result, in any emergency, abdominal surgery during pregnancy, Today, early intervention saves lives and reduces morbidity, but ectopic pregnancy still kills 4 to 10% of pregnant women and results in a higher ectopic pregnancy rate following pregnancy.

Experience Verification of 63 Cases of Liver Transplantation Anesthesia Management

Background: We reviewed the intraoperative management of previous liver transplantation (LT) cases to identify an optimal anesthetic method, which may affect patient outcomes and lead to faster postoperative recovery for future recipients. Methods: This single-center retrospective study reviewed 63 patients who underwent LT, including 51 living donor LT (LDLT), seven deceased donor LT (DDLT), and five simultaneous liver-kidney transplantation patients. We examined the patients’ backgrounds, intraoperative management (anesthetic method, water balance, and catecholamine dosage), and postoperative courses (hospitalization period, length of intensive care unit stay, renal function). Results: All patients received general anesthesia using inhalational anesthetics, either sevoflurane or desflurane, and both drugs were administered similarly. Rocuronium was administered at its usual dose despite liver failure. All patients undergoing preoperative dialysis due to acute kidney injury were successfully withdrawn from dialysis after surgery. The albumin infusion volume was 32% of the total infusion and transfusion volume. The five-year survival rate was 88% and graft failure occurred in one case. Conclusion: The anesthetic management of LT is currently conducted empirically in our institution, and we could not identify an optimal anesthetic method. However, we drew some conclusions. First, the use of human atrial natriuretic peptide as a drug infusion and appropriate transfusion management was expected to restore renal function. Second, the infusion volume of albumin was high. Third, the usual dose of rocuronium was required because excessive bleeding may cause unstable plasma drug concentration. Our results will be useful in future multi-institutional studies or meta-analyses and further improving the outcomes of future transplant recipients.

The polyanionic drug suramin neutralizes histones and prevents endotheliopathy

Drugs are needed to protect against the neutrophil derived histones responsible for endothelial injury in acute inflammatory conditions such as trauma and sepsis. Heparin and other polyanions can neutralize histones but may cause secondary, deleterious effects such as excessive bleeding. Here, we demonstrate that suramin (a widely available polyanionic drug) completely neutralizes the toxic effects of histones. The sulfate groups on suramin form stable electrostatic interactions with hydrogen bonds in the histone octamer with a dissociation constant of 250 nM. In cultured endothelial cells (Ea.Hy926), histone induced thrombin generation was significantly decreased by suramin. In isolated murine blood vessels, suramin abolished aberrant endothelial cell calcium signals and rescued impaired endothelial dependent vasodilation caused by histones. Suramin significantly decreased pulmonary endothelial cell ICAM-1 expression and neutrophil recruitment caused by infusion of sublethal doses of histones in vivo. Suramin also prevented lung edema, intraalveolar hemorrhage and mortality in mice receiving a lethal dose of histones. Protection of vascular endothelial function from histone-induced damage is a novel mechanism of action for suramin with therapeutic implications for conditions characterized by elevated histone levels.

Catastrophe at menarche

Menarche, the beginning of menstrual function occurs as a result of complex interaction between the hypothalamus, pituitary and ovarian hormones and is an important event in any girl’s life as it signifies the beginning of fertility. Rarely some diseases like migraine, epilepsy, inherited bleeding disorders can manifest at menarche and cause significant anxiety to the parents and the adolescent girl. A 13-year-old girl presented with convulsions following 8 days of excessive bleeding at the time of menarche. She had altered sensorium, severe anaemia with Respiratory alkalosis and needed ICU Care. She needed multiple transfusions of blood and blood products. She showed features of sepsis on haemogram at admission later manifested respiratory findings. Her bleeding per vaginum did not respond to antifibrinolytics and progesterones and stopped only after evacuation of contents on day 5 under GA. No organism could be isolated and she recovered on Day 6 of higher broad spectrum antibiotics. Her parents were counselled to watch for occurrence of seizures in later life as this catastrophe may signify onset of epilepsy in later life.

Heavy Menstrual Bleeding in Adolescent: Normal or a Sign of an Underlying Disease?

Heavy, and often irregular, menstrual bleeding (HMB) is a common gynecologic complaint among adolescents. During the first few post-menarcheal years, anovulatory cycles related to immaturity of the hypothalamic–pituitary–ovarian axis are the most common etiology for abnormal uterine bleeding and should be considered as a part of normal pubertal development rather than a disease. If an already regular menstrual cycle becomes irregular, secondary causes of anovulation should be ruled out. Inherited and acquired bleeding disorders, such as von Willebrand disease, and quantitative and qualitative abnormalities of platelets are relatively common findings in adolescents with HMB from menarche. History of excessive bleeding or a diagnosed bleeding disorder in the family supports this etiology, warranting specialized laboratory testing. First-line treatment of HMB among adolescents is medical management with hormonal therapy or nonhormonal options. Levonorgestrel-releasing intrauterine device is an effective tool also for all adolescents with menstrual needs.