Hematogenous thrombophilia as an additional risk factor for cerebral circulation disorders

Введение. Гематогенная тромбофилия служит дополнительным фактором риска нарушений мозгового кровообращения (НМК). Цель исследования: изучить влияние повышенного уровня фактора VIII и нарушений в системе фибринолиза на НМК у пациентов с сочетанной патологией системы свертывания крови. Материалы и методы. Обследовано 20 пациентов с перенесенными ишемическими инсультами в возрасте от 36 до 56 лет. Определяли показатели плазменного, тромбоцитарного звеньев гемостаза, системы фибринолиза, а также генетические полиморфизмы системы гемостаза. Результаты. У всех пациентов выявлены различные сочетания генетических полиморфизмов, связанных с изменениями антикоагулянтного звена гемостаза, а также дефекты системы фибринолиза и коагуляционного звена гемостаза, что является дополнительным фактором риска НМК. Заключение. У пациентов молодого и среднего возраста, перенесших острое НМК по ишемическому типу, необходимо исследование системы свертывания крови, включающее определение содержания фактора VIII в крови, показателей системы фибринолиза и уровня гомоцистеина. Background. Hematogenous thrombophilia is an additional risk factor for cerebral circulatory disorders (ССD). Objectives: to study the impact of increased factor VIII level and disturbances of fibrinolysis system on ССD in patients with combined pathology of blood coagulation. Patients/Methods. We examined 20 patients with ischemic strokes aged from 36 to 56 years. The parameters of plasma hemostasis, platelet function, fibrinolysis system, as well as the genetic polymorphisms of hemostasis system were determined. Results. All patients had different combinations of genetic polymorphisms associated with anticoagulant hemostasis changes, as well as defects in fibrinolysis system and coagulation hemostasis that is an additional risk factor for ischemic stroke. Conclusions. In young and middle-aged patients with history of acute ischemic ССD, it is necessary to study blood coagulation, including the determination of blood factor VIII level, fibrinolysis system parameters and homocysteine content.

BERPIKIR GEOMETRI LEVEL VISUALISASI SISWA SEKOLAH MENENGAH PERTAMA MELALUI TOPIK SEGIEMPAT MENURUT TEORI VAN HIELE

This research aims to describe the level of geometric thinking and geometric thinking processes of Junior High School students according to van Hiele's level of thinking on the topic of quadrilaterals. The qualitative approach is the research method used in this study through a case study method by testing the Van Hiele Geometry Test (VHGT) which was adapted from Usiskin's CDASSG and conducting interviews about the thinking process in the form of identifying, defining, and classifying which was adapted from the interview guide of Burger and Shaughnessy (1986). The subjects of this study were 297 grade VII and VIII students from two schools located in the Lembang sub-district. The results of the VHGT test showed that there were 81 students counting level 0 (visualization). The results showed that the students of class VII and VIII level 0 were as follows: 1) students were able to recognize the types of quadrangle but still affected by the prototype, 2) students were not able to classify quadrilaterals, and 3) overall description of the geometric thinking process level 0 in the form of identifying, defining, and classifying aspects according to van Hiele's thinking characteristics in general.

Aseptic necrosis of the femoral head in the course of haemophilia; a different clinical and radiological course compared to typical Legg-Calve-Perthes disease (twenty years of follow-up) – case report

The authors analyse the course of aseptic necrosis of the femoral head in a 7-year-old boy with haemophilia A (factor VIII level - 0%) caused by massive haemarthrosis into the hip joint (joint tamponade). The patient’s clinical and radiological symptoms differed from those in classic LCP disease, and now, after 20 years, the consequences of necrosis do not confirm typical Perthes disease (LCP). Significant shortening (about 5 cm) of the limb and the X-ray image of the proximal end of the femur resemble the consequences of severe necrosis of the femoral head in the treatment of an infant with developmental dysplasia of the hip (DDH). The study presents necrosis of the femoral head in the course of haemophilia due to its extremely rare occurrence as opposed to haemophilic arthropathy typical for this disease. This description may also contribute to considerations on the etiopathology of LCP disease.

Acute Atraumatic Compartment Syndrome of the Thigh Due to Acquired Coagulopathy Disorder: A Case Report in Known Healthy Patient

Introduction: We present a case of spontaneous compartment syndrome due to a very rare cause which is acquired hemophilia. Case Presentation:A 34-year-old patient presented with the right thigh swelling and features of acute compartment syndrome without history of trauma. He had no history of bleeding disorder. There were no features of infection. As his initial blood tests were within normal 16 g/dl, and his compartment syndrome worsened, he had decompression of the thigh. During the post-operative period, the patient developed persistent bleeding from the decompressed wounds and a fall in hemoglobin which led to further investigation when the blood profile showed a deficiency of factor VIII and antibodies to factor VIII, diagnosis of acquired hemophilia was made and appropriate treatment given. Conclusion: If atraumatic compartment syndrome diagnosed, possibility of acquired factor VIII deficiency should be raised by isolated prolonged activated partial thromboplastin time and diagnosis confirmed by measuring factor VIII activity level and detecting any factor’s VIII antibodies in blood, such as in this case, the factor VIII level was 5.5 (very low) and against factor VIII antibodies level was 60.8 (high). Here, hematologist should be involved in management. Keywords: Compartment syndrome, atraumatic, acquired factor VIII deficiency.

Analisis Effect Size Pengaruh Bahan Ajar IPA Bermuatan Literasi Sains Terhadap Hasil Belajar Siswa SMP/MTs

The 21st century is the century where science literacy into focus on science education or science. The results of the test PISA the year 2018 showed that the literacy skills of students in Indonesia are still low. The average scientific literacy of Indonesian students is 396 and still below the score specified by the OECD 489. Compared to other countries, Indonesia ranked no 9 from the bottom to the aspects of assessment science. The purpose of this study was to determine the magnitude of the influence of the teaching materials of integrated IPA learning outcomes and the improvement of scientific literacy of students in SMP/MTs. This study used the effect size analysis method that studied 20 articles. Based on the results of the research that has been done can be known as 1) the use of integrated science teaching materials with literacy has a significant effect on the aspects of the theme, especially on the theme of motion in everyday life with an effect size of 4,41 in the high category, 2) the use of integrated science teaching materials with literacy has a more effective effect on Grade VIII level aspects with an effect size of 1.80 high categories, and 3) integrated science teaching materials with literacy have a significant effect on aspects of learning outcomes, especially knowledge aspects with an effect size of 1.80 high categories

ABO incompatibility and mild factor VIII deficiency in the neonate: Not too much of a problem but a challenge on ECMO

Coagulopathy and bleeding on extracorporeal membrane oxygenation (ECMO) contribute to a worse outcome, and hyperbilirubinemia is an additional threat for newborn babies. We report a case of a newborn boy with congenital diaphragmatic hernia (CDH) associated with ABO incompatibility and an inherited mild hemophilia A. Due to respiratory failure he needed ECMO on his first day of life. During ECMO an exchange transfusion was performed after an extensive hyperbilirubinemia had evolved. Thereafter severe bleeding occurred, and a very low factor VIII level was found causative for that. After factor VIII substitution bleeding was under control and the baby eventually could be weaned from ECMO, underwent corrective surgery, and recovered.

Elevated factor VIII levels and arterial stroke: a review of literature with a case report

Background Cerebral arterial thromboses or ischemic strokes may be caused by cumulative or independent effects of a variety of risk factors. High factor VIII level is one of those important but less known risk factors for arterial and venous thrombosis. We hereby provide a comprehensive review of the role of high factor VIII levels as a risk factor of arterial thrombosis. Moreover, we present our views on inclusion of factor VIII testing in the etiology workup protocol of young patients with ischemic strokes and their treatment with anticoagulant therapy. Case presentation We illustrate a case of 32-year-old North Indian female patient with Ischemic stroke whose only identifiable risk factor was revealed to be an elevated factor VIII level. She was treated with oral anticoagulant with an uneventful follow-up of 6 months. Conclusions Elevated factor VIII levels have their independent and additive effects in causation and prognosis of arterial strokes. We herein discuss the mechanism of this association, the feasibility and yield of routine testing, appropriate cut-off levels, and further treatment protocol especially in young stroke patients.

Extensive catastrophic thromboses from elevation of factor VIII

Catastrophic thrombotic syndrome, otherwise known as thrombotic storm (TS) is an extreme prothrombotic clinical syndrome that presents as rapid onset of multiple thromboembolic events affecting a large variety of vasculature. In recent studies, there has been a correlation of high plasma levels of factor VIII with thrombotic events. We present the case of a young man who exhibited multi-organ failure due to thrombotic storm. A 38-year-old male presented to the emergency department for progressive dyspnea and was diagnosed to have pulmonary embolism. The patient developed respiratory distress requiring intubation and was diagnosed with both an ST-elevation myocardial infarction and right cerebral infarction during the hospital course. The patient expired and autopsy revealed the cause of death to be myocardial, cerebral and renal infarction from widespread vascular thrombosis. Autopsy revealed cause of death to be elevated factor VIII associated thrombotic coagulopathy. Factor VIII level upon autopsy was 375% (55-200%). Although TS is rare, it can be lifethreatening if not recognized early. Survival depends on the prompt initiation and duration of anticoagulation.