ACQUIRED NEONATAL SEVERE FACTOR II DEFICIENCY- TWO CASES REPORT

In present study two cases of transient acquired and isolated factor II deficiency associated with severe bleeding are reported. Two infants were involved in severe coagulopathy. The blood clot time (CT) in case 2 was excessively prolonged over 16 hours. One-stage prothrombin time (PT) was remarkable prolonged. Haemostatic markers analysis showed an isolated deficiency of factor II at 2.5% and 4.5% respectively. No inhibitory activity against factor II could be detected. We successfully treated the deficiency with vitamin K1 during 15 days. It was interesting that in the case 2 female baby the cause of vitamin K deficiency might be breast feed problem (nutrition deficiency) and/or poor absorption from bowel. Physiopathological laboratory results and therapeutic aspects of two patients were presented. Peer Review History: Received: 1 November 2021; Revised: 9 December; Accepted: 28 December, Available online: 15 January 2022 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, [email protected] Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka, Nigeria, [email protected]

Heterologous expression of MiHAK14 enhances plant tolerance to K+ deficiency and salinity stresses in Arabidopsis

As one of the most abundant ions in cells, potassium (K+) is closely related to plant growth and development and contributes to plant tolerance to various abiotic stresses. However molecular mechanisms towards K+ uptake and transport are unclear in tropic fruit trees. In this study, 18 KT/HAK/KUP family genes (MiHAKs) were isolated and characterized in mango. Results showed that MiHAKs were unevenly expressed in distinct tissues and were differentially responded to K+ depletion, PEG, and NaCl stresses in roots, in which K+ depletion and PEG treatment significantly enhanced while NaCl treatment mainly reduced responsive MiHAK genes. In particular, MiHAK14 was the most abundant KT/HAK/KUP family gene in mango, especially in roots. Functional complementation in TK2420 mutant revealed that MiHAK14 could uptake external K+. Moreover, overexpression of MiHAK14 in Arabidopsis enhanced plant tolerance to K+ depletion and NaCl stresses with strengthened K+ nutritional status and ROS scavenging ability. This study provides molecular basis for further functional studies of KT/HAK/KUP transporters in tropic fruit trees, and favorably demonstrates the essentiality of K+ homeostasis in plant tolerance to abiotic stresses, including K+ deficiency and NaCl stress.

Analysis of White Blood Cell Count and Its Differential Count in Gingival and Periodontal Conditions Associated with Bleeding Gingiva

Background: Bleeding gingiva is caused primarily due to the accumulation of plaque and calculus which eventually leads to gingivitis or periodontitis. Other causes of bleeding gingiva can be due to improper flossing, over brushing of the teeth and gingiva, hormonal changes due to pregnancy, ill-fitting dentures and any other dental appliances impinging the gingiva. The bleeding gingiva can also indicate serious health problems like leukemia, scurvy, idiopathic thrombocytopenic purpura, vitamin k deficiency and any bleeding disorder. Persistent gingival bleeding is a sign of serious medical problems like leukemia and platelet disorders. Leukemia is a group of cancer where there is an increased number of immature or abnormal white blood cells. In this study, the WBC and their differential count is analyzed in patients with bleeding gingiva to check the possibilities for the patient to get cancer. Aim: To measure and observe the WBC count and its differentials by testing the blood from patients with bleeding gingiva. Materials and Methods: The study was conducted in the clinical pathology lab at Saveetha Dental College and Hospitals, Chennai. 100 subjects were subjected to the study. Subjects with chief complaint of bleeding gingiva, without systemic diseases like diabetes, hypertension, and patients with the age of above 10 were included in the study. Results and Conclusion: This study was conducted to analyze the WBC count and differential count among the patients with bleeding gingiva. No significant correlation was found between bleeding gingiva and white blood cells & their differential count in this study.

Belgian Consensus Recommendations to Prevent Vitamin K Deficiency Bleeding in the Term and Preterm Infant

Neonatal vitamin K prophylaxis is essential to prevent vitamin K deficiency bleeding (VKDB) with a clear benefit compared to placebo. Various routes (intramuscular (IM), oral, intravenous (IV)) and dosing regimens were explored. A literature review was conducted to compare vitamin K regimens on VKDB incidence. Simultaneously, information on practices was collected from Belgian pediatric and neonatal departments. Based on the review and these practices, a consensus was developed and voted on by all co-authors and heads of pediatric departments. Today, practices vary. In line with literature, the advised prophylactic regimen is 1 or 2 mg IM vitamin K once at birth. In the case of parental refusal, healthcare providers should inform parents of the slightly inferior alternative (2 mg oral vitamin K at birth, followed by 1 or 2 mg oral weekly for 3 months when breastfed). We recommend 1 mg IM in preterm <32 weeks, and the same alternative in the case of parental refusal. When IM is perceived impossible in preterm <32 weeks, 0.5 mg IV once is recommended, with a single additional IM 1 mg dose when IV lipids are discontinued. This recommendation is a step towards harmonizing vitamin K prophylaxis in all newborns.

Use of an Antifibrinolytic Agent and Vitamin K As Alternative to Platelet Transfusions in Autologous Hematopoietic Cell Transplantation

Background Managing thrombocytopenia with a prophylactic strategy was previously recommended for patients with impaired bone marrow function, hematological malignancies, and recipients of HCT when platelet counts declined to under 10,000/uL. However, the updated 2018 ASCO guidelines now suggest a place for a therapeutic i.e., after a bleeding event rather than a prophylactic platelet transfusion strategy for patients with hematologic malignancies undergoing autologous HCT. Studies show a lack of significant difference between trial groups in hemostatic outcomes, such as the number of WHO grade 2-4 bleeds, and number of days with bleeding events. Platelet transfusions increase risks of infectious and non-infectious complications as well as inducing a platelet refractory state. Our Transfusion Free Medicine Program has now performed over 200 autologous hematopoietic stem cell transplants (HCT) in Jehovah's Witnesses who due to religious convictions, do not accept red cell or platelet transfusions. Vitamin K is a fat-soluble vitamin that is required for normal blood clotting. Autologous HCT patients are at risk for vitamin K deficiency from multiple reasons including malnutrition, frequent use of antibiotics, chemotherapy induced gastrointestinal toxicity leading to malabsorption and colitis. The prothrombin test lacks the sensitivity and specificity to detect mild deficiency. A mild vitamin K deficiency may be underdiagnosed in our transplant patients adding to bleeding risk. With the effective use of antifibrinolytic agents and Vitamin K as an alternative to platelet transfusions we believe this may enhance hemostasis and prove a valuable adjunct to a therapeutic approach. Methods Patients in our study were those who were of the Jehovah's Witness faith undergoing autologous HCT for Multiple Myeloma and Lymphoma. Patients received aminocaproic acid as an alternative to platelet transfusion to enhance hemostasis at a dose of 1 g every 4 hours or prophylactically for platelet counts less than 30,000 /uL. Titration to 4 g every 4 hours intravenously was required for platelet counts less than 10,000/ul or clinical bleeding. Vitamin K 10 mg orally or subcutaneous was also started at this time. Results Table 1 illustrates the low number of bleeding events especially grade 3 or 4 that occurred. There were no Grade 3 or 4 bleeding events in patients with platelet counts above 5000/uL. No patient had residual long term effects nor was there an increase in thromboembolic events. Conclusions These data add to the body of literature supporting a therapeutic platelet transfusion strategy in an experienced center for autologous HCT patients and challenges the prophylactic platelet count of 10,000 /uL suggesting instead 5000/uL. The safety and efficacy of antifibrinolytic agents and Vitamin K as an alternative to platelet transfusions to enhance hemostasis in autologous stem cell transplant patients may prove beneficial not only in JW patients but also in those transplant centers wishing to offer a therapeutic platelet transfusion approach and as a strategy to manage platelet refractoriness. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: Aminocaproic Acid is an antifibrinolytic agent approved for treatment of bleeding in surgical patients and hematological bleeding disorders. Vitamin K is approved for use in reversal of anticoagulation from Warfarin, vitamin K deficiency without liver disease and in the newborn.