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   Table of Contents - Current issue
October-December 2019
Volume 10 | Issue 4
Page Nos. 111-153

Online since Monday, January 13, 2020

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Oral anticoagulants: Optimizing venous thromboembolism management p. 111
Fahad A S. Aleidan
A decade ago, oral anticoagulants were limited to Vitamin K antagonists, i.e., warfarin. Since 2010, the US Food and Drug Administration has approved several non-Vitamin K oral anticoagulants: dabigatran is a direct thrombin inhibitor, while apixaban, edoxaban, and rivaroxaban are direct factor Xa inhibitors. Oral anticoagulants are used for the management of several venous thromboembolism (VTE) events, including the prevention of stroke in nonvalvular atrial fibrillation; acute coronary syndromes; treatment of VTE; and VTE prophylaxis after total hip or knee replacement. In this review article, we address the main indications, dosages, bleeding and reversal agents, pharmacokinetic and pharmacodynamic properties, and methods of switching between oral anticoagulants.
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Toxoplasmosis among blood donors: Unsafe blood transfusion in ibadan, southwest nigeria p. 120
Abimbola Amoo, Kariuki Njaanake, HO Dada-Adegbola, Gloria Omosa-Manyonyi
BACKGROUND: In Nigeria, there is paucity of data on transfusion-transmissible parasitic infections that can cause post-transfusion illness, especially in immunocompromised and transfusion-dependent patients. This study was designed to bridge the gap by screening for Toxoplasma gondii which can be transmitted by blood transfusion. OBJECTIVES: The main objective of the study is to employ serology methods to screen blood donor's serum for T. gondii, in Blood Bank Transfusion Service Centre, Southwest Nigeria MATERIALS AND METHODS: This is a cross-sectional study. Donor sera were tested for T. gondii infection using IgG and IgM enzyme-linked immunosorbent assay test kits. RESULTS: A total of 248 donated blood sera were tested for T. gondii infection after storage. The seroprevalence of T.gondii IgG and IgM was 19.8% and 42.7%, respectively. There was a significant difference in anti-T. gondii IgM seroprevalence between vegetarian and generalists (3.2% vs. 40.8%; P < 0.002). CONCLUSIONS: The anti-T. gondii IgM prevalence was relatively higher compared to anti-T. gondii IgG, implying the majority of seropositive donors had an acute or recent infection, might seroconvert to chronic infection. There was a lower seropositivity of T.gondii among vegetarian.
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Prevalence of Iron-deficiency anemia and its associated risk factors in female undergraduate students at prince sultan military college of health sciences Highly accessed article p. 126
Lamiaa Al-Jamea, Alexander Woodman, Elmoeiz A Elnagi, Sultan S Al-Amri, Abdulrahman A Al-Zahrani, Njoud H Al-shammari, Rawan A Al-zahrani, Fatimah S Al-Yami, Sultan A Al- Ameri
OBJECTIVES: This study's objectives are to (1) determine the current prevalence of iron-deficiency anemia (IDA) and risk factors for female college students at Prince Sultan Military College of Health Sciences (PSMCHS) in the Eastern Province of Saudi Arabia and (2) address the gap in the current literature. A written survey in both Arabic and English was administrated to 214 female students, and only 201 students completed the survey. It was randomly selected from all registered female students. A number of factors possibly associated with IDA were examined using the Chi-square test. CONTEXT: Globally, iron deficiency is known to be the most common nutritional disorder. About 30% of the world's population are iron deficient (ID). Women seem to be more affected with IDA than men, which constitute an epidemic public health issue. AIMS: The aim of the study was to determine the prevalence of IDA and the risk factors among healthy Saudi undergraduate female college students studying at PSMCHS in Dhahran. SETTINGS AND DESIGN: A cross-sectional study on 201 female students (18–25 years) was conducted between January and March 2019. SUBJECTS AND METHODS: A questionnaire which contains sociodemographic data was completed by each participant. Two blood samples were collected from each participant to estimate the iron profile and to analyze the complete blood counts. STATISTICAL ANALYSIS: The statistical analysis was carried out using the Statistical Packages for the Social Sciences software. RESULTS: The overall prevalence of IDA was 35.3%. The questionnaire analysis of the dietary habit and clinical characteristics revealed that family history of hereditary disease and physical activity have a significant effect on the development of IDA. Statistical analysis showed that having breakfast regularly significantly reduced the development of IDA compared with irregularly having breakfast. CONCLUSIONS: The prevalence of IDA in this study was moderately high, and our results suggest that further education regarding IDA is highly encouraged. This is the first study that demonstrated the prevalence and risk factors of IDA among undergraduate female college students in PSMCHS, and the data generated will provide a database for further studies.
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Double heterozygosity for hemoglobin S and D Punjab in Basra, Iraq: A Clinical and hematological study of 42 patients p. 134
Zuhair Abd Ali Al-Barazanchi, Subeh Salim Abdulateef, Meaad Kadhum Hassan, Rawshan Zuhair Jaber
BACKGROUND: Patients with compound heterozygosity for sickle hemoglobin (HbS) and hemoglobin DPunjab (Hb SDPunjab) may present with a variable clinical course and may be indistinguishable from those with homozygous HbS. OBJECTIVES: The objective was to identify Hb SDPunjab phenotypes and the association of fetal Hb with disease severity. PATIENTS AND METHODS: This descriptive, cross-sectional study included 42 (17 males and 25 females) patients with double heterozygosity for HbS and D. In addition to full clinical data, the complete blood count and Hb quantitation were assessed. Statistical analyses were performed using SPSS software version 20.0. RESULTS: The mean age at diagnosis was 4.6 ± 0.7 years. Pallor and acute painful episodes (>90%) were the most common presenting symptoms, followed by jaundice (76.2%). Six patients (14.3%) had acute splenic sequestration crises and five (11.9%) had cardiac complications. Of the 42 studied patients, 17 (40.5%) had nonsevere disease and 25 (59.5%) had severe disease. Patients with severe disease had statistically significantly more blood transfusions (47.4 ± 10.27) than those with nonsevere disease (17.14 ± 1.82, P < 0.001). No significant association was reported between HbF level and either the number of blood transfusions or acute painful episodes requiring hospitalization/year. Conclusion: Double heterozygosity for Hb S and DPunjab in Basra results in SCD with a severe phenotype, and the Hb F level did not modulate the disease severity.
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Massive lymphadenopathy and hypereosinophilia in cd5-negative small lymphocytic lymphoma p. 141
Shweta Pal, Michael Leonard Anthony, Rituparna Chetia, Uttam Kumar Nath, Ashok Singh, Harish Chandra
Small lymphocytic lymphoma (SLL) is a relatively rare B-cell non-Hodgkin lymphoma that is considered to be the tissue equivalent of the much more common entity chronic lymphocytic leukemia (CLL). Most patients with SLL present with indolent generalized lymphadenopathy, which has frequently been present for several years. We hereby describe an unusual case of SLL in a patient who presented with a huge swelling at the right shoulder region and a single right enlarged axillary lymph node. The other uncommon findings were the presence of peripheral blood hypereosinophilia and CD5 immunonegativity.
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Successful use of fondaparinux for perioperative bridging in a patient with a mechanical heart valve and heparin-induced thrombocytopenia p. 146
CR Pruthvi, Krishna Prasad, Dinakar Bootla, V Krishna Santosh, Parag Barwad
The mechanical heart valve prosthesis is a thrombotic state requiring anticoagulation at therapeutic doses. Heparin-induced thrombocytopenia (HIT) is both a thrombotic and bleeding state which has a high chance of recurrence when heparin is reinitiated. Unfractionated heparin and low molecular-weight heparin are the standard of care for bridging therapy that are on anticoagulation with warfarin for various reasons. However, perioperative bridging in patients having a prior history of HIT is often elusive. We successfully used fondaparinux as a bridging agent for warfarin in a mitral valve replacement patient with a history of HIT.
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Diagnostic challenges of de novo acute leukemia with positive BCR-ABL1 fusion: Case report and review of literature p. 149
Abdulrahman Hamdan Almaeen
A 32-year-old female was admitted because of an acute course of gum bleeding and fatigability. On complete blood cell counts, bicytopenia was evident. Morphologic evaluation of the peripheral blood smear and bone marrow materials revealed remarkable involvement by two separate blastic populations (myeloid/B-cell lymphoid). Karyotyping, fluorescence in situ hybridization, and molecular analysis showed positive Philadelphia chromosome and BCR-ABL1 (p210) fusion. chronic myeloid leukemia in blast phase (CML-BP) versus mixed phenotype acute leukemia was critically debated as to which the final diagnosis should be assigned.
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