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https://www.readbyqxmd.com/read/28440126/transcranial-doppler-screening-for-stroke-risk-in-children-with-sickle-cell-disease-a-systematic-review
#1
Sara Mazzucco, Marina Diomedi, Amrana Qureshi, Laura Sainati, Soundrie T Padayachee
Background Sickle cell disease (SCD) is one of the most common causes of stroke in children worldwide. Based on the results of the Stroke Prevention Trial in Sickle Cell Anemia (STOP), annual transcranial Doppler ultrasound (TCD) screening for affected children is standard practice. However, the need for TCD surveillance programs could override the accuracy of the screening, affecting the correct stratification of stroke risk and subsequent clinical management of the target population. Aims To shed light on this issue, a systematic review of the literature on TCD screening for children and adolescents with SCD was carried out (CRD42016050549), according to a list of clinically relevant questions, with a particular focus on screening practices in European countries...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28439953/feasibility-trial-for-primary-stroke-prevention-in-children-with-sickle-cell-anemia-in-nigeria-spin-trial
#2
Najibah Galadanci, Shehu Umar Abdullahi, Leah D Vance, Abdulkadir Musa Tabari, Shehi Ali, Raymond Belonwu, Auwal Salihu, Aisha Amal Galadanci, Binta Wudil Jibir, Halima Bello-Manga, Kathleen Neville, Fenella J Kirkham, Yu Shyr, Sharon Phillips, Brittany V Covert, Adetola A Kassim, Lori C Jordan, Muktar H Aliyu, Michael R DeBaun
The vast majority of children with sickle cell anemia (SCA) live in Africa, where evidence-based guidelines for primary stroke prevention are lacking. In Kano, Nigeria, we conducted a feasibility trial to determine the acceptability of hydroxyurea therapy for primary stroke prevention in children with abnormal transcranial Doppler (TCD) measurements. Children with SCA and abnormal non-imaging TCD measurements (≥ 200 cm/s) received moderate fixed-dose hydroxyurea therapy (∼20 mg/kg/day). A comparison group of children with TCD measurements < 200 cm/s was followed prospectively...
April 25, 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28428899/watershed-infarct-in-beta-thalassemia-major-patient
#3
Behnaz Ansari, Mohammad Saadatnia, Ali Asghar Okhovat
Background. The mechanism of stroke in beta-thalassemia was reported previously as cardioembolic and hypercoagulable state. However, there is no report of watershed infarct in beta-thalassemia anemia. Method. We present an adult β-thalassemia major patient with manifest asymptomatic chronic left carotid occlusion who suffered watershed infarct. Result. In the presence of asymptomatic chronic left internal carotid occlusion, we assumed that severe anemia (hemoglobin = 3) at admission leads to watershed infarct...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/28417646/cerebral-hemodynamic-assessment-and-neuroimaging-across-the-lifespan-in-sickle-cell-disease
#4
Lori C Jordan, Michael R DeBaun
Children and adults with sickle cell anemia (SCA) have a higher risk of strokes compared to age- and race-matched peers. Velocity in the middle cerebral or distal internal carotid artery as measured by transcranial Doppler ultrasound is a recognized method to identify children but not adults with SCA at high-risk for first stroke. For both children and adults with SCA that have had a stroke, no methods clearly identify individuals at highest risk of recurrent strokes or an initial silent stroke, the most common neurological injury...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28397407/sanguinate-pegylated-carboxyhemoglobin-bovine-mechanism-of-action-and-clinical-update
#5
Abraham Abuchowski
Historically, blood substitutes were under development that would provide oxygen carrying capacity as well as fluid replacement for both trauma and surgical indications. Their development was halted by the inability of the products to deliver therapeutic amounts of oxygen targeted to hypoxic tissue as well as from the inherent toxicity of the molecules. This led to the concept of an oxygen therapeutic that would be targeted for indications caused by anemia/ischemia/hypoxia but would not exhibit the toxicity that plagued earlier products...
April 2017: Artificial Organs
https://www.readbyqxmd.com/read/28370487/contrast-induced-nephropathy-in-patients-undergoing-endovascular-peripheral-vascular-intervention-incidence-risk-factors-and-outcomes-as-observed-in-the-blue-cross-blue-shield-of-michigan-cardiovascular-consortium
#6
P Michael Grossman, Syed S Ali, Herbert D Aronow, Michael Boros, Timothy J Nypaver, Theodore L Schreiber, Yeo Jung Park, Peter K Henke, Hitinder S Gurm
BACKGROUND: The incidence, risk factors, and outcomes associated with Contrast-induced nephropathy (CIN) after Percutaneous Vascular Intervention (PVI) in contemporary medical practice are largely unknown. METHODS: A total of 13 126 patients undergoing PVI were included in the analysis. CIN was defined as an increase in serum creatinine from pre-PVI baseline to post-PVI peak Cr of ≥0.5 mg/dL. RESULTS: CIN occurred in 3% (400 patients) of the cohort, and 26 patients (6...
April 3, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28362411/continuous-manual-exchange-transfusion-for-patients-with-sickle-cell-disease-an-efficient-method-to-avoid-iron-overload
#7
Bérengère Koehl, Florence Missud, Laurent Holvoet, Ghislaine Ithier, Oliver Sakalian-Black, Zinedine Haouari, Emmanuelle Lesprit, André Baruchel, Malika Benkerrou
Children with sickle cell anemia (SCA) may be at risk of cerebral vasculopathy and strokes, which can be prevented by chronic transfusion programs. Repeated transfusions of packed red blood cells (PRBCs) is currently the simplest and most used technique for chronic transfusion programs. However, iron overload is one of the major side effects of this therapy. More developed methods exist, notably the apheresis of RBC (erythrapheresis), which is currently the safest and most efficient method. However, it is costly, complicated, and cannot be implemented everywhere, nor is it suitable for all patients...
March 14, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28348599/a-rare-case-of-stroke-secondary-to-iron-deficiency-anemia-in-a-young-female-patient
#8
Kavitha Gopalratnam, Kevin Andrew Woodson, Jigarkumar Rangunwala, Kanaga Sena, Manisha Gupta
Ischemic strokes occur when there is a sudden obstruction of an artery supplying blood flow to an area of the brain, leading to a focal neurological deficit. Strokes can be thrombotic or embolic in etiology and are associated with underlying conditions such as hypertension and atherosclerosis. Possible etiologies of strokes include cardioembolic disease, hematologic disorders, connective tissue disorders, and substance abuse or can be cryptogenic. Most stroke cases are seen in patients over 65 years of age...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28323673/clinical-pearls-of-maternal-critical-care-part-2-sickle-cell-disease-in-pregnancy
#9
Vinod Patil, Gamunu Ratnayake, Galina Fastovets
PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined...
March 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28296183/high-stroke-volume-variation-is-an-independent-predictor-for-decreased-blood-pressure-during-hemodialysis
#10
Fumiki Yoshihara, Masatsugu Kishida, Koji Ogawa, Takayuki Nishigaki, Hironori Nakasaki, Azusa Ishizuka, Ryo Koezuka, Miki Matsuo, Teruyuki Hayashi, Satoko Nakamura
It currently remains unclear whether stroke volume variation (SVV) before hemodialysis (HD) is an independent predictor of decreased blood pressure (BP) during HD. Fifty-two patients were divided into two groups (Decreased BP during HD group: N = 10, Non-decreased BP group: N = 42). Fractional shortening was lower, and mean arterial pressure (MAP) and SVV were higher in the Decreased BP during HD group. A multiple logistic regression analysis identified low fractional shortening, high MAP, and high SVV as independent predictors of decreased BP during HD...
March 10, 2017: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/28279287/a-42-year-old-woman-with-anemia-shock-and-ischemic-stroke-after-lung-transplantation
#11
Abhishek Biswas, Ali Ataya, Juan C Salgado, Satish Chandrasekharan, Tiago N Machuca, Amir M Emtiazjoo
A 42-year-old woman with mixed connective tissue disease-associated interstitial lung disease underwent bilateral lung transplantation. She had an uneventful surgery and was extubated 3 h later. Induction immunosuppression therapy included methylprednisolone 500 mg intraoperatively, basiliximab (anti-IL-2 monoclonal antibody) on days 0 and 4 after transplantation, and methylprednisolone 125 mg intravenously bid for 2 days following surgery. Maintenance immunosuppression therapy consisted of prednisone 20 mg daily, mycophenolate mofetil 750 mg bid, and enteral tacrolimus 0...
March 2017: Chest
https://www.readbyqxmd.com/read/28270343/comprehensive-neuropsychological-evaluation-of-children-and-adolescents-with-sickle-cell-anemia-a-hospital-based-sample
#12
Samantha Nunes, Nayara Argollo, Marivania Mota, Camilo Vieira, Eduardo Pondé de Sena
BACKGROUND: Individuals with sickle cell anemia may suffer symptomatic or silent cerebral infarcts leading to neurocognitive complications. This study investigated the cognitive and intellectual performance of children and adolescents with sickle cell anemia. METHODS: The socioeconomic status, clinical aspects and behavioral profile of 15 young individuals with sickle cell anemia were evaluated. The Wechsler Intelligence Scale for Children, the Developmental Neuropsychological Assessment Test, and the Child Behavior Checklist were applied...
January 2017: Revista Brasileira de Hematologia e Hemoterapia
https://www.readbyqxmd.com/read/28267467/anemia-is-associated-with-bleeding-and-mortality-but-not-stroke-in-patients-with-atrial-fibrillation-insights-from-the-apixaban-for-reduction-in-stroke-and-other-thromboembolic-events-in-atrial-fibrillation-aristotle-trial
#13
B Daan Westenbrink, Marco Alings, Christopher B Granger, John H Alexander, Renato D Lopes, Elaine M Hylek, Laine Thomas, Daniel M Wojdyla, Michael Hanna, Matyas Keltai, P Gabriel Steg, Raffaele De Caterina, Lars Wallentin, Wiek H van Gilst
BACKGROUND: Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. METHODS: We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13...
March 2017: American Heart Journal
https://www.readbyqxmd.com/read/28261784/fatal-folic-acid-toxicity-in-humans
#14
Gerard Pradeep Devnath, Senthil Kumaran, R Rajiv, Kusa Kumar Shaha, Ashok Nagaraj
Folic acid is B-9 vitamin. Folic acid is prescribed commonly for pregnant women to prevent neural tube defects in the fetus, patients under chemotherapy, pernicious anemia and to reduce the risk of stroke and cardiovascular disease. Acute or chronic ingestion of a large dose of folic acid generally manifests as neurological complications, which are reversible. In this present case, a 23-year-old pregnant woman committed suicide by consuming folic acid tablets and succumbed to death within 36 h. Postmortem toxicological analysis detected folic acid in viscera...
March 6, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28259602/perioperative-strokes-and-early-outcomes-in-mitral-valve-surgery-a-nationwide-analysis
#15
Reshmi Udesh, Amol Mehta, Thomas G Gleason, Lawrence Wechsler, Parthasarathy D Thirumala
OBJECTIVE: To demonstrate the role of perioperative stroke as an independent risk factor for in-hospital morbidity and mortality after mitral valve surgery and review the trends in the early outcomes of mitral valve surgery over the past decade. DESIGN: Using data from the National Inpatient Sample database for analysis, all patients who underwent isolated mitral valve procedures were identified using International Classification of Diseases-Ninth Revision codes...
April 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28256417/ischemic-stroke-mortality-is-more-strongly-associated-with-anemia-on-admission-than-with-underweight-status
#16
Satoshi Kubo, Naohisa Hosomi, Naoyuki Hara, Shuichiro Neshige, Takahiro Himeno, Shinichi Takeshima, Kazuhiro Takamatsu, Yutaka Shimoe, Taisei Ota, Hirofumi Maruyama, Toshiho Ohtsuki, Masaru Kuriyama, Masayasu Matsumoto
BACKGROUND: Underweight patients have recently been reported as a group with a high risk of poststroke death. Anemia also increases mortality rates in stroke patients. However, the causal associations between body weight and anemia resulting in stroke-related death remain unclear. We examined the association of weight status and hemoglobin levels with 3-month mortality after ischemic stroke. METHODS: The study enrolled all consecutive patients with acute ischemic stroke and no history of stroke admitted to our hospital between January 2010 and December 2013...
February 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28252537/daily-lowest-hemoglobin-and-risk-of-organ-dysfunctions-in-critically-ill-patients
#17
Sarah J Hemauer, Adam J Kingeter, Xue Han, Matthew S Shotwell, Pratik P Pandharipande, Liza M Weavind
OBJECTIVES: To determine the association between hemoglobin levels and the daily risk of individual organ dysfunctions in critically ill patients. DESIGN: Post hoc analysis of prospectively collected data. SETTING: Vanderbilt University Medical Center and Saint Thomas Hospital Medical and Surgical ICUs. PATIENTS: Medical and surgical ICU patients admitted with respiratory failure or shock. INTERVENTIONS: Baseline demographic data, and detailed in-ICU and hospital data, including daily lowest hemoglobin, were collected up to hospital day 30...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28249030/low-versus-high-dose-erythropoiesis-stimulating-agents-in-hemodialysis-patients-with-anemia-a-randomized-clinical-trial
#18
Valeria Saglimbene, Suetonia C Palmer, Jonathan C Craig, Marinella Ruospo, Antonio Nicolucci, Marcello Tonelli, David Johnson, Giuseppe Lucisano, Gabrielle Williams, Miriam Valentini, Daniela D'Alonzo, Fabio Pellegrini, Paolo Strippoli, Mario Salomone, Antonio Santoro, Stefano Maffei, Jörgen Hegbrant, Gianni Tognoni, Giovanni F M Strippoli
The increased risks of death and adverse events with erythropoiesis-stimulating agent (ESA) therapy targeting a higher hemoglobin level are established. It is uncertain whether the adverse effects of ESA therapy are related to dose and are mitigated when a fixed low ESA dose is used. We conducted a multicenter, prospective randomized open-label, blinded-endpoint (PROBE) trial to evaluate fixed low versus high dose ESA therapy on patient outcomes. We intended to recruit 2104 hemodialysis patients >18 years with anemia or receiving ESA treated at dialysis clinics in Italy...
2017: PloS One
https://www.readbyqxmd.com/read/28248201/intravascular-hemolysis-and-the-pathophysiology-of-sickle-cell-disease
#19
REVIEW
Gregory J Kato, Martin H Steinberg, Mark T Gladwin
Hemolysis is a fundamental feature of sickle cell anemia that contributes to its pathophysiology and phenotypic variability. Decompartmentalized hemoglobin, arginase 1, asymmetric dimethylarginine, and adenine nucleotides are all products of hemolysis that promote vasomotor dysfunction, proliferative vasculopathy, and a multitude of clinical complications of pulmonary and systemic vasculopathy, including pulmonary hypertension, leg ulcers, priapism, chronic kidney disease, and large-artery ischemic stroke. Nitric oxide (NO) is inactivated by cell-free hemoglobin in a dioxygenation reaction that also oxidizes hemoglobin to methemoglobin, a non-oxygen-binding form of hemoglobin that readily loses heme...
March 1, 2017: Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28242402/hypoalbuminemia-predicts-perioperative-morbidity-and-mortality-after-infrainguinal-lower-extremity-bypass-for-critical-limb-ischemia
#20
Matthew R Peacock, Alik Farber, Mohammad H Eslami, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Nishant K Shah, Jeffrey J Siracuse
OBJECTIVES: Poor nutritional status has been associated with a higher risk of morbidity and mortality in general surgery patients, however outcomes in vascular surgery patients are unclear. Our goal was to determine the effect of poor nutritional status on perioperative morbidity and mortality after lower extremity bypass (LEB). METHODS: The 2005-2012 National Surgical Quality Improvement Program was analyzed to determine associated complications, mortality, length of stay (LOS), and readmissions for patients with hypoalbuminemia (serum albumin <3...
February 24, 2017: Annals of Vascular Surgery
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