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Tzu-Yun McDowell, John Lawrence, Jeffry Florian, Mary Ross Southworth, Stephen Grant, Norman Stockbridge
A target international normalized ratio (INR) of 2-3 has been recommended for patients with atrial fibrillation (AF) and risk factors for thromboembolism. This recommendation is largely based on evidence from observational studies a decade ago. This study utilized collective data from modern trials with warfarin controls to examine the relationship of warfarin anticoagulation, as assessed by INR, on the clinical outcome events of interest. METHODS: Data on warfarin-treated patients from 3 clinical studies supporting the approval of dabigatran (Pradaxa® ), apixaban (Eliquis® ), and edoxaban (Savaysa® ) were pooled...
June 19, 2018: Pharmacotherapy
Carolina Vázquez, María Orlova, Paula Scibona, Bruno L Ferreyro, Victoria Otero, Esteban G Jáuregui, Jorge Arbelbide, Waldo H Belloso
: Coumadin oral anticoagulants are widely used in multiple clinical scenarios. Their narrow therapeutic range and a dosing strategy based on 'a posteriori' algorithms, pose them as an interesting group for prediction modelling research. Extensive literature explaining the association between clinical and genetic variables with the dose of warfarin have been published. Limited information exists regarding these factors and acenocoumarol dosing. The aim of the study is to explain through clinical/genetic variables, the weekly dose of acenocoumarol necessary for achieving stable anticoagulation status...
June 18, 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
L Uhler, S Knipping
BACKGROUND: Epistaxis is a symptom with many causes, often multifactorial and a frequent cause of consultation in acute medicine. OBJECTIVES: The goal of this study is to analyse the diagnostics used for and therapy of epistaxis, complications and the predictive benefit of laboratory tests. MATERIALS AND METHODS: In this retrospective clinical analysis reports of 720 patients with epistaxis in the period from January 2005 to December 2015 were evaluated...
June 18, 2018: HNO
Tarundeep Singh, Nidhi Bhatnagar, Gopal Singh, Manmeet Kaur, Sukhvinder Kaur, Preeti Thaware, Rajesh Kumar
Objective: To determine pattern of health care utilization and extent of out-of-pocket healthcare expenditure in rural areas of Punjab in India. Methods: Using multi stage sampling procedure, 660 participants were selected from 110 villages, out of all 22 districts; 440 participants had utilized outpatient care in past 15 days, and 220 had been hospitalized in past one year. Pretested semistructured questionnaires were used to enquire about household and healthcare expenditures...
January 2018: Journal of Family Medicine and Primary Care
Matthew Laubham, Eric Kallwitz
Synthetic dysfunction observed in cirrhosis results in altered production of procoagulants and anticoagulants that can lead to both bleeding and thrombotic events, respectively. In patients with decompensated cirrhosis, frequent hospital visits often require bedside procedures such as diagnostic paracenteses, thoracenteses and endoscopy. It can be difficult to determine at what coagulation threshold procedures can safely be performed. Currently, the most common therapies given pre-procedurally include fresh frozen plasma (FFP) and vitamin K...
2018: Journal of Community Hospital Internal Medicine Perspectives
Paul Horn, Christian von Loeffelholz, Franziska Forkert, Sven Stengel, Philipp Reuken, René Aschenbach, Andreas Stallmach, Tony Bruns
Nutritional status, infections, inflammation and extrahepatic organ dysfunction are critical factors for the progression of chronic liver disease. Chemerin is an immune-metabolically and chemotactically active adipokine and we hypothesized that it is associated with disease severity and prognosis in patients with advanced decompensated cirrhosis. Therefore, we measured serum concentrations of chemerin in a prospectively characterized cohort of 80 patients with decompensated cirrhosis and ascites and assessed the associations with markers of disease severity and short-term outcome at 28 days...
June 18, 2018: Scientific Reports
Katie B Tellor, Steffany N Nguyen, Amanda C Bultas, Anastasia L Armbruster, Nicholas A Greenwald, Abigail M Yancey
BACKGROUND: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI. METHODS: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization)...
June 1, 2018: Therapeutic Advances in Cardiovascular Disease
Catherine T Frenette, Giuseppe Morelli, Mitchell L Shiffman, R Todd Frederick, Raymond A Rubin, Michael B Fallon, Jason T Cheng, Matt Cave, Saira A Khaderi, Omar Massoud, Nikolaos Pyrsopoulos, James S Park, James M Robinson, Mason Yamashita, Alfred P Spada, Jean L Chan, David T Hagerty
BACKGROUND & AIMS: Caspase-mediated apoptosis and inflammation contribute to progression of liver disease. Emricasan is a pan-caspase inhibitor that reduced serum markers of apoptosis and liver inflammation in patients with hepatitis C and non-alcoholic steatohepatitis (NASH). METHODS: We performed a multicenter study of 86 patients with cirrhosis (Child-Pugh class A or B; mean score, 6.9; 38% with alcohol-associated cirrhosis, 29% with HCV-associated cirrhosis, and 23% with NASH) and model for end-stage liver disease (MELD) scores of 11-18 (mean, 12...
June 15, 2018: Clinical Gastroenterology and Hepatology
Nitin Bansal, Ram Gopalakrishnan, Nandini Sethuraman, Nagarajan Ramakrishnan, P Senthur Nambi, D Suresh Kumar, R Madhumitha, M A Thirunarayan, V Ramasubramanian
Background: The (1,3)-β-D-glucan assay (BDG) is recommended for the early diagnosis of invasive candidiasis (IC). Methods: Records of 154 critically ill adults with suspected IC, on whom BDG was done, were analyzed. Patients were divided into three groups: Group A (confirmed IC), Group B (alternative diagnosis or cause of severe sepsis), and Group C (high candidal score and positive BDG [>80 pg/mL] but without a confirmed diagnosis of IC). Results: Mean BDG levels were significantly higher in Group A ( n = 32) as compared to Group B ( n = 60) and Group C ( n = 62) (448...
May 2018: Indian Journal of Critical Care Medicine
J Lee, M Y Kim, S H Kang, J Kim, Y Uh, K J Yoon, H S Kim
Objective Noninvasive liver fibrosis evaluation is an important issue in chronic hepatitis B infection, and may be assessed using transient elastography (Fibroscan) or with blood markers. We compared the value of Fibroscan with that of a panel of routine serum markers. Materials and methods We recruited 278 chronic hepatitis B patients who underwent Fibroscan and HBV DNA testing. Fibroscan assessments were made, and blood taken for the measurement of the gamma-glutamyl transferase (GGT) to platelet ratio (GPR), platelet count, aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), international normalised ratio (INR), total cholesterol, trigylcerides, bilirubin, mean platelet volume (MPV), AST to platelet ratio index (APRI) and neutrophil to lymphocyte ratio...
June 12, 2018: British Journal of Biomedical Science
Stephanie Post, Galina Karashchuk, John D Wade, Waseem Sajid, Pierre De Meyts, Marc Tatar
Insulin and IGF signaling (IIS) is a complex system that controls diverse processes including growth, development, metabolism, stress responses, and aging. Drosophila melanogaster IIS is propagated by eight Drosophila insulin-like peptides (DILPs), homologs of both mammalian insulin and IGFs, with various spatiotemporal expression patterns and functions. DILPs 1-7 are thought to act through a single Drosophila insulin/IGF receptor, InR, but it is unclear how the DILPs thereby mediate a range of physiological phenotypes...
2018: Frontiers in Endocrinology
Xiaoyan Li, Chunlan Chen, Chuang Zhao, Zunyuan Li, Wei Liang, Zhidan Liu
BACKGROUND: Hypophasis is one of the most frequently observed sequelae of patients with Bell's palsy, who have not recovered completely, creating a clinical difficulty for physicians. Acupuncture therapy has been widely used to treat Bell's palsy as a reasonable resolution for management of symptoms such as hypophasis. The number of acupuncture points (acu-points) is frequently selected in the approach of acupuncture therapy; however, whether these had high efficiency has not been proved...
June 11, 2018: Trials
Lukas Peter Maria Kremer, Judith Korb, Erich Bornberg-Bauer
Social insects show an extreme degree of phenotypic plasticity. In highly eusocial species, this manifests in the generation of distinct castes with extreme differences in both morphology and life span. The molecular basis of these differences is highly entangled and not fully understood, but several recent studies demonstrated that insulin/insulin-like growth factor signaling (IIS) is one of the key pathways. Here, we investigate the molecular evolution of insect insulin receptors (InRs), which are membrane-bound dimers that enable IIS by relaying extracellular signals to intracellular signaling cascades...
June 10, 2018: Journal of Experimental Zoology. Part B, Molecular and Developmental Evolution
Masresha Seyoum, Bamlaku Enawgaw, Zegeye Getaneh, Getabalew Engidaye, Fikir Asrie, Mulugeta Melku
Objective: We aimed at assessing the basic coagulation parameters of HIV-infected adults at the University of Gondar Hospital antiretroviral therapy clinic. Methods: A comparative cross-sectional study was conducted from February to May 2017. A total of 300 study participants, consisting of 100 HAART-naïve HIV-infected adults, 100 HIV-infected adults who were taking HAART, and 100 HIV-seronegative apparently healthy adults, were included. Basic coagulation functional assays such as PT, APTT, and INR were determined by coagulation analyzer...
2018: BioMed Research International
Kumar Jayant, Isabella Reccia, Francesco Virdis, A M James Shapiro
Introduction: The success of liver transplantation has been limited by the unavailability of suitable donor livers. The current organ preservation technique, i.e., static cold storage (SCS), is not suitable for marginal organs. Alternatively, normothermic machine perfusion (NMP) promises to recreate the physiological environment and hence holds promise for the better organ preservation. The objective of this systematic review is to provide an overview of the safety, benefits, and insight into the other potential useful parameters of NMP in the liver preservation...
2018: HPB Surgery: a World Journal of Hepatic, Pancreatic and Biliary Surgery
Adam J Singer, Merry Taylor, Deborah LeBlanc, Kristen Meyers, Karol Perez, Henry C Thode, Jesse M Pines
BACKGROUND: Core laboratory testing may increase length of stay and delay care. OBJECTIVES: We compared length of emergency department (ED) care in patients receiving point-of-care testing (POCT) at triage vs. traditional core laboratory testing. METHODS: We conducted a prospective, case-controlled trial of adult patients with prespecified conditions requiring laboratory testing and had POCT performed by a nurse after triage for: a basic metabolic panel, troponin I, lactate, INR (i-STAT System), urinalysis (Beckman Coulter Icon), or urine pregnancy test...
June 7, 2018: Journal of Emergency Medicine
J A Barea-Mendoza, L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto Del Portillo, C Mudarra-Reche, M Valiente-Fernández, A Rodríguez-Biendicho, J C Montejo González, M Chico-Fernández
BACKGROUND: Hypoperfusion plays a central role in shock states, and has been proposed as a coagulopathy trigger. The study of the rotational thromboelastometry (ROTEM) profile during cardiac arrest could offer new insights to the role of hypoperfusion in coagulation during shock states. OUTCOME: To describe the ROTEM profile in a cohort of asystole donors and elucidate the incidence of hyperfibrinolysis. DESIGN: A prospective observational study was carried out in 18 patients consecutively admitted to the ICU after out-of-hospital non-recovered cardiac arrest (CA)...
June 7, 2018: Medicina Intensiva
Gerhard Jung, Pol Olivas, Alba Díaz, Sabela Lens
A 65-year-old patient with long-term metabolic syndrome and no relevant alcohol consumption was admitted to the hospital due to jaundice. His electronic record revealed a first suspicion of NAFLD 3 months ago because of slight alterations of LFT (AST 80 IU/L). Actual testing showed an important worsening of all LFT (AST 639 IU/L, ALT 456 IU/L, AP 248 IU/L, GGT 293 IU/L) with TB 23 mg/dl and an INR 1.22. This article is protected by copyright. All rights reserved.
June 9, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
Laurent Lafarge, Fouzi Khayi, Anis Bel-Kamel, Nicolas Charhon, Laura Sarfati, Benoit Falquet, Michel Ducher, Laurent Bourguignon
BACKGROUND: Oral vitamin K antagonists (VKAs) are commonly used in older adults. To ensure the efficiency and safety of these drugs, the international normalized ratio (INR) must be monitored. The time in therapeutic range (TTR) is an internationally recommended assessment of the anticoagulation quality. OBJECTIVE: Our study aimed to assess the TTR of VKAs in a hospitalized geriatric population and identify factors associated with low TTR. METHODS: This was a multicenter retrospective study of data from 1899 patients with a mean age of 87 years between 2013 and 2015 in the geriatric units of four French hospitals...
June 8, 2018: Drugs & Aging
Kritika Raj, Surajit Sarkar
Polyglutamine [poly(Q)] disorders are a class of trinucleotide repeat expansion neurodegenerative disorders which are dominantly inherited and progressively acquired with age. This group of disorders entail the characteristic formation of protein aggregates leading to widespread loss of neurons in different regions of the brain. SCA3 and HD, the two most commonly occurring types of poly(Q) disorders were examined in the present study. With the aim of elucidating novel genetic modifiers of poly(Q) disorders, the Drosophila insulin receptor (InR) was identified as a potential suppressor of poly(Q)-induced neurotoxicity and degeneration...
June 7, 2018: Molecular Neurobiology
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