Reference intervals and biological variation in parameters of the thrombin generation test in healthy individuals

INTRODUCTION

Establish the referenceintervals (RIs) and analyze biological variability (BV) to introduce the thrombin generation test (TGT) into clinical practice.

METHODS

To determine the RIs parameters of TGT, we analyzed platelet-poor plasma (PPP) (n = 123), rich (PRP) (n = 76), and microparticle-mediated TGT (MP-TGT) (n = 32) in healthy participants. For the BV study, we collected samples from five participants over 5 weeks. A nested analysis of variance (ANOVA) was performed to evaluate the BV results.

RESULTS

The between-individual variation (CVG ), within-individual variation (CVI ), analytical variation (CVA ) for TGT on PPP for all parameters were from 5.5% to 17.3%, 5.4% to 17.7%, and 2.6% to 5.3%, respectively. For PRP, the CVG , CVI , and CVA were ranged from 3.0% to 23.7%, 8.4% to 23.0%, and 4.1% to 6.9%, respectively. The index of individuality (II) ranged from 0.3 to 3.1 for PPP and from 0.3 to 4.5 for PRP. The reference change value (RCV) for PPP was from 19.8% to 50.1%, while for PRP, it was 27.2% to 66.5%. We recommend using the RIs for the parameters ETP (nM/min): 1101.6-2332.1 and Peak (nM): 163.5-381.3 for PPP and ETP (nM/min): 1088.5-2634.9; Peak (nM): 72.6-210.7 for PRP. The resulting MP-TGT are highly dependent on age require a larger sample.

CONCLUSION

For TGT on PPP and PRP the RIs developed on our population for Peak and ETP parameters can be used. Time parameters: Lagtime and ttPeak, min with II < 0.6, require monitoring over time with RCV calculation.

Evaluating of Existing VTE Risk Scales in Glioma Patients

INTRODUCTION

Postoperative venous thromboembolism (VTE) is a frequently occurring complication among glioma patients. Several risk assessment models (RAMs), including the Caprini RAM, the IMPROVE Risk Score, the IMPROVED VTE Risk Score, and the Padua Prediction Score, have not been validated within the glioma patient population. The purpose of this study was to assess the predictive accuracy of established VTE risk scales in patients with glioma.

MATERIALS AND METHODS

A single-center, retrospective, observational cohort study was conducted on 265 glioma patients who underwent surgery at the Almazov Medical and Research Centre between 2021 and 2022. VTE detection followed the current clinical guidelines. Threshold values for the Caprini, IMPROVE VTE, IMPROVEDD, and Padua scales were determined using ROC analysis methods, with cumulative weighting for sensitivity and specificity in predicting VTE development. The areas under the ROC curves (AUC) were calculated, and comparisons were made using the DeLong test.

RESULTS

The area under the curve for the Caprini risk assessment model was 80.41, while the IMPROVEDD VTE risk score was 75.38, the Padua prediction score was 76.9, and the IMPROVE risk score was 72.58. No significant differences were observed in the AUC values for any of the scales. The positive predictive values of all four scales were low, with values of 50 (28-72) for Caprini, 48 (28-69) for IMPROVEDD VTE, 50 (30-70) for Padua, and 64 (35-87) for IMPROVE RAM. No significant differences were found in terms of PPV, NPV, positive likelihood ratio, and negative likelihood ratio among the analyzed scales.

CONCLUSIONS

The Caprini Risk Assessment Model, the IMPROVE Risk Score, the IMPROVED VTE Risk Score, and the Padua Prediction Score exhibit acceptable specificity and sensitivity for glioma patients. However, their low positive predictive ability, coupled with the complexity of interpretation, limits their utility in neurosurgical practice.

Surgical retention for immediate obturator in maxillectomy patients

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.

Drug Utilization and Cost Analysis Review of Anticancer Drugs Used in a Tertiary Care Teaching Hospital in South India

Background: Cancer is ranked high among noncommunicable diseases and millions of people in India receive treatment of cancer every year. Aim: The current study aims to evaluate the trends and pattern of prescribing of anticancer drugs. The objectives of the study were to assess the rational use of anticancer drugs, to identify various types of cancer and to analyze the cost distribution of anticancer drugs. Methods: An observational, prospective study was conducted in 200 prescriptions in oncology department. Data were collected from case reports, prescriptions and medication charts in specially designed forms. Results: Out of 200 patients enrolled, majority were female (59.5%) and in the age group of 40-60 years (52%). Gastrointestinal tract cancers (25%) were most commonly observed, followed by breast cancer (18.5%) and genitourinary cancers (16.5%). Cisplatin (35%) was the most commonly prescribed anticancer drug, followed by paclitaxel (18.5%), carboplatin (14%), 5-fluorouracil (12.5%) and oxaliplatin (7.5%). Ranitidine, dexamethasone and ondansetron were used as palliative therapy either to prevent or manage the adverse reactions of the anticancer drugs. Trastuzumab contribute to the major cost (Rs. 450,000) in the drug therapy. The average cost of drug per prescription was Rs. 11,135. The overall prescribing indicators, point that the average number of total drugs, anticancer drugs and antibiotics were 12.22, 1.73 and 0.43 respectively. Conclusion: The usage of drugs was found to be rational and about 99.38% of the drugs used were from the hospital formulary. The prescribing habits are appropriate and are in accordance with WHO guidelines. The current study may support best prescribing practices to promote cost effective treatment and better health care delivery.

Blunt splenic injury: authors' experience and comparison to literature

AIM

Splenic injuries, like other blunt traumatic injuries, are very frequent, especially in case of traffic accident. The purpose of this study was to present the authors' experience of blunt splenic trauma and to compare it with the studies described in literature.

METHODS

Over a 5-year period 512 injured patients were admitted to the trauma center, 57 of whom presented splenic injuries, and they were retrospectively analyzed. Data review included demographic information, trauma mechanism, admitting hemodinamic parameters, Injury Severity Score. The patients were classified in two groups, one composed by immediate operated injured because their initially hemodinamic instability (27 patients) and another where patients underwent planned nonoperative management (29 patients), which included strict bed rest, frequent physical examinations, serial hematocrits and repeated diagnostic images. The patients were compared to find which factors influence the choice of surgical treatment.

RESULTS

There are statistically significant differences between the groups, concerning admitting hemodinamic parameters, as blood pressure and pulse rate, and the grade of anatomic splenic injury. Four patients failed nonsurgical management and required a splenectomy, because during the third day they suddenly presented clinical deterioration.

CONCLUSIONS

Comparing these results with literature the authors try to improve spleen preserving program avoiding surgery when possible and using for example splenic embolization.

[Crush syndrome]

Crush injuries and crush syndrome are common after natural (e.g. earthquake, land-slide, tornadoes, tsunami) or man-made catastrophes (e.g. wars, terrorist attacks), in fact the history of this disease is well reported both in earthquake rescue reviews and in military literature. However, there are instances due to conventional causes, such as building collapses, road traffic accident, accident at work or altered level of consciousness after stroke or drug overdose. These situations of ''big or small'' catastrophes can occur at any time and anywhere, for this reason every clinician should be prepared to address issues of crush syndrome quickly and aggressively. The treatment has to manage and to predict clinical conditions before they present themselves. In particular, acute renal failure is one of the few life-threatening complications that can be reversed. This article reviews the various evidences and summarizes the treatment strategies available. Fundamental targets in crush syndrome management are early aggressive hydration, urine alkalinization and, when possible, forced diuresis. Since electrolyte imbalance may be fatal due to arrhythmias secondary to hyperkalemia (especially associated with hypocalcemia), it's necessary to correct these abnormalities using insulin-glucose solution and/or potassium binders, and if nevertheless serum potassium levels remain high this serious disease will necessitate dialysis, which is often a vital procedure.

Effect of L-carnitine supplementation on red blood cells deformability in hemodialysis patients

Anemia is a serious problem in hemodialysis patients, the main cause of which is erythropoietin deficiency. After the discovery of recombinant human erythropoietin (rHuEpo) at the end of the last decade, the hematological profile of hemodialysis patients improved significantly but at considerable expense. The deformability of red blood cells (RBC) influences their microcirculation and tissue oxygen delivery along with their life span. We investigated the deformabilty of RBCs in 15 hemodialysis patients before and after three months on L-carnitine supplementation (30 mg/Kg body wt/dialysis session). We excluded from the study all patients who received blood transfusions three months before or during the study, patients who had hemorrhagic episodes, those with hyperparathyroidism or infections, and any who required surgical intervention during the study. The serum iron, folic acid and vitamin B-12 levels were kept normal during the duration of the study. The erythropoietin dose taken before the beginning of L-cartnitine supplementation was not changed. The deformability of RBCs before and after dialysis, prior to and following three months on L-carnitine was determined and compared to the deformability of RBCs from a control group. Hematocrit levels were measured before entry into the study and every month for three months. We found that the deformability of RBCs before the dialysis session was significantly greater than that found in the control group (t-test, p < 0.00001), and that there was a further increase after the end of the dialysis session. Three months following L-carnitine supplementation, we found a significant reduction of RBCs deformability (paired t-test, p < 0.004), and a significant increase in the hematocrit (ANOVA, p < 0.0001). We concluded that abnormalities in the deformability of RBCs improved after L-carnitine and that this was responsible for the increase in the hematocrit. This may allow a substantial reduction in rHuEpo dose.