Evaluation of Hemostatic Behavior of Micro and Nano Gelatin/Silica Hybrid in Severe Bleeding

Background:

The pH variation of the injury site is an important factor in the failure of styptic and its structural damage. In this study, the behaviour of a gelatin-silica hybrid in severe bleeding was evaluated under different pH values. On the other hand, the effect of the hybrid particle size, which is one of the key physical properties of the hybrid, has been studied in rapid control of haemostasis. </P><P> Method: The hybrid haemostatic behaviour varied drastically by changing the particle size, so that the hybrid containing SiO2 with the average particle size of about 1 micro-meter (Hyb Gel-MSiO2) demonstrated very poor ability in platelet adhesion in neutral pH, about 24%. Also, the aPTT was not shorter than the normal time, whereas reduction of the particle size beyond a certain limit (with nanometer SiO2 for Hyb Gel-NSiO2) led to both increasing platelet adhesion to 32% and very considerable reduction of aPTT. </P><P> Results: Alignment of all results showed that the particle size reduction improves the haemostatic behaviour of the hybrid toward its best performance by controlling excessive bleeding. By changing the pH for a certain particle size, structural integrity, and thereby the hybrid haemostatic behaviour changed dramatically. Therefore, the nano-hybrid showed the most blood absorption (around 470%) in natural pH and acceded to a coherent structure. The results demonstrated that in alkaline or acidic environment, the hybrid haemostatic behaviour was limited. Based on the results of this study, it was found that changes in the hybrid behaviour in acidic pH were much more drastic than in alkaline pH, and also the hybrid with the optimum particle size (Hyb Gel-NSiO2) can maintain the structural integrity with rapid haemostasis (<3 seconds). </P><P> Conclusion: Based on the objective that the pH at the injury site change to the alkaline side, the resulting hybrid has an excellent ability to control excessive bleeding and can be proposed for further in vivo studies as a novel styptic.</P>

Genetic characterization of human-derived hydatid cysts of Echinococcus granulosus in Lorestan Province, Western Iran

The aim of the present investigation was genotyping of hydatid cysts of cystic echinococcosis (CE) patients residing in Lorestan province by sequencing and analyzing of the partial mitochondrial cytochrome c oxidase subunit 1 (cox1). A total of 26 hydatid cysts (6 hydatid cysts) from 6 patients suffering from hepatic CE and 20 formalin-fixed paraffinembedded (FFPE) tissue samples from 20 human patients with histologically confirmed CE. DNA was extracted, and genotyping was performed by sequencing and analyzing mitochondrial cox1 gene. All the samples were analyzed using mitochondrial cox1 primers. In sequencing analysis, the alignment of the determined sequence with those of knows genotypes of E. granulosus demonstrated that the isolates belonged to genotype G1 (sheep strain). Representative nucleotide sequence obtained in this study was deposited in the GenBank database under the accession number LC068913.1. The phylogenetic analysis showed two clusters. One of the clusters includes G3 genotype (HM5630221) and the other cluster represents all strains related to G1 and G3 genotypes which contain genotype defined in this study as well. The obtained findings demonstrated that G1 genotype is predominant strain of human CE in Lorestan province, Iran, which indicating the sheep-doge cycle in this area. Further studies with more sample size should be conducted to be sure of the sheep strain G1 which is predominant strain in this province.

A Comparison of Efficacy Between Recombinant Activated Factor VII (Aryoseven) and Novoseven in Patients With Hereditary FVIII Deficiency With Inhibitor

Introduction:

This study compared the efficacy of Aryoseven with Novoseven to control bleeding episodes in patients with hemophilia A with inhibitors.

Methods:

Sixty-six patients were randomized into 2 groups, with 4 consecutive block randomization. These groups received Aryoseven and Novoseven dosages of 90 to 120 μg/kg intravenously every 2 hours.

Results:

Median (interquartile range) level of factor VIII (FVIII) inhibitor in groups A and B was 15.0 and 19.0 Bethesda Unit (BU) preadministration. Bleeding onset in group A was 1246 ± 1104 minutes and in group B was 2301 ± 1693 minutes ( P = .311). The Kavakli global response scores and treatment success rate was comparable in both the groups. The side effects in groups A (9.7%) and B (2.9%) were comparable.

Conclusion:

Biosimilar recombinant activated FVII is found to be as effective as Novoseven in the treatment of acute joint bleeding in patients with hemophilia with inhibitors. Its usage will decrease the gaps in hemophilia.

A Comparison Between Recombinant Activated Factor VII (Aryoseven) and Novoseven in Patients With Congenital Factor VII Deficiency

In order to establish the efficacy and biosimilar nature of AryoSeven to NovoSeven in the treatment of congenital factor VII (FVII) deficiency, patients received either agent at 30 μg/kg, intravenously per week for 4 weeks, in a randomized fashion. The primary aim was to compare FVII:coagulation activity (FVII:C), 20 minutes after recombinant activated FVII (rFVIIa) injection, in the 2 groups. A secondary measure was self-reported bleeding. The median interquartile baseline range of the plasma level of activated FVII (FVIIa) activity in the 2 groups was 1.6 (1.1-14.0) IU/dL and 5.0 (1.1-25.5) IU/dL. All patients achieved levels of FVIIa (FVII:C) >30 IU/dL, 20 minutes after the injection of rFVIIa. Bleeding was similar between the 2 groups, with a comparable decrease in severity and frequency compared to the last month prior to treatment. AryoSeven is similar to NovoSeven in increasing postinjection FVIIa activity as well as in clinical safety and efficacy.

Anatomical variations in sinus imaging in sinusitis: a case control study

OBJECTIVE

To compare anatomical variations in sinusitis patients and control subjects.

SUBJECTS AND METHODS

We reviewed and compared the computed tomography (CT) scans of 87 sinusitis patients after adequate medical treatment and scans of 103 healthy subjects. All images were scored for sinusitis severity using the Lund-Mackay scoring system. Anatomical variations such as septal deviation, concha bullosa, presence of the Haller's cell, paradoxical middle turbinate, prominent agger nasi cell, and Onodi cell were also recorded.

RESULTS

Of the 190 evaluated CT images, 55.2% of the cases and 47.6% of the controls had septal deviation (p > 0.05). The prevalence of concha bullosa was 68% in patients and 61% in controls (p > 0.05).

CONCLUSION

There were no significant differences in the evaluated anatomical variations between cases and controls in this study. Mucosal inflammation may play a more essential role than anatomical variation in the development of sinusitis.

Comparison of local anesthetic effects of tramadol and lidocaine used subcutaneously in minor surgeries with local anesthesia

OBJECTIVES

In this study, the local anesthetic and post-operative analgesic effects of tramadol were compared to those of lidocaine in minor surgeries under local anesthesia.

METHODS

This double-blind clinical trial study included 70 patients in ASA physical status I and II, aging between 20 and 50 years, undergoing minor surgery (lipoma excision and revision of scars less than 4 cm within 30 minutes or less) under local anesthesia. The patients were randomly assigned to receive either 2 mg/kg tramadol (group T, n = 35) or 1 mg/kg lidocaine 2% (group L, n = 35) subcutaneously. Scores of the pain sensation were recorded as VAS (visual analogue scale 0-10) during injection, incision and 15, 30 and 45 minutes after incision, and then 2, 4 and 6 hours post-operatively at the ward.

RESULTS

There was no significant difference between pain scores of the two groups during injection, incision and surgery or in the post-operative period at the ward (p = 0.181). Incidence of nausea was 0% and 22.8% in group L and group T, respectively. The difference was statistically significant (p = 0.002). Furthermore, 82.9% of subjects in group L and 60% of subjects in group T needed acetaminophen to control their pain and the difference was significant (p = 0.004).

CONCLUSION

Tramadol 2 mg/kg has local anesthetic and post-operative analgesic effect equal to lidocaine 1 mg/kg in minor surgeries performed subcutaneously. Therefore, we concluded that tramadol can be used as an alternative drug to lidocaine in local anesthesia and has the ability to decrease the demand for post operative analgesics.

Effects of soy consumption on oxidative stress, blood homocysteine, coagulation factors, and phosphorus in peritoneal dialysis patients

OBJECTIVE

We studied the effects of soy consumption on oxidative stress, blood homocysteine, coagulation factors, and phosphorus in peritoneal dialysis patients.

DESIGN

This was an unblinded, randomized clinical trial.

SETTING

This study involved peritoneal dialysis centers in Tehran, Iran.

PATIENTS

We included 40 peritoneal dialysis patients (20 males and 20 females).

INTERVENTION

Peritoneal dialysis patients were randomly assigned to either a soy or control group. Patients in the soy group received 28 g/day textured soy flour (containing 14 g of soy protein) for 8 weeks, whereas patients in the control group received their usual diet, without any soy.

MAIN OUTCOME MEASURES

Blood oxidized low-density lipoprotein (ox-LDL), homocysteine, phosphorus, fibrinogen concentrations, and the activities of coagulation factors VII, IX, and X were measured at baseline and at the end of week 8 of the study.

RESULTS

The percentage of plasma coagulation factor IX activity decreased significantly by 17% in the soy group at the end of week 8 compared with baseline (P < .01), and the reduction was significant compared with the control group (P < .05). There were no significant differences between the two groups in mean changes of blood ox-LDL, homocysteine, phosphorus, fibrinogen concentrations, and the activities of coagulation factors VII and X.

CONCLUSION

Soy consumption reduces plasma coagulation factor IX activity, which is a risk factor for thrombosis in peritoneal dialysis patients.

A combined molecular approach to screen for mec gene variants from methicillin-resistant Staphylococcus aureus

Previous reports have suggested a common origin for all methicillin resistance (mec) genes from methicillin-resistant Staphylococcus aureus (MRSA) isolates examined so far. The purpose of this study was to explore several molecular methods for screening MRSA isolates from different sources and, in some cases, with varying phenotypes. Eighty MRSA isolates from three teaching hospitals in the University of Louisville Medical Center were compared with MRSAs from a hospital in southern California and with methicillin-sensitive S. aureus isolates. The methods were used to detect the presence of mec gene and to screen for any polymorphisms in these genes for the respective strains. The mec gene for each isolate was amplified via the polymerase chain reaction, and each polymerase chain reaction product was compared to the others by restriction enzyme digestion, denaturing-gradient gel electrophoresis, and mutation detection enhancement. By these criteria, the mec genes from the 80 MRSA strains in this study seemed to be identical. Such a finding was not unexpected and supported the existing hypothesis of a common ancestor for all mec genes isolated in MRSA isolates. However, the combination of methods used in this study may facilitate screening of MRSA strains in population studies as mec gene variants begin to emerge.

The effects of allopurinol on the ultrastructure of ischaemic and reperfused large intestine of sheep

OBJECTIVE

To test the possible inhibitory effect of allopurinol on reperfusion injury, caused by oxygen-derived free radicals, of sheep large intestine.

DESIGN

An ultrastructural study on caecal tissues from control and treated groups.

ANIMALS

Fifty sheep in four ischaemic and reperfused (treatment) groups and one control group. Three of the treatment groups were subdivided for half to be injected with allopurinol and the other half with its solvent, potassium hydroxide (KOH).

PROCEDURE

Ischaemia of the caecum was induced in the four treatment groups for 60 minutes by clamping the apex. Allopurinol and its KOH solvent were injected intravenously in three treatment groups prior to ischaemia. Samples were collected before and 1 hour after induction of ischaemia and 1 min, 1 h and 8 h after reperfusion. Tissues were processed and examined with an electron microscope.

RESULTS

Untreated and solvent injected sheep showed minor ultrastructural changes following ischaemia. With reperfusion, there was severe mitochondrial, goblet cell and basement membrane damage. Tissues from allopurinol-treated sheep were preserved and appeared similar to tissues from the control group.

CONCLUSION

Pre-treatment with allopurinol prevented damage to tissues whereas untreated or allopurinol solvent-treated showed severe damage following reperfusion. It is believed that allopurinol, an analogue of hypoxanthine and xanthine, prevents reperfusion injury by competitively binding with xanthine oxidase. This reduces or inhibits the xanthine oxidase mediated conversion of hypoxanthine to xanthine thereby preventing the formation of oxygen-derived free radicals.

Evaluation of effectiveness and tolerability of isosorbide mononitrate during a three-year period in patients with angina pectoris

The antianginal effect and tolerability of isosorbide mononitrate (ISMN), 20 mg 2-3 times daily, orally were investigated in an open study in 28 patients, suffering from coronary heart disease and stable angina pectoris. Ergometric exercise tests were carried out before treatment and 2 h after drug intake, every 3 months during the first year and at 6-month intervals during the following 2 years. At the conclusion of the 3-year study the reduction of ST-segment depression, which had amounted to 58% after 1 year, could be improved to 78% (p less than 0.01). The frequency of angina was markedly reduced during the treatment with ISMN. While 14 of the patients had more than 3 episodes per day prior to the study, 16 patients were symptom-free at the end of the three years' therapy, and none of the patients had more than 1 or 2 attacks per day. The consumption of sublingual nitroglycerin diminished by 94% after one year and by 98% after 3 years of therapy (p less than 0.01). Headache was the only adverse effect observed in some of the patients (at the initiation of the treatment only). In conclusion this study demonstrated (1) the good tolerability of ISMN, at the doses used, and (2) the fact that the antianginal efficacy may be enhanced during the course of the therapy.

Slow-release isosorbide-5-mononitrate--a new once daily therapeutic modality for angina pectoris

The acute and chronic efficacy of slow-release isosorbide-5-mononitrate (IS-5-MN) in the form of Elantan long capsules (50 mg) and the tolerability to this agent were evaluated in an open study of 45 patients with chronic stable angina pectoris, treated for one year. After 3 days of replacement of previous antianginal treatment with placebo, an Elantan long capsule (50 mg) was given once daily in the morning. Exercise test was performed 6 hours after ingestion of the capsule, on placebo (after wash-out of 3 days), in the first day of treatment, and after 3 and 6 months of treatment as well as 6 and 24 hours after 12 months of treatment compared to the exercise test at the same time after discontinuation of treatment (three days on placebo). At comparable work load the drug was associated with a 26.6% reduction in ST-segment depression after 6 hours of acute treatment, 46.7% after 3 months of treatment, 52.2% after 6 months, and 66% at the end of treatment (12 months) (P less than 0.001). Even 24 hours after intake of the last capsule of Elantan long the ST-segment reduction was still 49.5%. Exercise test 24 hours after ingestion of the drug revealed that the effect still exists. In the post-treatment placebo period all values returned to pretreatment levels. The sublingual nitroglycerin consumption was reduced by 90% and the frequency of anginal attacks was reduced from 19 +/- 15 to 1.1 +/- 4.2 weekly (P less than 0.001). The drug was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)