- Iron deficiency and anemia in patients with inherited bleeding disorders. [Journal Article]
- TATransfus Apher Sci 2018; 57(6):735-738
- Patients with inherited bleeding disorders are predisposed to acute and chronic blood loss, which places them at high risk of iron deficiency anemia (IDA). The clinical effects of iron deficiency (ID...
Patients with inherited bleeding disorders are predisposed to acute and chronic blood loss, which places them at high risk of iron deficiency anemia (IDA). The clinical effects of iron deficiency (ID) and IDA in the general population are significant and include low energy, reduced cardiovascular health, impaired cognition and reduced health-related quality of life. However, the incidence and impact of ID and IDA in patients with bleeding disorders is largely unknown. Here we review our approach to the diagnosis and management of iron deficiency in patients with inherited bleeding disorders. Given their risk of future iron losses, we propose more aggressive iron supplementation and higher target ferritin values in patients with ID and ongoing bleeding.
- Clinical Features of Idiopathic Portal Hypertension in China: A Retrospective Study of 338 Patients and Literature Review. [Journal Article]
- JGJ Gastroenterol Hepatol 2018 Nov 21
- CONCLUSIONS: High-quality liver biopsy, detailed clinical information, and expert pathologist are necessary for diagnosis of IPH. IPH can occur concurrently with other liver disease such as hepatitis and drug-induced liver injury. Medication appears to be an important etiological factor for IPH in China. Management approach was largely focused on treatment of portal hypertension and its complications.
- Management of disseminated intravascular coagulation in a patient with hepatic angiosarcoma: A case report. [Case Reports]
- MMedicine (Baltimore) 2018; 97(47):e13321
- CONCLUSIONS: Laboratory measurement of prothrombin fragment 1.2, a byproduct of prothrombin conversion to thrombin, proved to be a useful way to monitor this patient's DIC over time.
- Demographic population cycles and ℛ0 in discrete-time epidemic models. [Journal Article]
- JBJ Biol Dyn 2018; 12(1):961-982
- We use a general autonomous discrete-time infectious disease model to extend the next generation matrix approach for calculating the basic reproduction number, [Formula: see text], to account for pop...
We use a general autonomous discrete-time infectious disease model to extend the next generation matrix approach for calculating the basic reproduction number, [Formula: see text], to account for populations with locally asymptotically stable period k cycles in the disease-free systems, where [Formula: see text]. When [Formula: see text] and the demographic equation (in the absence of the disease) has a locally asymptotically stable period k population cycle, we prove the local asymptotic stability of the disease-free period k cycle. That is, the disease goes extinct whenever [Formula: see text]. Under the same period k demographic assumption but with [Formula: see text], we prove that the disease-free period k population cycle is unstable and the disease persists. Using the Ricker recruitment function, we apply our results to discrete-time infectious disease models that are formulated for Susceptible-Infectious-Recovered (SIR) infections with and without vaccination, and Infectious Salmon Anemia Virus (ISA[Formula: see text]) infections in a salmon population. When [Formula: see text], our simulations show that the disease-free period k cycle dynamics drives the SIR disease dynamics, but not the ISAv disease dynamics.
- Relationship of Estimated GFR and Albuminuria to Concurrent Laboratory Abnormalities: An Individual Participant Data Meta-analysis in a Global Consortium. [Journal Article]
- AJAm J Kidney Dis 2018 Oct 19
- CONCLUSIONS: Variations in study era, health care delivery system, typical diet, and laboratory assays.Lower eGFR was strongly associated with higher odds of multiple laboratory result abnormalities. Knowledge of risk associations might help guide management in the heterogeneous group of patients with CKD.
- Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy. [Review]
- PPharmaceuticals (Basel) 2018 Sep 30; 11(4)
- Anemia in cancer patients is quite common, with remarkable negative impacts on quality of life and overall prognosis. The pathogenesis is complex and typically multifactorial, with iron deficiency (I...
Anemia in cancer patients is quite common, with remarkable negative impacts on quality of life and overall prognosis. The pathogenesis is complex and typically multifactorial, with iron deficiency (ID) often being a major and potentially treatable contributor. In turn, ID in cancer patients can be due to multiple concurring mechanisms, including bleeding (e.g., in gastrointestinal cancers or after surgery), malnutrition, medications, and hepcidin-driven iron sequestration into macrophages with subsequent iron-restricted erythropoiesis. Indeed, either absolute or functional iron deficiency (AID or FID) can occur. While for absolute ID there is a general consensus regarding the laboratory definition (that is ferritin levels <100 ng/mL ± transferrin saturation (TSAT) <20%), a shared definition of functional ID is still lacking. Current therapeutic options in cancer anemia include iron replacement, erythropoietic stimulating agents (ESAs), and blood transfusions. The latter should be kept to a minimum, because of concerns regarding risks, costs, and limited resources. Iron therapy has proved to be a valid approach to enhance efficacy of ESAs and to reduce transfusion need. Available guidelines focus mainly on patients with chemotherapy-associated anemia, and generally suggest intravenous (IV) iron when AID or FID is present. However, in the case of FID, the upper limit of ferritin in association with TSAT <20% at which iron should be prescribed is a matter of controversy, ranging up to 800 ng/mL. An increasingly recognized indication to IV iron in cancer patients is represented by preoperative anemia in elective oncologic surgery. In this setting, the primary goal of treatment is to decrease the need of blood transfusions in the perioperative period, rather than improving anemia-related symptoms as in chemotherapy-associated anemia. Protocols are mainly based on experiences of Patient Blood Management (PBM) in non-oncologic surgery, but no specific guidelines are available for oncologic surgery. Here we discuss some possible approaches to the management of ID in cancer patients in different clinical settings, based on current guidelines and recommendations, emphasizing the need for further research in the field.
- Risk Factors for Complications following Introduction of Radical Surgery for Colon Cancer: A Consecutive Patient Series. [Journal Article]
- SJScand J Surg 2018 Sep 06; :1457496918798208
- CONCLUSIONS: Severe complications following the introduction of complete mesocolic excision are patient dependent and related to open surgery. Patients selected for laparoscopy had less number of complications; therefore, introducing complete mesocolic excision by laparoscopy is justified. Identification of these factors can improve selection of appropriate surgical approach and postoperative patient safety.
- When Transfusion Is Not an Option-the Challenges and Rewards. [Case Reports]
- CCCrit Care Nurs Q 2018 Oct/Dec; 41(4):347-355
- The decision to develop a formal Bloodless Medicine Program to attract and effectively care for patients who decline blood transfusion was made in 1998 by clinical and administrative leaders at our f...
The decision to develop a formal Bloodless Medicine Program to attract and effectively care for patients who decline blood transfusion was made in 1998 by clinical and administrative leaders at our flagship hospital, Allegheny General Hospital, part of the Allegheny Health Network. The Bloodless Medicine Program has more than 20 years of experience in caring for this sometimes challenging patient population and with this experience has provided extensive insight into best practices related to effective, safe, patient blood management. Patient blood management is a patient-centered, evidence-based approach to transfusion that seeks to provide the right care, in the right setting, in the right way, every time. It includes honoring the wishes of patients who decline blood products in their care, that is, "bloodless" medicine. Encouraging patients to participate in their own health care decisions is a vital part of safe, compassionate care. When called upon to provide care to a patient who declines a common therapy such as blood transfusion, clinicians must often develop alternative strategies to achieve the desired results. Their willingness to think creatively and push boundaries has resulted in significant advancement of clinical knowledge and practice related to the use of blood products for all patients. Nurses who advocate for the best care for their patients are a vital component of any successful patient blood management program.
- Systematic review: Features, diagnosis, management and prognosis of hepatic hematoma, a rare complication of ERCP. [Review]
- DLDig Liver Dis 2018; 50(10):997-1003
- CONCLUSIONS: HH is a rare but severe complication following ERCP which needs a multidisciplinary approach. Antibiotics administration is the only treatment able to reduce the risk of death.
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- Predicting patients requiring discharge to post-acute care facilities following primary total hip replacement: Does anesthesia type play a role? [Journal Article]
- JCJ Clin Anesth 2018; 51:32-36
- CONCLUSIONS: We developed a predictive model for post-acute care facility discharge following THR. The use of neuraxial anesthesia was associated with decreased odds for post-acute care facility discharge.