Lupus anticoagulant in systemic lupus erythematosus and its association with complications

Background: The anti-phospholipid antibody which can occur secondary to SLE have a broad spectrum of both thrombotic and non-thrombotic manifestations. Among the three antiphospholipid antibodies, lupus anticoagulant has the strongest association with antiphospholipid syndrome (APS) and increased chance of recurrence of thrombotic events. Hence early screening of lupus anticoagulant is needed.Methods: 72 clinically diagnosed SLE patients were included. The PT, aPTT were done in all patients. The clotting time is assessed by semi-automated coagulation analyser by using dilute russell viper venom time (dRVV) screen and confirm kits. Lupus anticoagulant was considered to be positive if the screen to confirm ratio is ≥1.2. The patients were followed up for a period of 1 year at regular 3 months interval. The various complications like hemolytic anemia, thrombocytopenia, deep vein thrombosis, cerebrovascular accident/transient ischemic attack (CVA/TIA), myocardial infarction, abortions, pulmonary artery hypertension and lupus nephritis were recorded.Results: Lupus anticoagulant was positive in 38.8% among the study group. The most common thrombotic event observed was DVT (16.7%) followed by MI (11.1%) and CVA/TIA (8.3%). There is significant association between lupus anticoagulant positivity with hemolytic anemia, DVT and pulmonary artery hypertension.Conclusions: The lupus anticoagulant has the strongest association with APS in SLE patients and dRVVT is the test of choice in diagnosing APLA. Early recognition of APLA can reduce the risk of thrombotic complications and can prevent further episodes by giving adequate thromboprophylaxis to lupus anticoagulant positive patients

Expression of core antigen of HCV genotype 3a and its evaluation as screening agent for HCV infection in Pakistan

<p>Abstract</p> <p>Background</p> <p>Pakistan is facing a threat from hepatitis C infection which is increasing at an alarming rate throughout the country. More specific and sensitive screening assays are needed to timely and correctly diagnose this infection.</p> <p>Methods</p> <p>After RNA extraction from specimen (HCV-3a), cDNA was synthesized that was used to amplify full length core gene of HCV 3a. After verification through PCR, DNA sequencing and BLAST, a properly oriented positive recombinant plasmid for core gene was digested with proper restriction enzymes to release the target gene which was then inserted downstream of GST encoding DNA in the same open reading frame at proper restriction sites in multiple cloning site of pGEX4t2 expression vector. Recombinant expression vector for each gene was transformed in <it>E. coli </it>BL21 (DE3) and induced with IPTG for recombinant fusion protein production that was then purified through affinity chromatography. Western blot and Enzyme Linked Immunosorbant Assay (ELISA) were used to detect immuno-reactivity of the recombinant protein.</p> <p>Results</p> <p>The HCV core antigen produced in prokaryotic expression system was reactive and used to develop a screening assay. After validating the positivity (100%) and negativity (100%) of in-house anti-HCV screening assay through a standardized panel of 200 HCV positive and 200 HCV negative sera, a group of 120 serum specimens of suspected HCV infection were subjected to comparative analysis of our method with commercially available assay. The comparison confirmed that our method is more specific than the commercially available assays for HCV strains circulating in this specific geographical region of the world and could thus be used for HCV screening in Pakistan.</p> <p>Conclusion</p> <p>In this study, we devised a screening assay after successful PCR amplification, isolation, sequencing, expression and purification of core antigen of HCV genotype 3a. Our developed screening assay is more sensitive, specific and reproducible than the commercially available screening assays in Pakistan.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Relatório de estágio em farmácia comunitária

Relatório de estágio realizado no âmbito do Mestrado Integrado em Ciências Farmacêuticas, apresentado à Faculdade de Farmácia da Universidade de Coimbr

Enhancement in the efficiency of heat recovery in a Williamson hybrid nanofluid over a vertically thin needle with entropy generation

The purpose of the present research is to conduct an examination of entropy generation in a 2D magneto Williamson hybrid nanofluid flow that contains cobalt ferrite and titanium oxide nanoparticles and undergoes surface-catalyzed reactions through a thin vertical needle. The consequences of joule heating and viscous dissipation are considered to elaborate the features of heat transport. Further, the influence of thermal stratification, thermal radiation, and homogeneous-heterogeneous reaction is also taken into account. Through the application of appropriate similarity variables, the dimensionless system of coupled ordinary differential equations is achieved. The coupled system of equations is numerically solved by the usage of the bvp4c technique in the MATLAB algorithm. The current investigation also compared the existing outcomes with the available literature, which shows great harmony between the two. The consequences of the physical parameters are discussed graphically and with numerical data. It is worth noting that larger values of homogeneous reaction strength and the surface-catalyzed parameter diminish the concentration field. Further, the velocity distribution and their related momentum boundary layer thickness, diminishes with the enlargement of the Weissenberg parameter