Platelet dysfunction and inhibition of multiple electrode platelet aggregometry caused by penicillin

Beta-lactam antibiotics, e.g. penicillin, may inhibit platelet function and lead to reduced response in light transmission aggregometry and adhesion. However, influence on platelet function tests more commonly used in clinical practice, such as multiple electrode platelet aggregometry (MEA), have not been described so far. We report a case of a patient with local streptococcus infection. Treatment with penicillin resulted in mild bleeding tendency after 3 days. While coagulation parameters were normal, assessment of platelet function by MEA revealed strong platelet inhibition of both ADP and arachidonic acid induced platelet aggregation comparable to normal responders to antiplatelet therapy. Change of antibiotic regime resulted in recovery of platelet function. Thus, penicillin therapy may impact on platelet function and consecutively commonly used platelet function assays, e.g. MEA

Afiliação das estudantes negras ao curso de Medicina da UFRB

This present work has as its theme, the affiliation of black girl student from Medicine course who are assisted by the Management Centre of the Dean of Affirmative Policies and Student Affairs, at the UFRB Health Sciences Centre. It is guided by the question: “what is the path of the black girl student in medicine course who is assisted by the NGP/CCS at UFRB like?” The general aim is to understand the affiliation process of the black girl student assisted by the NGP/CCS to the UFRB Medicine course. In addition, the specific goals are: a) to describe the students' life stories based on their own accounts, b) to describe their university trajectories and c) to identify the strategies developed by them in their adaptation to the chosen course. Coulon's affiliation theory and Nery's contributions have been used. The Chicago School tradition goes on. It considers the point of view of social actors for the production of useful knowledge. As a theoretical framework of methodological support, this work is anchored by symbolic interactionism and it makes use of the comprehensive interview by Kaufmann as a technique. The field is the Management Nucleus of the Dean of Affirmative Policies and Student Affairs, at the Health Sciences Centre. Four students who met the research inclusion criteria were interviewed, being the criteria as follows: a) to be a university girl student from the Medicine course, b) to be self-declared as black or mixed raced and c) to be guided by the NGP/CCS of UFRB. Results: the students are the first from their families to enter the Medicine course and their families support the continuity of their studies. In their affiliation processes, the girl students suffer socio-affective and pedagogical ruptures during the period of estrangement, however, an anticipation of ambiguity has been perceived. Although there is high competition in the Medicine course, the students managed to create a new social-affective support network and develop adaptive skills and strategies. There is an extension of time for affiliation, which is completed in the third year of the course, when they enter the second cycle. A demand for guidance regarding study methods in higher education has been identified. At some point in their university trajectories, the students showed concern for their health, which strengthens the importance of psychological support and the need for the university to invest in the Psychology Service. There is recognition of the contribution of the affirmative action policy for the university trajectories of the participants; however, it is not possible to frame UFRB as an illustrative case of an anti-racist university. Reports on situations of moral and sexual harassment and gender discrimination have also emerged from the field. Due to its results, this research can contribute to improving the implementation of the affirmative action policy, especially for the expansion and the strengthening of the Psychology Service. This study finds limits in issues regarding race, gender and inclusion of people with disabilities, as it did not include black boy students, non-black male nor female students, neither male cis students nor transgender students or students with disabilities.OUTRASO presente trabalho tem como tema a afiliação da estudante negra assistida pelo Núcleo de Gestão da Pró-reitoria de Políticas Afirmativas e Assuntos Estudantis, no Centro de Ciências da Saúde da UFRB, ao curso de Medicina, e guia-se pela questão: “como se dá a trajetória da estudante negra do curso de Medicina assistida pelo NGP/CCS da UFRB?”. Tem como objetivo geral: compreender o processo de afiliação da estudante negra assistida pelo NGP/CCS ao curso de Medicina da UFRB, e como objetivos específicos: a) descrever as histórias de vida das estudantes a partir de suas próprias narrativas, b) descrever suas trajetórias universitárias e c) identificar as estratégias por elas desenvolvidas na sua adaptação ao curso escolhido. Este estudo adota a teoria da afiliação de Coulon e as contribuições de Nery, e segue com a tradição da Escola de Chicago, que considera o ponto de vista dos atores sociais para a produção de conhecimento útil. Como marco teórico de sustentação metodológica, este trabalho ancora-se no interacionismo simbólico e vale-se da entrevista compreensiva de Kaufmann como técnica. O campo é o Núcleo de Gestão da Pró-reitoria de Políticas Afirmativas e Assuntos Estudantis, no Centro de Ciências da Saúde. Foram entrevistadas quatro estudantes que cumpriam os critérios de inclusão da pesquisa: a) ser estudante universitária do curso de Medicina, b) autodeclarar-se preta ou parda e c) estar sendo acompanhada pelo NGP/CCS da UFRB. Resultados: as estudantes são as primeiras de seus núcleos familiares a ingressarem no curso de Medicina e suas famílias apoiam a continuidade de seus estudos. Em seus processos de afiliação, as estudantes sofrem as rupturas socioafetiva e pedagógica no tempo do estranhamento, contudo, foi percebida antecipação da ambiguidade. Apesar da competição no curso ter sido destacada, as estudantes conseguiram criar uma nova rede de apoio socioafetiva e desenvolver competências e estratégias adaptativas. Há o prolongamento do tempo para a afiliação, que se perfaz no terceiro ano do curso, com o ingresso no segundo ciclo. Foi identificada demanda por orientação quanto aos métodos de estudo no ensino superior. Em algum momento de suas trajetórias universitárias, as estudantes demonstraram preocupação com sua saúde, o que fortalece a importância do acompanhamento psicológico e a necessidade de a universidade investir no Serviço de Psicologia. Há o reconhecimento da contribuição da política de ação afirmativa para a trajetória universitária das participantes, todavia, não é possível enquadrar a UFRB como um caso ilustrativo de universidade antirracista. Emergiram do campo também relatos sobre situações de assédio moral, sexual e discriminação de gênero. Por conta de seus resultados, esta pesquisa pode contribuir para o aprimoramento da execução da política de ação afirmativa, em especial para a ampliação e o fortalecimento do Serviço de Psicologia. Este estudo encontra limites em questões de raça, gênero e inclusão de pessoas com deficiência, pois não contemplou estudantes não-negros, nem os estudantes cis do gênero masculino nem os estudantes transgênero nem estudantes com deficiência

Plasma TF activity predicts cardiovascular mortality in patients with acute myocardial infarction

<p>Abstract</p> <p>Objectives and Background</p> <p>Tissue factor (TF) contributes to thrombosis following plaque disruption in acute coronary syndromes (ACS). Aim of the study was to investigate the impact of plasma TF activity on prognosis in patients with ACS.</p> <p>Methods and Results</p> <p>One-hundred seventy-four patients with unstable Angina pectoris (uAP) and 112 patients with acute myocardial infarction (AMI) were included with a mean follow up time of 3.26 years. On admission, plasma TF activity was assessed. Patients were categorized into 2 groups: a high-TF activity group with TF >24 pmol/L and low TF activity group with TF ≤ 24 pmol/L. Fifteen cardiovascular deaths occurred in the uAP group and 16 in the AMI group. In AMI TF activity was 24,9 ± 2,78 pmol/l (mean ± SEM) in survivors and 40,9 ± 7,96 pmol/l in nonsurvivors (P = 0.024). In uAP no differences were observed (25.0 ± 8.04 pmol/L nonsurvivors vs. 25.7 ± 2.14 pmol/L survivors; P = 0.586). Kaplan-Meier estimates of survival at 3.26 years regarding TF activity in AMI were 81.3% and 92.2% with an hazard ratio of 3.02 (95% CI [1.05–8.79], P = 0.03). The Cox proportional hazards model adjusting for correlates of age and risk factors showed that plasma TF activity was an independent correlate of survival (hazard ratio 9.27, 95% CI [1.24–69.12], P = 0.03). In an additional group of patients with uAP and AMI, we identified circulating microparticles as the prevailing reservoir of plasma TF activity in acute coronary syndromes.</p> <p>Conclusion</p> <p>Systemic TF activity in AMI has an unfavorable prognostic value and as a marker for dysregulated coagulation may add to predict the atherothrombotic risk.</p

Clinical Considerations with the Use of Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

Despite the proven benefits of using antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI), a number of key questions remain to be answered. In recent years, clopidogrel dosing strategies among such patients have evolved considerably, with newer approaches involving loading doses prior to PCI and increases in the time interval and loading dosage in an effort to overcome variable responsiveness/hyporesponsiveness to platelet inhibition. Further, the role of glycoprotein (GP) IIb/IIIa antagonists in elective stenting continues to be defined, with recent evidence suggesting that most appropriate use of these agents is in high-risk patients with elevated troponin levels. There appears to be a relationship between the use of GP IIb/IIIa antagonists with clopidogrel loading and attenuation of early inflammatory and cardiac marker release. Strategies to minimize the chance of late stent thrombosis in patients who receive drug-eluting stents (DES) are also under intense investigation. Among some patients receiving sirolimus and paclitaxel DES, current standard long-term antiplatelet strategies may be insufficient. Patient nonadherence to treatment and premature discontinuation and underutilization of antiplatelet therapies by physicians remain important clinical problems with potentially dire consequences. Copyright © 2008 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58553/1/20359_ftp.pd

Transoral Robotic Surgery in the Nordic Countries : Current Status and Perspectives

Background: The five Nordic countries with a population of 27 M people form a rather homogenous region in terms of health care. The management of head and neck cancer is centralized to the 21 university hospitals in these countries. Our aim was to gain an overview of the volume and role of transoral robotic surgery (TORS) and to evaluate the need to centralize it in this area as the field is rapidly developing. Materials and Methods: A structured questionnaire was sent to all 10 Departments of Otorhinolaryngology-Head and Neck Surgery in the Nordic countries having an active programme for TORS in December 2017. Results: The total cumulative number of performed robotic surgeries at these 10 Nordic centers was 528 and varied between 5 and 240 per center. The median annual number of robotic surgeries was 38 (range, 5-60). The observed number of annually operated cases remained fairly low ( Conclusions: The present results showing a limited volume of performed surgeries call for considerations to further centralize TORS in the Nordic countries.Peer reviewe

Is there any relationship between ABO/Rh blood group and patients with pre-eclampsia?

Objectives: The purpose of the present study was to evaluate the association between pre-eclampsia and blood groups in a group of pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil -Hospital São Lucas (HSL)/PUCRS. Study design: Our sample consisted of 10.040 pregnant women admitted to the maternity department of HSL between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Medical records of 414 women were diagnosed as preeclampsia/eclampsia and were identified 9611 women to the control group. The patients were divided into two groups: the group with preeclampsia/eclampsia and the control group, and their blood groups were considered. Data were analyzed using SPSS for Windows version 17.0. Categorical data were summarized by counts and percentages, with the statistical significance evaluated by the Chi-square test. The null hypothesis was rejected when p<0.05. Main outcome measures: Maternal parameters were compared between control group and pre-eclampsia, respectively, Systolic Blood Pressure (117±19,98 vs. 165±19,99); Diastolic Blood Pressure (73±14,23 vs. 106±14,24) and maternal weight at booking (73± 33 vs. 83± 33). For all data: mean+SD; P<0.05. In relation to blood groups, firstly they were stratified by Rh and ABO phenotypes, separately. After that the groups were stand together Results: No differences in blood group distribution were observed between controls and pre-eclampsia for any analysis. (p>0.05). Conclusions: When we adopted stricter criteria for pre-eclampsia and a large sample from the same region we noted that the results did not show any association between blood groups and the development of pre-eclampsia