Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates

Objective: Cardiac catheterization is one of the basic procedures applied in the diagnosis and treatment of cardiovascular diseases. Development of thrombosis is a serious complication of catheterization. In this study, the frequency and the factors affecting the development of arterial thrombosis were prospectively evaluated in neonates who were subjected to diagnostic or interventional cardiac catheterization. Methods: Twenty newborns that received femoral artery catheterization within 6-month period were enrolled in this study. Blood samples were taken for complete blood count, prothrombin, activated partial thromboplastin time, INR ratio and mutations of factorV Leiden, prothrombin 20210A, methylenetetrahydrofolate reductase C667T and A1298 before the procedure. 100 U/kg bolus of heparin was infused during catheterization. 28 U/kg/hour infusion of heparin was given to the patients with clinically suspected thrombosis during first few hours after catheterization. Doppler ultrasonography was performed in all patients within 6 hours after catheterization. Results: The gestational age of patients ranged from 31 to 40 weeks (median 39). Mean birth weight was 2996 ± 589 (1880-4000 gr). Arterial thrombosis was detected in 10 patients by Doppler USG. On development of arterial thrombosis, patient age, gender, diagnosis, treatments, platelet count, hemoglobin, prothrombin and activated partial thromboplastin time values, FactorV Leiden, prothrombin 20210A, methylenetetrahydrofolate reductase C667T and A1298 mutations were found as not impacting (p>0.05). Those who were found to have thrombosis in Doppler ultrasonography had lower INR levels compared to others (p= 0.023). Conclusions: The rate of femoral arterial thrombosis in newborns after catheterization detected by Doppler ultrasonography was 50% in this study. Our data suggest that early clinical assessment for the diagnosis of thrombosis may be misleading but Doppler ultrasonography may be helpful early detection. Further studies are needed to prediction appropriate drugs and/or doses for prevention of thrombosis after arterial catheterization in newborns

Clinical and laboratory findings of 97 pediatric brucellosis patients in central Turkey

Brucellosis is a disease transmitted to humans by consumption of unpasteurized animal milk, or through direct contact with infected animals. The aim of this study was to evaluate clinical, laboratory findings of pediatric patients with brucellosis. Data of 97 patients diagnosed with brucellosis between January 2000 and December 2010 were evaluated retrospectively

Clinical and laboratory findings of 97 pediatric brucellosis patients in central Turkey

Brucellosis is a disease transmitted to humans by consumption of unpasteurized animal milk, or through direct contact with infected animals. The aim of this study was to evaluate clinical, laboratory findings of pediatric patients with brucellosis. Data of 97 patients diagnosed with brucellosis between January 2000 and December 2010 were evaluated retrospectively. Copyright (C) 2014, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)