Background: Deep venous thrombosis (DVT) is an important complication in the peripartal and postpartal period. Methods: We followed up prospectively the prevalence of DVT in 34720 prenatal mothers between June 2002 and July 2006 attending the antenatal clinics of two major hospitals in Mumbai, India. Thirty two women (0.1%) presented for the first time with symptomatic DVT i.e. 17 in the first trimester, 6 in the second and 9 in the third trimester of pregnancy. Nine had history of fetal loss while in the remaining twenty three there was no history of fetal loss. Results: The evaluation of both acquired and heritable thrombophilia showed a conglomeration of thrombophilia in this group when compared to 100 normal pregnant women who have given birth to at least one healthy baby with no history of fetal death, DVT or other obstetrical complications. The relative risks for all the antiphospholipid antibodies (APA) studied i.e lupus anticoagulant (LA), IgG/IgM antibodies for cardiolipin (ACA), 2 glycoprotein 1 ( 2 GP 1) and annexin V were significantly higher in women with pregnancy associated DVT (RR 7.4 95% CI 4.3 11.3 P < 0.05). Among the genetic thrombophilia markers studied, Protein S (PS) deficiency was the strongest risk factor (RR 5.00 95% CI 3.02 5.00 P < 0.05) followed by factor V Leiden (FVL) mutation (RR 4.57 95% CI 2.23 4.57 P < 0.05) and PAI 4G/4G homozygosity (RR 3.24 95% CI 1.85 5.12 P < 0.05). Protein C (PC) and endothelial protein C receptor (EPCR) 23 bp insertion polymorphism was also increased in the patient group as compared to controls but the difference was not statistically significant. The MTHFR C677T, fibrinogen gene 448 Arg/Lys polymorphisms were not significantly different from the normal controls, while antithrombin III (AT III) deficiency and PT G20210A polymorphism were absent in both controls and patients. Two or more risk factors were present in 22 out of 32 cases (68.75%). Conclusion: We conclude that the prevalence of DVT in India is more or less similar to other reports published and both acquired and heritable thrombophilia show strong association with DVT associated with pregnancy.

Doctor Who - Day of the Daleks
Doctor Who - Day of the Daleks Customer Review: an eye sore and a bore to boot. Like a lot of the 1972 pertwee stuff this was flat and had a lot of extra scenes of running around and Pertwee action which was lame and snoozer boring. The Three-wheeler(3-wheeled motorcycle called a “rover” […]

Evaluation of the TEG platelet mapping assay in blood donors
Background: Monitoring of antiplatelet therapy in patients at cardiovascular risk is difficult because existing platelet function tests are too sophisticated for clinical routine. The whole blood TEG Platelet Mapping assay measures clot strength as maximal amplitude (MA) and enables for quantification of platelet function, including the contribution of the adenosine diphosphate (ADP) and thromboxane A2 (TxA2) receptors to clot formation. Methods: In 43 healthy blood donors, the analytical (CVa) and inter-individual variability (CVg) of the TEG Platelet Mapping assay were determined together with platelet receptor inhibition in response to arachidonic acid (AA) and ADP. Results: The CVa of the assay for maximal platelet contribution to clot strength (MAThrombin) was 3.5%, for the fibrin contribution to clot strength (MAFibrin) 5.2%, for MAAA 4.5% and for MAADP it was 6.6%. The MAThrombin CVg was 2.8%, MAFibrin 4.7%, MAAA 6.6% and for MAADP it was 26.2%. Females had a higher MAThrombin compared to males (62.8 vs. 58.4 mm, p = 0.005). The platelet TxA2 receptor inhibition was 1.2% (range 0 10%) and lower than for the ADP receptor (18.6% (0 58%); p < 0.0001). Conclusion: The high variability in ADP receptor inhibition may explain both the differences in response to ADP receptor inhibitor therapy and why major bleeding sometimes develops during surgery in patients not treated with ADP receptor inhibitors. An analytical variation of ~5 % for the TEG enables, however, for routine monitoring of the variability in ADP receptor inhibition and of antiplatelet therapy.

Why differentiate low molecular weight heparins for venous thromboembolism?
Editorial

HPA-1 polymorphism of IIb 3 modulates platelet adhesion onto immobilized fibrinogen in an in-vitro flow system
Background: Platelet adhesion and subsequent thrombus formation on a subendothelial matrix at the site of vascular damage play a crucial role in the arrest of posttraumatic bleeding but also in different pathological thrombotic events, such as acute coronary syndrome and stroke. Recently published studies have clearly demonstrated that platelet integri IIb 3 is intimately involved in the occlusive thrombus formation at the site of endothelial damage. Therefore, any genetic variation in the expression of this receptor may lead to an excessive bleeding or excessive thrombus formation. In this study, we evaluated the influence of HPA-1 polymorphism of integrin IIb 3 on platelet adhesion onto immobilized fibrinogen using an in vitro system simulating blood flow. Methods: Platelets in anticoagulated whole blood [49 healthy previously genotyped blood donors) were labelled with fluorescence dye and perfused through a rectangular flow chamber (shear rates of 50 s-1, 500 s-1 and 1500 s-1). A fluorescence laser-scan microscope was used for visualisation and quantification of platelet adhesion at 15 sec, 1 and 5 minutes after start of perfusion. Results: During perfusion, the platelet adhesion linearly increased with regard to exposition time and shear rate. Perfusion of blood preincubated with Abciximab over fibrinogen-coated cover-slips showed reduced platelet adherence (absolute fluorescence: 168 35 U vs. 53000 19000 at control experiments, p < 0.05), as well as by perfusion over BSA-coated glass coverslips. Platelet with HPA-1a/1a genotype exhibited initial better adhesion but they also exhibited higher detachment under arterial flow conditions compared to the HPA-1b/1b platelets. Analysis of stable adhesion rate indicate that the platelets carrying the HPA-1b/1b genotype have a higher reactivity threshold for initial interaction with fibrinogen but under the higher shear rate (in regard to time of perfusion) also realize more stable bonds with fibrinogen than platelets with the HPA-1a/1a genotype. Conclusion: Our data support the contention that genetically determined variants of platelet integrins IIb 3 could play a role in arterial thrombogenesis and thus confirm the hypothesis derived from epidemiological studies.

Histological composition and progression of carotid plaque
Background: To analyse histological composition and progression of carotid plaque. Methods: Thirty-one patients (22 males, mean age 68.03 7.3 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis ( 70% luminal narrowing) were enrolled. The patients were divided into 2 groups according to symptomatology (group I, 17 symptomatic patients; and group II, 14 asymptomatic patients). A histological analysis and inflammatory cell quantification of each excised carotid plaque was made. Nine carotid arteries were removed from human cadavers that were not preselected for carotid artery disease. These specimens were used as a control tissue without any macroscopic signs of atherosclerotic plaques. Results: Fifty eight percent of all carotid plaques were classified as complex plaque with possible surface defect, hemorrhage or thrombus. The inflammatory cells concentration did not differ between the two groups. All specimens from human cadavers were classified as preatheroma with extracellular lipid pools. Conclusion: Asymptomatic and symptomatic patients could have the same histological components on their carotid plaques. Fibrotic and calcific plaques could become vulnerable as complex plaques with surface defect, hemorrhage and thrombus could remain silent. Asymptomatic carotid stenosis should be followed close with no invasive diagnostic methods and clinical evaluation.

Living Yoga: Stress Relief Yoga for Beginners
Living Yoga: Stress Relief Yoga for Beginners “Today our world moves more quickly than ever, with greater responsibilities and expectations,” says instructor Suzanne Deason. “When we experience stress, it’s held in our muscles as tension.” This 20-minute yoga practice, filmed at sunset on the beach at Maui, will help relax your mind and muscles–especially […]

Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation
Recommendations for urgent reversal of oral anticoagulation with vitamin K1 antagonists are largely derived from case series employing empirical dosing regimens with vitamin K1 and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR) reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K1 in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.

Designer Retro Ice Bag - Pink Hearts
Designer Retro Ice Bag - Pink Hearts Remember those old fashioned English ice bags grandma had before pre-made ice packs came along? Well they?re back! The Retro Ice Bag is a scaled down version of the old style updated with colorful design fabrics. Holds hot water as well as ice, so it?s a great […]

For lazy women children (equals) child support (equals) social security bonus Keychain
For lazy women…children (equals) child support (equals) social security bonus Keychain Text on keychain: For lazy women…children (equals) child support (equals) social security bonus* Durable acrylic key chain is crystal-clear and double-sided so the artwork or message is seen twice. * Sturdy metal ring holds your keys securely. * Full color printed images […]

This entry was posted on Friday, August 24th, 2007 at 10:12 pm and is filed under Vitamins. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.