D-Dimer assay as a non invasive test for the diagnosis of left atrial Thrombi in Indian patients with Rheumatic MS

Background

Systemic embolism is a serious and sometime fatal complication of rheumatic MS.

Objective

We assessed the predictive power of D-Dimer level to predict occurrence of left atrial (LA) thrombi in patients with rheumatic mitral stenosis (MS).

Methods

D-dimer levels were analyzed for 24 patients with rheumatic MS with LA clot and 22 patients with rheumatic MS with no LA clot undergoing transeosophageal echocardiography. A level more than 4 µg/ml was taken as elevated to predict the presence of LA clot in the study groups.

Results

For a cut-off value of 4 µg/ml, sensitivity was 66.67 % and specificity 100 % for prediction of LA clot and AUC 0.710. A cut-off value of less than 1 µg/ml, sensitivity was 91.67 % and 87. 5 % negative predictive value for ruling out presence of LA clot and AUC 0.721.

Conclusion

A higher value of D-dimer can predict the possible presence of a LA clot and very low value can predict absence of clot in patients with rheumatic MS.     

Characterization of erythrocyte quality during the refrigerated storage of whole blood containing di-(2-ethylhexyl) phthalate

Di-(2-ethylhexyl) phthalate (DEHP) accumulates in blood brought into contact with materials utilizing this compound as a plasticizer. To determine whether this phthalate diester affects red blood cell integrity, we have compared cell morphology, plasma hemoglobin accumulation, micro-vesicle production, and the concentration of intracellular metabolites and electrolytes of erythrocytes from blood stored at 4 degrees C with and without DEHP. When sufficient emulsified DEHP was mixed with blood to give a final concentration of 300 micrograms/mL, plasma hemoglobin accumulation was reduced by an average of 70%, the percentage of cells exhibiting normal morphology was enhanced by at least 20-fold, and the volume of microvesicles released from red blood cells was reduced by 50% after 35 days of refrigerated storage compared to the values obtained from corresponding samples stored without added phthalate. Similar effects were observed regardless of whether blood was stored in nonplasticized polypropylene or tri-(2-ethylhexyl) trimellitate plasticized polyvinylchloride containers and with DEHP solubilized by a variety of emulsifiers. When 300 micrograms/mL DEHP was added to stored blood containing erythrocytes predominantly in the echinocyte conformation, many of the cells reverted to the normal discoid morphology. The addition of this quantity of DEHP to blood had no significant effect on the course of storage-induced changes in erythrocyte adenosine triphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG), sodium or potassium concentrations. The data are consistent with the hypothesis that DEHP inhibits the deterioration of the red blood cell membrane that results from the refrigerated storage of whole blood.     

1282名驾驶员焦虑水平与危险驾驶关系研究

[摘要] 目的 探讨驾驶员焦虑水平对危险驾驶行为的关系。方法 采用问卷调查法,分别使用贝克焦虑量表与 Dula危险驾驶行为量表( DDDI-Dula Dangerous Driving Index)对1285名驾驶员的焦虑水平与危险驾驶行为进行了评价。此外,研究分析两者之间的相关性,对不同焦虑水平驾驶员的危险行为进行方差分析。 结果 （1）焦虑总分与危险驾驶量表总分呈显著性正相关（p<.01）,焦虑总分与危险驾驶量表的三个子量表分数均呈显著性正相关（p<.01）。（2）由F检验知,处于不同焦虑水平的驾驶员其危险驾驶行为在以下方面存在不同（p<.05）：DDDI总分,过去6个月的驾驶肇事次数,过去两个周 "尾随"行为的次数,过去两周内超速的次数,过去两周内超速驶入应停车减速的区域的次数,过去四周影响下驾驶行为的次数。结论 驾驶员的焦虑水平可以影响危险驾驶行为,高的焦虑水平与更多的危险驾驶行为显著相关。     

Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands

Background  

In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands.     

Phototherapy and malignancy: possible enhancement by iron administration and hyperbaric oxygen

Photodynamic therapy (PDT) is a new therapeutic approach for the treatment of malignant tumors. Hyperbaric oxygen (HBO(2)) shows beneficial effects in various modalities of cancer interventions. Tumor cells tend to accumulate large amount of iron. There is interaction between tissue content of oxygen, iron, free radical production and tissue damage. Accumulation of intracellular iron is necessary for the production of oxygen radicals. HBO(2) increases tissue oxygen and hydrogen peroxide production in the cells. Malignant cells require iron, and exhibit more transferrin receptors. The photodynamic sensitization of human leukemic cells is achieved with accumulation of porphyrins stimulated by 5-aminolaevulanic acid (ALA) plus hemin. Further, a significant improvement in tumor response is obtained when PDT is delivered during hyperoxygenation. When PDT is combined with hyperoxygenation, the hypoxic condition is improved and the cell killing rate at various time points after PDT is significantly enhanced. Photosensitization with use of porphyrins is used with HBO(2) and PDT for treatment of certain tumors. PDT with ALA is used for treatment of actinic keratosis (AK). The combination of iron administration (by injection or oral rout), hemin, or transferrin, as a source for iron, HBO(2) as a source of oxygen under pressure and PDT as a source of generating free-radical tissue damage may be useful in the treatment of tumors. The possibility of combining HBO(2), iron, light and local photosensitizers to overcome skin tumors deserve extensive laboratory and clinical research work. Conclusively, iron, HBO(2), and PDT may have synergistic effect to hamper tumor cells.