Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion

BACKGROUND: Babesiosis is an increasingly recognized parasitic infection with manifestations that range from a subclinical or mild flu-like illness to life-threatening disease. Risk factors that may be associated with a more severe clinical course include immunosuppression, splenectomy, and advanced age. The most effective chemotherapeutic regimen, clindamycin plus quinine, is sometimes ineffective in cases of severe disease. CASE REPORT: A previously healthy, 58-year-old man was infected by Babesia microti, presumably through a tick bite. He developed fulminant disease characterized by severe hemolytic anemia, disseminated intravascular coagulation, acute renal failure, and respiratory failure. There was no history of splenectomy or immunodeficiency. He was given oral clindamycin (300 mg/4x/day) 2 days before admission. Oral quinine (650 mg/3x/day) was added upon hospitalization. There was no clinical improvement despite antibiotic therapy with clindamycin and quinine. On the second hospital day, a whole-blood exchange transfusion was performed to simultaneously lower the parasite load and replace the patient's plasma. With an automated blood cell separator, 87 percent of the patient's total blood volume was exchanged. As replacement fluid, 6.7 L of packed RBCs reconstituted with FFP (average Hct, 33%) was used. The patient's Hct increased from 26.9 percent before the exchange to 28.3 percent after the exchange. The percentage of parasitized RBCs decreased from 13.8 percent just before exchange to 4.2 percent immediately after exchange. There was rapid clinical improvement after the whole-blood exchange transfusion. The patient's subsequent clinical course was marked by a disappearance of the parasitemia and continued slow, general improvement. Therapy with clindamycin was continued for 14 days after the exchange transfusion and quinine for 17 days. CONCLUSION: In cases of severe babesiosis, prompt institution of whole-blood exchange transfusion, in combination with appropriate antimicrobial therapy, can be life-saving.     

Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions

BACKGROUND: Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, the target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore, the neonates who might benefit from rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identifying these patients. STUDY DESIGN AND METHODS: A historic cohort study of all patients in the neonatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted. RESULTS: Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with extracorporeal membrane oxygenation and were excluded from further analysis. Of the remaining 114 patients, 55 (48%) received one transfusion and 59 (52%) received more than one transfusion (21 had >4). None of the demographic factors examined predicted multiple platelet transfusions. However, two clinical conditions did; liver disease and renal insufficiency. Neonates who received one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 platelet transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001). CONCLUSION: NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial.     

The relationship between blood leptin level and bone density is specific to ethnicity and menopausal status

Leptin, the obesity hormone, has been linked to bone mineralization and tumorigenesis. In addition, both bone mineral density (BMD) and postmenopausal breast cancer are associated with obesity, but the interrelationships between obesity, leptin, BMD, and breast cancer are not yet clear. In particular, there is little published research comparing white and black women in terms of these variables. We obtained blood specimens for leptin analysis from a group of 320 breast cancer patients and controls with an ethnic composition of 49% white women and 51% black women. Distal and proximal radial BMD (DBMD and PBMD) were measured by dual-energy X-ray absorptiometry, and age- and ethnicity-specific standardized scores (Z-scores) were calculated for bone density. Blood leptin levels were determined by radioimmunoassay. Blood leptin level was not linked to breast cancer risk. Leptin levels were significantly higher in black women than in white women and were also significantly higher in obese and overweight women than in normal-weight women. Black women weighed more and had a higher body mass index (BMI) than white women. After controlling for BMI, leptin was correlated with DBMD ( r = .17; P < .05) and PBMD ( r = .21; P < .05) in whites, but not in blacks. Leptin was also correlated with both distal and proximal Z-scores in postmenopausal women ( r = .14 and .13; P < .05). Thus leptin may be a predictor for BMD in a population that is prone to have a low BMD, and this relationship is independent of the effect of body weight on leptin levels. Our results suggest that ethnicity and menopausal status should be considered when comparing results from different studies.     

不同型号仪器测定凝血酶原时间的可比性研究

目的探讨不同型号血凝仪检测凝血酶原时间（PT）的检测结果是否具有可比性。方法分别采用不同水平STAGO质控物、DADE质控物和75例不同浓度的患者新鲜血浆，在2个不同的检测系统（STA—R、CA7000）测定PT，并对其检测结果进行相关的统计学分析。结果5个水平的质控物测定结果经t检验，各组间的差异均有显著性（P〈0．01）。各检测系统间不同浓度的患者新鲜血浆测定结果差异有非常显著性（P〈0．01）；相关系数均=0．975。以STA—R作标准检测系统对其他检测系统作临床可接受性能评价，CA7000可接受。结论2个检测系统测定PT精密度和临床可接受性能评价均符合临床要求，应定期对以上的检测系统进行比对实验，以保证检验结果间的可比性。     

Comparison of biliary atresia with and without intracranial hemorrhage

Background/Purpose

Intracranial hemorrhage (ICH) is a severe complication of biliary atresia (BA). We aimed to compare the clinical data of BA patients with and without ICH.

妊娠晚期孕妇血凝状态的对照研究

目的探讨妊娠晚期(孕28~40 w)孕妇PT、APTT、F IB和TT等血凝指标的变化。方法用SY SM EX CA-1500全自动血凝分析仪和D ade B ehring血凝试剂对照检测100例妊娠晚期女性与100例正常育龄未孕女性凝血PT、APTT、F IB和TT。结果两组人群血凝指标中APTT(P<0.05)有显著性差异,PT(P<0.001)、F IB(P<0.001)、TT(P<0.002)结果有极显著性差异。结论妊娠晚期与正常育龄未孕女性血凝指标中除APTT有显著性差异外,PT、F IB、TT均有极显著性差异。提示应密切观察孕妇PT、APTT、F IB及TT等的变化,以便及时了解孕妇凝血功能。     

Self-Report of Outpatient Therapy Dose at 6 and 12 Months After Severe Traumatic Brain Injury

Objective

Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.

Subchronic toxicity evaluation of aloesin

Aloesin, an aromatic chromone present in various Aloe species, shows potential beneficial effects on indices related to pre-diabetic states, including metabolic syndrome. Aloesin may have utility as a functional food ingredient. As part of a program to assess its safety, aloesin was administered by oral gavage at doses of 250, 500, and 1000 mg/kg body weight/day to groups of 10 male and 10 female Sprague-Dawley rats for 90 days. Treatment was not associated with mortality and appeared to be well tolerated. There were no toxicologically or statistically significant changes in body weight gain or in feed and water consumption. A few statistically significant changes in serum biochemistry and hematology parameters were noted, but all were mild in nature, were confined to one sex, and/or did not show dose–response relationships. Urinalysis revealed dose-dependent increases in urinary ketones. This result was due to the presence of aloesin, which possesses ketone functionalities, in the urine and not due to a systemic effect. There was no effect of treatment on organ weights or on the results of the histopathological examinations. The no-observed-adverse-effect level was considered to be 1000 mg/kg body weight/day, the highest dose tested. The results support potential use of aloesin as a functional food ingredient.     

Safety evaluation of Lactobacillus pentosus strain b240

Lactobacillus pentosus has a long history of use in cooked and uncooked fermented foods. Viable and heat-killed nonviable preparations of L. pentosus strain b240 were evaluated for short term and subchronic toxicity and genotoxic potential. Dose levels were determined through acute oral toxicity tests with viable (LD₅₀ > 2500 mg/kg) and nonviable (LD₅₀ > 2000 mg/kg) b240. In the short term study, rats received 2500 mg/kg/day (∼1.7 × 10¹¹ cfu/kg/day) viable b240 for 28 days. In the subchronic study, rats received 500, 1000 or 2000 mg/kg/day (up to ∼3.0 × 10¹² cfu equivalents/kg/day) nonviable b240 for 91 days followed by a 28-day recovery. No mortalities occurred. No treatment-related effects were identified for general condition, body weight, food-water consumption, ophthalmology, urinalysis, hematology, blood chemistry, organ weights, histopathology and gross pathology. Although statistically significant effects were noted for several endpoints in the short term and subchronic studies, none were related to the test materials. The NOAEL for nonviable b240 was 2000 mg/kg/day, the highest dose tested. Additionally, nonviable b240 (?5000 μg/plate) was not mutagenic in Salmonella typhimurium or Escherichia coli tester strains nor did nonviable b240 orally administered to rats at levels ? 2000 mg/kg/day for two days, induce a clastogenic response.