Loneliness as a gender-specific predictor of physical and mental health-related quality of life in older adults

Quality of Life Research - Health-related quality of life (HRQOL) in older persons is influenced by physical and mental health, as well as by their social contacts and social support. Older women...     

Homozygosity for a Thr575Met missense mutation in the catalytic domain associated with factor XI deficiency

In this study we investigated an asymptomatic 55-year-old Lebanese woman with factor XI deficiency. The F11 gene was analyzed and a cross reacting material positive (CRM+) variant, Thr575Met, was identified in homozygosity in the proband, and in heterozygosity in four of her siblings.     

Agreement of a new whole-blood PT/INR test using capillary samples with plasma INR determinations

PURPOSE: The objective of the study was to compare in anticoagulated patients the international normalized ratio (INR) measured with a new capillary whole-blood device, the i-STAT Portable Clinical Analyser, with conventional plasma INR obtained from the central laboratory. PATIENTS AND METHODS: Between-cartridge variability was first determined with two lyophilized controls with INR levels of 1.60 and 2.75 (n=10). Next, in 35 patients under different intensities of oral anticoagulation, capillary blood INR was measured with two i-STAT devices and was compared to central laboratory plasma INR (Innovin reagent and BCS analyser). RESULTS: Between-cartridge coefficients of variation were 5% (95%, CI 3.4-9.1) and 3% (95%, CI 2.1-5.5) at INR levels of 1.60 and 2.75. Mean INR difference between the two i-STAT devices was 0.1, and the correlation coefficient was 0.98. Between i-STAT and central laboratory INR, the correlation coefficient was 0.95. Bias values were 0.04, 0.2, and -0.04 at INR levels of 2.0, 2.5, and 3.5, respectively. CONCLUSION: The INR measured with the i-STAT Portable Clinical Analyser is precise and compares well with plasma INR performed in a central laboratory.     

Inherited thrombophilia in arterial disease: a selective review

Thrombophilia may be defined as an acquired or congenital abnormality of hemostasis predisposing to thrombosis. Because arterial thrombosis is usually linked with classical risk factors such as smoking, hypertension, dyslipidemia, or diabetes, a thrombophilia workup is usually not considered in case of arterial thrombosis. The most accepted inherited hemostatic abnormalities associated with venous thromboembolism are factor V Leiden (FVL) and factor II (FII) G20210A mutations, as well as deficiencies in antithrombin (AT), protein C (PC), and protein S (PS). This review focuses on the link between these abnormalities and arterial thrombosis. Overall, the association between these genetic disorders and the three main arterial complications (myocardial infarction [MI], ischemic stroke [IS], and peripheral arterial disease [PAD]) is modest. Routine screening for these disorders is therefore not warranted in most cases of arterial complications. However, when such an arterial event occurs in a young person, inherited abnormalities of hemostasis seem to play a role, particularly when associated with smoking or oral contraceptive use. These abnormalities also seem to play a role in the risk of premature occlusion after revascularization procedures. Therefore thrombophilia tests may be informative in a very restricted population with arterial events. Anticoagulants rather than antiplatelet therapy may be preferable for these patients, although this remains to be proven.     

Predicting deep venous thrombosis in pregnancy: external validation of the LEFT clinical prediction rule

The assessment of clinical probability represents an important step in the diagnostic strategy of patients with suspected deep vein thrombosis. The recently derived LEFt clinical prediction rule for pregnant women combines three variables: symptoms in the left leg (L), calf circumference difference of 2 centimeters or over (E for edema) and first trimester presentation (Ft) but is lacking an external validation. The LEFt rule was computed among pregnant women with suspected deep vein thrombosis who were included in a multicenter prospective diagnostic management outcome study. We calculated the proportion of women and the prevalence of deep vein thrombosis in each probability group, along with the diagnostic performances of the LEFt rule. All variables needed to compute the rule could be retrieved in 157 of the 167 pregnant women with suspected deep vein thrombosis. The prevalence of confirmed deep vein thrombosis was 13 of 157 (8.3%). The LEFt rule was negative in 46 (29%) women. A deep vein thrombosis was diagnosed in 13 of 111 (11.7%, 95% Confidence Interval (CI): 8.3-20.9%) of women with at least one of the LEFt criteria, as compared with none of 46 (0.0%, 95%CI: 0.0-7.9%) of women with none of the LEFt criteria. These results suggest that a negative LEFt rule accurately identifies pregnant women in whom the proportion of confirmed deep vein thrombosis appears to be very low. The rule should not be used as stand-alone test for excluding DVT during pregnancy, but might rather be implemented in a diagnostic strategy in association with D-dimer measurement and compression ultrasonography. The original trial was registered at clinicaltrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT 00740454","term_id":"NCT00740454"}}NCT 00740454).     

Two new antithrombotic agents (fondaparinux and ximelagatran) and their implications in anesthesia.

PURPOSE: To describe two new antithrombotic agents (fondaparinux and ximelagatran), their mechanisms of action, the clinical studies available and some implications (regional anesthesia, monitoring and antidote) in anesthesia. SOURCE: Recently published articles on these two new drugs were reviewed. PRINCIPAL FINDINGS: These two drugs have several interesting properties. Both are of non animal origin, do not induce thrombocytopenia and do not require laboratory controls. In recent studies fondaparinux has shown a better efficacy than low molecular weight heparin in major orthopedic interventions. Ximelagatran, which can be given orally and is in phase III investigation, could replace vitamin K antagonist in the future. CONCLUSION: Anesthesiologists should be aware of these two new agents, one (fondaparinux) being now already registered in some countries.