scholarly journals The Diagnosis Is in the Smear: A Case and Review of Spur Cell Anemia in Cirrhosis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Gabriella A. Raffa ◽  
Diana M. Byrnes ◽  
John J. Byrnes
Keyword(s):  
Early Recognition ◽  
Treatment Options ◽  
Macrocytic Anemia ◽  
Alcoholic Cirrhosis ◽  
High Density Lipoproteins ◽  
Peripheral Smear ◽  
Decompensated Liver Disease ◽  
Risk Of Mortality ◽  
Unnecessary Procedures ◽  
Low Levels

The etiology of anemia in liver cirrhosis is multifactorial; one less recognized cause is hemolytic anemia due to spur cells, known as spur cell anemia. We present the case of a 57-year-old woman with alcoholic cirrhosis who presented with symptomatic macrocytic anemia with a hemoglobin level of 7.4 g/dL and signs of decompensated liver disease. Notably, she had no signs of overt bleeding. Further workup was consistent with hemolysis, with peripheral smear demonstrating spur cells. The patient was treated with both steroids and IVIG, although she eventually expired. The characteristic morphology of spur cells is due to alteration of the lipid composition of the erythrocyte membrane, changing its shape and leading to splenic sequestration and destruction. Characteristic of this disorder is an increased ratio of cholesterol to phospholipid on the membrane, as well as low levels of apolipoproteins and low- and high-density lipoproteins. The presence of spur cells is an indicator of poor prognosis and high risk of mortality. Currently, the only definitive cure is liver transplantation. There is a paucity of literature on the prevalence of this phenomenon and even less about treatment. This case highlights the importance of recognition of spur cell anemia as a cause of anemia in cirrhosis as well as the importance of the peripheral smear in the diagnostic workup. Early recognition can lead to avoidance of unnecessary procedures. Further research is needed to elucidate the true prevalence of spur cell anemia and examine further treatment options.

scholarly journals High-Density Lipoproteins and Cardiovascular Disease: The Good, the Bad and the Future

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 857
Author(s):  
Josep Julve ◽  
Joan Carles Escolà-Gil
Keyword(s):  
Cardiovascular Disease ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
Epidemiological Studies ◽  
High Density ◽  
High Density Lipoproteins ◽  
Atherosclerotic Cardiovascular Disease ◽  
Plasma High Density ◽  
Low Levels

Epidemiological studies have shown that low levels of plasma high-density lipoprotein cholesterol (HDL-C) are associated with increased atherosclerotic cardiovascular disease (CVD) [...]

scholarly journals Efficacy and Selectivity of FGF2-Saporin Cytosolically Delivered by PCI in Cells Overexpressing FGFR1

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1476
Author(s):  
Aurora K. Vikan ◽  
Michal Kostas ◽  
Ellen Margrethe Haugsten ◽  
Pål K. Selbo ◽  
Jørgen Wesche
Keyword(s):  
Treatment Options ◽  
Current Treatment ◽  
Fibroblast Growth Factor Receptors ◽  
Ribosome Inactivating Protein ◽  
Cytosolic Delivery ◽  
Low Levels ◽  
U2os Cells ◽  
Targeting Effect ◽  
Target Effects ◽  
In Cells

Fibroblast growth factor receptors (FGFRs) have become an attractive target in cancer research and therapy due to their implication in several cancers. Limitations of current treatment options require a need for additional, more specific and potent strategies to overcome cancers driven by FGFRs. Photochemical internalization (PCI) is a light-controlled method for cytosolic delivery of drugs that are entrapped in endosomes and lysosomes. We here evaluated the efficacy and selectivity of PCI of FGF2-saporin (FGF-SAP) in cells overexpressing FGFR1. FGF-SAP is a conjugate of FGF2 and the highly cytotoxic ribosome-inactivating protein (RIP) saporin, which is used as payload to eliminate cancer cells. Evaluation of the targeting effect of PCI of FGF-SAP was done by comparing the cytotoxic response in osteosarcoma cells with very low levels of FGFR1 (U2OS) to cells overexpressing FGFR1 (U2OS-R1). We demonstrate that PCI greatly enhances cytotoxicity of the drug showing efficient cell killing at pM concentrations of the drug in U2OS-R1 cells. However, U2OS cells were also sensitive to the toxin after PCI. Binding experiments using confocal microscopy and Western blotting techniques indicate that FGF-SAP is taken up by cells through heparan sulfate proteoglycans (HSPGs) in U2OS cells. We further show that the cytotoxicity of FGF-SAP in U2OS cells was reduced when cells were co-treated with heparin to compete out binding to HSPG, demonstrating that the cytotoxic effect was due to internalization by HSPGs. We conclude that to prevent off-target effects of FGF-based toxins, it will be necessary to circumvent binding to HSPGs, for example by mutating the binding site of FGF2 to HSPGs.

scholarly journals Nonvascular Complications of Injectable Fillers—Prevention and Management

2020 ◽  
Vol 53 (03) ◽  
pp. 335-343
Author(s):  
Kuldeep Singh ◽  
Shahin Nooreyezdan
Keyword(s):  
Early Recognition ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Vascular Complications ◽  
Physical Characteristics ◽  
Clear Understanding ◽  
Type Iv ◽  
Acute Infections ◽  
Tyndall Effect ◽  
Delayed Complications

AbstractInjectable filler treatments have increased in popularity because of enhanced safety profile and improved physical characteristics. ISAPS (International Society of Plastic Surgery) put out global data showing 3.7 million hyaluronic acid (HA) filler procedures in 2018, making it the second most often performed procedure in the world, after botulinum toxin. And these are only ‘those’ performed by qualified plastic surgeons. There was a concomitant increase in both the nonvascular and vascular complications, which coincided with the number and type of filler procedures performed. Filler complications were reviewed from existing literature, and an attempt was made to understand etiology, elucidate clinical features, and clarify optimum treatment strategies for each. Complications can be early or delayed in presentation, early consisting of injection site complications like bruising, edema, and hypersensitivity, Tyndall effect, and intravascular injection. Delayed complications included hypersensitivity type IV, acute infections like cellulitis, abscesses, and herpes and delayed ones like granulomas, biofilms, and atypical mycobacterial infections. These were analyzed and treatment options, protocols, and consensus guidelines were suggested. A clear understanding of facial anatomy, physical characteristics of all fillers used, early recognition, and treatment options of complications will ensure optimum outcomes.

Molecular bases of primary monogenic dyslipidemia

2020 ◽  
pp. 4-17
Author(s):  
О.Н. Иванова ◽  
П.А. Васильев ◽  
Е.Ю. Захарова
Keyword(s):  
Lipid Profile ◽  
Molecular Basis ◽  
Clinical Characteristics ◽  
Metabolic Disorders ◽  
Low Density Lipoproteins ◽  
Accurate Diagnosis ◽  
High Density Lipoproteins ◽  
Extreme Deviation ◽  
Low Levels ◽  
Molecular Bases

Дислипидемия - одно из наиболее распространенных метаболических нарушений, доминирующий фактор риска заболеваний сердечно-сосудистой системы. Своевременная диагностика и корректировка липидного профиля могут заметно снизить заболеваемость и смертность от сердечно-сосудистых заболеваний. Обширная гетерогенная группа заболеваний приводит к устойчивым изменениям липидного профиля. Предлагаемый обзор включает в себя описание метаболизма липидов, молекулярных основ и клинических характеристик первичных моногенных дислипидемий. Мутации двадцати пяти генов являются причиной большинства моногенных дислипидемий. На основании изменений липидного профиля выделяют пять групп фенотипов с экстремальным отклонением уровней маркеров липидного профиля: с высоким и низким уровнем липопротеинов низкой плотности, с высоким и низким уровнем липопротеинов высокой плотности, с высоким уровнем триглицеридов. Для каждого фенотипа обозначены ассоциированные гены, указан ген с чаще всего выявляемыми мутациями. Подробно описаны молекулярные основы наиболее распространенной дислипидемии, характеризующейся существенным повышением уровня липопротеинов низкой плотности - семейной гиперхолестеринемии. Генетическое тестирование пациентов с дислипидемией дает возможность постановки точного диагноза, каскадного обследования и консультирования членов семьи пациента, ранней диагностики для предотвращения или более позднего проявления осложнений. Dyslipidemia is one of the most common metabolic disorders, the dominant risk factor for diseases of the cardiovascular system. Timely diagnosis and correction of the lipid profile can significantly reduce morbidity and mortality from cardiovascular diseases. An extensive heterogeneous group of diseases leads to persistent changes in the lipid profile. This review includes a description of lipid metabolism, the molecular basis, and clinical characteristics of primary monogenic dyslipidemia. Mutations in twenty-five genes are responsible for most monogenic dyslipidemias. On the basis of changes in the lipid profile, five groups of phenotypes are distinguished with extreme deviation in the levels of lipid profile markers: with high and low levels of low density lipoproteins, with high and low levels of high density lipoproteins, with high levels of triglycerides. For each phenotype, the associated genes are indicated, the gene with the most frequently detected mutations is indicated. The molecular basis of the most common dyslipidemia, familial hypercholesterolemia, is described in detail. Genetic testing of patients with dyslipidemia makes it possible to make an accurate diagnosis, the possibility of cascade examination and counseling of the patient’s family members, the possibility of early diagnosis to prevent or later manifest complications.

scholarly journals Fecal impaction and colon obstruction

2021 ◽  
Vol 8 (3) ◽  
pp. 988
Author(s):  
Haitham A. Saimeh
Keyword(s):  
Gastrointestinal Tract ◽  
High Risk ◽  
Dietary Fiber ◽  
Water Intake ◽  
Early Recognition ◽  
Fecal Impaction ◽  
Lower Gastrointestinal Tract ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Lethal Complications

Fecal impaction is an important cause of lower gastrointestinal tract obstruction and carries high risk of mortality and morbidity, it is highly emphasized to early identify it to minimize any risk of complication. Recurrence is common, therefore preventive modalities as increasing the dietary fiber content to 30 gm/day, water intake, or discontinuation of medications that contribute to colon hypomotility. In this paper, I am pointing off the early recognition and treatment of fecal impaction to avoid lethal complications, therefore physicians should have higher level of suspicions because if fecal impaction goes unrecognized this will lead to fatal morbidity and mortality.

Modulation of High-Density Lipoproteins in a Population in Istanbul, Turkey, With Low Levels of High-Density Lipoproteins

2005 ◽  
Vol 96 (4) ◽  
pp. 547-555 ◽  
Author(s):  
Robert W. Mahley ◽  
Selçuk Can ◽  
Sinan Özbayrakçı ◽  
Thomas P. Bersot ◽  
Sibel Tanir ◽  
...  
Keyword(s):  
High Density ◽  
High Density Lipoproteins ◽  
Low Levels

Aortic tumour

ESC CardioMed ◽  
2018 ◽  
pp. 2619-2621
Author(s):  
Francesca Urgnani ◽  
Vincent Riambau
Keyword(s):  
Nuclear Medicine ◽  
Monoclonal Antibodies ◽  
Treatment Options ◽  
Aortic Occlusion ◽  
Malignant Tumours ◽  
Nuclear Medicine Imaging ◽  
Mesenchymal Neoplasms ◽  
Low Levels ◽  
Poor Outcomes ◽  
Clinical Conditions

Primary malignant tumours of the aorta are extremely rare and aggressive mesenchymal neoplasms. Symptoms can be related to embolization or aortic occlusion. Diagnosis is difficult since they may mimic heterogeneous clinical conditions. The therapeutic management of aortic tumours shows poor outcomes. Improvements in imaging for an earlier and more precise detection of this pathology, as well as better treatment options, are needed. Hopefully, they will come in the future from advances in nuclear medicine imaging systems and treatment with monoclonal antibodies. However, diagnostic and therapeutic improvements are complicated by the low levels of experience on this condition and the reduced available literature, due to the rarity of the pathology.

Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies

2020 ◽  
Vol 40 (1) ◽  
pp. 46-55
Author(s):  
Kirsti G. Catton ◽  
Jennifer K. Peterson
Keyword(s):  
Risk Factors ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Early Recognition ◽  
Treatment Options ◽  
Age Groups ◽  
Atrioventricular Node ◽  
Congenital Heart Surgery ◽  
Junctional Ectopic Tachycardia ◽  
Perioperative Morbidity

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

scholarly journals Prevalence of Iron Deficiency Anemia in Anemic Patients: A Hospital Based Study

2018 ◽  
Vol 6 (2) ◽  
pp. 41-45 ◽  
Author(s):  
Satyendra Kumar Mishra ◽  
Surendra Marasini ◽  
Badri Kumar Gupta ◽  
Krishna Kumar Agrawal ◽  
Narayan Gautam
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Serum Ferritin ◽  
Iron Status ◽  
Macrocytic Anemia ◽  
High Rate ◽  
Deficiency Anemia ◽  
Peripheral Smear ◽  
Significant Difference ◽  
Detailed Medical History

Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient  iron  intake, accompanied  by chronic  intestinal  blood  loss  due  to parasitic  and  malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal. Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively.  Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001).  Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia. 

scholarly journals Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Rashmi Dhital ◽  
Shivani Vyas ◽  
Priyadarshani Sharma ◽  
Theresa Lynn ◽  
Oreoluwa Oladiran ◽  
...  
Keyword(s):  
Early Recognition ◽  
Treatment Options ◽  
Young Female ◽  
Good Prognosis ◽  
Thyroid Peroxidase ◽  
Free T4 ◽  
Gradual Improvement ◽  
Fluid Analysis ◽  
Cardiac Cirrhosis ◽  
Congestive Liver

Cardiovascular symptoms remain the most common presenting features and leading causes of death in hyperthyroidism. We report a young female with reported thyroid disease and medication noncompliance presenting with atrial fibrillation, severe atrioventricular regurgitation, severely dilated right heart with reduced function, and moderate pulmonary hypertension (PH), which was further complicated by congestive liver injury with ascites and pancytopenia. Thyroid work-up revealed suppressed TSH, elevated free T4 and T3 along with elevated anti-thyroglobulin antibodies, thyroid peroxidase antibodies, and thyroid-stimulating immunoglobulin, suggesting Graves’ thyrotoxicosis. Ultrasound of the abdomen was suggestive of liver cirrhosis and ascites, which was thought to be cardiac cirrhosis, after multiple negative work-ups for alternate causes of cirrhosis. Ascitic fluid analysis revealed portal hypertension as the cause. The patient was restarted on antithyroid medication with gradual improvement of thyroid function and in clinical and echocardiogram findings. In contrast to primary PH that carries a poor prognosis and has limited treatment options, PH due to Graves’ disease carries a good prognosis with prior reports of resolution after appropriate treatment, emphasizing the importance of early recognition. Also, unlike cirrhosis caused by alcohol or viral hepatitis, the effect of cardiac cirrhosis on overall prognosis has not been clearly established.

Sign in / Sign up

Export Citation Format

Share Document