Validation of the Serbian version of the Asthma Control Test

Background/Aim. Asthma still remains poorly controlled in the majority of patients. The Asthma Control Test (ACT) is a short and useful patient-administered questionnaire for identification of patients with poor asthma control in clinical settings. The aim of this study was to validate a Serbian version of the ACT in the adults with asthma. Methods. A total of 250 consecutive adult asthmatic patients were recruited in a prospective observational study. The exclusion criteria were chronic respiratory disease and acute respiratory tract infection in preceding 4 weeks. Results. The spirometry and ACT questionnaire were performed on the baseline visit and 6 months later. The ACT test was completed by 98.8% of patients with the mean time of completion of 4.5 minutes. The correlation of ACT score and lung function parameters (forced expiratory volume in 1 second ? FEV1 and forced vital capacity ? FVC) was significant (p = 0.016 and p = 0.002, respectively). A change in the ACT scores between baseline and 6- months visit was not associated with a change in FVC and FEV1. The ACT score had excellent diagnostic accuracy according to the physicians asthma control classification and even outstanding accuracy according to the patients? classification. Conclusion. The results of this study confirm the reliability, validity and accuracy of Serbian version of the ACT, contributing to established value of original ACT test and with consistent findings as the previously reported validity of ACT in other languages. Therefore, it should be utilized more in everyday clinical practice as a useful and reliable tool of asthma control assessment.

Heparin-Induced Thrombocytopenia in Infants after Heart Surgery

Background Heparin-induced thrombocytopenia (HIT) in infants is a rare disorder, and the diagnosis and management of HIT still remains challenging. Argatroban is a synthetic direct thrombin inhibitor (DTI) that is widely used for treating HIT. However, little is known about the efficacy of the activated clotting time (ACT) test in monitoring DTI treatment as an alternative to the routinely used activated partial thromboplastin time (aPTT). Methods Between July 2013 and January 2015, four infants were diagnosed with HIT after surgical correction of congenital anomalies. In all cases, heparin was used during cardiopulmonary bypass (CPB). Diagnosis of HIT was based on the “4 Ts” pretest clinical scoring system, and platelet factor 4 (PF4) antibody was detected using enzyme-linked immunosorbent assay. Argatroban was used in treating HIT. When argatroban was infused, anticoagulation tests (aPTT, prothrombin time [PT], thrombin time [TT], and fibrinogen) were performed every 4 to 12 hours. ACT was used in addition to monitor the anticoagulation effect of argatroban. The target ACT was 1.5 to 3.0 times the baseline. ACT was measured every 2 to 4 hours and remeasured 1 hour after each dosage adjustment. Results Thrombocytopenia (defined as a 50% decrease in platelet count) occurred during the 3rd to 6th day postoperatively. After the diagnosis of HIT, argatroban was started immediately, and platelet counts stabilized and gradually increased. Anticoagulation effect of argatroban was successful monitored by ACT and aPTT. Poor correlation between the ACT test and aPTT test (R = 0.270, p = 0.092) was noted in one patient. ACT values increased rapidly after 3 to 7 days on argatroban treatment. In most cases, low dosage of argatroban was given ranging from 0.04 to 5.00 μg/kg/min. Conclusion Argatroban may be an effective medicine in treating HIT in infants, in a reduced dosage. The great fluctuation in argatroban dosage during the course of HIT treatment necessitates close monitoring. ACT test may be reliable and convenient for monitoring HIT treatment and may contribute to positive clinical outcomes in infants. The efficacy of argatroban and the use of ACT monitoring in the management of HIT infants needs further study.