A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting

Cardiopulmonary bypass is frequently associated with excessive blood loss. Platelet dysfunction is the main cause of non-surgical bleeding after open-heart surgery. We randomized 65 patients in a double-blind fashion to receive tranexamic acid or placebo in order to determine whether antifibrinolytic therapy reduces chest tube drainage. The tranexamic acid group received an intravenous loading dose of 10 mg/kg, before the skin incision, followed by a continuous infusion of 1 mg kg-1 h-1 for 5 h. The placebo group received a bolus of normal saline solution and continuous infusion of normal saline for 5 h. Postoperative bleeding and fibrinolytic activity were assessed. Hematologic data, convulsive seizures, allogeneic transfusion, occurrence of myocardial infarction, mortality, allergic reactions, postoperative renal insufficiency, and reopening rate were also evaluated. The placebo group had a greater postoperative blood loss (median (25th to 75th percentile) 12 h after surgery (540 (350-750) vs 300 (250-455) mL, P = 0.001). The placebo group also had greater blood loss 24 h after surgery (800 (520-1050) vs 500 (415-725) mL, P = 0.008). There was a significant increase in plasma D-dimer levels after coronary artery bypass grafting only in patients of the placebo group, whereas no significant changes were observed in the group treated with tranexamic acid. The D-dimer levels were 1057 (1025-1100) æg/L in the placebo group and 520 (435-837) æg/L in the tranexamic acid group (P = 0.01). We conclude that tranexamic acid effectively reduces postoperative bleeding and fibrinolysis in patients undergoing first-time coronary artery bypass grafting compared to placebo.

An attempt to study the case fatality rate in Schistosoma japonicum infection in the Philippines.

As a sequence to a cross-sectional study on the clinical gradient of the disease by Pesigan et al., (1965) a follow-up of the subjects in that study was made after 12 years. Of the 135 untreated cases followed up, 23 (17.04%) died from various causes of which 12 (8.89%) had signs and symptoms attributable to schistosomiasis as the immediate cause or one of the main causes of death. This occurred in 1 to 11 years with an average of 5 years, which corresponds roughly to 1.78% of the infected cases per year. This is considered a conservative estimate because in the other deaths due to other diseases, schistosomiasis is a contributory cause. A diminishing severity of the disease was observed among the surviving patients which could imply that they must have developed some degree of immunity to the disease.

Anestesia no coronariopatia / Anesthesia in the coronary disease patient

O equilíbrio entre a oferta e o consumo de oxigênio pelo miocárdio é essencial para uma adequada anestesia foi mantida no paciente coronariopata O halotano tem sido utilizado como anestésico para pacientes com cardiopatia isquêmica por diminuir o consumo de oxigênio pelo miocárdio. Este trabalho tem como finalidade avaliar a técnica anestésica utilizada em 100 pacientes estudados retrospectivamente e 20 prospectivamente, submetidos à cirurgia de revascularizaçäo do miocárdio. A induçäo foi realizada com tiopental sódico (4- 6 mg. kg-1), brometo de pancurônio (0,1 mg. kg-1) e fentanil (3 microng. kh-1). A anestesia foi mantida com halotano na concentraçäo de 0,5 - 1,5% e fentanil completando a dose de 10 -15 microng. kg-1. Em 29 pacientes utilizou-se a clorpromazina (0,2 mg. kg-1) com a finalidade de reduzir a pós-carga. Foram pesquisadas alteraçöes que pudessem modificar o consumo de oxigênio pelo miocárdio, tais como hipertensäo, hipotensäo, bradicardia disritmias e alteraçöes eletrocardiográficas tentando-se correlacionar estas alteraçöes com seus fatores causais. No estudo retrospectivo ocorreu hipertensäo em 21%, taquicardia em 24%, hipotensäo em 4% bradicardia em 5% e disritmias em 5% dos pacientes. No entanto prospectivo tivemos hipertensäo em 15%, taquicardia em 5%, bradicardia em 15% e disritmias em 20% dos pacientes. A técnica anestésica utilizada mostrou-se eficaz, exceto em alguns casos onde a analgesia foi insuficiente

Experimental infection of Oncomelania quadrasi with Paragonimus ohirai.

Two hundred Oncomelania quadrasi collected from Leyte, Philippines were exposed to infection with Paragonimus ohirai, a rodent type lung fluke. In a group, each snail was exposed individually to 10 miracidia hatched from eggs which were brought from Japan to the Philippines. In another group, 100 snails were placed in a Petri dish and P. ohirai miracidia were added to provide 10 per snail. The observations were made each successive week after exposure. All the snails examined were positive for the larvae of P. ohirai. Nine-ten weeks after exposure, many cercariae were recognized. It was proved that O. quadrasi is highly susceptible to P. ohirai.

Current status of schistosomiasis japonica in Sorsogon Province, Republic of the Philippines.

A resurvey of Irosin and the eight municipalities surrounding it for schistosomiasis japonica using COPT and FECT was done in order to determine the status of the disease thirty years after it was first reported in the town of Irosin in 1947. In Irosin, the results by FECT showed that there was a decrease in prevalence from 5.7% to 2.8%, however, if by COPT, then there was an increase from 5.7% to 12.2%. There is a definite trend of the disease to spread from Irosin into the surrounding municipalities. Whereas in 1951, only Irosin and Juban have been established as endemic foci for schistosomiasis, the result of previous surveys by the schisto-unit at Irosin and the present study seem to indicate that the disease has spread into seven additional towns surrounding Irosin. In like manner, the snail intermediate host, Oncomelania quadrasi has a tendency to spread to outlying areas outside of Irosin and Juban.

Current chemotherapy of schistosomiasis japonica in the Philippines.

For the past several decades, the drug being used for the treatment of schistosomiasis in the Philippines has been Stibophen. It is administered intramuscularly at a dose of 1 ml per 10 kg body weight with a maximum of 5 ml every other day after 2 initial daily smaller sensitivity doses at a total dose of 45 to 70 ml fof adult patients. In recent years, a number of drugs for the treatment of schistosomiasis have been developed. These were evaluated clinically either in the hospital or in field trials in Leyte. Unfortunately, none of these were found to be suitable for mass treatment on account of toxicity to prolonged course of treatment. In view of the pressing need for a safe and effective schistosomicidal agent, the search for a better drug is imperative.

Prevalence and distribution of schistosomiasis in the Philippines: a review.

The known endemic areas in the Philippines are the provinces of Mindoro Oriental and Sorsogon in Southern Luzon; the provinces of North, East and Western Samar; Leyte; and Bohol in Eastern Visayas, and all the provinces of Mindanao with the exception of Misamis Oriental, Davao Oriental and Maguindanao. The total snail area in 22 affected provinces is estimated aorth latitude. There are 655,124 estimated cases out of 3,961,000 exposed population or a prevalence of 16.5% based on the results of stool surveys conducted by Regional Schistosomiasis Advisory Teams and projected to the total population in the endemic areas.

Estimation of annual incidence of schistosomiasis japonica among school children in the Philippines;.

An attempt was made to estimate the annual incidence of schistosomiasis from the prevalences at ages 7 to 10 in the Philippines.