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1.
Int J Lab Hematol ; 43(4): 837-844, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34092029

RESUMO

INTRODUCTION: Methemoglobin (MetHb) and sulfhemoglobin (SHb) measurements are useful in the evaluation of cyanosis. When one or both values are elevated, additional analysis is important to establish the etiology of the disorder. Methemoglobinemia occurs from acquired or hereditary causes with diverse treatment considerations, while true sulfhemoglobinemia is only acquired and treatment is restricted to toxin removal. Some toxic exposures can result in a dual increase in MetHb and SHb. Hereditary conditions, such as M-Hemoglobin variants (M-Hbs), can result in increased MetHb and/or SHb values but are clinically compensated and do not require treatment if they are cyanotic but otherwise clinically well. METHODS: Herein, we report 53 hemoglobin variant cases that have associated MetHb and SHb levels measured by an adapted Evelyn-Malloy laboratory assay method. RESULTS: Our data indicate M-Hbs cause variable patterns of MetHb and SHb elevation in a fairly reproducible pattern for the particular variant. In particular, α globin chain M-Hbs can mimic acquired sulfhemoglobinemia due to an isolated increased SHb value. CONCLUSION: If the patient appears clinically well other than cyanosis, M-Hbs should be considered early in the evaluation process to differentiate from acquired conditions to avoid unnecessary testing and treatment regimens and prompt genetic counseling.


Assuntos
Cianose/sangue , Metemoglobina/análise , Sulfa-Hemoglobina/análise , Adolescente , Adulto , Criança , Pré-Escolar , Cianose/genética , Feminino , Variação Genética , Hemoglobina M/análise , Hemoglobina M/genética , Humanos , Lactente , Masculino , Metemoglobinemia/sangue , Metemoglobinemia/genética , Sulfemoglobinemia/sangue , Sulfemoglobinemia/genética , Adulto Jovem
2.
Int J Mol Sci ; 22(4)2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33546389

RESUMO

Cyanosis is a pathological condition that is characterized by a bluish discoloration of the skin or mucous membranes. It may result from a number of medical conditions, including disorders of the respiratory system and central nervous system, cardiovascular diseases, peripheral vascular diseases, deep vein thrombosis, and regional ischemia. Cyanosis can also be elicited from methemoglobin. Therefore, a simple, rapid, and simultaneous monitoring of changes in oxygenated hemoglobin and deoxygenated hemoglobin is useful for protective strategies against organ ischemic injury. We previously developed a red-green-blue camera-based spectral imaging method for the measurements of melanin concentration, oxygenated hemoglobin concentration (CHbO), deoxygenated hemoglobin concentration (CHbR), total hemoglobin concentration (CHbT) and tissue oxygen saturation (StO2) in skin tissues. We leveraged this approach in this study and extended it to the simultaneous quantifications of methemoglobin concentration (CmetHb), CHbO, CHbR, and StO2. The aim of the study was to confirm the feasibility of the method to monitor CmetHb, CHbO, CHbR, CHbT, and StO2. We performed in vivo experiments using rat dorsal skin during methemoglobinemia induced by the administration of sodium nitrite (NaNO2) and changing the fraction of inspired oxygen (FiO2), including normoxia, hypoxia, and anoxia. Spectral diffuse reflectance images were estimated from an RGB image by the Wiener estimation method. Multiple regression analysis based on Monte Carlo simulations of light transport was used to estimate CHbO, CHbR, CmetHb, CHbT, and StO2. CmetHb rapidly increased with a half-maximum time of less than 30 min and reached maximal values nearly 60 min after the administration of NaNO2, whereas StO2 dramatically dropped after the administration of NaNO2, indicating the temporary production of methemoglobin and severe hypoxemia during methemoglobinemia. Time courses of CHbT and StO2, while changing the FiO2, coincided with well-known physiological responses to hyperoxia, normoxia, and hypoxia. The results indicated the potential of this method to evaluate changes in skin hemodynamics due to loss of tissue viability and vitality.


Assuntos
Diagnóstico por Imagem/métodos , Hemoglobinas/análise , Metemoglobina/análise , Oxiemoglobinas/análise , Algoritmos , Animais , Cianose/sangue , Cianose/diagnóstico , Análise de Dados , Diagnóstico por Imagem/instrumentação , Diagnóstico por Imagem/normas , Masculino , Método de Monte Carlo , Oxigênio , Ratos , Análise de Regressão , Análise Espectral/métodos
3.
Paediatr Anaesth ; 29(6): 597-603, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30938906

RESUMO

BACKGROUND: Pulse oximetry overestimates arterial oxygen saturation (SaO2 ) at less than 90% saturation in cyanotic children. The Masimo Blue sensor (Masimo Corp., Irvine, CA) is a pulse oximetry sensor developed for use in children with cyanosis. However, there remains a lack of research in actual clinical practice. AIMS: We evaluated the intraoperative performance of three different pulse oximeters to measure oxyhemoglobin saturation (SpO2 ) at low saturations in pediatric patients with cyanotic heart disease and the influence of clinical variables (SaO2 , hemoglobin concentration, perfusion index, and weight) on the accuracy of the sensors. METHODS: This prospective observational study compared SpO2 measured using three pulse oximeters (Masimo Blue [Masimo Corp., Irvine, CA]; Masimo LNCS, and Nellcor [Medtronic, Dublin, Ireland]) at selected SaO2 ranges (≥85%, 75%-84%, 60%-74%, and < 60%). Accuracy was evaluated according to bias and Bland-Altman analysis with appropriate correction for multiple measurements. Relationships between bias and clinical variables were assessed using a generalized estimating equation. RESULTS: Two hundred and fifty-eight samples were analyzed. The mean overall bias (limits of agreement) of Masimo Blue, Masimo LNCS, and Nellcor sensor was -5.3 (-20.9 to 10.3%), -7.4 (-21.9 to 7.1%), and -7.4 (-22.5 to 15.1%), respectively. However, there was no difference in bias among the three sensors at SaO2 <60%. Generalized estimating equation showed that SaO2 value was associated with bias of all sensors. Perfusion index affected the bias of Blue sensor and LNCS sensor, and patients' weight was associated with bias of Nellcor sensor. CONCLUSION: Masimo blue sensor demonstrated overall lower bias compared to the other two sensors. However, the accuracy of all sensors was similarly poor at SaO2 less than 60%. Bias was influenced by SaO2 , perfusion index, and body weight.


Assuntos
Cianose/sangue , Cardiopatias/sangue , Hipóxia/sangue , Oximetria/instrumentação , Oximetria/métodos , Criança , Pré-Escolar , Cianose/etiologia , Feminino , Cardiopatias/complicações , Humanos , Hipóxia/etiologia , Lactente , Masculino , Oxigênio , Estudos Prospectivos
4.
Am J Cardiol ; 123(10): 1696-1702, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30885417

RESUMO

Adults with cyanotic congenital heart diseases (CCHD) have a higher risk for bleeding, but also for thrombosis. Rotational thromboelastometry (RT), using tissue factor (EXTEM), a contact activator (INTEM) or cytochalasin (FIBTEM), assesses coagulation by determining the time to initiation of clotting (CT) and clot firmness (MCF) including platelet-fibrin-interaction. The aim of this study was to evaluate RT and whole blood impedance aggregometry (IA) in CCHD compared with a control group without chronic cyanosis (NCCHD). These were used to establish normal reference ranges. We prospectively included 124 patients (76 CCHD, 48 NCCHD). Mean oxygen saturation in CCHD was 81.5%, and 98% in NCCHD (p <0.001). Fifty-five CCHD and 1 NCCHD had pulmonary hypertension. Eisenmenger syndrome was present in 39 CCHD (51.3%). Hemoglobin, hematocrit, and reticulocyte levels were significantly higher in CCHD, and they also showed more thrombocytopenia. Platelet aggregation was under normal range in 89.5% of CCHD after triggering with ADP, in 85.5% after triggering with arachidonic acid (ASPI) and in 73.7% after TRAP-6. RT showed significantly longer clotting times and reduced clot firmness in both EXTEM and INTEM tests. FIBTEM-MCF was also significantly reduced. Moderate inverse correlation was found between platelet count and erythrocytes (r = -0.608, p <0.001). Significant correlations were found between platelet number and RT-parameters as well as with all IA parameters. In conclusion, according to RT and IA, CCHD present hypocoagulable disorders. No signs of hypercoagulability were found.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Coagulação Sanguínea/fisiologia , Cianose/complicações , Cardiopatias Congênitas/complicações , Agregação Plaquetária/fisiologia , Tromboelastografia/métodos , Adulto , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/complicações , Cianose/sangue , Cianose/congênito , Feminino , Cardiopatias Congênitas/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Reprodutibilidade dos Testes , Adulto Jovem
5.
Sultan Qaboos Univ Med J ; 19(4): e345-e351, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31897318

RESUMO

Objectives: Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory secondary erythrocytosis. This study aimed to determine the serum iron status and prevalence of iron deficiency among children with cyanotic congenital heart disease attending the Paediatric Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Methods: This cross-sectional case-control study took place between May and October 2015 at the Lagos State University Teaching Hospital. A total of 75 children with cyanotic congenital heart disease and 75 apparently healthy age-, gender- and socioeconomically-matched controls were analysed to determine serum iron status and the prevalence of iron deficiency as defined by the World Health Organization criteria. Results: The mean age of the children was 47.5 ± 2.9 months (range: 6-144 months old). Iron deficiency was significantly more frequent among CCHD patients compared to control subjects (9.3% versus 0%; P = 0.006). While latent iron deficiency was more prevalent among children in the control group compared to those with CCHD, this difference was not statistically significant (13.3% versus 9.3%; P = 0.303). No cases of iron deficiency anaemia were observed in the studied sample. Conclusion: Neither the children in the control group nor those with CCHD had iron deficiency anaemia. However, iron deficiency was significantly more prevalent among children with CCHD in Lagos. Periodic serum iron status screening is therefore recommended for this population.


Assuntos
Anemia Ferropriva/complicações , Cianose/fisiopatologia , Cardiopatias Congênitas/fisiopatologia , Policitemia/fisiopatologia , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Cianose/sangue , Cianose/epidemiologia , Índices de Eritrócitos , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/complicações , Hemoglobinas/análise , Humanos , Lactente , Ferro/sangue , Masculino , Nigéria/epidemiologia , Policitemia/sangue , Policitemia/etiologia , Prevalência
6.
Asian Cardiovasc Thorac Ann ; 27(2): 75-79, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30580530

RESUMO

BACKGROUND: Cardioplegia is an integral part of myocardial protection. The superiority of blood cardioplegia in adult patients has been reported. However, this is yet to be studied in cyanotic pediatric patients. METHODS: A randomized open-label trial was conducted in 70 patients with tetralogy of Fallot. They were divided into two groups: 35 patients had crystalloid cardioplegia (controls), and 35 had blood cardioplegia. Lactate and coronary oxygen extraction in arterial blood and the coronary sinus were measured immediately after cessation of cardiopulmonary bypass, 15 and 30 min later. Postoperative mortality, major adverse cardiac events, mechanical ventilation time, inotrope administration, arrhythmias, right ventricular function, intensive care unit and hospital length of stay were observed. RESULTS: There were no significant differences in clinical outcomes or lactate levels. There was a significant difference in coronary oxygen extraction immediately and 15 min after cessation of cardiopulmonary bypass ( p = 0.038, p = 0.015). CONCLUSION: Blood cardioplegia gave a better postoperative oxygen extraction value but there were no differences in myocardial damage or clinical outcome between the two groups.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Soluções Cardioplégicas/uso terapêutico , Ponte Cardiopulmonar , Parada Cardíaca Induzida/métodos , Compostos de Potássio/uso terapêutico , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Soluções Cardioplégicas/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Criança , Pré-Escolar , Cianose/sangue , Cianose/etiologia , Feminino , Parada Cardíaca Induzida/efeitos adversos , Humanos , Indonésia , Lactente , Recém-Nascido , Ácido Láctico/sangue , Masculino , Oxigênio/sangue , Complicações Pós-Operatórias/etiologia , Compostos de Potássio/efeitos adversos , Fatores de Risco , Tetralogia de Fallot/sangue , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
J Matern Fetal Neonatal Med ; 32(7): 1117-1123, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29183208

RESUMO

AIMS: S100B has been proposed as a consolidated marker of brain damage in infants with congenital heart disease (CHD) undergoing cardiac surgery and cardiopulmonary bypass (CPB). The present study aimed to investigate whether S100B blood levels in the perioperative period differed in infants complicated or not by cyanotic CHD (CHDc) and correlated with oxygenation status (PaO2). METHODS: We conducted a case-control study of 48 CHD infants without pre-existing neurological disorders undergoing surgical repair and CPB. 24 infants were CHDc and 24 were CHD controls. Blood samples for S100B assessment were collected at six monitoring time-points: before the surgical procedure (T0), after sternotomy but before CPB (T1), at the end of the cross-clamp CPB phase (T2), at the end of CPB (T3), at the end of the surgical procedure (T4), at 24 h postsurgery (T5). RESULTS: In the CHDc group, S100B multiples of median (MoM) were significantly higher (p < .05, for all) from T0 to T5. PaO2 was significantly lower (p < .05, for all) in CHDc infants at T0-T1 and at T4 while no differences (p > .05, for all) were found at T2, T3, T5. Linear regression analysis showed a positive correlation between S100B MoM at T3 and PaO2 (R = 0.84; p < .001). CONCLUSIONS: The present data showing higher hypoxia/hyperoxia-mediated S100B concentrations in CHDc infants suggest that CHDc are more prone to perioperative brain stress/damage and suggest the usefulness of further investigations to detect the "optimal" PaO2 target in order to avoid the side effects associated with reoxygenation during CPB.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Cianose/sangue , Cardiopatias Congênitas/cirurgia , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Artérias , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Estudos de Casos e Controles , Feminino , Humanos , Hiperóxia/sangue , Hipóxia/sangue , Lactente , Masculino , Oxigênio/sangue , Pressão Parcial
8.
Respir Care ; 64(2): 201-208, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30254042

RESUMO

BACKGROUND: Widespread use of transcutaneous PCO2 (PtcCO2 ) monitoring is currently limited by concerns many practitioners have regarding accuracy. We compared the accuracy of PtcCO2 with that of PaCO2 measurements in critically ill children, and we investigated whether clinical conditions associated with low cardiac output or increased subcutaneous tissue affect this accuracy. METHODS: We performed a single-center prospective study of critically ill children placed on transcutaneous monitoring. RESULTS: There were 184 children enrolled with paired PaCO2 and PtcCO2 values. Subjects had a median age of 31.8 mo (interquartile range 3.5-123.3 mo). Most children were mechanically ventilated (n = 161, 87.5%), and many had cardiac disease (n = 76, 41.3%). The median PaCO2 was 44 mm Hg (interquartile range 39-51 mm Hg). The mean bias between PaCO2 and PtcCO2 was 0.6 mm Hg with 95% limits of agreement from -13.6 to 14.7 mm Hg. The PtcCO2 and PaCO2 were within ±5 mm Hg in 126 (68.5%) measurements. In multivariable modeling, cyanotic heart disease (odds ratio 3.5, 95% CI 1.2-10, P = .02) and monitor number 2 (odds ratio 3.8 95% CI 1.3-10.5, P = .01) remained associated with PtcCO2 ≥ 5 mm Hg higher than PaCO2 . Serum lactate, fluid balance, renal failure, obesity, vasoactive-inotrope score, and acyanotic heart disease were not associated with high or low PtcCO2 values. In 130 children with a second paired PtcCO2 and PaCO2 measurement, predicting the second measured PaCO2 by subtracting the initial observed difference between the PtcCO2 and PaCO2 from the subsequent measured PtcCO2 decreased the mean bias between observed and predicted PaCO2 to 0.2 mm Hg and the 95% limits of agreement to -9.4 to 9.7 mm Hg. CONCLUSIONS: PtcCO2 provides an acceptable estimate of PaCO2 in many critically ill children, including those with clinical conditions that may be associated with low cardiac output or increased subcutaneous tissue, although it does not perform as well in children with cyanotic heart disease. PtcCO2 may be a useful adjunct monitoring method, but it cannot reliably replace PaCO2 measurement.


Assuntos
Gasometria/estatística & dados numéricos , Monitorização Transcutânea dos Gases Sanguíneos/estatística & dados numéricos , Dióxido de Carbono/sangue , Artérias/química , Gasometria/métodos , Criança , Pré-Escolar , Estado Terminal , Cianose/sangue , Confiabilidade dos Dados , Feminino , Humanos , Masculino , Estudos Prospectivos
9.
Pediatr Cardiol ; 40(3): 546-553, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30430186

RESUMO

Cyanotic heart lesions are a complex subset of congenital heart disease (CHD) in which patients are desaturated until surgical repair or palliation. We hypothesized that a direct relationship would exist between degree of desaturation and presence of systemic inflammation and brain injury in unrepaired patients less than 1 year of age. The pre-operative desaturation with augmented systemic inflammation would predict a more complex post-operative course. Fifty patients with CHD were enrolled in this study and classified as cyanotic (O2 ≤ 90%) or acyanotic (O2 > 90%) based on SpO2. Serum inflammatory mediators measured included interleukins (IL)-6, IL-8, IL-12p70, IL-10, IL-1ß, tumor necrosis factor (TNF)-α, interferon (INF)-γ; macrophage inhibitory factor (MIF) and a novel brain biomarker, phosphorylated neurofilament heavy subunit (pNF-H). Twenty-two cyanotic and 28 acyanotic subjects were enrolled with SpO2 of 78 ± 18% and 98 ± 2% (p < 0.001), respectively, and mean age of 72 days (range 2-303) and 102 days (range 1-274), respectively. Cyanotic vs acyanotic subjects had elevated serum IL-6 (6.6 ± 7.6 vs 2.9 ± 2.9 pg/ml, p = 0.019) and pNF-H (222 ± 637 vs 57 ± 121 pg/ml, p = 0.046), and both biomarkers correlated with degree of desaturation (Spearman rank-order correlation ρ = - 0.30, p = 0.037 and ρ = - 0.29 p = 0.049, respectively). Post-operative inotrope scores at 24 h and duration of mechanical ventilation correlated inversely with pre-operative oxygen saturation (ρ = - 0.380, p = 0.014 and ρ = - 0.362, p = 0.020, respectively). The degree of pre-operative desaturation correlated with a more complicated post-operative course supporting the need for advanced peri-operative therapy in this population.


Assuntos
Biomarcadores/sangue , Lesões Encefálicas/sangue , Cianose/sangue , Cardiopatias Congênitas/sangue , Lesões Encefálicas/etiologia , Cardiotônicos/administração & dosagem , Citocinas/sangue , Feminino , Cardiopatias Congênitas/complicações , Humanos , Lactente , Recém-Nascido , Inflamação/sangue , Inflamação/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Oxigênio/sangue , Período Pós-Operatório , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos
11.
Cardiol Young ; 28(5): 632-638, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29409559

RESUMO

Trace elements are essential micronutrients for the human body. In this study, we evaluated the alterations in copper, chromium, manganese, selenium, magnesium, zinc, iron, arsenic, boron, and silicon levels in children with cyanotic and acyanotic CHD who underwent cardiac surgery with cardiopulmonary bypass. Participants were divided into the following three groups: patients acyanotic CHDs (n=34), patients with cyanotic CHDs (n=30), and healthy controls (n=30). Blood samples were collected before the surgery and 1 hour after the sternum was closed. Serum trace elements were determined by Inductively Coupled Plasma Optical Emission Spectrometer-ICAP 6000. The baseline serum arsenic, manganese, and zinc levels of both patient groups were lower compared with controls, but there was no significant difference between baseline serum trace element levels of cyanotic and acyanotic patients. In both the patient groups, there was a significant decrease in postoperative serum arsenic, boron, copper, and zinc levels, and a significant increase in postoperative serum iron and magnesium levels. Silicon levels increased in cyanotic patients. Alterations in trace element levels were in the same direction in cyanotic and acyanotic patients. Copper, zinc, and manganase replacement may be needed after on-pump cardiac surgery.


Assuntos
Ponte Cardiopulmonar , Cianose/sangue , Cardiopatias Congênitas/cirurgia , Oligoelementos/sangue , Biomarcadores/sangue , Pré-Escolar , Cianose/etiologia , Feminino , Seguimentos , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/complicações , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Prospectivos
12.
Acta Paediatr ; 107(4): 653-657, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29210110

RESUMO

AIM: This study assessed cardiac performance and iron in subjects aged 12-36 months with breath-holding spells (BHSs). METHODS: We consecutively recruited 40 subjects (55% male) experiencing BHSs from the general paediatric outpatients department at the Children's Hospital, Ain Shams University, Egypt, from 2015 to 2016. The 20 matched comparisons were mainly healthy siblings. The workup included iron levels and electrocardiograms. RESULTS: The age at the onset of BHSs was 5-24 months with a median monthly frequency of 13. Almost two-thirds of the patients had cyanotic spells, and one-third had pallid spells, lasting 25-90 seconds. Lower serum iron levels and higher QT dispersion and T-wave dispersion were recorded in patients than the comparison group, and 4.8% had dysrhythmia and bradycardia. We observed higher durations of bradycardia during attacks and higher occurrences of dysrhythmia during cyanotic spells, which were more frequent in patients with prolonged or frequent BHSs. CONCLUSION: Our study of patients aged 12-13 months supported the theory of autonomic dysfunction in BHSs. The ECG findings, especially in patients with prolonged or frequent spells, need to be studied further to evaluate the risk of life-threatening events. Iron deficiency may play a role in autonomic dysfunction in patients with BHSs.


Assuntos
Anemia Ferropriva/diagnóstico , Doenças do Sistema Nervoso Autônomo/sangue , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Suspensão da Respiração , Ferro/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/fisiopatologia , Doenças do Sistema Nervoso Autônomo/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Cianose/sangue , Cianose/fisiopatologia , Egito , Eletrocardiografia , Feminino , Humanos , Lactente , Masculino
14.
Hemoglobin ; 41(2): 137-139, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28621168

RESUMO

We describe a case with a low oxygen affinity hemoglobin (Hb) variant who presented with cyanosis in the absence of cardiopulmonary disease. The patient, a 27-year-old pregnant female (P1G2), complained of a productive cough and bluish discoloration of the lips that started 3 days prior to seeking attention. She had no previous episodes and has generally been in good health. A positive family history of cyanosis was obtained in one sibling. Systematic examination, notably the cardiorespiratory system, revealed no abnormalities. The arterial Hb oxygen saturation (SpO2) on pulse oximetry was 81.0% and Hb separation studies revealed an Hb variant identified as Hb Rothschild [ß37(C3)Trp→Arg] (HBB: c.[112 T>A or 112 T>C]) by gene sequencing. The amino acid substitution (Trp→Arg) is an important contact point at the α1ß2 interface and favors a T-quaternary state of the Hb tetramer. This leads to a low oxygen affinity state, which results in premature release of oxygen and drop in oxygen saturation. In the absence of cardiopulmonary disease, a decreased oxygen saturation reading, with or without cyanosis, should arouse suspicion for a possible dysHb.


Assuntos
Índices de Eritrócitos , Hemoglobinas Anormais , Oximetria , Complicações Hematológicas na Gravidez , Adulto , Cianose/sangue , Cianose/genética , Feminino , Hemoglobinas Anormais/genética , Hemoglobinas Anormais/metabolismo , Humanos , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/genética
15.
Br J Anaesth ; 118(5): 788-796, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28510741

RESUMO

Background: In newborns and small infants undergoing cardiac surgery with cardiopulmonary bypass (CPB) and blood priming, it is unclear whether there is reduced blood loss if fresh frozen plasma (FFP) is added to the CPB priming volume. This single-centre, randomized trial tested the hypothesis that the administration of FFP after CPB (late FFP group) is superior to FFP priming (early FFP group) in terms of postoperative bleeding and overall red blood cell (RBC) transfusion. Methods: Seventy-three infants weighing <10 kg were randomly allocated to receive FFP to supplement RBCs in the CPB priming solution ( n =36) or immediately after CPB ( n =37). The primary endpoint was a difference in postoperative blood loss; secondary endpoints included the amount of RBCs and FFP transfused through the first 48 postoperative hours. Results: All patients were included in the analysis. Patients in the late FFP arm had greater postoperative mean blood loss than patients in the early FFP arm [33.1 ( sd 20.6) vs 24.1 (12.9) ml kg -1 ; P =0.028], but no differences in transfusions were found. The subgroup of cyanotic heart disease patients had comparable results, but with greater use of RBCs in the late FFP group. Conclusions: In infants undergoing cardiac surgery, FFP in the priming solution appears slightly superior to late administration in terms of postoperative bleeding. Clinical trial registration: www.ClinicalTrials.gov , NCT02738190.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Plasma , Volume Sanguíneo , Ponte Cardiopulmonar/métodos , Cianose/sangue , Cianose/terapia , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Cardiopatias Congênitas/cirurgia , Hemostasia , Humanos , Lactente , Recém-Nascido , Masculino , Hemorragia Pós-Operatória/epidemiologia , Resultado do Tratamento
17.
Asian Cardiovasc Thorac Ann ; 25(2): 118-122, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28068786

RESUMO

Background Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both. Methods Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg-1 intravenously after sternotomy and 20 mg kg-1 after heparin reversal. Group B patients were given tranexamic acid 50 mg kg-1 in 20 mL of saline intrapericardially before sternal closure, with the drain clamped for 20 min. Group C patients were given tranexamic acid 20 mg kg-1 intravenously after sternotomy and 50 mg kg-1 intrapericardially before sternal closure. A number of clinical variables were recorded in the first 3 postoperative days. Ventilator time, intensive care unit stay, and outcome were also recorded. Results Chest tube drainage and blood product requirements were lowest in group C. Blood urea and serum creatinine levels were higher in groups A and C ( p < 0.05). Intensive care unit stay and ventilator time were similar in all 3 groups. No patient died and none had a seizure or other neurological event or thromboembolic complication postoperatively. Conclusion The combination of low-dose intravenous and topical tranexamic acid reduces postoperative blood loss and blood product requirement without incurring neurological, renal or thromboembolic complications. We recommend the routine use of topical and low-dose systemic tranexamic acid in cyanotic pediatric cardiac surgery.


Assuntos
Antifibrinolíticos/administração & dosagem , Coagulação Sanguínea/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos , Cianose/etiologia , Fibrinólise/efeitos dos fármacos , Cardiopatias Congênitas/tratamento farmacológico , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Intravenosa , Administração Tópica , Adolescente , Antifibrinolíticos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tubos Torácicos , Criança , Pré-Escolar , Cianose/sangue , Cianose/diagnóstico , Método Duplo-Cego , Drenagem/instrumentação , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Humanos , Lactente , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos , Respiração Artificial , Fatores de Tempo , Ácido Tranexâmico/efeitos adversos , Resultado do Tratamento
18.
World J Pediatr ; 13(2): 122-128, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27878778

RESUMO

BACKGROUND: The levels of ghrelin and tumor necrosis factor alpha (TNF-α) are considered biological markers of congenital heart diseases (CHD). The present meta-analysis was conducted to investigate the clinical significance of serum levels of ghrelin and TNF-α in children with (CHD). METHODS: Chinese and English scientific literature databases were searched to retrieve published studies relevant to ghrelin, TNF-α and CHD. Manual search was additionally employed to identify other relevant studies from cross-references. The retrieved studies were screened on the basis of our stringent inclusion and exclusion criteria to select high quality case-control studies for meta-analysis. RESULTS: We initially retrieved 108 published studies (20 in Chinese and 88 in English) from database searches. Finally, 6 case-control studies (5 in English and 1 in Chinese) were enrolled in our meta-analysis, and contained a total of 160 cyanotic congenital heart disease (CCHD) patients and 215 acyanotic congenital heart disease (ACHD) patients, along with 162 healthy controls. The results of meta-analysis showed that serum levels of ghrelin and TNF-α in CCHD or ACHD children were significantly higher than those in healthy controls. CONCLUSIONS: Our meta-analysis results showed that serum levels of ghrelin and TNF-α are elevated in children with CHD, and could be used as effective biologic markers in early diagnosis of CHD.


Assuntos
Cianose/sangue , Diagnóstico Precoce , Grelina/sangue , Cardiopatias Congênitas/sangue , Fator de Necrose Tumoral alfa/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Cianose/diagnóstico , Ensaio de Imunoadsorção Enzimática , Feminino , Cardiopatias Congênitas/diagnóstico , Humanos , Masculino , Sensibilidade e Especificidade , Índice de Gravidade de Doença
19.
Anesth Analg ; 124(1): 23-29, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27861436

RESUMO

BACKGROUND: Children with congenital heart defects (CHD) have quantitative and qualitative differences in coagulation compared with healthy children. Secondary to polycythemia and increased deformability of red blood cells, cyanosis may be an important confounding factor for altered whole-blood coagulation in this population with potential implications for interpreting intraoperative thromboelastometry (TEM) for children with CHD undergoing major surgery. The primary aim of the study was to evaluate the association between cyanosis in children with CHD and measures of whole-blood coagulation determined using TEM (ROTEM [Tem International, GmbH, Munich, Germany]). METHODS: In this retrospective cohort study, children who underwent congenital cardiac surgery in a 12-month period between April 2014 and 2015 were investigated. Children who were receiving antiplatelet or anticoagulant medications in the preoperative period were excluded. Eligible children were categorized by the presence of cyanosis, defined as an oxyhemoglobin concentration ≤85%. Multivariable linear regression analyses were used to determine the relationship between cyanosis and TEM outcomes (primary outcome, fibrinogen/fibrin polymerization [FibTEM] maximal clot firmness [MCF]) adjusting for potential confounding factors. RESULTS: Three hundred forty-five TEM profiles from 320 children were included in the cohort for analysis. Twenty-two percent (76/345) of children had cyanotic CHD. Clot firmness measured using the FibTEM assay was decreased in cyanotic children compared with noncyanotic children, median difference (95% confidence interval) interim [2 (0-3) mm; P = .01], and maximal [2 (1-3) mm; P = .01] clot firmness. The association between cyanosis and fibrinogen/fibrin polymerization clot firmness was not significant (A10, P = .7; MCF, P = .7) after adjusting for confounding factors (hematocrit, platelet count, and sex). There was a significant association between cyanosis and intrinsically activated clot firmness (A10, P = .03; MCF, P = .02), but not other TEM outcomes, after adjusting for confounding factors. CONCLUSIONS: Cyanotic children had decreased clot firmness in the fibrinogen/fibrin polymerization component of the clot compared with noncyanotic children, but the association between cyanosis and clot firmness was accounted for by differences in hematocrit, platelet count, and sex between groups. These findings will help guide the identification and treatment of coagulopathy in this vulnerable population.


Assuntos
Coagulação Sanguínea , Cianose/etiologia , Cardiopatias Congênitas/complicações , Tromboelastografia , Fatores Etários , Criança , Pré-Escolar , Cianose/sangue , Cianose/diagnóstico , Feminino , Fibrina/metabolismo , Fibrinogênio/metabolismo , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/diagnóstico , Hematócrito , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Análise Multivariada , Contagem de Plaquetas , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais
20.
Ann Card Anaesth ; 19(2): 300-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27052073

RESUMO

INTRODUCTION: Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes. MATERIALS AND METHODS: Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post-CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded. RESULTS: The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut-off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803). CONCLUSIONS: The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cianose/sangue , Hipoalbuminemia/etiologia , Hipoalbuminemia/metabolismo , Complicações Pós-Operatórias/sangue , Albumina Sérica/metabolismo , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte Cardiopulmonar/efeitos adversos , Cardiotônicos/uso terapêutico , Criança , Pré-Escolar , Cianose/diagnóstico , Cianose/mortalidade , Humanos , Hipoalbuminemia/mortalidade , Lactente , Recém-Nascido , Inflamação/sangue , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Respiração Artificial , Albumina Sérica/análise , Tetralogia de Fallot/mortalidade , Tetralogia de Fallot/cirurgia , Adulto Jovem
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