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Blood disorders that can contribute to abnormal bleeding can have a detrimental effect during cardiac surgery. Patients who are known to have such pathologies should be investigated thoroughly and cautious measures would need to be taken when cardiac surgery is needed in this cohort. The majority of current literature for cardiac surgery in patients with von Willebrand Disease and haemophilia are case reports. Nevertheless, evidence shows that optimising factor levels pre, intra and postoperatively offers outcomes similar to that of patients without these disorders. Preoperative screening followed by appropriate iron therapy reduces mortality for patients with anaemia. In this group, haemoglobin levels can be improved postoperatively through iron supplementation. The management strategy of cardiac surgery for people with blood disorders requires a multidisciplinary approach that is highly individualised for each patient. It is essential to adequately adjust preoperative, perioperative and postoperative care to the patient's blood disorder in order to achieve outcomes similar to that of patients without blood disorders.

Several drugs that reduce functional levels of the plasma protease zymogen factor XI (FXI), or that inhibit its activated form (FXIa), are being evaluated as treatments to prevent thrombosis. Based on the observation that individuals with inherited FXI deficiency have a relatively mild bleeding disorder, it is anticipated that therapeutic FXI(a) inhibitors will have a smaller impact on hemostasis than anticoagulants targeting thrombin or factor Xa. However, even if FXI(a) inhibitors are determined to be safer than currently used anticoagulants, some patients on these drugs will experience abnormal bleeding or require emergent surgery. Strategies for dealing with such situations are required. Treatment with antifibrinolytic agents and low doses of recombinant factor VIIa effectively prevent abnormal bleeding in FXI-deficient patients with alloantibody inhibitors to FXI who undergo surgery. We propose that a similar strategy can be used for patients on therapeutic FXI(a) inhibitors who are bleeding or require invasive procedures.

Women with abnormal uterine bleeding (AUB) have been reported to develop chronic spontaneous urticaria (CSU). Nevertheless, whether or not AUB women have an increased risk of CSU has not been examined in large-scale epidemiologic studies. This study aimed to investigate the risk of CSU among reproductive-aged women with AUB. A total of 79 595 patients and 79 107 propensity-score matched controls were recruited from Taiwan's National Health Insurance Research Database to conduct a nationwide cohort study. The Cox proportional-hazard regression model was applied to examine the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for CSU in relation to AUB. We found that women with AUB had a higher risk for CSU (aHR = 1.83; 95% CI, 1.76-1.90) than women without AUB. Subgroup analyses revealed that AUB with an abnormal bleeding frequency (aHR = 1.70; 95% CI, 1.60-1.79), irregular bleeding (aHR = 1.80; 95% CI, 1.71-1.89), and intermenstrual bleeding (aHR = 1.65; 95% CI, 1.49-1.83) were associated with an increased risk of CSU compared with those without abnormalities. The Kaplan-Meier analysis revealed that the cumulative incidence of developing CSU was consistently higher in the AUB cohort than in the non-AUB cohort during the entire follow-up period (log-rank test, p

Background The presence of uterine endometrial polyps is associated with not only abnormal uterine bleeding but also infertility, so the use of hysteroscopic polypectomy has been increasing. This operation is considered to increase cost-effectiveness when performed prior to infertility treatments. However, there are typical problems to consider, including the possibility of spontaneous regression of the polyp and the duration of complete endometrial wound healing after surgery. Meaningless interventions must be avoided, when possible. Therefore, data acquisition and analysis of various findings obtained from surgery have become important for improving treatment procedures and patient selection. To estimate the spontaneous regression rates and contributions of multiple factors to uterine endometrial polyps during the waiting period (approximately 2–3 months) before hysteroscopic polypectomy, we performed a multivariate analysis of data from the records in our hospital. Methods The medical records of 450 cases from September 2014 to April 2021 in our hospital were retrospectively reviewed under the approval of our Institutional Review Board. We included all cases of hysteroscopic polypectomy with postoperative pathological diagnosis. We defined cases as having a “spontaneously regressed polyp” when the target polyp was not detected by postoperative pathological examination. We extracted data on the following ten factors: “Advanced age” (≥ 42 years), “Small polyp” (2), “Nulliparity,” “Single polyp,” “Infertility,” “Hypermenorrhea,” “Abnormal bleeding,” “No symptom,” and “Hormonal drug use.” We also classified cases into five groups according to the size of the polyp (≤ 4.9 mm, 5.0–9.9 mm, 10.0–14.9 mm, 15.0–19.9 mm, and ≥ 20.0 mm) and determined the frequency of spontaneously regressed polyp in each group. Results After exclusion of cases with insufficient data or other diseases, such as submucosal leiomyoma, 424 cases were analyzed. Among them, 28 spontaneously regressed polyps were identified, and the highest frequency of spontaneously regressed polyp was detected among the cases with polyps measuring 5.0–9.9 mm (16.4%). On multivariate analysis of the ten factors, “Small polyp” and “Hormonal drug use” were found to significantly impact the frequency of spontaneously regressed polyp. Conclusions On the basis of the factors identified in this analysis, the indications for observation or medical therapy adapted to small polyps might be expanded.

Radical trachelectomy (RT) is a surgery for early-stage cervical cancer treatment that preserves the childbearing ability, and its use has become increasingly common worldwide. Thus, the rate of conception in women who have undergone RT is increasing. However, pregnancy after RT is associated with a higher risk of several obstetric complications such as preterm delivery, preterm premature membrane rupture, and abnormal bleeding from varices at the site of uterovaginal anastomosis. Furthermore, since RT have a residual prophylactic cerclage, it is difficult to manage first- and second-trimester miscarriages. There is little previous data on the management of pregnancy after RT. In this review article, we summarize various management methods and experiences to provide a guide to clinicians for perinatal management after RT.

This study assesses outcomes of colposcopy referrals for post‐coital, intermenstrual, or other abnormal bleeding with negative oncogenic human papillomavirus and negative to low‐grade cytology. Of 112 cases with median age of 34.5 years, cervical biopsy occurred in 19%, treatment of ectropion in 19%, endometrial sampling in 8%, polypectomy in 4%, and contraceptive change in 2%. No cervical or endometrial neoplasia was detected. Patients with bleeding symptoms and reassuring co‐test may instead attend a general gynaecology clinic.

Gestational choriocarcinoma (GCC) is a highly malignant but rare tumour originating in the trophoblastic tissue. It is associated with high maternal morbidity and mortality especially when there is a delay in diagnosis and treatment. This is the only female malignant condition that is curable with chemotherapy following early treatment. The objective of this study was to retrospectively determining the incidence of choriocarcinoma, its clinical presentations, risk factors, the interval between the antecedent case and time of diagnosis, treatment options and outcome in ESUT-TH. The folders of patients treated for GCC over the period of the study served as source of data. Results showed that the incidence of GCC was 0.1% or 1 in 1731 deliveries. It further shows that GCC accounted for 0.2% of gynaecological admission in ESUT-TH. Abnormal bleeding per vaginum and amenorrhoea were the commonest presenting symptoms discovered in this study, while other clinical presentations noted include; isolated vaginal nodule, ovarian mass and haemoptysis. Molar gestation and miscarriage were the risk factors discovered in this study, lungs were discovered to be the commonest site of metastasis. It is concluded that gestational choriocarcinoma is a rare malignancy in ESUT-TH, South-East Nigeria with minor case fatality. Keywords: Gestational, Choriocarcinoma, incidence.

Background Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages. The underlying disorder causing the development of an autoimmune phenomenon is not always known, but 10%-15% could be linked to malignancies. Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy. Case summary We present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease. Haemostasis was established with recombinant activated factor VII, and immunosuppressive therapy was started immediately. An extensive surgical procedure was performed in order to remove the cancer and, therefore, eliminate the inhibitory autoantibodies. Due to a complicated postoperative course, relatively short period of treatment and likelihood of micrometastases, no improvement in the patient's status was observed. Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed. Conclusion Prompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality. Among patients with cancer, other causes of abnormal bleeding related to malignancy should be considered.

Congenital factor X (FX) deficiency is a rare autosomal-recessive disease that induces bleeding disorder. Herein, we present the 10-year posttransplant course of a pediatric patient who underwent liver transplantation (LT) with portal vein (PV) stenting for cor rection of severe congenital FX deficiency, with focus on long-term maintenance of coagulation function and patency of PV stenting. A 17-month-old infant with recurrent hemorrhagic episodes due to FX deficiency underwent split LT using a left lateral sec tion graft. The graft-recipient weight ratio was 2.2%. The graft implantation procedures were performed by following the standard pediatric split LT procedure. Nevertheless, a wall stent was inserted due to PV anastomotic stenosis on posttransplant day 1. Graft function recovered slowly because of partial parenchyma infarct, and the patient was discharged at 46 days after LT operation. The FX activity started to increase soon after LT and gradually normalized; the coagulation profiles have been maintained well for the past 10 years. The patient has been doing well for the past 10 years after LT without any episodes of abnormal bleeding. Due to the risk of vascular complications owed to PV stenting, life-long follow-up is mandatory with special attention until attainment of com plete physical growth to adolescent and adulthood.

Objectives To present the consequences of and risk factors for abnormal bleeding after ECV (external cephalic version). Methods We conducted a retrospective chart review at a single center in Japan. Abnormal bleeding was defined as vaginal bleeding and/or intrauterine hemorrhage. We descriptively assessed birth outcomes among women with abnormal bleeding, and investigated the risk factors using a logistic regression analysis. Results Of 477 women who received ECV, 39 (8.2%) showed abnormal bleeding, including 16 (3.4%) with intrauterine hemorrhage. Of the 16 women with intrauterine hemorrhage, 14 required emergency cesarean section; none experienced placental abruption, a low Apgar score at 5 min (50 mm (adjusted odds ratio [OR]: 3.48, 95% confidence interval [CI]: 1.23–9.90), as was higher in women with unsuccessful ECV than in those with successful ECV (aOR: 4.54, 95% CI: 1.95–10.6). Conclusions A certain number of women who underwent ECV had abnormal bleeding, including vaginal bleeding and/or intrauterine hemorrhage, many of them resulted in emergency cesarean section. Although all of cases with abnormal bleeding had good birth outcomes, one case of vaginal bleeding was accompanied by placental abruption. Small amniotic fluid volume and unsuccessful ECV are risk factors for abnormal bleeding.

Background Apixaban (ELIQUIS®) is a direct oral anticoagulant authorised for multiple indications in the European Economic Area (EEA). Additional risk minimisation measures (aRMMs) to address the risk of bleeding include educational materials comprising a Prescriber Guide and Patient Alert Card. Objectives This study evaluated effectiveness of the apixaban Prescriber Guide and Patient Alert Card in terms of healthcare professional (HCP) and patient knowledge of associated bleeding risk, as well as material distribution, utilisation and behaviour. Methods This non-interventional, cross-sectional study included online surveys in ten countries that represented a high proportion of apixaban usage in the EEA. The HCP source population was based on HCP lists used for communications about and distribution of the risk minimisation materials. Patient recruitment took place via HCPs. Study participants included HCPs involved in apixaban treatment and patients treated with apixaban (or their caregivers) for multiple indications. Data collection took place over an 18-month period between August 2015 and February 2017. Results Survey responses from 385 HCPs and 125 patients/caregivers were analysed. HCP knowledge of bleeding risk included early recognition of symptoms requiring immediate contact with an HCP (96.1%), appropriate dosing (83.6%), contraindications (76.1%) and subpopulations at increased risk of bleeding complications (ranging from 63.5 to 85.9%). Patient knowledge included abnormal bleeding as an important side effect (71.2%), communicating risk factors to HCPs (76.8%) and recognition of potential bleeding symptoms (‘high’ knowledge levels 22.4%, ‘moderate’ knowledge levels 49.6%). Of 226 (58.7%) HCPs who recalled receiving/obtaining the Prescriber Guide, 97.8% read at least part of it and 74.8% had used it to assist patient discussions. Of 74 (59.2%) patients who were aware of the Patient Alert Card, 89.2% recalled receiving/obtaining a copy. When received, 90.9% of patients read the card at least once and 93.9% kept it with them at least some of the time. Conclusions HCP and patient respondent knowledge of bleeding risk was satisfactory. Although not optimal, reach of the aRMMs was consistent with other studies. No modifications to aRMM content were required. To increase reach, the Prescriber Guide has been provided in an additional format as a web-based platform whilst the Patient Alert Card was included within product packaging. Supplementary Information The online version contains supplementary material available at 10.1007/s40290-021-00380-1.

Aim: The aim of present study was to analyse endometrial estrogen and progesterone receptor expression and blood vessel density in cases of abnormal uterine bleeding. Material and method: The present study was conducted in the department of Pathology at SMS Medical College, Jaipur among specimens received from 266 patients presenting with abnormal uterine bleeding in reproductive age group (18-45 years) on endometrial biopsies and hysterectomy specimens. The intensity and distribution of ER, PR was evaluated using a semi-quantitative method Allred score. Also density of blood vessels /10 HPF was evaluated. Results: Neoplastic cases were found among 9.4% (25) of the subjects whereas non-neoplastic lesions were present in 90.6% (241) of the subjects. Mean Allred scoring of estrogen and progesterone receptor in glandular component was highest among endometrial carcinoma. Mean Allred scoring of estrogen receptor in stromal component was highest among Hyperplasia without atypia (5.13±1.58). Mean progesterone receptor in stroma component was highest among Hyperplasia without atypia followed by disordered maturation and endometrial carcinoma. Conclusion: The results of the present study showed that ER and PR expression are useful investigations. There expression varies in various causes of abnormal bleeding. Future studies with clinical trials could be done to try medical treatment of AUB.

Introduction: Thrombocytopenia is not a disease itself, but a subnormal number of platelets in blood and is one of the most common causes of abnormal bleeding. The patient with thrombocytopenia often presents diagnostic and management challenges. The differential diagnosis is broad because the disorders leading to thrombocytopenia are diverse, with failed production at one extreme and the accelerated destruction at the other. Aims and Objective: To highlight and diagnose thrombocytopenia and investigate the cause of thrombocytopenia in our tertiary care center. Materials and Methods: The present study is retrospective, cross sectional study done on screened 389 thrombocytopenia patients which were came to our hematology lab. All patients of proved thrombocytopenia patients were included in the study over a period of 3 years from May 2013 to April 2016. Pseudo-thrombocytopenia patients were excluded from the study. All these patients were investigated in a systemic manner, causes of thrombocytopenia were ascertained and data was analyzed. Results: The most common affected age group of thrombocytopenia was 3rd decades and 2nd decades respectively with male predominance. The most common cause of thrombocytopenia is anemia, infection, spleenomegaly and alcoholism. Dimorphic anemia, malaria and HIV are the most etiology of anemia and infection respectively. Conclusion: Thrombocytopenia is root cause of abnormal bleeding in many cases. Importance of early and prompt diagnosis of thrombocytopenia is always warranted as treatment differs depending upon the etiology. Thrombocytopenia is multifactorial and a finding that may result from various diseases and clinicopathological approach is important in these cases. Keywords: Thrombocytopenia, Platelets, Etiology, Multifactorial, Clinicopathological.

Introduction: Abnormal uterine bleeding (AUB) is the most common complaint in women of all age groups. The causes for abnormal bleeding needs to be evaluated before subjecting the patient to complicated surgical procedures. Transvaginal sonography is a simpleoutpatient procedure to identify suitable candidates for endometrial biopsy which provides an accurate diagnosis. Aims and Objectives: 1. To emphasize on the correlation of sonology and histopathological findings and to provide the cause of pathology for Abnormal Uterine Bleeding (AUB) in majority of cases. 2. To study the clinical data of the patients presenting with AUB and its histopathological spectrum. Materials and Methods: This was a prospective study conducted in the Department of Pathology over a period of one year from January 2016 to December 2016. Endometrial biopsies of patients of all age groups presenting with a chief complaint of Abnormal uterine bleeding and abnormal USG findings were included in the study while inadequate biopsies and patients with genital infections, pregnanacy–complications were excluded. The biopsies were processed as per the standard protocol. Histopathological examination was done and the diagnosis was given. Results were statistically analyzed. Results: A total of 87 cases were analyzed based on age, clinical presentation, parity, correlation of sonography- histopathological findings was done and the results were found to have statistically significant p values. Conclusion: A combination of sonography with histopathology provides an accurate diagnosis for AUB in most of the cases, specifically those with organic pathology. Keywords: Abnormal uterine bleeding, histopathology, organic pathology, transvaginal sonography.

Mesonephric adenocarcinoma of the uterine cervix is an extremely rare tumor of the female genital tract which derives from the remnants of embryonic mesonephric ducts and its prognosis, diagnosis and treatment is rather challenging. We report a case of a 46-year-old woman with history of abnormal uterine bleeding and an enlarged uterine cervix on physical examination without obvious mass lesion. She was clinically underdiagnosed with cervical myoma and mesonephric hyperplasia. After simple hysterectomy, stage IB2 mesonephric adenocarcinoma was diagnosed. Despite adjuvant chemoradiation, she presented with peritoneal and locoregional recurrence in less than a year. So, in the presence of abnormal bleeding and cervical mass, mesonephric hyperplasia in cervical biopsy specimen should be suspected for adenocarcinoma. Radical hysterectomy and complete staging with or without salpingo-oophorectomy is the mainstay of treatment. Despite all ambiguities, due to the small number of reported cases, the overall prognosis seems to be less favorable than conventional cervical adenocarcinoma.

Heavy menstrual bleeding or abnormal bleeding is most common problems in females in present era due to improper diet habits, sleeping habits due to increasing degrees of civilisation. There are various treatment on heavy menstrual flow like hormonal replacement therapy where there is hormonal imbalancement, Anti fibrinolytics drugs in dysfunctional uterine bleeding available today. According to Ayurveda it can be correlated with Raktapradar. Various drugs are suggested in raktapradar in classical text. In this study efficacy of Sphatik bhasma (potassium aluminium sulphate also known as potassium alum or potashalum, has a molecular formulae of K2(SO4).Al2(SO4)3.24H2O) as haemostatic drug is observed through clinical trial. The clinical study was conducted on 15 patients having heavy menstrual bleeding. Interventional drug Sphatik Bhasma with pakwa kadali phala (banana or Musa paradisiaca) is administered for 3 days. The clinical assessment was done on the basis of grading criteria of Rakta Pradar like amount and duration of bleeding, pain, burning sensation and weakness and were assessed on mean scores before and after treatment and analysed. The results were statistically and clinically highly significant in Raktapradar.

A 66-year-old woman had experienced abnormal bleeding since the age of 7. Thrombocytopenia was not detected until she was 48, and immune thrombocytopenia was diagnosed at age 66. She also reported experiencing hearing disturbance since the age of 30 and acute renal failure since the age of 61 but reported no visual disturbance. Her younger son, who was 40 years old, also experienced abnormal bleeding since the age of 6, but immune thrombocytopenia was diagnosed as late as age 35. He had no other associated disorders. Laboratory examinations of both mother and son revealed a low platelet count (8000 and 29,000 µL, respectively), giant platelets and Dohle body-like granulocyte inclusion bodies. The mother had a high creatinine level (15.4 mg/dL) and normal liver enzyme levels. MYH9 genetic analysis identified a heterozygous mutation, c.101T>A, p.Val34Glu at exon 2 in both patients. These clinical and laboratory findings were consistent with a diagnosis of an MYH9-related disorder with different phenotypes observed in the same family. MYH9-related disorders were recognised in 2003, but were often misdiagnosed as immune thrombocytopenia, and hence, they have rarely been reported in Taiwan.

BackgroundTo determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul Afghanistan.MethodsAn observational study was designed to determine the prevalence, related factors and maternal outcomes of primary PPH in governmental hospitals in Kabul-Afghanistan. The population of this study consisted of all women who gave birth to a child between August and October 2018. The structured checklist was used to collect the data from patients who were suffering from primary PPH.ResultsAmong the 8652 women who were observed, 215 (2.5%) of them suffered from primary PPH and 2 (0.9%) of them died under caesarean section. The most common related factors of primary PPH were uterine atonia (65.6%), previous PPH (34.9%), prolonged labor (27%), genital tract trauma (26.5%), and induction of labor (20.5%). The most common maternal outcomes of primary PPH were respiratory failure (7%), hysterectomy (6%), and hypovolaemic shock (5.1%).ConclusionsAccording to our findings, the major cause of postpartum bleeding was uterine atonia. Therefore, postpartum care of women is essential, especially for those with previous PPH and prolonged labor that require more attention.

Macrothrombocytopenia (MTP) is a group of rare disorders characterized by giant platelets, thrombocytopenia, and variable association with abnormal bleeding. Inherited MTP are frequently misdiagnosed as immune thrombocytopenia. Associated second-organ manifestation can help narrow down syndromic MTPs. We describe a case of autosomal dominant sensorineural hearing loss and MTP caused by a gain of function mutation in DIAPH1. This mutation causes altered megarkaryopoiesis and platelet cytoskeletal deregulation. Although hearing loss and MTP were likely progressive, clinically significant bleeding was not observed. DIAPH1-related MTP can be distinguished clinically from MYH9 mutation by the absence of cataracts and glomerular disease.

Objective This study aims to evaluate the safety and efficacy of lobaplatin in prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gastric cancer. Methods Advanced gastric cancer patients who underwent radical gastric resection and/or prophylactic HIPEC were systematically reviewed in our department from January 2016 to June 2017. All enrolled patients were grouped in either HIPEC or non-HIPEC groups. Clinical data were collected and analyzed. Results A total of 129 patients were enrolled with 61 cases in the HIPEC group and 68 in the non-HIPEC group. The two groups were well balanced in terms of clinical characteristics. In patients of the HIPEC group, three suffered leakage from the duodenal stump or anastomosis, one suffered abnormal bleeding and two were found to have abnormal routine blood tests; no significant difference in adverse events between groups, however, was noted (p > 0.05) and most patients recovered uneventfully. During follow-up, peritoneal recurrence was significantly less among HIPEC patients (p = 0.029), with only three suffering peritoneal recurrence, as compared to 12 non-HIPEC patients. In addition, the estimated illness-specific 3-year disease-free survival rate was significantly higher in the HIPEC group as compared to the non-HIPEC group (89.4% vs.73.9%; p = 0.031). Conclusion Lobaplatin in prophylactic HIPEC is safe for advanced gastric cancer patients after treatment by radical resection and can effectively improve illness-specific 3-year disease-free survival.

Inherited platelet disorders (IPDs), which manifest as primary hemostasis defects, often underlie abnormal bleeding and a family history of thrombocytopenia, bone marrow failure, hematologic malignancies, undefined mucocutaneous bleeding disorder, or congenital bony defects. Wide heterogeneity in IPD types with regard to the presence or absence of thrombocytopenia, platelet dysfunction, bone marrow failure, and dysmegakaryopoiesis is observed in patients. The individual processes involved in platelet production and hemostasis are genetically controlled; to date, mutations of more than 50 genes involved in various platelet biogenesis steps have been implicated in IPDs. Representative IPDs resulting from defects in specific pathways, such as thrombopoietin/MPL signaling; transcriptional regulation; granule formation, trafficking, and secretion; proplatelet formation; cytoskeleton regulation; and transmembrane glycoprotein signaling are reviewed, and the underlying gene mutations are discussed based on the National Center for Biotechnology Information database and Online Mendelian Inheritance in Man accession number. Further, the status and prevalence of genetically confirmed IPDs in Korea are explored based on searches of the PubMed and KoreaMed databases. IPDs are congenital bleeding disorders that can be dangerous due to unexpected bleeding and require genetic counseling for family members and descendants. Therefore, the pediatrician should be suspicious and aware of IPDs and perform the appropriate tests if the patient has unexpected bleeding. However, all IPDs are extremely rare; thus, the domestic incidences of IPDs are unclear and their diagnosis is difficult. Diagnostic confirmation or differential diagnoses of IPDs are challenging, time-consuming, and expensive, and patients are frequently misdiagnosed. Comprehensive molecular characterization and classification of these disorders should enable accurate and precise diagnosis and facilitate improved patient management.

Background Carotid-cavernous fistula (CCF) is a rare complication after transsphenoidal surgery. Methods The aim of this article is to report a case of CCF after the endoscopic resection of a growth hormone secreting pituitary microadenoma, and to discuss and review all the cases of CCF secondary to transsphenoidal procedures described in literature. Results A patient aged 74 years was operated for a growth hormone pituitary microadenoma through an endoscopic transsphenoidal surgery. During the procedure, a copious bleeding from the left cavernous sinus was managed with hemostatic material. A direct CCF was diagnosed and managed with transvenous and transarterial coiling. A complete exclusion of the fistula was possible, and the patency of the internal carotid artery was maintained. A total of 9 other cases have been reported. A transsphenoidal approach was performed for sellar tumors in 6 cases, and for chronic sinusitis in 2 cases. In 7 cases, intraoperative hemorrhage was reported, which could be controlled in 5 cases. The postoperative diagnosis of CCF was immediate in 5 cases. Patients presented with persistent bleeding after nasal unpacking or later with chemosis and proptosis. Cerebral angiography was the gold standard for the diagnosis. Eight cases were successfully treated through endovascular techniques with no recurrence observed at follow-up (mean of 15 months). No major neurologic complications were observed. Conclusions CCF should be suspected with every abnormal bleeding after transsphenoidal surgeries, even when the symptoms are mild. Diagnostic arteriography and endovascular treatment represent the mainstay of the management, and an early diagnosis strongly improves the prognosis.

OBJECTIVE To assess the efficacy of ulipristal acetate (UPA) for reducing abnormal bleeding among women using the 52-mg levonorgestrel intrauterine system (LNG-IUS). METHODS A randomized, double-blind, placebo-controlled pilot study conducted from September 1, 2016 to September 30, 2018, at the University of Campinas, Brazil. LNG-IUS users reporting prolonged or frequent uterine bleeding for at least 1 year were randomized to receive 5 mg UPA per day for 5 days or placebo at an identical regimen. Bleeding was recorded for 90 days after treatment began and was compared between the groups. RESULTS Of 94 eligible women, 64 with abnormal bleeding associated with LNG-IUS use declined treatment or device removal after counselling regarding anticipated bleeding patterns. For the 25 study participants, differences were nonsignificant between the UPA and placebo groups for number of days before bleeding stopped and days free of bleeding; however, UPA users displayed a trend for shorter duration before bleeding stopped and longer time free of bleeding. A similar trend for mean number of bleeding days at 30-, 60-, and 90-day follow-up was observed. CONCLUSION A nonsignificant trend in reduction of abnormal bleeding was observed among LNG-IUS users taking 5 mg UPA per day for 5 days compared with placebo; however, further research is needed. CLINICALTRIALS.GOV: NCT03186586.

BACKGROUND: This study aims to explore the influence of off-pump coronary artery bypass grafting (OPCABG) on coagulation function and the effects of diabetes on coagulation function during OPCABG. METHODS: Patients who met the inclusion and exclusion criteria were divided into two groups: diabetes mellitus (DM) and non-diabetes mellitus (NDM) groups. Thromboelastography (TEG) was tested at the following time points: T0, five days after aspirin and clopidogrel therapy, and before OPCABG; T1, returning to care unit after OPCABG; T2, 5 days after aspirin and clopidogrel therapy, and after OPCABG. RESULTS: A total of 56 patients were involved. There were no deaths, or no early postoperative thrombotic events and abnormal bleeding after OPCABG. Intra-group comparison: Compared with T0, the R and K value decreased, while the α angle and MA value increased at T1 and T2, in both groups (P0.05). CONCLUSIONS: The coagulation function of patients was at a hypercoagulable state at the early stage after OPCABG. The coagulation function was affected by diabetes at the day of OPCABG. However, there was no statistical difference after 5 days of aspirin and clopidogrel therapy following OPCABG.

Nesta revisão de literatura, será abordado os obstáculos que jovens e crianças portadores da hemoglobina S enfrentam em seu dia a dia. Devido a falcização das hemácias quando há desoxigenação, os portadores da anemia falciforme sofrem diariamente danos irreparáveis. Inúmeros são os desconfortos, como dores permanentes em diversas áreas do corpo, complicações como acidente vascular cerebral, priaprismo, limitações em exercícios físicos e em caso de complicações e rigorosidade no quadro clínico é preciso fazer transfusão sanguínea. Desta forma, é preciso que os pacientes, pais, parentes, profissionais da área da saúde e do esporte saibam lidar com eventos como esse e quais os riscos que o mesmo corre de acordo com suas atividades diárias. Entretanto, a desigualdade social é notória no Brasil, por mais que a gama de informações seja extensa, nem todos tem igualdade de acesso a ela e muitas vezes essa falta de conhecimento atrapalham o bem-estar e a qualidade de vida do indivíduo e até mesmo o convívio social. O objetivo deste trabalho é, levar maiores informações aos portadores e pessoas próximas aos mesmos, conhecer quais as maiores dificuldades que enfrentam e analisar as consequências que a falta de conhecimento a respeito da anemia falciforme pode causar na vida de um indivíduo. In this literature review, the obstacles that young people and children with hemoglobin S face in their daily lives will be addressed. Due to sickling of the red blood cells when there is deoxygenation, patients with sickle cell anemia suffer irreparable damage daily. There are countless discomforts, such as permanent pain in different areas of the body, complications such as stroke, priaprism, limitations in physical exercises and in case of complications and rigor in the clinical situation, blood transfusion is necessary. In this way, it is necessary that patients, parents, relatives, health and sports professionals know how to deal with events like this and what risks they run according to their daily activities. However, social inequality is notorious in Brazil, as much as the range of information is extensive, not everyone has equal access to it and often this lack of knowledge hinders the well-being and quality of life of the individual and even the social conviviality. The objective of this work is to bring more information to patients and people close to them, to know what are the biggest difficulties they face and to analyze the consequences that the lack of knowledge about sickle cell anemia can cause in an individual's life. En esta revisión bibliográfica se abordarán los obstáculos que enfrentan los jóvenes y niños con hemoglobina S en su vida diaria. Debido a la falcificación de los glóbulos rojos cuando hay desoxigenación, los pacientes con anemia de células falciformes sufren daños irreparables a diario. Son innumerables las molestias, como dolor permanente en diferentes zonas del cuerpo, complicaciones como ictus, priaprismo, limitaciones en los ejercicios físicos y en caso de complicaciones y rigor en la situación clínica es necesaria la transfusión de sangre. De esta forma, es necesario que pacientes, padres, familiares, profesionales de la salud y del deporte sepan cómo afrontar eventos como este y qué riesgos corren según sus actividades diarias. Sin embargo, la desigualdad social es notoria en Brasil, por más que la oferta de información sea amplia, no todos tienen igual acceso a ella y muchas veces esa falta de conocimiento dificulta el bienestar y la calidad de vida del individuo e incluso la convivencia social. El objetivo de este trabajo es acercar más información a los pacientes y personas cercanas a ellos, conocer cuáles son las mayores dificultades a las que se enfrentan y analizar las consecuencias que el desconocimiento sobre la anemia falciforme puede ocasionar en la vida de un individuo.

Purpose of review To summarize the recent literature related to female hemophilia A carriers with respect to prevalence in the population, the impact of baseline factor VIII levels and other influences on bleeding phenotype, and clinical management needs. Recent findings Many female hemophilia A carriers are at risk for abnormal bleeding, yet they are underrecognized by healthcare providers and their bleeding symptoms are underreported. Low FVIII levels are consistently associated with clinically significant bleeding and correlate well with skewed X chromosome inactivation (XCI). Most interestingly, bleeding tendency is also observed in some hemophilia A carriers with normal factor VIII levels and requires further investigation. Well controlled studies investigating peripartum and periprocedural FVIII levels and adequate hemostatic treatment are necessary to inform management guidelines. Summary Prevalence and bleeding tendency of hemophilia A carriers remain underreported, despite a significant proportion having low FVIII levels. Skewed XCI may explain low FVIII but does not explain the bleeding risk encountered in a larger proportion of hemophilia A carriers with random XCI and borderline/normal FVIII.

Hemophilia A is a bleeding disease caused by loss of coagulation factor VIII (FVIII) function. Although prophylactic FVIII infusion prevents abnormal bleeding, disability and joint damage in hemophilia patients are common. The cost of treatment is among the highest for a single disease, and the adverse effects of repeated infusion are still an issue that has not been addressed. In this study, we established a nonviral gene therapy strategy to treat FVIII knockout (FVIII KO) mice. A novel gene therapy approach was developed using dipalmitoylphosphatidylcholine formulated with iron oxide (DPPC-Fe3O4) to carry the B-domain-deleted (BDD)-FVIII plasmid, which was delivered into the FVIII KO mice via tail vein injection. Here, a liver-specific albumin promoter-driven BDD-FVIII plasmid was constructed, and the binding ability of circular DNA was confirmed to be more stable than that of linear DNA when combined with DPPC-Fe3O4 nanoparticles. The FVIII KO mice that received the DPPC-Fe3O4 plasmid complex were assessed by staining the ferric ion of DPPC-Fe3O4 nanoparticles with Prussian blue in liver tissue. The bleeding of the FVIII KO mice was improved in a few weeks, as shown by assessing the activated partial thromboplastin time (aPTT). Furthermore, no liver toxicity, thromboses, deaths, or persistent changes after nonviral gene therapy were found, as shown by serum liver indices and histopathology. The results suggest that this novel gene therapy can successfully improve hemostasis disorder in FVIII KO mice and might be a promising approach to treating hemophilia A patients in clinical settings.

Background: The term “Abnormal Uterine Bleeding (AUB)” is used for abnormal genital tract bleeding that accounts for 10-15% of all outdoor patient visits in Gynecology department. Common causes of AUB include endometrial polyps, endometrial hyperplasia, sub mucous fibroids and anovulation. Accurate diagnosis of AUB can reduce the incidence of un-necessary surgical interventions and hysterectomies. Aims & Objectives: Aim of this study is to evaluate the usefulness of transvaginal sonography (TVS) in comparison to hysteroscopy in patients of AUB. Materials and Methods: A prospective and comparative study was carried out in the Department of Obstetrics and Gynecology over a period of one year in 100 patients attending the OPD with AUB. TVS and hysteroscopy were done in all the patients presenting with AUB and further procedure was done according to the need. Results were analyzed to check the performance of TVS pick up rate in relation to hysteroscopy and biopsy report was taken as gold standard. Results: Grossly it seems hysteroscopy is closure to tissue diagnosis, but p-value is not significant. Conclusion: Combination of all the three modalities is helpful in accurate diagnosis of AUB etiology and better management of the patient by reducing unnecessary hysterectomies.