Search

Abstract The anticoagulants of choice for the prevention and treatment of venous thromboembolic disease during pregnancy are unfractionated heparin and low‐molecular‐weight heparin. Heparin‐induced thrombocytopenia (HIT) is introduced as a rare but critical side effect of heparin products raising the thromboembolic event paradoxically. Here, we present a case of HIT in pregnancy with challenging management due to coincidence of lupus anticoagulant (LA) and limited anticoagulant options in the pharmaceutical market of our country of residence. We describe a 6‐week pregnant patient with deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), which developed HIT during antenatal care. Therapeutic anticoagulation was initiated with argatroban, then switched to apixaban due to limited access to argatroban. Another therapeutic challenge was the concurrent incidence of LA. The interdisciplinary care team decided on adding up warfarin and scheduled termination at 12 weeks regarding the hazardous condition of the patient. We also reviewed related case literature to convey a new insight into managing pregnancy‐related HIT. HIT is a pro‐coagulatory and lethal complication associated with heparin therapy that can be diagnosed by clinical suspicion, the 4T score system, and confirmatory laboratory analyses. Alternative anticoagulation is the cornerstone of the treatment and an interdisciplinary plan will be worthwhile to make the best clinical decision regarding the critical situation and least the thromboembolic events mortality during pregnancy.

Patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 represents usually a variety range of symptoms related to influenza-like syndrome and respiratory tract infections. Likewise, kidney involvement and acute kidney injury (AKI) were reported in many previous studies. Although a hypovolemic circulation would be the most common reason in patients with AKI, some strong proofs are suggesting a cytokine storm due to immune system exaggeration and inflammation-mediated tubular injury in COVID-19 infections. The inflammatory response in cytokine storm leads to the high release of cytokines mostly including TNFα, IL-1β, IL-6, INFγ, IL-2, IL-7, and endothelial mediators. The main culprits in the AKI and consequent organ failure are resident leukocytes in specific tissues, activated following the cytokine release, and systemic inflammatory response. AKI management and cytokine profile evaluation should be highly emphasized in patients with COVID-19 to prevent the progression of chronic kidney disease or permanent renal failure. Treatment options in COVID-19 regarding no specific drugs should be supportive and based on stabilizing the patients; however, combination therapy with different antiviral have shown promising outcomes. As a result, utilizing the anti-TNFα and anti-IL-1 agents should be noticed if indicated. Additionally, the hematopoietic stem cell transplantation is a curative approach.

Background and aims: Nosocomial infections are the main cause of the problems related to health and health care costs. One of the pathogens that causes these infections is Staphylococcus aureus. Its resistance to antibiotics forced researchers to find herbal substitution such as Sesame and Olive. This study was aimed to determine antibacterial effect of sesame oil, olive oil and their synergism on S. aureus. Methods: In this experimental study, at first, olive oil and sesame oil was extracted by cold press assay and the mixture of them was prepared with equal proportion of both oils, and then the standard strain of lyophilized S. aureus ATCC 25923 was prepared from the Iranian Research Organization for Science and Technology. To determine minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the oils, micro-broth dilution method was used. Results: This study indicated the amounts of MIC for sesame oil, olive oil and their synergism; 32 mg/ml, 32 mg/ml, 8 mg/ml and the amounts of MBC; 128 mg/ml, 128 mg/ml, 32 mg/ml, respectively. Conclusion: The results showed the same antibacterial activity for olive oil and sesame oil. It also showed that mixture of these oils enhances the growth inhibitory and bactericidal properties of the oils compared to using them individually.