Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half-life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual-site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual-site VTE.Direct oral anticoagulants (DOACs) are widely used in several indications, but data on their efficacy and safety in individuals affected by severe inherited thrombophilia, yet without any personal history of thrombosis, is lacking. Severe inherited thrombophilia abnormalities, especially antithrombin deficiency, confer a higher risk of developing venous thromboembolism (VTE) than is the case in the general population. In this article, we propose primary prevention with low-dose DOACs for certain patients with severe inherited thrombophilia but without any personal history of VTE, while taking into consideration the type of thrombophilia, family history, comorbidities, and bleeding risk.As a result of the coronavirus disease 2019 pandemic, the International Society on Thrombosis and Haemostasis (ISTH), like many societies around the world, canceled their in-person hematology congress planned for Milan, Italy, in July 2020. As a result, the first virtual ISTH congress in the organisation's 51-year history was delivered, inviting free registration from across the globe. As part of the social media support, marketing, and scientific dissemination efforts for the virtual congress, the ISTH assembled a group of official Twitter Ambassadors, which represented the broad and diverse ISTH community. Ambassadors were tasked to tweet daily throughout the congress and to share their commentary on the hematology research being presented with the "#ISTH2020" hashtag. Ambassadors were also supported by Twitter activities from the two official ISTH-affiliated journals the Journal of Thrombosis and Haemostasis (JTH) and Research and Practice in Thrombosis and Haemostasis (RPTH). https://www.selleckchem.com/products/ABT-263.html In this forum and through the Twitter ambassadors' lens, we present the Twitter Ambassadors' experience, reflect on the impact of social media on the ISTH 2020 congress, and share this experience with the wider scientific community. Specifically, we report on the role of Twitter communication for virtual meetings, discuss the pros and cons of the virtual congress, and offer Twitter-related recommendations for future virtual or blended congresses. We conclude that the ISTH Twitter Ambassador program broadened social media engagement and offers a novel route to improve social connectivity in the virtual research congress setting.The field of Cardio-oncology is rapidly growing with significant advances in research leading to better understanding of the underlying pathogenesis with implications in the diagnosis and management of cancer-related cardiomyopathy. Parallel to advancement in cardio-oncology is an increased awareness of the incidence of congestive heart failure and cardiomyopathy associated with malignancy. While specific cardiotoxic profiles exist for certain chemotherapeutic agents, there is increasing evidence of unexpected cardiotoxic side effects of some therapeutic modalities, combination chemo- and radiotherapy with large analyses identifying a strong association between malignancy and Takotsubo cardiomyopathy. Takotsubo Cardiomyopathy, also known as "broken-heart" syndrome or stress cardiomyopathy, is characterized by transient and reversible, regional or global, myocardial dysfunction without inciting ischemic perfusion defect from obstructive coronary artery disease. While direct causative pathophysiologic mechanisms continue to be investigated, much of the postulated pathways center on the high emotional and physical burdens of cancer and the related emotional stress associated with the diagnosis of cancer as well as the corporal effects of anti-neoplastic therapies, radiation, and oncologic surgery. In this manuscript we review the most current data in this rapidly emerging field highlighting the epidemiology, the postulated pathogenetic mechanisms as well as the current guidelines by major societies addressing malignancy -associated heart failure and cardiomyopathy, a rather complex disease entity with high morbidity and mortality.
To define the care cascade for patients with serious injection drug use related infections (SIRI) in a tertiary hospital system and compare outcomes of those who did and did not participate in an opioid use disorder (OUD) treatment referral program.
The medical records of patients admitted with both OUD and SIRI including endocarditis, osteomyelitis, septic arthritis, epidural abscess, thrombophlebitis, myositis, bacteremia, and fungemia from 2016-2019 were retrospectively reviewed. Patient demographics, clinical covariates, 90-day readmission rates, and outcomes data were collected. We compared data from those who were successfully referred to outpatient care through Engaging Patients in Care Coordination (EPICC), a peer recovery specialist-run OUD treatment referral program, to those who did not receive outpatient referral.
During the study period 334 persons who inject opioids were admitted with SIRI. Fourteen admitted patients died and were excluded from the analysis. The all-cause readmission rate was lower among patients referred to the EPICC program (18/76 [23.7%]) compared to those not referred to EPICC (100/244 [41.0%]) (OR 0.44; 95% CI 0.25 - 0.80).
An OUD care cascade evaluation for patients with SIRI demonstrated that referral to peer recovery services with outpatient OUD treatment was associated with reduced 90-day readmission rate.
An OUD care cascade evaluation for patients with SIRI demonstrated that referral to peer recovery services with outpatient OUD treatment was associated with reduced 90-day readmission rate.
Klinefelter syndrome (KS) is the most common sex aneuploidy in men. Affected males have hypogonadism, and, as a result, face an increased risk for osteoporosis and fractures. Androgen therapy is standard in adolescents and adults with KS but has not been used earlier in childhood.
To determine the effects of androgen treatment on bone mass in children with KS.
Randomized, double-blind, placebo-controlled clinical trial of oxandrolone (OX; 0.06 mg/kg daily; n = 38) versus placebo (PL; n = 40) for 2 years in boys with KS (ages 4-12 years). Changes in bone mass were examined by digital x-ray radiogrammetry, which determines the Bone Health Index (BHI) and standard deviation score (SDS).
BHI SDS was similar between groups at baseline (-0.46 ± 1.1 vs -0.34 ± 1.0 OX vs PL,
> .05) and higher in the OX group at 2 years (-0.1 ± 1.3 vs -0.53 ± 0.9, OX vs PL,
< .01). At baseline, BHI SDS values of all subjects were not normally distributed with 25.7% of subjects plotted below -1 SDS (
< .001), suggesting a deficit in bone mass. In total, 13.5% of subjects had sustained a fracture and their BHI SDS was lower than those with no fractures (-1.6 ± 1.3 vs -0.3 ± 1.0,
= .004).
Bone mass using BHI SDS is reduced in some children with KS and improves with OX. Since these individuals are at risk for osteoporosis, age-appropriate androgen replacement and future studies on bone health in children with KS should be further explored.
Bone mass using BHI SDS is reduced in some children with KS and improves with OX. Since these individuals are at risk for osteoporosis, age-appropriate androgen replacement and future studies on bone health in children with KS should be further explored.The etiology of reproductive disorders correlates with weight gain in patients, but the link between reproduction, diet, and weight has been difficult to translate in rodents. As rates of childhood obesity and reproductive disorders increase, the need to study the effects of weight and diet on adolescent females is key. Previous studies show that female mice are resistant to high-fat diet-induced weight gain, but the mechanisms are unclear. Literature also suggests that ovarian function is essential to resistance in weight gain, as an ovariectomy leads to a weight-gaining phenotype similar to male mice on a high-fat diet. However, reproductive changes that occur in adolescent mice on high-fat diet have not been assessed. Here, we show that regulation of the estrus cycle via progesterone is critical to metabolic homeostasis in female mice on a high-fat diet. Female mice were put on high-fat diet or control diet for 12 weeks starting at 4 weeks of age. Every 4 weeks, their estrus cycle was tracked and fasting glucose was measured. We found that after 4 weeks on high-fat diet, there was no difference in weight between groups, but an increase in time spent in proestrus and estrus in mice on high-fat diet and an increase in serum progesterone during proestrus. These results show that intact females modulate their estrus cycle in response to a high-fat diet as a mechanism of homeostatic regulation of body weight, protecting them from metabolic abnormalities. Understanding the mechanisms behind this protection may yield therapeutic opportunities for treatment of reproductive disorders in adolescent female patients.The difficulty of effectively monitoring and managing the environment to conserve biodiversity is as yet an unsolved conundrum. A project of the Chinese Academy of Sciences has concluded that progress can be made through the use of flagship species selected using criteria drawn from conservation biology, ecosystem function, socio-economics, and cultural importance. Inclusion of the latter three criteria will help attract and maintain the commitment of the public to play full parts in carrying out any conservation measures needed. A system is proposed for scoring species to select those that are most suitable as flagships. This method can be used regardless of the size of the area chosen for attention, whether it is a region, a country, or a particular protected area.Rural communities in Kenya largely depend on plant resources for their livelihood. The utilization of these resources depends on the availability of plant resources and the level of knowledge of the residents. We conducted an ethnobotanical study in Tharaka-Nithi County in Kenya to determine the knowledge and utilization of various plant species by the local communities. The study was conducted in four major administrative regions from June 2018 to February 2019, involving interview schedules using semi-structured open-ended questionnaires and guided field collections with 48 informants. A total of 214 plant species distributed in 73 families and 169 genera with 616 Use Reports (URs) were documented. Fabaceae was the highest family cited by the informants (31 species) followed by Lamiaceae and Euphorbiaceae (each with 11 species). Trees (49%) and shrubs (32%) were the top life forms of the plants frequently utilized by the local residents. The general plant uses reported were medicinal, food, fodder, construction, fuel, pesticidal, religious, live fencing, and making crafts.
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