Hypofibrinogenemia in Patient with Extended Exposure to Argatroban Therapy

A 42 year old female with past medical history of asthma and recent admission for Alprazolam overdose presented to our hospital with dyspnea and generalized weakness.. She was noted by paramedics to be hypoxic, hypotensive and bradycardic, and she was intubated in the field prior to arrival.. Medication prior to admission, Albuterol HFA. Patient had no known drug allergies. On presentation to the emergency department, patient appeared critically ill, hypotensive to 74/50 , hypoxic with oxygen saturation of 60%, heart rate of 137 BPM, respiratory rate 15/min, temp 99 F, and unresponsive to verbal stimuli. Endotrachial tube placement was confirmed using laryngoscope. Whilein ED, patient went into Pulseless Electrical activity state and CPR was started immediately. She was given one round of Epinephrine with return of spontaneous circulation after 3 minutes.Bedside transthoracic echo suggestive of right heart strain, patient was given Tenecteplase given high risk of Pulmonary embolism. She was then transferred to the Intensive care unit and was started on pressure support.. Initial Chest CT angiogram showed no signs of pulmonary embolism. Pertinent laboratory values at admission were, serum Creatinine 1.28 mg/dl , WBC 14 K/mcl, HGB 12/4 g/dl, Platelet count 186 K/mcl, PT 12.4 sec, INR 1.1, APTT 29.9 sec, Arterial blood gas with PH 7.039, PCO2 70.9 mmhg, PO2 35.9 mmhg, HCO3 18.2 mmol/l and Lactate 11.0 mmol/l. Hepatic function panel showing Albumin 3.7 gm/dl, Total protein 7.2 gm...
Source: Blood - Category: Hematology Authors: Tags: 322. Disorders of Coagulation or Fibrinolysis Source Type: research

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Publication date: Available online 12 October 2019Source: Sensors and Actuators B: ChemicalAuthor(s): C. Busacca, A. Donato, M. Lo Faro, A. Malara, G. Neri, S. TrocinoAbstractCobalt oxide (Co3O4) nanostructures are synthesized by the electrospinning method and their performances as CO gas sensor are investigated. Ethanol (EtOH) and N,N-Dimethylformamide (DMF) are selected as solvents to be separately mixed with cobalt(II) nitrate hexahydrate (Co(NO3)2·6H2O) and polyvinylpyrrolidone (PVP) in order to obtain two different solutions for the electrospinning and consequently two different morphologies of the electrospun ...
Source: Sensors and Actuators B: Chemical - Category: Chemistry Source Type: research
In this study, a UV-irradiation was exploited as an ease non-toxic photochemical method for a one-step reduction-deposition of gold nanoparticles (AuNPs) on zinc oxide nanorods supporter (AuNPs@ZnO) patterned on a flexible and porous membrane. Here, we were able to fabricate a self-cleaned and recyclable SERS-active flexible substrate for the quantitative analysis of hazard organic contaminants. The photocatalytic activity of AuNPs@ZnO nanorods was significantly improved under UV- irradiation and after the deposition of AuNPs of ∼21 nm on the surface of ZnO nanorods of average particle size ∼ 60 nm. T...
Source: Colloids and Surfaces A: Physicochemical and Engineering Aspects - Category: Chemistry Source Type: research
Publication date: Available online 12 October 2019Source: Colloids and Surfaces A: Physicochemical and Engineering AspectsAuthor(s): Arijita Paul, Siddhartha Sankar DharAbstractHerein we report a facile and cost-effective design for the fabrication of a new binary MnMoO4/NiFe2O4 nanocomposite through co-precipitation and hydrothermal routes. The resulting nanomaterial was characterized using powder X-ray Diffraction Studies (XRD), Fourier Transform Infrared Spectroscopy (FT-IR), Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDX), High Resolution Transmission Electron Microscopy (HR-TEM), Vibrati...
Source: Colloids and Surfaces A: Physicochemical and Engineering Aspects - Category: Chemistry Source Type: research
ConclusionsPhysicians should be alert of this tumor despite its rarity because diagnostic delays increase mortality. In this report, we summarize the features that differentiate PPAS from PE and the importance of imaging in diagnosing the tumor.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Publication date: Available online 12 October 2019Source: The Lancet Respiratory MedicineAuthor(s): Stefano Barco, Seyed Hamidreza Mahmoudpour, Luca Valerio, Frederikus A Klok, Thomas Münzel, Saskia Middeldorp, Walter Ageno, Alexander T Cohen, Beverley J Hunt, Stavros V KonstantinidesSummaryBackgroundEuropean estimates of the burden imposed by pulmonary embolism are not available to this date. We aimed to assess pulmonary embolism-related mortality and time trends in the WHO European Region.MethodsWe analysed vital registration data from the WHO Mortality Database (2000–15) covering subregions of the WHO Europea...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
Publication date: Available online 12 October 2019Source: Social Science ResearchAuthor(s): Anaïd Flesken, Jakob HartlAbstractEstablishing electoral legitimacy across the population is vital for democratic stability, yet in contrast to other measures of political support, perceived electoral fairness has received scant scholarly attention. Moreover, while research into other measures of political support has shown that they differ by both ethnicity and socio-economic status, no study examines both at once, potentially overlooking important interrelationships between the two variables. This paper combines data from the...
Source: Social Science Research - Category: Psychiatry & Psychology Source Type: research
ConclusionsExtra-pelvic endometriosis, traditionally thought to be rare, have been reported in a considerable number of cases. Heightened awareness and clinical suspicion of the disease, and multi-disciplinary approach is recommended to achieve prompt diagnosis and optimize patient outcomes. At this time, there are no comparative studies to provide recommendations regarding optimal diagnostic methods, treatment options and outcomes for endometriosis involving extra-pelvic sites.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
ConclusionsGVS appeared as a well-tolerated and powerful procedure for the relief of experimental pain, probably through physiological interaction within insular nociceptive networks. Either isolated or in combination with other types of vestibular activation (e.g., optokinetic stimuli), GVS deserves being tested in clinical settings.
Source: Brain Stimulation - Category: Neurology Source Type: research
ConclusionThe twin block is effective in the long-term management of masticatory myofascial pain as compared to trigger point injections.Trial RegistrationClinicalTrials.gov Identifier: NCT03870191
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology - Category: ENT & OMF Source Type: research
Publication date: Available online 12 October 2019Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyAuthor(s): Şehrazat Evirgen, Halil Tolga Yüksel, Gökçe Yüksel, Barış Kaki, Kıvanç KamburoğluAbstractObjectiveTo identify the prevalence and radiological characteristics of intravertebral pneumatocysts (IVP), degenerative joint disease (DJD), and ponticulus posticus (PP) in the cervical spine using CBCT images. The correlations between the presence of these lesions, and the correlations of the lesions to patient age and sex, were also evaluated.Study DesignCBCT images obta...
Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology - Category: ENT & OMF Source Type: research
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