When is a heavy period too heavy?
It’s common for girls and their parents to wonder if the bleeding with their periods is too often or too much. Especially in the first few years of having a period, any bleeding can feel like too much. Usually, it’s not — but sometimes it is, and it’s important for parents to know what to watch for, and when to call the doctor. In the first couple of years after periods begin, it’s really normal for periods to be irregular — and for some of them to be heavy. At the beginning, periods aren’t associated with ovulation, and the hormones and hormonal patterns that help regulate periods...
Source: Harvard Health Blog - February 12, 2020 Category: Consumer Health News Authors: Claire McCarthy, MD Tags: Adolescent health Children's Health Parenting Source Type: blogs

Fight Aging! Newsletter, April 29th 2019
In this study, we report the age-associated differences between fetal MSC (fMSC) populations and MSCs isolated from elderly donors with respect to their transcriptomes. We successfully reprogrammed fMSCs (55 days post conception) and adult MSC (aMSC; 60-74 years) to iPSCs and, subsequently, generated the corresponding iMSCs. In addition, iMSCs were also derived from ESCs. The iMSCs were similar although not identical to primary MSCs. We unraveled a putative rejuvenation and aging gene expression signature. We show that iMSCs irrespective of donor age and cell type re-acquired a similar secretome to that of th...
Source: Fight Aging! - April 28, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Dysfunctional and Senescent Immune Cells in Bone Marrow as a Cause of Age-Associated Lineage Skewing of Hematopoietic Stem Cells
The immune system declines with age for a range of reasons. The thymus atrophies, reducing the supply of new T cells; persistent infection by cytomegalovirus causes cells to become uselessly specialized rather than ready to tackle new threats; and the hematopoietic stem cells responsible for generating immune cells become damaged, inactive, and dysfunctional. One of these forms of dysfunction is that hematopoietic stem cells begin to generate too many myeloid cells and too few lymphoid cells, the so-called myeloid skew. The cause of this skewing in cell production is much debated, but researchers have found that chr...
Source: Fight Aging! - April 26, 2019 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

GI bleed with Continuous flow LVAD – Mechanisms
GI bleed with Continuous flow LVAD – Mechanisms Gastrointestinal bleeds can occur in 15-40% of patients on continuous flow left ventricular assist devices (LVAD) for end stage heart failure. Proposed mechanisms for gastrointestinal bleeds with continuous flow LVAD includes: Acquired von Willebrand disease Impaired platelet aggregation Enhanced angiogenesis causing arteriovenous malformations (AVM) Intensity of anticoagulation AVMs may contribute to about half of the GI bleed with continuous flow LVADS. Hypoperfusion of gastrointestinal mucosa leads to angiogenesis and the new friable vessels are prone for bleeding...
Source: Cardiophile MD - April 13, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs

New Treatment for Acquired Thrombotic Thrombocytopenic Purpura: Caplacizumab
Immune-mediated deficiency of the von Willebrand factor –cleaving protease ADAMTS13 allows unrestrained adhesion of von Willebrand factor multimers to platelets and microthrombosis. This results in thrombocytopenia, hemolytic anemia, and tissue ischemia. These are the hallmarks of  acquired thrombotic thrombocytopenic purpura (TTP).Caplacizumab is an anti –von Willebrand factor humanized. Caplacizumab is not a full antibody, but just a fragment if it, as you can see in the video below. It inhibits interaction between von Willebrand factor multimers and platelets.In this double-blind, controlled trial, 145 ...
Source: Clinical Cases and Images - Blog - February 1, 2019 Category: Universities & Medical Training Tags: Hematology NEJM Source Type: blogs

TXA a Late Bloomer in Bleeding Management
​Tranexamic acid (TXA) was invented by a Japanese husband-and-wife research team in the 1960s. Years earlier, this same research team had discovered epsilon-aminocaproic acid, a derivative and an analogue of the amino acid lysine. In their search for a more potent antifibrinolytic agent, they discovered tranexamic acid, a synthetic analog of the amino acid lysine. Tranexamic acid is eight to 10 times more powerful than epsilon-aminocaproic acid.The antifibrinolytic actions of TXA result from the binding of four or five lysine receptor sites on plasminogen. This binding prevents plasmin from binding to and degrading fibri...
Source: M2E Too! Mellick's Multimedia EduBlog - February 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

TAVR reverses the acquired Von Willebrand syndrome in severe aortic stenosis
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - October 7, 2018 Category: Internal Medicine Tags: cardiovascular hematology Source Type: blogs

Acquired von Willebrand disease in severe aortic stenosis: reversal with TAVR
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - May 23, 2018 Category: Internal Medicine Tags: cardiovascular hematology Source Type: blogs

Airway hemorrhage in Eisenmenger syndrome – Cardiology MCQ – Answer
New !!! Cardiology MCQs from Cardiophile MD – Volume 3: Interactive Kindle Edition Cardiology MCQs from Cardiophile MD – Volume 3 Paperback All of the following are true about airway hemorrhages in Eisenmenger syndrome except: Correct answer: c) More likely while descending a mountain In Eisenmenger syndrome airway hemorrhages have to be thought of specially when moving from lower to a higher altitude as during air travel or while ascending a mountain. Hemoptysis has been reported as a cause of death in Eisenmenger syndrome in 11-29% [1]. Defects in hemostatic mechanism due to abnormal platelet function, throm...
Source: Cardiophile MD - May 15, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

Fight Aging! Newsletter, July 17th 2017
This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD). This study followed 130,473 UK Biobank participants aged 60-69 years (baseline 2006-2010) for 8.3 years (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a "healthier agers" group. Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects. However, among normal-weight subjects...
Source: Fight Aging! - July 16, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Towards the Mass Manufacture of Blood Platelets
Blood donation will at some point in the next decade or two be replaced with the mass manufacture of blood, produced to order and as needed. It will be far more efficient than the present system of donations and stockpiles, but there is still a great deal of work to be accomplished in order to reach this goal. The review here covers just a fraction of the scope of work, focused on the technical details of the production of platelets and their predecessor cells. Currently this is being carried out somewhat in advance of any ability to scale up to a far larger pace of production, but that will come with time. As the paper sh...
Source: Fight Aging! - July 11, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Von Willebrand ’s Disease via Now@NEJM
Von Willebrand's  Disease via Now@NEJMPosted oninfosnack. (Source: Kidney Notes)
Source: Kidney Notes - November 24, 2016 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs

Heyde ’ s syndrome: Acquired von Willebrand Syndrome in Severe Aortic Stenosis
Severe gastrointestinal bleeding can occur in those with severe aortic stenosis (Heyde’s syndrome). The initial description was in 1958 [1]. An important mechanism for the bleeding is deficiency of large von Willebrand factor multimers. This is due to the structural damage to the large protein when blood passes through the severely stenotic aortic valve as a high velocity jet. Loss of large multimers can be measured as the large von Willebrand factor multimer index and it is significant if it is less than 80% [2]. Anemia due to Heyde’s syndrome improves after aortic valve replacement. The gastro intestinal blee...
Source: Cardiophile MD - August 2, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs

Improved Synthetic Blood Platelets Spur Clotting
Present work on artificial blood tends to focus on narrow areas of functionality in which short-term augmentation of the capabilities of natural blood are useful, such as oxygen transport and clotting. From these diverse paths a wholly artificial blood substitute will no doubt eventually arise, but bear in mind that this line of development faces stiff competition from the use of cell technologies to produce biological blood as needed. One way or another blood donation will be a thing of the past not so many years from now: An additive nanoparticle manufacturing process has been used to design and realize a synthetic plat...
Source: Fight Aging! - November 10, 2014 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Research and Reviews in the Fastlane 052
This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up. Recommended by: Anand Swaminathan PediatricsSingleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163 Bleeding...
Source: Life in the Fast Lane - October 9, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Infectious Disease Intensive Care International Emergency Medicine Microbiology Neurosurgery Obstetrics / Gynecology Ophthalmology Source Type: blogs

The LITFL Review 148
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. Welcome to the 148th edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR]...
Source: Life in the Fast Lane - August 12, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: LITFL review LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 041
This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values? Recommended by: Jerremy Fried Read More: Age Adjusted D-Dimer Testing (RE...
Source: Life in the Fast Lane - July 29, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

Phenocopy Mimics of Rare Diseases: Lessons for the Common Diseases
In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases. The topic of phenocopy diseases was introduced in yesterday's blog post. Phenocopy diseases are medical conditions that closely mimic a genetic disease, but are caused or triggered by an environmental factor. In many cases, phenocopy diseases are non-hereditary and acute. In some cases, the phenocopy disease is reversible when the environmental tr...
Source: Specified Life - July 6, 2014 Category: Pathologists Tags: common disease complex disease disease biology genetic disease mimics of disease orphan disease orphan drugs pathogenesis phenocopy disease principles of pathology rare disease Source Type: blogs

Baxter completes patient enrollment in phase III trial of BAX 855, extended half-life rFVIII to treat haemophilia A
Baxter International Inc. has completed enrollment in its phase III clinical trial of BAX 855, an investigational extended half-life, recombinant factor VIII (rFVIII) treatment for haemophilia A. The ongoing trial is aimed at assessing the efficacy of the compound in reducing annualized bleed rates (ABR) in both prophylaxis and on-demand treatment schedules, and will also evaluate its safety and pharmacokinetic profile.BAX 855 was designed based on the full-length ADVATE [Antihemophilic Factor (Recombinant) Plasma/Albumin-Free Method] molecule, a product with 10 years of real-world experience. The BAX 855 molecule was modi...
Source: Medical Hemostat - November 15, 2013 Category: Technology Consultants Authors: hemostatguy at gmail.com (hemostat guy) Source Type: blogs

Treatment of salivary gland hypofunction by transplantation with dental pulp cells
ConclusionsOur results show that radiation-induced salivary hypofunction is partially reverted following transplantation of DPECs. We established a mouse model in which DPCs could be used as a cell source for the treatment of salivary gland hypofunction. (Source: Dental Technology Blog)
Source: Dental Technology Blog - June 29, 2013 Category: Dentists Source Type: blogs

NIH - NHLBI Discontinues Guidelines Program Passes Work off to Associations
Conclusion NHLBI's decision demonstrates an interesting point: even the most cutting edge scientists who are constantly analyzing new scientific and medical information and data are sometimes not able to keep up with the pace or have enough resources to synthesize this kind of information to create new information that physicians can act on to improve patient care. This point is the very heart of why continuing medical education (CME) is so critical for America's healthcare system. CME provides an additional resource for physicians who do not have the time or resources to learn about clinical practice guidelines, th...
Source: Policy and Medicine - June 20, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs

FDA: Enhancing Benefit-Risk Assessment in Regulatory Decision Making
Last summer, Congress enacted the Food and Drug Administration Safety and Innovation Act (FDASIA), which included the fifth authorization of the Prescription Drug User Fee Act (PDUFA V).  Title I of FDASIA reauthorizes the Prescription Drug User Fee Act (PDUFA), which provides FDA with the necessary user fee resources to maintain an efficient review process for human drug and biologic products.  The reauthorization of PDUFA includes performance goals and procedures that represent FDA’s commitments during FY 2013-2017.  These commitments are referred to in section 101 of FDASIA. Section X of these comm...
Source: Policy and Medicine - April 25, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs