North American Journal of Medicine and Science
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Delayed Hemolytic Transfusion Reaction due to Anti-Jkb: Case Report Highlighting the Importance of Early Blood Bank Consultation and Literature Review
Get PDFDelayed hemolytic transfusion reactions (DHTR) can be asymptomatic or mimic other conditions and may be misdiagnosed. Failure to recognize this entity could lead to inappropriate treatment and future transfusions reactions. Anti-JKa and anti-JKb are the most frequently encountered antibodies responsible for DHTR ac companied by intravascular hemolysis on rare occasions. The antibodies are often difficult to detect because of their transient nature and their frequent dosage effect. We report the case of a 40-year-old female with DHTR due to unexpected weakly reactive anti-JKb. The patient, with a medical history of hypertension, multiple transfusions, multiple abortions and vaginal bleeding due to uterine fibroids, presented to our emergency department complaining of back pain for four days and red-brown color urine for one day. Significant jaundice was noted on physical examination. Laboratory data showed low hemoglobin (Hb) (6.0g/dl) and increased creatinine (3.11 mg/dl). Differential diagnosis included hemolytic-uremic syndrome, hematuria caused by urinary tract calculi, and autoimmne hemolytic anemia. Significant hemolysis was observed in the patient’s blood sample. Further questioning elicited a recent blood transfusion seven days prior. Red cell antibody work-up at that time showed the presence of anti-K and anti-E. The patient was transfused 2 units of K and E antigen negative cross-match compatible packed red blood cells(PRBCs). Post-transfusion Hb was 8.8 g/dl and there were no signs of any immediate complication. Review of the recent history of blood transfusion and the current findings led to our strong suspicion of intravascular hemolysis. The patient was treated vigorously with fluids and intravenous diuretics. Stat tests subsequently confirmed the intravascular hemolysis. A ‘new’ request for blood transfusion was put on hold while an antibody workup was initiated. Red cell antibody work-up results confirmed the presence of anti-K and anti-E; the direct antiglobulin test (DAT) was negative. An eluate prepared from the patient’s red cells was non-reactive by indirect antiglobulin test. Additional samples were sent to a reference laboratory for further investigation of unexpected red cell antibodies. Results from the reference laboratory confirmed the anti-E and -K, and, in addition, a weak anti- JKb was identified in the plasma and eluate. Both of the prior transfused units were subsequently shown to be Jk(b+), adding further evidence that the anti- JKb is most likely the culprit of the DHTR. The patient was subsequently transfused with E-, K- and Jk(b-) PRBCs and her condition improved. This case emphasizes the central role of blood bank consultation for early treatment and diagnosis of DHTR and for the avoidance of incompatible blood component transfusion, thus minimizing the risks of morbidity and reduce the potential for mortality. It is our opinion that blood bankers should be consulted when patients have an acute drop in Hb following recent transfusions. Moreover, transfusion medicine should be part of medical school education and part of hospital grand round conferences, to raise clinicians’ awareness to improve recognition and reporting of DHTR so that timely diagnosis and treatment can be made.
Characterization of Lung Cancer: A 10-Year Experience from a Tertiary Hospital in Yaounde, Cameroon
Get PDFThe incidence rate of lung cancer in Africa is low. However, there are few studies reporting clinical characteristics of lung cancer in African countries. We did a study of lung cancer at the Medical Oncology Service of the Yaounde General Hospital, Cameroon, from January 1998 to December 2007. Out of the 2,355 cancer patients seen at this hospital over a 10-year period, 48 patients (28 men and 20 women) were diagnosed with lung cancer. The average age (SD) of patients was 53 (13) years and ranged from 25 to 80 years. Seven patients were cigarette smokers. The median duration from initial symptoms to visiting doctors was 5 months (interquartile range: 3-11 months). The most common histology types were squamous cell carcinomas (31, 65%), followed by adenocarcinomas (8, 17%), large cell carcinomas (4, 8%), small cell carcinomas (4, 8%), and fibrosarcoma (1, 2%). Of the 19 patients with stage classification, 8 had stage IV and 11 had stage III disease. Only 14 patients reported having received treatment, including chemotherapy, radiotherapy, and/or surgery. In conclusion, lung cancer was uncommon in Yaounde, Cameroon, but most of patients presented with advanced stage due to long delay in seeking diagnosis. Less than half of the patients received chemotherapy, radiotherapy, or surgery
Management of Complex Wounds with Fresh Cryopreserved Human Allografts
Get PDFIn this manuscript, we review the use of fresh cryopreserved human skin allografts for the treatment of complex wounds. The reasons why this technology has generated renewed interest, as well as some clinical outcomes are examined. Based on our experience, we feel that cryopreserved human skin allografts offer an effective, relatively inexpensive alternative for the treatment of complex wounds such as diabetic foot ulcers and venous leg ulcers
An Aggressive Psammomatoid Ossifying Fibroma Presenting as a Sphenoethmoidal Mass
Get PDFAggressive psammomatoid ossifying fibromas are rare, benign fibro-osseous tumors characterized by the presence of numerous calcified spherules within an actively proliferating connective tissue stroma. They are mainly seen in the sino-naso-orbital region of young individuals. CT scans tend to show a relatively well delineated heterogeneous mass with varying degrees of radiodensity depending on the amount of calcification present. As the name implies, they are prone to aggressive behavior and a high rate of recurrence. We report a case of an aggressive psammomatoid ossifying fibroma presenting as a sphenoethmoidal mass. The relevant histopathological differential diagnoses are also discussed
Plasma Amyloid- Peptides and Homocysteine in Depression in the Homebound Elderly
Get PDFObjectives: Both plasma amyloid-b peptide 40 (Ab40) and homocysteine (tHcy) are linked to vascular disease, which is related to depression in the elderly. We sought to study whether the relationship between tHcy and plasma Ab40 differs in those with and without depression. Study Design and Methods: In a cross-sectional study of 1058 homebound elders, vascular depression was defined as a score > 16 on the Center for Epidemiological Studies Depression scale (CES-D) along with self-reported cardiovascular disease (CVD). Plasma Ab40 and Ab42, and serum tHcy and creatinine were measured
Comprehensive Principle of HPLC Fingerprint in the Construction and Evaluation of Chinese Herbal Medicine
Get PDFThe establishment of a Chinese herbal medicines quality control system is at the core of the modernization development of Chinese medicine. High Performance Liquid Chromatography (HPLC) fingerprint technology is applied to quality control of Chinese herbal medicines from the perspective of systems biology and depends on the classical theory of Chinese medicine system together with information processing technology. In the view of the characteristics of Chinese medicine and the development and application of the top-notch technology in recent years, we tried to integrate information and establish a standard evaluation system of Chinese medicine by using standard chromatographic fingerprints, with a view to improve Chinese medicine quality control and modernization of Chinese medicine development
American Chinese Medical Exchange Society 2010 Annual Conference
Get PDFOn October 30, 2010, American Chinese Medical Exchange Society (ACMES) held her annual conference at the Best Western Hotel near Harvard Medical School featuring “Asian Health Education”, participated by nearly 300 physicians and health care professionals across the country, including visiting physicians and scholars from China
Extranodal Rosai-Dorfman Disease Involving Colon A Case Report with Review of the Literature
Get PDFRosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare, idiopathic and non-neoplastic histiocytic disorder. The most common presentation of RDD is painless cervical lymphadenopathy in a young patient. However, in about 25% of cases there is no lymph node involvement, and the disease presents as a mass in skin, soft tissue, nasal cavity, eye, bone, or other extranodal sites (extranodal type). This can pose a diagnostic challenge if RDD is not considered in differential diagnoses. Gastrointestinal (GI) involvement of RDD is extremely rare; only 15 cases had been reported. We report a case of extra-nodal RDD involving the GI tract of a 24-year-old African-American woman who presented with chronic lower abdominal pain, constipation and an 8 cm mass involving her colonic wall. Microscopically, the mass was well demarcated, partially covered with serosa and extended into the muscularis propria and submucosa of the colon. The lesional cells consisted of spindle-shaped and epithelioid histiocytes intermixed with plasma cells and lymphocytes. Rare histiocytes showed emperipolesis. The histiocytes were positive for S100 (strong) and CD68, and negative for c-kit and CD1a. The above morphological and immunohistochemical features are diagnostic for RDD, extra-nodal type. The related literature was reviewed and compared with this case.
Potential Effects of Omega-3 Fatty Acid Supplements in the Prevention of Type 2 Diabetes: A Critical Appraisal of Data from Randomized Clinical Trials
Get PDFEmerging evidence has suggested favorable effects of marine omega-3 fatty acids on glucose homeostasis, lipid metabolism, endothelial function, and chronic inflammation, which could contribute individually or synergistically to the development of type 2 diabetes (T2D). With increasing prevalence of use of fish oil supplements and increasing fortification of the food supply with marine omega-3 fatty acids in the general population, it will be critically important to assess the overall balance of benefits and risks of omega-3 fatty acid supplements on glucose tolerance and diabetes. This article aims to summarize the evidence from available randomized clinical trials on the potential effects of fish oil and/or omega-3 fatty acid supplements among both nondiabetic and diabetic participants. Overall, the evidence for the beneficial or deleterious effects of fish oil supplements on insulin sensitivity has been inconsistent, with limited randomized trial data involving small trials of short duration. However, dietary recommendation of taking omega-3 fatty acids for prevention of T2D or diabetic complications may ultimately only be resolvable by definitive data from future large-scale clinical trials that include T2D as a primary outcome in a general population
Monoclonal Antibodies as Cancer Therapeutics
Get PDFMonoclonal antibodies have emerged as key therapeutic modalities for a range of human diseases. Owing to selective targetting of these agents on tumor cells, cancer has become one of the major focuses for development of monoclonal antibody therapeutics. The most significant breakthroughs in the development of monoclonal antibodies as oncology therapeutics have been the introduction and approval of bevacizumab (Avastin), an anti-vascular endothelial growth factor antibody and of trastuzumab (Herceptin), an anti-human epidermal growth factor receptor 2 antibody and of cetuximab (Erbitux), an anti-epidermal growth factor receptor antibody. In current review, advances in antibody engineering, mechanisms of action of anti-cancer antibodies and trends in the clinical development of monoclonal antibodies for cancers are overviewed and future directions of research and development for this class of therapeutics are discussed