Showing papers by "Keita Morikane published in 2019"

APSIC guidelines for the prevention of surgical site infections

Abstract: The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices. The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions. Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.

Direct comparison of prognostic ability of cardiac biomarkers for cardiogenic stroke and clinical outcome in patients with stroke

Abstract: Despite many recent advances in medicine, cardiogenic stroke is still a health problem with a high mortality rate. Cardiac biomarkers have been reported to be useful indicators for cardiogenic stroke and subsequent cerebrovascular events. However, there are no data directly comparing the cardiac biomarkers in stroke patients. We measured atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) levels and performed transthoracic and transesophageal echocardiography in 282 stroke patients. There were 108 cases of cardiogenic stroke and 47 cases of major adverse cardiovascular and cerebrovascular events (MACCE) during the follow-up period. Association with left atrial function and left atrial appendage function appeared somewhat stronger for BNP and NT-proBNP than ANP and hsTnT. Multivariate logistic analysis demonstrated that cardiac biomarkers excluding ANP were significantly associated with cardiogenic stroke in stroke patients, multivariate Cox's proportional hazards regression analysis demonstrated that all biomarkers were significantly associated with MACCE after adjustment for confounding risk factors. Receiver operating characteristic curve analysis showed that the C indices of BNP and NT-proBNP for cardiogenic stroke and MACCE were almost equal, but significantly greater than those of ANP and hsTnT. Both BNP and NT-proBNP levels are useful predictors of cardiogenic stroke and subsequent MACCE superior to ANP and hsTnT in stroke patients.

A high titer of acquired factor V inhibitor in a hemodialysis patient who developed arterial thrombosis.

Abstract: An 87-year-old man with diabetes mellitus was admitted to control recurrent bleeding from hemodialysis puncture sites. He was a smoker and had been diagnosed with arteriosclerosis obliterans. His PT and APTT were markedly prolonged, and all coagulation factors were markedly decreased (factor V [FV] activity < 1%) or below the measurement threshold, with the exception of fibrinogen and factor XIII. Neither PT nor APTT were corrected upon mixing with normal plasma. A high titer of FV inhibitor was found at 415 BU/mL, and anti-FV autoantibody was detected by both immunoblot assay and ELISA. Prednisolone administration and plasma exchange partially improved prolonged PT and APTT and decreased the FV inhibitor level. Five months later, he manifested symptoms of severe ischemia in both legs. Angiography revealed diffuse stenosis downstream of both common iliac arteries. Endovascular therapy was repeated four times, the prednisolone dose was reduced, and low-dose antiplatelet therapy was initiated. After the final successful endovascular therapy, arterial thrombosis was detected using ultrasound and angiography. Aspiration thrombectomy and thrombolytic therapy failed to achieve recanalization, and necrosis of the legs worsened. Despite the severe coagulation abnormalities, vascular interventions should have been performed with regular-dose antiplatelet therapy, as the patient exhibited multiple risk factors for atherothrombosis.

Complete remission in a bleeding patient with idiopathic autoimmune factor X deficiency caused by non-neutralizing anti-factor X autoantibody.

Abstract: Coagulation factor X/10 (F10) is a vitamin K‐dependent protease precursor. F10 functions in the common pathway of the clotting cas‐ cade, and its severe deficiency, whether inherited or acquired, leads to variable bleeding symptoms.1 Isolated acquired F10 deficiency (AcF10D) is an uncommon coagulation disorder; about 10% of cases with amyloid light chain amyloidosis develop AcF10D, probably due to F10 absorption by amyloid fibrils.2 In contrast, non‐amyloidosis‐ related AcF10D is quite rare and is associated with various disor‐ ders/conditions in the limited number of patient reports. Among them, few patients demonstrated the presence of autoantibodies against F10, termed immune‐mediated AcF10D or autoimmune F10 deficiency (AiF10D).3 Autoantibodies can be generated against any coagulation fac‐ tor.4 The following are the types of anti‐coagulation factor auto‐ antibodies: (a) the neutralizing type binds the functional regions of a coagulation factor to inhibit its functional activities; (b) the non‐ neutralizing type binds the non‐functional regions of a coagulation factor and enhances its clearance from circulation (hyper‐clearance); and (c) the combination of types (a) and (b) inhibits the functions of a coagulation factor and promotes its rapid clearance. Other types of autoantibodies bind the non‐functional regions of a coagulation factor to have little, if any, effect on its properties; another type may alter the function of a clotting protein. Here, we present a case of AiF10D caused by a non‐neutralizing anti‐F10 autoantibody in bleeding patient.

Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Cardio-Renal Anemia Syndrome - Difference in Prognostic Ability.

Abstract: Background: Cardio-renal anemia syndrome (CRAS) is a growing health problem, with a high mortality rate. Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are well-established diagnostic and prognostic biomarkers of heart failure (HF). The difference in the clinical significance of these biomarkers, however, has not yet been completely elucidated in HF. The aim of the present study was to compare the prognostic ability of BNP and NT-proBNP in HF patients with CRAS. Methods and Results: We measured BNP and NT-proBNP in 492 consecutive HF patients and in 17 control subjects. All patients were prospectively followed up during a median follow-up period of 1,034 days. NT-proBNP/BNP ratio was elevated in HF patients with CRAS compared with those without CRAS and the control subjects. There was no significant difference in the prognostic abilities of BNP and NT-proBNP in all HF patients. The C-index for NT-proBNP for predicting cardiovascular events and mortality, however, was significantly higher than that for BNP in HF patients with CRAS. On multivariate Cox proportional hazards-regression analysis, NT-proBNP, but not BNP, was an independent predictor for clinical outcome in HF with CRAS. Conclusions: The difference in the prognostic abilities of BNP and NT-proBNP was high in HF patients with CRAS. NT-proBNP had a superior prognostic ability to BNP in HF patients with CRAS.