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  1. Article: An Unusual Presentation of Superior Mesenteric Venous Occlusion in Mild COVID-19.

    Batra, Sakshi / Nair, Asha G / Syal, Kirtimaan

    Indian journal of clinical biochemistry : IJCB

    2022  Volume 38, Issue 2, Page(s) 275–278

    Abstract: SARS-CoV-2, an etiological agent of COVID-19, has been reported to inflict remarkably diverse manifestations in different subjects across the globe. Though patients with COVID-19 predominantly have fever, respiratory and constitutional symptoms, atypical ...

    Abstract SARS-CoV-2, an etiological agent of COVID-19, has been reported to inflict remarkably diverse manifestations in different subjects across the globe. Though patients with COVID-19 predominantly have fever, respiratory and constitutional symptoms, atypical presentations are becoming increasingly evident. COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization, and diffuse intravascular coagulation in moderate to severe symptomatic cases. In this case report, we are reporting thromboembolic complications of COVID-19 in a mild symptomatic subject incidentally diagnosed with mesenteric venous occlusion with no abdominal symptoms. Early recognition of the abdominal symptoms, diagnosis, initiation of anticoagulants, and timely surgical intervention may improvise the outcome in a patient with COVID-19 infection-induced mesenteric thrombosis. Superior mesenteric artery and venous thrombosis may lead to subsequent ischemia necessitating emergency laparotomy. Thus, the usage of low-dose anticoagulants in all the patients of COVID-19 irrespective of the categorization into mild, moderate, and severe COVID-19 disease should be considered.
    Language English
    Publishing date 2022-08-10
    Publishing country India
    Document type Case Reports
    ZDB-ID 1033583-3
    ISSN 0974-0422 ; 0970-1915
    ISSN (online) 0974-0422
    ISSN 0970-1915
    DOI 10.1007/s12291-022-01067-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2949: Show issues Location:
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  2. Article ; Online: Mesalamine-induced myopericarditis in a paediatric patient with Crohn's disease.

    Nair, Asha G / Cross, Russell R

    Cardiology in the young

    2015  Volume 25, Issue 4, Page(s) 783–786

    Abstract: Mesalamine-containing products are considered first-line treatment for inflammatory bowel disease. Myocarditis is recognised as a very rare possible side effect of these medications, but has not often been described in the paediatric population. We ... ...

    Abstract Mesalamine-containing products are considered first-line treatment for inflammatory bowel disease. Myocarditis is recognised as a very rare possible side effect of these medications, but has not often been described in the paediatric population. We present a case of an adolescent with Crohn's disease who presented with myopericarditis after recent initiation of Pentasa. Once identified as the causative agent, the drug was discontinued, with subsequent normalisation of troponin and improvement of function. This case identifies the importance of prompt evaluation, diagnosis, and treatment of paediatric patients receiving mesalamine-containing medications that present with significant cardiovascular symptoms.
    MeSH term(s) Adolescent ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Crohn Disease/drug therapy ; Electrocardiography ; Humans ; Male ; Mesalamine/adverse effects ; Myocarditis/blood ; Myocarditis/chemically induced ; Pericarditis/blood ; Pericarditis/chemically induced ; Treatment Outcome ; Troponin I/blood
    Chemical Substances Anti-Inflammatory Agents, Non-Steroidal ; Troponin I ; Mesalamine (4Q81I59GXC)
    Language English
    Publishing date 2015-04
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1078466-4
    ISSN 1467-1107 ; 1047-9511
    ISSN (online) 1467-1107
    ISSN 1047-9511
    DOI 10.1017/S1047951114001048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 4050: Show issues Location:
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  3. Article ; Online: Partial thromboplastin time is more predictive of bleeding than anti-Xa levels in heparinized pediatric patients after cardiac surgery.

    Oladunjoye, Olubunmi O / Sleeper, Lynn A / Nair, Asha G / Trenor, Cameron C / VanderPluym, Christina / Kheir, John N / Emani, Sitaram M

    The Journal of thoracic and cardiovascular surgery

    2018  Volume 156, Issue 1, Page(s) 332–340.e1

    Abstract: Objectives: Anticoagulation with unfractionated heparin (UFH) after pediatric cardiac surgery can be monitored using either activated partial thromboplastin time (aPTT) or anti-factor Xa activity (anti-Xa). However, correlation of bleeding with either ... ...

    Abstract Objectives: Anticoagulation with unfractionated heparin (UFH) after pediatric cardiac surgery can be monitored using either activated partial thromboplastin time (aPTT) or anti-factor Xa activity (anti-Xa). However, correlation of bleeding with either of these laboratory values has not been established. We sought to determine the correlation between bleeding events and aPTT and anti-Xa in patients who undergo anticoagulation after congenital heart surgery.
    Methods: We prospectively studied pediatric patients treated with UFH after cardiac surgery over an 11-month period. Bleeding events were prospectively assessed and adjudicated. The highest aPTT and corresponding anti-Xa for the 24 hours before bleeding events were collected to assess for association with bleeding. Statistical analysis was performed using generalized additive logistic regression.
    Results: A total of 202 patients received UFH over 1488 patient-days. The median age at surgery was 0.4 years (interquartile range, 0.1-2.2). A total of 45 major or clinically relevant bleeding events were observed. The correlation between aPTT and anti-Xa was of moderate strength (R = 0.58; P < .001). The odds of bleeding increased significantly when aPTT exceeded 150 (odds ratio, 1.71 per 10-second increase in aPTT, 95% confidence interval, 1.21-2.42; P = .003). Anti-Xa was not associated with bleeding (odds ratio, 1.11 per 0.1 IU/mL increase, 95% confidence interval, 0.89-1.29; P = .34).
    Conclusions: In heparinized pediatric patients after cardiac surgery, increased risk of bleeding is more closely associated with elevated aPTT levels than elevated anti-Xa levels. In addition to anti-Xa, monitoring of aPTT levels should be considered during titration of UFH in pediatric patients after cardiac surgery.
    MeSH term(s) Age Factors ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Biomarkers/blood ; Blood Coagulation/drug effects ; Cardiac Surgical Procedures/adverse effects ; Child, Preschool ; Drug Monitoring/methods ; Factor Xa/metabolism ; Heart Defects, Congenital/surgery ; Heparin/administration & dosage ; Heparin/adverse effects ; Humans ; Infant ; Partial Thromboplastin Time ; Postoperative Hemorrhage/blood ; Postoperative Hemorrhage/chemically induced ; Postoperative Hemorrhage/diagnosis ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; Thrombosis/blood ; Thrombosis/diagnosis ; Thrombosis/etiology ; Thrombosis/prevention & control ; Time Factors ; Treatment Outcome
    Chemical Substances Anticoagulants ; Biomarkers ; Heparin (9005-49-6) ; Factor Xa (EC 3.4.21.6)
    Language English
    Publishing date 2018-04-04
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Webcasts
    ZDB-ID 3104-5
    ISSN 1097-685X ; 0022-5223
    ISSN (online) 1097-685X
    ISSN 0022-5223
    DOI 10.1016/j.jtcvs.2018.02.101
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Extracorporeal Membrane Oxygenation Support After Heart Transplantation in Children-Outcomes of a Single Center Cohort.

    Nair, Asha G / Sleeper, Lynn A / Smoot, Leslie B / Wigmore, Daniel / Mecklosky, Jessica / Andren, Kristofer / Bastardi, Heather J / Blume, Elizabeth D / Fynn-Thompson, Francis / Thiagarajan, Ravi R / Alexander, Peta M A

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2019  Volume 21, Issue 4, Page(s) 332–339

    Abstract: Objectives: Extracorporeal membrane oxygenation is used for postcardiotomy low cardiac output but is less established following heart transplantation. We characterized outcomes for children supported with extracorporeal membrane oxygenation after heart ... ...

    Abstract Objectives: Extracorporeal membrane oxygenation is used for postcardiotomy low cardiac output but is less established following heart transplantation. We characterized outcomes for children supported with extracorporeal membrane oxygenation after heart transplantation.
    Design: Single-center retrospective study.
    Setting: Large pediatric cardiac referral center.
    Patients: All patients who received heart transplantation and were cannulated to extracorporeal membrane oxygenation between 1995 and 2016.
    Interventions: Primary outcome measure was mortality 12 months postextracorporeal membrane oxygenation. Patient characteristics were analyzed for association with outcome according to early graft failure (extracorporeal membrane oxygenation ≤ 7 d after heart transplantation), or late graft failure.
    Measurements and main results: There were 246 heart transplants during the study period and 50 extracorporeal membrane oxygenation runs in 44 patients. Median time from transplant to extracorporeal membrane oxygenation was 1 day (range, 0-11.7 yr), with early graft failure in 28 patients (median 1, range 0-2 d) and 22 extracorporeal membrane oxygenation runs in 20 late graft failure patients (median, 0.8 yr; range, 8 d to 11.7 yr), including four patients with prior extracorporeal membrane oxygenation for early graft failure. Twenty-six patients (59%) survived to hospital discharge, and survival 12 months postextracorporeal membrane oxygenation was 24 patients (55%), lower in those with late graft failure (40% vs 67%; p 0.02). Independent risk factors for 12-month mortality were congenital heart disease, higher pulmonary vascular resistance indexed to body surface area (> 2.2 Woods U/m), and higher creatinine. Higher panel reactive antibody levels were associated with 12-month mortality in the late graft failure group only.
    Conclusions: Extracorporeal membrane oxygenation can be effectively used to rescue patients with graft dysfunction after heart transplantation but is associated with high early mortality. Factors associated with mortality within 12 months include presence of congenital heart disease, renal dysfunction, elevated pulmonary vascular resistance indexed to body surface area and in those supported with extracorporeal membrane oxygenation late after heart transplantation, significant human leukocyte antigen sensitization.
    MeSH term(s) Child ; Cohort Studies ; Extracorporeal Membrane Oxygenation ; Heart Transplantation ; Humans ; Infant ; Retrospective Studies ; Time Factors
    Language English
    Publishing date 2019-10-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000002192
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: An anticoagulation protocol for use after congenital cardiac surgery.

    Nair, Asha G / Oladunjoye, Olubunmi O / Trenor, Cameron C / LaRonde, Meena / van den Bosch, Sarah J / Sleeper, Lynn A / VanderPluym, Christina / Emani, Sitaram M / Kheir, John N

    The Journal of thoracic and cardiovascular surgery

    2018  Volume 156, Issue 1, Page(s) 343–352.e4

    Abstract: Background: Patients undergoing surgery for congenital heart disease are at high risk for bleeding as well as thrombosis in the postoperative period. The objective of the study was to describe the design and effects of implementing a standardized ... ...

    Abstract Background: Patients undergoing surgery for congenital heart disease are at high risk for bleeding as well as thrombosis in the postoperative period. The objective of the study was to describe the design and effects of implementing a standardized unfractionated heparin anticoagulation protocol for children after congenital heart surgery.
    Methods: We created a tiered guideline for the postoperative management of bleeding and thrombosis. In patients treated with unfractionated heparin, anti-factor Xa activity level as well as activated partial thromboplastin time were used for dose titration. Clinical outcomes, including bleeding and thrombosis events, were prospectively collected for 5 months before and after protocol implementation and adjudicated as either minor, clinically relevant nonmajor, or major.
    Results: Among 792 surgical patients followed during the study period, a total of 203 patients (87 preimplementation, 116 postimplementation) were treated with therapeutic unfractionated heparin over a total of 1481 patient days. Of these, 28% were neonates and 35% were infants (29 days to 1 year), with a trend toward fewer neonates and lower Risk Adjustment for Congenital Heart Surgery (RACHS) scores after protocol implementation. Among 1321 time-matched pairs, activated partial thromboplastin time and antifactor Xa activity levels were poorly correlated (r
    Conclusions: The use of a standardized anticoagulation protocol is feasible and might reduce the incidence of bleeding and thrombosis events in postcardiotomy patients.
    MeSH term(s) Age Factors ; Anticoagulants/administration & dosage ; Anticoagulants/adverse effects ; Biomarkers/blood ; Blood Coagulation/drug effects ; Boston ; Cardiac Surgical Procedures/adverse effects ; Clinical Protocols ; Drug Administration Schedule ; Drug Monitoring/methods ; Factor Xa/metabolism ; Female ; Heart Defects, Congenital/blood ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/surgery ; Hemorrhage/chemically induced ; Heparin/administration & dosage ; Heparin/adverse effects ; Humans ; Infant ; Infant, Newborn ; Male ; Partial Thromboplastin Time ; Prospective Studies ; Risk Factors ; Thrombosis/blood ; Thrombosis/diagnosis ; Thrombosis/etiology ; Thrombosis/prevention & control ; Time Factors ; Treatment Outcome
    Chemical Substances Anticoagulants ; Biomarkers ; Heparin (9005-49-6) ; Factor Xa (EC 3.4.21.6)
    Language English
    Publishing date 2018-04-07
    Publishing country United States
    Document type Journal Article ; Video-Audio Media
    ZDB-ID 3104-5
    ISSN 1097-685X ; 0022-5223
    ISSN (online) 1097-685X
    ISSN 0022-5223
    DOI 10.1016/j.jtcvs.2018.02.106
    Database MEDical Literature Analysis and Retrieval System OnLINE

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