DOCSLIB.ORG

Factor V Leiden, Prothrombin G20210A Substitution and Hormone

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Factor V Leiden, Prothrombin G20210A Substitution and Hormone Article in press - uncorrected proof J Lab Med 2006;30(5):317–325 ᮊ 2006 by Walter de Gruyter • Berlin • New York. DOI 10.1515/JLM.2006.999 2006/13 Ha¨ mostaseologie Redaktion: Ch. Schambeck Factor V Leiden, prothrombin G20210A substitution and hormone therapy: indications for molecular screening testing1) Faktor-V-Leiden, Prothrombin G20210A Substitution und Hormontherapie: Indikationen fu¨ r molekulare Screening Tests Maria Grazia Andreassi1,*, Nicoletta Botto1 and Zusammenfassung Silvia Maffei2 Venenthrombosen sind eine bekannte Komplikation bei 1 Laboratory of Cellular Biology and Genetics, CNR oraler Kontrazeption und Hormonersatztherapie. Erbliche Institute of Clinical Physiology, ‘‘G. Pasquinucci’’ Thrombophilie wird als wichtiger Faktor gesehen, der Hospital, Massa, Italy Effekte von O¨ strogenen auf das Thromboserisiko beein- 2 CNR Institute of Clinical Physiology, Pisa, Italy flusst. Die Zahl kommerziell vertriebener Testkits fu¨r Thrombophilie-Mutationen (Factor V Leiden, G20210A Prothrombin und MTHFR C677T Gene) steigt und das Screening auf erbliche Thrombose-Risikofaktoren geho¨rt Abstract zu den am ha¨ ufigsten angeforderten Leistungen in mole- kulardiagnostischen Labors. Die Frage nach der routi- nema¨ ßigen Durchfu¨ hrung von Sceenings auf solche Venous thromboembolism is a well-known complication Risikofaktoren vor einer Verschreibung von Hormonpra¨- of oral contraception and hormonal replacement therapy. paraten wird jedoch kontrovers diskutiert. In diesem Inherited thrombophilia is viewed as an important deter- Artikel werden der Wert und die praktischen Anwen- minant in modulating the effects of estrogens on throm- dungsmo¨ glichkeiten von genetischen Tests auf Throm- botic risk. An increasing number of kits for thrombophilic bose-Risikofaktoren diskutiert, um zu definieren, welche w mutations factor V Leiden, G20210A prothrombin and Patientinnen im Interesse der Erho¨ hung von Sicherheit methylenetetrahydrofolate reductase (MTHFR) C677T und Effizienz einer individuellen O¨ strogentherapie getes- x genes are becoming commercially available, and tet werden sollten. screening for inherited thrombotic risk is among the most requested genetic tests in molecular diagnostic labora- Schlu¨ sselwo¨ rter: erbliche Thrombophilie; genetische tories. However, the question of routine genetic screen- Tests; Hormonersatztherapie; orale Kontrazeption; ing for thrombophilia before prescribing hormones is still Thromboserisiko. a matter of debate. The purpose of this article is to dis- cuss the usefulness and practical applications of throm- botic genetic testing to identify which women should be tested to improve both the safety and efficacy of individ- Introduction ualized estrogen therapy. Exogenous hormones are used worldwide by women as Keywords: genetic testing; hormonal replacement ther- oral contraceptives (OCs) and hormonal replacement apy; inherited thrombophilia; oral contraception; throm- therapy (HRT). Epidemiologic studies have shown a two- botic risk. to six-fold increase in the relative risk of venous throm- boembolism (VTE) with the use of either hormonal 1)This article is a re-publication with kind permission from the contraception or postmenopausal treatment w1x. Recent- authors. The original source is Andreassi MG, Botto N and Maf- ly, it has been suggested that the risk/benefit ratio could fei S. Factor V Leiden, prothrombin G20210A substitution and be, in part, mediated by the genetic predisposition of hormone therapy: indications for molecular screening testing. w x Clin Chem Lab Med 2006;44:514–21. women 2, 3 . In particular, genetic thrombophilia might *Correspondence: Maria Grazia Andreassi, CNR Institute of be implicated in the risk of VTE in women who use exog- Clinical Physiology, G. Pasquinucci Hospital, Via Aurelia Sud- enous hormones w2, 3x. The most common causes of Montepepe, 54100 Massa, Italy genetic hypercoagulability known today are factor V Lei- Phone: q39-0585-493646 Fax: q39-0585-493601 den, G20210A prothrombin polymorphisms, and the E-mail: [email protected] genetic variant C677T of the methylenetetrahydrofolate Article in press - uncorrected proof 318 M.G. Andreassi et al.: Genetic testing and hormone therapy reductase (MTHFR) gene (where the association appears of excess risk for VTE, which was also significantly to be much weaker) w4–6x. Indeed, diagnostic assays of increased during the first year w19x. Recently, it has been VTE predisposition are among the most requested genet- suggested that the benefit of HRT could have been ic tests in molecular diagnostic laboratories w7x. However, obscured by an increased risk of cardiovascular disease the question as to whether it is beneficial to screen wom- in a subset of women genetically predisposed to a throm- en for genetic thrombophilia before prescribing hor- botic complication w20x. In particular, genetic polymor- mones remains controversial. On the other hand, there is phisms in genes regulating the coagulation and considerable debate over the new ‘‘predictive medicine’’ fibrinolytic cascade may contribute to estrogen-associ- that could generate serious ethical, social and psycho- ated increase in risk for thrombotic events observed in logical consequences. Receiving genetic risk information the trials w2, 3x. During recent years, several studies have may, therefore, be more harmful than positive by raising found an association between candidate genetic poly- unnecessary anxieties and providing a real prospect of morphisms (fibrinogen, plasminogen activator, factor XIII, discrimination based on a person’s genetic make-up thrombin activatable fibrinolysis inhibitor, angiotensin- w8, 9x. converting enzyme genes) and venous thrombosis Furthermore, genetic tests are generally time-consum- w21–25x. In addition, the search for amino acid substitu- ing and expensive, and they should not be used to tions in factor V, other than that causing factor V Leiden, ‘‘screen’’ the general population. However, testing for has identified some additional polymorphisms w26, 27x. inherited thrombophilia could have a positive impact on However, the association of these genetic variants with the possibility of preventing VTE in high-risk women, as thrombosis is still debated and definitive recommenda- well as for careful clinical surveillance. Both physicians tions are not available as yet. and women need to obtain accurate information con- Conversely, there is clinical evidence that indicates a cerning the appropriate use of genetic thrombophilia strong association between increased risk of VTE and screening. The purpose of this article is to discuss the factor V Leiden or prothrombin G20210A substitution. usefulness and the practical applications of thrombotic genetic testing to define which women should be tested Thrombosis gene polymorphisms to improve both the safety and efficacy of individualized and risk with estrogen estrogen therapy. Genetic risk factors for VTE have been known since Hormone preparations and thrombotic risk 1965, when the first family with an identified hereditary tendency caused by antithrombin deficiency to throm- The first case of thrombosis associated with hormonal bosis was reported w28x. However, genetic defects in the contraception occurred in 1961, when a nurse developed three principal anticoagulant proteins (antithrombin, pro- a pulmonary embolism shortly after starting a high-dose tein C and protein S deficiencies) appear to be very rare estrogen pill w10x. These early reports seemed to suggest and extremely heterogeneous. More recently, researchers that the thrombotic potential of OC use was related to its have described new genetic abnormalities in the genes relatively high estrogen content of 50 mg or higher w11x. encoding factor V and prothrombin w29, 30x. These Subsequently, a number of European epidemiologic genetic disorders predispose to a hypercoagulable state studies confirmed the association between OC and an and are well-conserved mutations. Moreover, a genetic increase in VTE, despite the lower overall estrogen con- polymorphism in the MTHFR gene has also been report- tent w12, 13x. The absolute risk of VTE is estimated at ed as a risk factor for deep venous thrombosis w4–6x. The one event per 10,000 individuals per year among non- relevance of these abnormalities lies in their high preva- users and 3–6 events per 10,000 per person-year among lence, which, contrary to deficiencies of natural antico- hormonal contraceptive users w12–14x. agulants, affects a large number of people (Table 1). As with hormonal contraception, a number of studies have shown an increase in the risk of venous thrombosis Factor V Leiden after postmenopausal estrogen therapy w15x. The risk of VTE is 2.1- to 3.6-fold higher among users of oral or Activated factor V (factor Va) is an essential cofactor for transdermal preparations w15x. Recently, the Women’s the conversion of prothrombin (factor II) to thrombin, and Health Initiative (WHI) reported 34 events of VTE annually factor Va is inactivated by activated protein C (APC). APC per 10,000 women treated with HRT vs. 16 VTE events cuts factor V into two parts. A common variation in the per 10,000 women who were non-HRT users w16x. Again, factor V gene (G1691A or factor V Leiden) is responsible the Heart and Estrogen/progestin Replacement Study for APC resistance. In fact, the resulting amino-acid sub- w17x and the Estrogen Replacement and Atherosclerosis stitution is located at one of the sites in factor V that is trial w18x found a 1.7% and 2.6% increase, respectively recognized,
Load more

Recommended publications
  • AMP Molecular Genetic Pathology Recommended Review Books
    ASSOCIATION FOR MOLECULAR PATHOLOGY Education. Innovation & Improved Patient Care. Advocacy. 6120 Executive Blvd. Suite 700, Rockville, MD 20852 Tel: 301-634-7939 | Fax: 301-634-7995 | [email protected] | www.amp.org AMP Molecular Genetic Pathology : RECOMMENDED REVIEW BOOKS Updated: March, 2021 The following books are suggested for those preparing for the Molecular Genetic Pathology board exam administered by the American Board of Medical Genetics and the American Board of Pathology. This list represents the recommendations of the MGP Review Course faculty and the AMP Training and Education Committee; endorsement by the ABMG or the ABP is not implied. GENERAL MOLECULAR PATHOLOGY Thompson & Thompson Genetics in Medicine, 8th edition Nussbaum RL et al., eds. Elsevier, 2015 Molecular Pathology: The Molecular Basis of Human Diseases 2nd edition Coleman WB and Tsongalis GJ, eds. Elsevier, 2018 Diagnostic Molecular Pathology: A Guide to Applied Molecular Testing Coleman WB and Tsongalis GJ, eds. Elsevier, 2016 Molecular Basis of Human Cancer, 2nd edition Coleman WB and Tsongalis GJ, eds. Elsevier, 2017 Molecular Diagnostics: Fundamentals, Methods, and Clinical Applications 3rd edition Buckingham L. ASCP, 2021 Genomic Medicine: A Practical Guide Tafe LJ and Arcila ME, eds. Springer, 2020 CYTOGENETICS Gardner and Sutherland’s Chromosome Abnormalities and Genetic Counseling, 5th edition McKinlay Gardner RJ, Amor DJ. Oxford University Press, 2018 The Principles of Clinical Cytogenetics, 3rd edition Gersen SL and Keagle MB, eds. Human Press, 2013 Human Chromosomes, 4th edition Miller OJ and Therman E, eds. Springer Press, 2000 Vance GH, Khan WA. Utility of Fluorescence In Situ Hybridization in Clinical and Research Applications. Advances in Molecular Pathology 2020; 3:65-75.
    [Show full text]
  • Mutation in the Prothrombin Gene G20210A As a Cause of Cerebral Venous Thrombosis
    Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 828050, 3 pages doi:10.1155/2012/828050 Case Report Mutation in the Prothrombin Gene G20210A as a Cause of Cerebral Venous Thrombosis Jorge A. Arroyave1 and Jairo Quinones˜ 2 1 Internal Medicine, Universidad CES, Medell´ın, Colombia 2 Neuroinmunology, Clinical Neurology, Fundacion´ Cl´ınica Valle del Lili, Cali, Colombia Correspondence should be addressed to Jorge A. Arroyave, [email protected] Received 8 February 2012; Accepted 21 February 2012 Academic Editor: Mamede de Carvalho Copyright © 2012 J. A. Arroyave and J. Quinones.˜ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Cerebral venous sinus thrombosis (CVST) is a rare form of cerebrovascular disease, which may manifest clinically by a wide variety of signs and symptoms. It has been associated with multiple risk factors including genetic or acquired blood disorders, infections, and trauma. Case Report. Man of 17 years who presented with 10 days of intense global headache with nausea and vomiting and subsequent onset of mild hemiparesis and hypoesthesia in right hemibody. Studies show venous thrombosis of the superior longitudinal sinus. It was identified a gene mutation in prothrombin G20210A as a probable cause of the thrombosis. Conclusions. Substitution of guanine for adenine at nucleotide 20210 in the coding region of the prothrombin gene is the second most common primary thrombophilia. Multiple cases of CVST have been associated with this mutation. In the presence of CVST must be considered the primary studies for thrombophilia gene mutations, including prothrombin G20210A.
    [Show full text]
  • Leave Policy for Residents and Fellows.Pdf
    Leave Policy for Residents and Fellows The following policy outlines indications and training modifications to accommodate leave during accredited training for certification in all of the ABMGG specialties. Candidates for certification are required to successfully complete training in one of the following programs: ACGME-accredited Programs: 24 months (2 years) • Medical Genetics and Genomics Residency • Clinical Biochemical Genetics Postdoctoral Fellowship • Laboratory Genetics and Genomics Postdoctoral Fellowship Approved Combined Residency Programs: 48 months (4 years) • Medical Genetics and Genomics/Internal Medicine • Medical Genetics and Genomics/Pediatrics • Medical Genetics and Genomics/Maternal Fetal Medicine • Medical Genetics and Genomics/Reproductive Endocrinology and Infertility Subspecialty Fellowship Programs: 12 months (1 year) • Medical Biochemical Genetics • Molecular Genetic Pathology (cosponsored with American Board of Pathology) General Leave Policy: All candidates are allotted 4 weeks leave per year, which may be accrued or averaged through the duration of training for any indication. All candidates must take at least one week off per year as designated vacation time. Leave time cannot be forfeited to shorten training duration. Parental, Caregiver, and Medical Leave Policy: This policy refers to leave for the following indications: parental leave (the birth and care of a newborn including adopted and foster children for either partner), caregiver leave (care for an immediate (first degree) family member or partner with a serious health condition), or medical leave for significant personal medical needs. For Parental, Caregiver, and Medical leave, the ABMGG will allow up to 6 weeks leave during an academic year to occur once during the training program. For trainees who take indicated leave, they must still take at least one additional week for vacation during the same training year.
    [Show full text]
  • The Underrecognized Prothrombotic Vascular Disease of COVID-19
    Journal Articles 2020 The underrecognized prothrombotic vascular disease of COVID-19. KP Cohoon G Mahé AC Spyropoulos Zucker School of Medicine at Hofstra/Northwell, [email protected] Follow this and additional works at: https://academicworks.medicine.hofstra.edu/articles Part of the Internal Medicine Commons Recommended Citation Cohoon K, Mahé G, Spyropoulos A. The underrecognized prothrombotic vascular disease of COVID-19.. 2020 Jan 01; 4(5):Article 6487 [ p.]. Available from: https://academicworks.medicine.hofstra.edu/articles/ 6487. Free full text article. This Article is brought to you for free and open access by Donald and Barbara Zucker School of Medicine Academic Works. It has been accepted for inclusion in Journal Articles by an authorized administrator of Donald and Barbara Zucker School of Medicine Academic Works. For more information, please contact [email protected]. Received: 6 May 2020 | Revised: 16 May 2020 | Accepted: 21 May 2020 DOI: 10.1002/rth2.12396 LETTER TO THE EDITOR The underrecognized prothrombotic vascular disease of COVID-19 We have read with interest “COVID-19-associated coagulopathy around elevated markers of hypercoagulability, including D-dimer, and thromboembolic disease: Commentary on an interim expert tissue factor expression, fibrinogen levels, factor VIII levels, guidance” recently provided by Cannegieter and Klok.1 This com- short-activated partial thromboplastin time, platelet binding, and mentary exemplifies the importance that venous thromboembolism thrombin formation.8 Based on well-defined clinical and laboratory (VTE) and atheroembolism may be underrepresented and a cause parameters, a proposal for staging COVID-19 coagulopathy may for increased morbidity and mortality among coronavirus disease provide treatment algorithms stratified into 3 stages.9 However, 2019 (COVID-19) patients.
    [Show full text]
  • Department of Molecular Biology and Immunology
    Genetics Student Handbook 2020-2021 The information provided in this document serves to supplement the requirements of the Graduate School of Biomedical Sciences detailed in the UNTHSC Catalog with requirements specific to the Genetics discipline. Genetics Discipline (8/6/20) 1 Table of Contents Page Description of the Genetics Discipline ............................................ 3 Graduate Faculty and Their Research ............................................. 5 Requirements ................................................................................... 9 Required Courses ....................................................................... 9 Journal Club and Seminar Courses ............................................ 9 Elective Courses ......................................................................... 9 Sample Degree Plans ..................................................................... 11 Advancement to Candidacy ........................................................... 14 Genetics Discipline (8/6/20) 2 1. Description of the Genetics Discipline John V. Planz, Ph.D., Graduate Advisor Center for BioHealth, Rm 360 Phone: 817-735-2397 E-mail: [email protected] Program website: www.unthsc.edu/graduate-school-of-biomedical-sciences/genetics/ Graduate Faculty: Allen; Barber; Budowle; Cihlar; Coble; Ge; Phillips; Planz; Woerner Genetics is a broad interdisciplinary field that unites biochemistry, microbial and cellular biology, molecular processes, biotechnology, computational biology, biogeography and human disease
    [Show full text]
  • Importance of Medical Genetics Research in Medicine
    cs an eti d D n N e A G f R Journal of Genetics and DNA o e l s a e a n Sboui S, Tabbabi A, J Genet DNA Res 2018, 2:1 r r c u h o J Research Short Communication Open Access Importance of Medical Genetics Research in Medicine Sajida Sboui1 and Ahmed Tabbabi2* 1Faculty of Medicine of Monastir, Monastir University, Monastir, Tunisia 2Department of Hygiene and Environmental Protection, Ministry of Public Health, Tunis, Tunisia *Corresponding author: Ahmed Tabbabi, Department of Hygiene and Environmental Protection, Ministry of Public Health, Tunis, Tunisia, Tel: +216 71 577 115; +216 71 577 302; E-mail: [email protected] Received date: February 09, 2018, Accepted date: February 20, 2018, Published date: February 27, 2018 Copyright: © 2018 Sboui S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Chromosome; Genes; Cleft lip; Transforming growth In medical genetics, the work diagnosis includes molecular analyzes factors (DNA, proteins and chromosomes) and clinical manisfestations of conditions, including malformations birth. If monogenic diseases are Short Communication rare, those caused by the gene/environment interaction are common and include many diseases. Prevention in medical genetics involves for About millions of families are affected by hereditary diseases around common pathologies the identification of subjects with high risk, with the world. Statistics analysis showed that about 5% of all pregnancies the intention of preventing the disease (e.g.
    [Show full text]
  • An Updated Primer
    The new england journal of medicine review article Genomic Medicine W. Gregory Feero, M.D., Ph.D., and Alan E. Guttmacher, M.D., Editors Genomic Medicine — An Updated Primer W. Gregory Feero, M.D., Ph.D., Alan E. Guttmacher, M.D., and Francis S. Collins, M.D., Ph.D. Cathy, a 40-year-old mother of three, arrives in your office for her annual physical. From the National Human Genome Re- She has purchased a commercial genomewide scan (see the Glossary), which she be- search Institute (W.G.F.), the Eunice Ken- nedy Shriver National Institute of Child lieves measures the clinically meaningful risk that common diseases will develop, H e al t h an d Human D e ve l o p m e n t ( A . E .G .), and has completed her family history online using My Family Health Portrait (www and the Office of the Director (F.S.C.), .familyhistory.hhs.gov), a tool developed for this purpose by the U.S. Surgeon Gen- National Institutes of Health, Bethesda, MD; and the Maine Dartmouth Family eral. Her genomewide scan suggests a slightly elevated risk of breast cancer, but Medicine Residency Program, Augusta, you correctly recognize that this information is of unproven value in routine clinical ME (W.G.F.). Address reprint requests to care. On importing Cathy’s family-history file, your office’s electronic health record Dr. Feero at the National Human Ge- nome Research Institute, National Insti- system alerts you to the fact that Cathy is of Ashkenazi Jewish heritage and has sev- tutes of Health, Bldg.
    [Show full text]
  • Genetic Testing for BRCA Mutations: a POLICY PAPER
    Genetic testing for BRCA mutations: A POLICY PAPER 2019 This report was initiated and funded by Pfizer. Pfizer has provided funding to The Health Policy Partnership (HPP) for research, drafting and coordination. The report was written by Kirsten Budig, Jody Tate and Suzanne Wait from HPP under the guidance of a group of expert contributors. The experts contributed through telephone interviews and written comments, and were not financially compensated for their time. The following expert contributors were consulted and provided feedback during the development of this European-level report and the country profiles, for which we are hugely grateful. European-level report • Karen Benn, Deputy CEO/ Head of Public Affairs, Europa Donna • Antonella Cardone, Director, European Cancer Patient Coalition • Lydia Makaroff, former Director, European Cancer Patient Coalition; current Chief Executive Officer, Fight Bladder Cancer • Elżbieta Senkus-Konefka, Associate Professor at the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland France country profile • Pascal Pujol, President, BRCA-France; Professor of Medical Genetics, Centre Hospitalier Universitaire de Montpellier • Dominique Stoppa-Lyonnet, Director of the Genetics Department, Institut Curie; Professor of Genetics, University Paris-Descartes Germany country profile • Rita Schmutzler, Director, Centre for Breast and Ovarian Cancer, Cologne • Evelin Schröck, Director, Institute for Clinical Genetics at the TU Dresden Ireland country profile • Liz Yeates, CEO, Marie
    [Show full text]
  • Genomic-Based Personalized Medicine (Reference Committee E)
    REPORT 4 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (A-10) Genomic-based Personalized Medicine (Reference Committee E) EXECUTIVE SUMMARY Objectives. The term “personalized medicine” (PM) refers to health care that is informed by each person’s unique clinical, genetic, and environmental information. Clinical integration of PM technologies is enabling health care providers to more easily detect individual differences in susceptibility to particular diseases or in response to specific treatments, then tailor preventive and therapeutic interventions to maximize benefit and minimize harm. This report will review current status of genomic-based PM and challenges to implementing it, and will briefly summarize the activities of key federal agencies, professional organizations, coalitions, and health systems that are working to further the integration of genomic-based technologies into routine care. Data Sources. Literature searches were conducted in the PubMed database for English-language articles published between 2005 and 2010 using the search terms “personalized medicine” and “personalized medicine AND clinic.” To capture reports that may not have been indexed on PubMed, a Google search was also conducted using the search term “personalized medicine.” Additional articles were identified by review of the literature citations in articles and identified from the PubMed and Google searches. Results. Genetic testing has been a routine part of clinical care for a number of years in screening and diagnosis. Recently, a number of genomic-based applications have advanced beyond these screening and diagnostic techniques and are “personalizing” the delivery of care by enabling risk prediction, therapy, and prognosis that is tailored to individual patients. Yet there are challenges to the clinical implementation of PM, such as the lack of genetics knowledge among health care providers, slow generation of clinical validity and utility evidence, a fragmentary oversight and regulatory system, and lack of insurance coverage of PM technologies.
    [Show full text]
  • Simulation Based Virtual Learning Environment in Medical Genetics
    Makransky et al. BMC Medical Education (2016) 16:98 DOI 10.1186/s12909-016-0620-6 RESEARCH ARTICLE Open Access Simulation based virtual learning environment in medical genetics counseling: an example of bridging the gap between theory and practice in medical education Guido Makransky1*, Mads T. Bonde2, Julie S. G. Wulff1, Jakob Wandall3, Michelle Hood4, Peter A. Creed4, Iben Bache5,6, Asli Silahtaroglu5 and Anne Nørremølle5 Abstract Background: Simulation based learning environments are designed to improve the quality of medical education by allowing students to interact with patients, diagnostic laboratory procedures, and patient data in a virtual environment. However, few studies have evaluated whether simulation based learning environments increase students’ knowledge, intrinsic motivation, and self-efficacy, and help them generalize from laboratory analyses to clinical practice and health decision-making. Methods: An entire class of 300 University of Copenhagen first-year undergraduate students, most with a major in medicine, received a 2-h training session in a simulation based learning environment. The main outcomes were pre- to post- changes in knowledge, intrinsic motivation, and self-efficacy, together with post-intervention evaluation of the effect of the simulation on student understanding of everyday clinical practice were demonstrated. Results: Knowledge (Cohen’s d = 0.73), intrinsic motivation (d =0.24),andself-efficacy(d = 0.46) significantly increased from the pre- to post-test. Low knowledge students showed the greatest increases in knowledge (d =3.35)andself- efficacy (d = 0.61), but a non-significant increase in intrinsic motivation (d = 0.22). The medium and high knowledge students showed significant increases in knowledge (d = 1.45 and 0.36, respectively), motivation (d = 0.22 and 0.31), and self-efficacy (d = 0.36 and 0.52, respectively).
    [Show full text]
  • Spontaneous Deep Vein Thrombosis in Hemophilia A: a Case Report Murat Bicer, Murat Yanar* and Oktay Tuydes
    Open Access Case report Spontaneous deep vein thrombosis in hemophilia A: a case report Murat Bicer, Murat Yanar* and Oktay Tuydes Address: Department of Cardiac Surgery, Kalp Damar Cerrahisi Anabilim Dali Görükle Yerles¸kesi, Nilüfer Bursa 16059, Turkey Email: MB - [email protected]; MY* - [email protected]; OT - [email protected] * Corresponding author Received: 4 March 2009 Accepted: 5 July 2009 Published: 11 September 2009 Cases Journal 2009, 2:6390 doi: 10.4076/1757-1626-2-6390 This article is available from: http://casesjournal.com/casesjournal/article/view/6390 © 2009 Bicer et al.; licensee Cases Network Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Venous thromboembolus is an important cause of hospital acquired morbidity and mortality. Venous thrombosis is a very rare occurrence in patients with haemophilia A. The thrombosis originated from the right main and external iliac veins, and effects the cranial segments of the main, deep and superficial femoral veins as an acute phase thrombus. Neither any local anatomic compression nor any predisposing thrombophilic risk factors were identified. We treated the patient with enoxaparine 1 mg/kg twice a day subcutaneously and then started oral anticoagulation with warfarin. Introduction was warmer and 2 cm larger than the left lower extremity in Venous thromboembolus is an important cause of hospital circumference. According to the visual analog scale, the acquired morbidity and mortality [1]. Hemophilia A is pain score was 6.
    [Show full text]
  • Thrombocytopenia and Intracranial Venous Sinus Thrombosis After “COVID-19 Vaccine Astrazeneca” Exposure
    Journal of Clinical Medicine Article Thrombocytopenia and Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine AstraZeneca” Exposure Marc E. Wolf 1,2 , Beate Luz 3, Ludwig Niehaus 4 , Pervinder Bhogal 5, Hansjörg Bäzner 1,2 and Hans Henkes 6,7,* 1 Neurologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany; [email protected] (M.E.W.); [email protected] (H.B.) 2 Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, D-68167 Mannheim, Germany 3 Zentralinstitut für Transfusionsmedizin und Blutspendedienst, Klinikum Stuttgart, D-70174 Stuttgart, Germany; [email protected] 4 Neurologie, Rems-Murr-Klinikum Winnenden, D-71364 Winnenden, Germany; [email protected] 5 Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London E1 1FR, UK; [email protected] 6 Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany 7 Medical Faculty, University Duisburg-Essen, D-47057 Duisburg, Germany * Correspondence: [email protected]; Fax: +49-711-278-345-09 Abstract: Background: As of 8 April 2021, a total of 2.9 million people have died with or from the coronavirus infection causing COVID-19 (Corona Virus Disease 2019). On 29 January 2021, the European Medicines Agency (EMA) approved a COVID-19 vaccine developed by Oxford University Citation: Wolf, M.E.; Luz, B.; and AstraZeneca (AZD1222, ChAdOx1 nCoV-19, COVID-19 vaccine AstraZeneca, Vaxzevria, Cov- Niehaus, L.; Bhogal, P.; Bäzner, H.; ishield). While the vaccine prevents severe course of and death from COVID-19, the observation of Henkes, H. Thrombocytopenia and pulmonary, abdominal, and intracranial venous thromboembolic events has raised concerns. Objec- Intracranial Venous Sinus Thrombosis after “COVID-19 Vaccine tive: To describe the clinical manifestations and the concerning management of patients with cranial AstraZeneca” Exposure.
    [Show full text]