Arrhythmias Associated with Administration of Anti-fungal Agents
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catastrophes, follow up and genetic counseling to prevent morbidity in affected children. Acknowledgments: Dr Spoorthi SM and Dr Lingaraja Gowda C Patil for help in data analysis and drafting the manuscript. SN NIKITHA RAJ* AND H RAMESH Department of Pediatrics, JJM Medical College, Davanagere, Karnataka, India. *[email protected] REFERRENCES 1. Shetty S, Shelar T, Mirgal D, Nawadkar V, Pinto S, Shabhag S, et al. Rare coagulation factor deficiencies: A countrywide screening data from India. Haemophilia. 2014;20:575-81. 2. Naderi M, Dorgalaleh A, Alizadeh S, Taibibian S, Hosseini S, Shamsizadeh M, et al. Clinical manifestations and management of life threatening bleeding in the largest group of patients with severe factor XIII deficiency. Int J Hematol. 2014;100:443-9. 3. Karaman K, Ceylan N, Karaman E, Akbayram S, Akbaryram HT, Garipardic M, et al. Evaluation of the hemostatic disorders in adolescent girls with menorrhagia: Experiences from a tertiary referral hospital. Indian J Hematol Blood Transfus. 2016;32:356-61. 4. Kohler HP, Ichinose A, Seitz R, Ariens RAS, Muszbek L. Diagnosis and classification of factor XIII deficiencies. J Thromb Haemost. 2011;9:1404-06. 5. Jennings I, Kitchen S, Woods TAL, Preston FE. Problems relatedto the laboratory diagnosis of factor XIII deficiency: A UK NEQAS study. J Thromb Haemostat. 2003;1:2603-8.
Although, coagulopathy is the second most common cause of pubertal menorrhagia [3] with congenital factor XIII deficiency being the commonest amongst the ‘rare congenital factor deficiencies’, it stays under diagnosed due to its rarity, heterogeneity and absence of diagnostic facilities [1]. Qualitative assay with clot solubility in 5M urea detects only severe form, but quantitative functional assay detects all forms and it is the recommended first line screening method as it has no false positivity [4]. The available treatment options include replacement and prophylactic therapy with cryoprecipitate, fresh frozen plasma and factor XIII concentrates [5]. Awareness about all possible features of factor XIII deficiency is essential among clinicians while managing cases for prompt diagnosis, appropriate treatment, improving quality of life, decreasing the burden of further medical
Arrhythmias Associated with Administration of Anti-fungal Agents
abdominal pain requiring temporary suspension of enteral feeding. Posaconazole was switched to intravenous voriconazole 210 mg every 12 hours. Five days after the coadministration of voriconazole and amphotericin B infusion, he developed an attack of non-sustained wide complex tachycardia lasting for 24 seconds after infusion of voriconazole and amphotericin B. Thirty seconds later, there were three similar attacks lasting for 15, 2 and 4 seconds, respectively with an interval duration of 1 second in between. He was asymptomatic during the attacks. He was receiving continuous renal replacement therapy at that juncture. An electrocardiogram performed immediately after the event failed to capture the ventricular tachycardia. It showed a QT i
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