Saudi Cultural Missions Theses & Dissertations
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Item Restricted Effectiveness and Safety of Nitric Oxide in Paediatric ECMO Circuits: A Systematic Review.(Saudi Digital Library, 2025) Alamri, Ahmed Ali; Alqarni, Abdullah Abdulgani; Wang, Justin Qi YueeIntroduction: Extracorporeal membrane oxygenation (ECMO) supports neonates and children with severe cardiac or respiratory failure, but clot formation in the circuit remains a major complication. Nitric oxide (NO), with known antiplatelet and vasodilatory effects, is being explored as an adjunct to reduce thrombosis. This systematic review aimed to evaluate the effectiveness and safety of NO delivered via ECMO sweep gas in paediatric populations. Methods: This PROSPERO-registered systematic review searched Medline, PubMed, and TRIP for published studies on nitric oxide (NO) delivered via ECMO sweep gas in paediatric patients. The primary outcome was circuit clotting. Eligible designs included RCTs, cohort, pilot, and relevant animal studies. References were screened in EndNote, with duplicates removed. Quality was assessed using the Newcastle–Ottawa Scale for clinical studies and SYRCLE’s Risk of Bias tool for animal studies. Results: Four studies were included: three clinical and one preclinical. The addition of nitric oxide (NO) to the sweep gas in the ECMO circuit was associated with fewer clotting events, fewer circuit changes, and reduced use of fresh frozen plasma (FFP). Red blood cell and platelet transfusion requirements did not differ significantly between the NO-treated patients and the control group. Methaemoglobin levels were slightly elevated in the NO group but remained within safe clinical limits. Conclusion: NO may improve ECMO circuit performance and reduce clotting without increasing bleeding risk. However, existing studies are limited by small sample sizes and a lack of randomised controlled trials. Further high-quality trials are needed to confirm its clinical benefit.42 0Item Restricted Understanding the mechanisms of the regulation of platelet function by thiol isomerase enzymes(Saudi Digital Library, 2025-10-31) Aldaghmi, Abdulrahman; Gibbins, JonathanBackground: Human platelets contain a number of thiol isomerases that are released to the cell surface upon platelet activation, such as protein disulphide isomerase (PDI), and endoplasmic reticulum (ER) proteins (ERp5, ERp57, and ERp72). Previous findings indicate that these enzymes play a role in regulating integrin αIIbβ3, the adhesion receptor that mediates platelet aggregation and thrombus formation, and the similarity in their inhibitory effects suggests functional overlaps. However, thiol isomerases are believed to facilitate disulphide exchange among themselves in mammalian cells. This suggests a potential cooperative interaction between these enzymes to regulate platelet function. Aims: The main aims of this research were to elucidate the mechanisms underlying the actions of thiol isomerases during platelet activation and explore potential interactions among these enzymes. The investigation aimed to identify common and distinctive substrates associated with PDI, ERp5, ERp57, and ERp72, and detect functional interactions among these enzymes. To understand more completely the associations between these enzymes, the study aimed to identify and characterise additional thiol isomerases in platelets that interact with these enzymes in other human cell types. To understand how these interactions affect platelet function, the investigation aimed to test the effects of novel broad- spectrum inhibitors on both platelet function and thiol isomerase interactions with potential substrates. Results: Experimental investigations of thiol isomerase interactions revealed inter-thiol complexes during platelet stimulation. The characterisation of platelet thiol isomerases revealed ERp18, a novel family member. Interactions among PDI, ERp5, ERp57, and ERp72 were detected and were particularly seen during platelet activation. Proteomics experiments revealed potential substrates and/or binding partners of these enzymes, which included key players in integrin inside-out signalling, such as the target receptor integrin αIIbβ3, thioredoxin, and heat shock proteins. In experiments to explore the collective function effects of thiol isomerases in the control of platelet function, the effects of the newly identified pan-thiol isomerase inhibitor were explored. Benserazide was demonstrated to inhibit the enzymatic activity of PDI, ERp5, ERp57, and ERp72, along with its capacity to inhibit various platelet functions. In proteomics studies, benserazide was shown to block the interactions between thiol isomerases and their substrates. Conclusions: These findings provide evidence that thiol isomerase enzymes participate in common and distinct protein complexes to regulate platelet function. The broad inhibition observed, resembling single inhibition of these enzymes, further supports the notion that platelet thiol isomerases collaborate to elicit their function roles upon their translocation to the cell surface. Lastly, benserazide, a well-tolerated drug with established therapeutic uses, holds promise as a potential fast-track option for developing a new anti-thrombotic therapy.26 0Item Restricted How well does a weight-based unfractionated heparin infusion protocol perform in adult patients during the initial dosing period(Saudi Digital Library, 2022-08-23) Fallatah, Osama; Patel, Jignesh; Man, KennethBackground: Unfractionated heparin (UFH) has been used in clinical practice for many years and remains the agent of choice in critically unwell patients, those patients with severe renal dysfunction, and peri-procedurally during cardiac procedures. At King’s College Hospital, a new IV UFH adult guideline was introduced in Oct 2021, recommending a weight-based dosing schedule and a calibrated anti-Xa assay to monitor UFH, in place of APTT. This audit aimed to review how well the new dosing protocol performed in clinical practice during the initial dosing period. Methods: A retrospective audit was conducted of all adult patients commencing UFH infusion from the launch of the guidelines - 13th October 2021 to the 27th of January 2022. In addition to the demographic information on the patients commenced on UFH, the indication and setting of the infusion were recorded, along with the initial dosing received and whether the guidelines were followed. Descriptive statistics were used to analyse the data. Result: Ninety-seven patients were commenced on a UFH infusion during the audit period with a mean age of 60.7 years [SD +/- 14.9] and a mean first anti-Xa result of 0.63 IU/mL [SD = 0.43]. Most patients were in the ICU [n=37, 38%], renal [n=22, 23%], and cardiac ward setting [n= 14, 15%] when the UFH infusion was initiated. Sixty-seven percent [n=65] were male, with 40% prescribed the UFH infusion for venous thromboembolism. The results show that patients who had been prescribed the UFH bolus dose and followed the weight-based UFH guideline [n=16, 41%] were above the target therapeutic range. However, patients treated according to the guideline but not administered a bolus dose [n=38] were more likely to have the first anti-Xa level in the range [n=27,71%]. Female patients were more likely to be above the range [n=11, 34%] compared to male patients [n=12, 18%]. Conclusion: The new protocol using a weight-based dosing schedule and anti-Xa performed well in ensuring therapeutic levels of anticoagulation with UFH. The findings suggest that patients who were not administered the bolus and followed the UFH infusion guideline were more likely to achieve the anti-Xa therapeutic range. We have now amended our UFH guideline from mandating the bolus to considering the administration of a bolus if clinically indicated. We plan to re-audit, following this change18 0