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Platelet Transfusion Does Not Improve Outcomes in Brain Injured Patients on Antiplatelet Therapy_ P. Maluso1 , C.L. Reynolds3 , M. Patel4 , S. Holland5 , N. Gamsky1 , H. Moore2 , E. Acquista6 , M. Carrick7 , R.L. Amdur1 , H. Hancock5 , J. Dunn9 , B. Sarani1 ; 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA; 2Carle Foundation Hospital, Surgery, Urbana, IL, USA; 3East Carolina University Brody School Of Medicine, Surgery, Greenville, NC, USA; 4Vanderbilt University Medical Center, Surgery, Nashville, TN, USA; 5San Antonio Military Medical Center, Surgery, Fort Sam Houston, TX, USA; 6University Of North Carolina At Chapel Hill, Surgery, Chapel Hill, NC, USA; 7Medical Center At Plano, Surgery, Plano, TX, USA; 8Columbia University College Of Physicians And Surgeons, Surgery, New York, NY, USA; 9Medical Center Of The Rockies, Surgery, Loveland, CO, USA_x000D_ Introduction: Brain injury is the most common cause of death following trauma. Platelet dysfunction is associated with worsening hemorrhage following brain injury (TBI). Use of antiplatelet medications (APM) is common, especially in elderly patients but the efficacy of platelet transfusion remains unknown. Thrombelastography platelet mapping (TEG-PM) assesses platelet function. We hypothesize that platelet transfusion can reverse the effects of APM but does not improve clinical outcomes in TBI patients on APM. Methods: A 2 year prospective, observational study at 6 US trauma centers was performed. Patients over 17 years old on APM with CT evident TBI after blunt injury were enrolled. Patients underwent TEG-PM and brain CT on arrival and repeat imaging within 24 hours. Platelets were transfused and repeat TEG-PM was ordered at physician discretion. Demographics, platelet transfusion, brain CT and TEG-PM results, length of stay (LOS), and injury severity score (AIS) were abstracted. Groups were compared using student t-test. Results: 66 patients were enrolled (89% aspirin, 34% clopidogrel, 2% ticagrelor). 23 ...

Sepsis and the killer platelets
Dermot Cox BSc, PG Dip Ed, PhD, Pharmacology Lead from the School of Pharmacy and Biomolecular Sciences – RCSI University of Medicine & Health Sciences, discusses sepsis and the killer platelets. Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection" (1) (Sepsis 3) and is typically diagnosed using the Sequential Organ Failure Assessment (SOFA) score. While sepsis typically arises in response to a bacterial infection, surprisingly, around 40% of cases are culture negative. The cause of culture negative sepsis is unclear but could be due to bacterial species that are difficult to grow in the lab.

© 2020 The Author(s). ; [INTRODUCTION]: Hepatitis C virus (HCV) infection has been related to increased cardiovascular (CV) risk. The aim of this study was to analyze the impact of sustained virological response (SVR) on endothelial dysfunction and subclinical atherosclerosis in patients with hepatitis C virus treated with direct-acting antiviral agents. [METHODS]: A total of 114 patients were prospectively recruited and underwent CV risk assessment including (i) endothelial dysfunction determined through laser Doppler flowmetry and (ii) subclinical atherosclerosis, elucidated by the ankle-brachial index (ABI). Atherogenic lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides); markers of oxidative stress (oxidized low-density lipoprotein antibodies [OLAbs]), soluble markers of adhesion (vascular cell adhesion molecule [VCAM], e-selectin, and soluble markers of angiogenesis; and vascular endothelial growth factor, endothelial [EMPs] and platelet [PMPs] apoptotic microparticles, and cell-free DNA [cfDNA]) were measured. All determinations were performed at baseline, 12 weeks (SVR time), and 1 year after treatment. [RESULTS]: In patients with endothelial dysfunction, area of hyperemia improved after virus clearance (P = 0.013) and was related to significant decrease in VCAM, e-selectin (P < 0.001), and cfDNA (P = 0.017) and to increased OLAb levels (P = 0.001). In patients with subclinical atherosclerosis at baseline, a significantly improved ABI was seen after HCV clearance (P < 0.001). Levels of both EMPs and PMPs also decreased after SVR and at follow-up (P = 0.006 and P = 0.002, respectively). [DISCUSSION]: HCV clearance improved not only liver function but also endothelial dysfunction and subclinical atherosclerosis promoted by decrease in levels of VCAM, e-selectin, cfDNA, and PMPs and EMPs. ; Postdoctoral fellowship from the Spanish Government (Juan de la Cierva fellowship FJC1-2014-21675). Instituto de Salud Carlos III Project GLD17/00203.

O Yanartas,1 HT Kani,2 E Bicakci,3 I Kilic,4 M Banzragch,3 C Acikel,5 O Atug,3 K Kuscu,1 N Imeryuz,3 H Akin31Department of Psychiatry, 2Department of Internal Medicine, 3Department of Gastroenterology, 4Department of Internal Medicine, Marmara University School of Medicine, Istanbul, 5Department of Public Health, Gulhane Military Medical Academy, Ankara, TurkeyObjective: Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder.Patients and methods: Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up.Results: Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn's disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months.Conclusion: In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn's disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.Keywords: anxiety, depression, sexual dysfunction, psychiatric treatment, inflammatory bowel disease

Abstract Background Thrombelastography is a laboratorial test that measures viscoelastic changes of the entire clotting process. There is growing interest in its clinical use in trauma resuscitation, particularly for managing acute coagulopathy of trauma and assisting decision making concerning transfusion. This review focuses on the clinical use of thrombelastography in trauma, with practical points to consider on its use in civilian and military settings. Methods A search in the literature using the terms "thrombelastography AND trauma" was performed in PUBMED database. We focused the review on the main clinical aspects of this viscoelastic method in diagnosing and treating patients with acute coagulopathy of trauma during initial resuscitation. Results Thrombelastography is not a substitute for conventional laboratorial tests such as INR and aPTT but offers additional information and may guide blood transfusion. Thrombelastography can be used as a point of care test but requires multiple daily calibrations, should be performed by trained personnel and its technique requires standardization. While useful partial results may be available in minutes, the whole test may take as long as other conventional tests. The most important data provided by thrombelastography are clot strength and fibrinolysis. Clot strength measure can establish whether the bleeding is due to coagulopathy or not, and is the key information in thrombelastography-based transfusion algorithms. Thrombelastography is among the few tests that diagnose and quantify fibrinolysis and thus guide the use of anti-fibrinolytic drugs and blood products such as cryoprecipitate and fibrinogen concentrate. It may also diagnose platelet dysfunction and hypercoagulability and potentially prevent inappropriate transfusions of hemostatic blood products to non-coagulopathic patients. Conclusions Thrombelastography has characteristics of an ideal coagulation test for use in early trauma resuscitation. It has limitations, but may prove useful as an additional test. Future studies should evaluate its potential to guide blood transfusion and the understanding of the mechanisms of trauma coagulopathy.

I. Regulatory Mechanisms -- Control of Red Cell Production -- Kinetics and Control of White Cell Production by Bone Marrow -- Heterogeneity and Circulation of Lymphocytes -- Megakaryocyte and Platelet Development and Regulation -- Discussion -- II. Metabolism and Function — A -- Normal Red Cell Metabolism and the Influences of Age and the Plasma Environment -- The Metabolism and Function of Red Cells with Inherited Defects -- Recent Studies on the Structure and Function of Leucocytes and Macrophages -- Increased Susceptibility to Infection Due to Dysfunction of Granulocytes -- Discussion -- III. Metabolism and Function — B -- Function of the Normal Lymphocyte -- Metabolism and Function of the Normal Platelets -- The Abnormal Platelet -- Discussion -- IV. Recent Developments in Therapy -- The Therapeutic Possibilities in the Hemoglobinopathies -- An Evaluation of the Present Status of Neutrophil Replacement Therapy -- Lymphoproliferative Disorders: Recent Concepts and Implications of Therapy -- Present Status of Blood Component Therapy -- Discussion -- Author Index.

Several problems related to coagulation dysfunctions induced by selective serotonin reuptake inhibitors (SSRIs) were reported in literature, as serotonin is widely distributed in the human organism and it has significant contribution in various vascular and hematologic regulatory mechanisms. First, a systematic review has integrated main results from the field of SSRIs and anticoagulants pharmacologic interactions. Secondly, a retrospective analysis was performed, based on the medical charts of hospitalized patients diagnosed with SSRI-treated depressive disorders, who also received concomitant anticoagulant treatment with acenocoumarol. Platelet count, prothrombin time, activated partial thromboplastin time, and bleeding time were monitored during hospitalization and their values before and after SSRI initiation treatment were compared.

Cover -- Half Title -- Title -- Copyright -- Contents -- List of Contributors -- Part I Current Trends in Pathophysiology and Post-COVID Effects -- Chapter 1 Pathophysiology of SARS-CoV-2 -- 1.1 Introduction -- 1.2 Structure of the Virus -- 1.3 Entry of SARS-CoV-2 -- 1.4 Entry Factors of SARS-CoV2 -- 1.5 Hallmark of COVID-19 -- 1.5.1 Pathophysiology of SARS-CoV-2 -- 1.6 Affecting Respiratory Tract -- 1.7 SARS-CoV-2 Infection Affects RAAS -- 1.8 Endothelial Dysfunction and Platelet Activation -- 1.9 Endocrine Dysfunction -- 1.9.1 Neuropathology -- 1.10 List of Abbreviations -- Acknowledgement -- References -- Chapter 2 Investigation of Post-COVID/Long COVID Complications in Humans -- 2.1 Introduction -- 2.2 Pathophysiology -- 2.3 Respiratory Complications -- 2.4 Cardiovascular Complexities -- 2.5 Haematological Abnormalities -- 2.6 Neurological Complications -- 2.7 Dermatological Sequelae -- 2.8 Diabetes-Related Comorbidities -- 2.9 Renal Complications -- 2.10 Gastrointestinal Sequelae -- 2.11 Conclusion -- References -- Part II SARS CoV-2 Co-Infection with Other Pathogens -- Chapter 3 Falciparum Malaria and COVID-19 Co-Infections -- 3.1 Introduction -- 3.2 Interactions Between SARS-CoV-2 Infection and Malaria -- 3.3 Similarity of Malaria and COVID-19 Symptoms and Problems Associated with It -- 3.4 Potential Effects of Previous Malaria Exposure on Clinical Profiles and Outcomes in Patients with SARS-CoV-2 Infection -- 3.5 Important Clinical Correlations of Co-Infection in High Malaria Burden Areas -- 3.6 Conclusion -- References -- Chapter 4 Interaction of COVID-19 and Tuberculosis -- 4.1 Introduction -- 4.2 Epidemiological and Clinical Presentation of COVID-19 with TB Infection -- 4.3 Biological Mechanism of COVID-19 and TB -- 4.4 Diagnostic Approaches for COVID-19 and Tuberculosis -- 4.4.1 Diagnostic Approaches for COVID-19.

Jacek Staszewski,1 Renata PiusiÅ"ska-Macoch,1 Bogdan Brodacki,1 Ewa Skrobowska,2 Adam StÄ™pieÅ"1 1Clinic of Neurology, 2Department of Radiology, Military Institute of Medicine, Warsaw, Poland Background: Endothelial dysfunction (ED) is involved in the pathogenesis of cerebral small vessel disease (SVD), however, it is not clear if specific biomarkers related to ED are associated with radiological progression of SVD.Methods: A single-center, prospective cohort study was conducted among consecutive, adult patients with SVD. Logistic regression was used to analyze the association of each baseline biomarker (highest vs lowest tertile) and the MRI radiological outcome after 2 years. The mean Z-score for vascular inflammation (VI) combined soluble intercellular cell adhesion molecule-1 (sICAM-1), soluble platelet selectin (sP-selectin), CD40 ligand (sCD40 L), platelet factor-4 (PF-4) and homocysteine; Z-score for systemic inflammation (SI) combined high-sensitivity C-reactive protein (hsCRP), interleukin-1α and -6 (IL-1α and IL-6, respectively) and tumor necrosis factor-α (TNF-α). Results: The study group comprised 123 patients (age, mean±SD: 72.2±8 years, 49% females), with lacunar stroke (n=49), vascular dementia (n=48), and vascular parkinsonism (n=26). Moreover, 34.9% patients experienced radiological progression, 43% had progression of isolated white matter lesions (WMLs), 23.2% had new lacunes, and 34.8% had both WMLs progression and new lacunes. After adjustment for confounders (age, sex, blood pressure, MRI lesions load), the PF-4 (OR; 95% CI 5.5; 1.5–21), sCD40L (4.6; 1.1–18.6), IL-6 (7.4; 1.48–37), Z-score for VI (4.5; 1.1–18.6), and, marginally, homocysteine (4.1; 0.99–17) were associated with the risk of any radiological progression; further, homocysteine (2.4; 1.4–14), Z-score for SI (2.1; 1.2–14) and, marginally, IL-6 (6.0; 0.95 -38) were related to the development of new lacunes; PF-4 (7.9; 1.6–38) and, marginally, the Z-score for VI (4.2; 0.9–19.5) were correlated with the risk of WMLs progression. Additional adjustment for clinical SVD manifestations did not significantly alter the results. Conclusion: The data supports the concept that ED modulates the radiological progression of SVD and WMLs and lacunes are associated with different inflammatory markers. Keywords: cerebral small-vessel disease, radiological progression, IL-6, PF-4, sCD40 L, homocysteine

PURPOSE: Data regarding the incidence of a coagulable state following heat stroke as assessed by Sonoclot signature analysis are limited. Our purpose was to appraise coagulopathy using a dynamic test capable of analyzing the entire coagulation cascade and to characterize coagulation in patients with heat stroke prior to transfusion. MATERIALS AND METHODS: The data of 106 patients were collected prospectively from the Critical Care Center of the General Hospital of Guangzhou Military Command. Coagulable state was defined as normal. Both hyper- and hypo-coagulable states were defined as coagulation defects. Hypercoagulability was defined as an activated clotting time (ACT) ≦195s and a clot rate (CR) >23, and hypocoagulability was defined as an ACT ≧119s and a CR < 7. The Sonoclot signature t examination was performed at the time of admission. Conventional tests, such as the prothrombin time (PT) and activated partial thromboplastin time (aPTT), were compared with Sonoclot monitoring to identify coagulation defects. RESULTS: The average age of the 106 patients was 23.2±2.5 years. There were 102 males (96.3%) and 4 females (3.7%). Thirty-four patients (32.1%) were hypercoagulable and 44 patients (41.5%) were hypocoagulable at the time of admission; 28 patients (26.4%) had no evidence of a coagulopathy. Patients with hypocoagulability, unlike patients with hypercoagulability, had a higher sequential Organ Failure Assessment score, indicating a more severe multiple organ dysfunction score. Mortality was 5.9% in patients with hypercoagulability compared with 3.5% in patients with normal coagulation, and 18.1% in patients with a hypocoagulable state (P < 0.05). ACT was a predictor of mortality, while the CR and platelet function did not show statistical significance. CONCLUSION: This study determined the clinical outcomes and prognostic value of coagulability in patients with heat stroke, as defined by Sonoclot signature analysis at the time of admission.

IntroductionChronic liver disease leads to neurocognitive impairment (NCI) and more advanced liver fibrosis is associated with greater deficits. Further, cognitive performances do not differ significantly among patients affected by diverse types of chronic liver diseases. Thus, it would be useful to have a clinical tool associated with early cognitive change applicable to the HIV‐infected population with high HCV prevalence. Aim of the analysis was to assess the association between NCI and aspartate aminotransferase‐platelet ratio index (APRI) or Fibrosis‐4, which are non‐invasive scores used to assess liver fibrosis.Materials and MethodsSingle‐centre, retrospective, cross‐sectional analysis of cART‐treated HIV‐infected patients undergoing neuropsychological assessment (NPA) by a set of 14 standardized and comprehensive tests on five different domains: concentration and speed of mental processing; mental flexibility; memory, fine motor functioning; visual‐spatial and constructional abilities. NPA obtained from the same patient were included, if collected while receiving different cART. Patients were classified as having NCI, if they scored >1 SD below the normative mean in at least two tests, or below >2 SD in one test. HIV‐associated neurocognitive disorders (HAND) were classified according to Frascati's criteria, controlling for confounding comorbidities. Univariable analysis and multivariable logistic regression models were carried out.ResultsA total of 556 HIV‐infected cART‐treated patients from 2006 to 2013 were included: male 78%; IVDUs 14%; CDC stage C 31%; median CD4 nadir 200/mm3; median current CD4 501/mm3; undetectable HIV‐RNA in 368 (67%); and HCV‐positivity in 150 (29%). Frequency among score levels was for FIB‐4: min‐1.44=404 (73%), 1.45–3.25=118 (21%), 3.26‐max=28 (5%); for APRI: min‐0.5=414 (75%), 0.5–1.5=112 (20%), 1.5‐max=24 (4%). Median FIB‐4 and APRI were 0.98 and 0.27 in HIV+/HCV‐ and 1.40 and 0.50 in HIV+/HCV+ individuals, respectively. HAND was found in 176 (32%): 91 ANI, 73 MND, 12 HAD. Association of variables with NCI are shown in Table 1.ConclusionsIn this large population, HAND was not associated with commonly used non‐invasive liver fibrosis scores. As aetiology of cognitive dysfunction in HIV mono‐ and HCV co‐infected patients is multifactorial and partially unknown, our results support the hypothesis of a direct or indirect effect on cognitive function of the viruses, rather than the consequence of alterations residing outside the brain.

Jinyi Min,1,* Peng Wan,2,* Guiwei Liu,1 Min Yu,2 Lei Su3 1Department of Critical Care Medicine, The People's Hospital, Dangyang City, Hubei, 444100, People's Republic of China; 2Department of Critical Care Medicine, The People's Hospital of China Three Gorges University, Yichang City, Hubei, 443000, People's Republic of China; 3Department of Critical Care Medicine, Guangzhou General Hospital of Guangzhou Military Command, The Military Key Laboratory of Trauma Care in Hot Zone and Tissue Repair in PLA, Guangzhou, 510000, People's Republic of China*These authors contributed equally to this workCorrespondence: Peng WanDepartment of Critical Care Medicine, The People's Hospital of China Three Gorges University, 4th Street Hudi, Xiling District, Yichang City, Hubei, 443000, People's Republic of ChinaTel + 86717-6287551Fax + 86717-6221636Email wanpeng0a0@163.comPurpose: Data regarding the incidence of a coagulable state following heat stroke as assessed by Sonoclot signature analysis are limited. Our purpose was to appraise coagulopathy using a dynamic test capable of analyzing the entire coagulation cascade and to characterize coagulation in patients with heat stroke prior to transfusion.Materials and Methods: The data of 106 patients were collected prospectively from the Critical Care Center of the General Hospital of Guangzhou Military Command. Coagulable state was defined as normal. Both hyper- and hypo-coagulable states were defined as coagulation defects. Hypercoagulability was defined as an activated clotting time (ACT) ≦195s and a clot rate (CR) > 23, and hypocoagulability was defined as an ACT ≧119s and a CR < 7. The Sonoclot signature t examination was performed at the time of admission. Conventional tests, such as the prothrombin time (PT) and activated partial thromboplastin time (aPTT), were compared with Sonoclot monitoring to identify coagulation defects.Results: The average age of the 106 patients was 23.2± 2.5 years. There were 102 males (96.3%) and 4 females (3.7%). Thirty-four patients (32.1%) were hypercoagulable and 44 patients (41.5%) were hypocoagulable at the time of admission; 28 patients (26.4%) had no evidence of a coagulopathy. Patients with hypocoagulability, unlike patients with hypercoagulability, had a higher sequential Organ Failure Assessment score, indicating a more severe multiple organ dysfunction score. Mortality was 5.9% in patients with hypercoagulability compared with 3.5% in patients with normal coagulation, and 18.1% in patients with a hypocoagulable state (P < 0.05). ACT was a predictor of mortality, while the CR and platelet function did not show statistical significance.Conclusion: This study determined the clinical outcomes and prognostic value of coagulability in patients with heat stroke, as defined by Sonoclot signature analysis at the time of admission.Keywords: heat stroke, coagulopathy, prognosis