The role of blood product removal in intraventricular hemorrhage of prematurity: a meta-analysis of the clinical evidence

The importance of corticosteroids in the therapy of COVID-19 has been controversial. However, as the world develops a better understanding regarding the pathophysiology of COVID-19, we are realizing that suppressing the host immune response may reduce lung inflammation preventing further complications. In addition, more high-quality randomized controlled trials, meta-analysis, and review articles are being published discussing the role of corticosteroids. Majority of these studies concluded that corticosteroids are beneficial for hospitalized severely ill COVID-19 patients requiring supplemental oxygen. To date, therapeutic guidelines for COVID-19 patients recommend dexamethasone or other alternative corticosteroids, including methylprednisolone, hydrocortisone, or prednisone, as a treatment choice for severely ill COVID-19 patients. This review will discuss the pharmacology, mechanism of action, pharmacodynamics, pharmacokinetics, and benefits of corticosteroids in COVID-19 patients, and review current published clinical evidence on corticosteroids. Keywords: Corticosteroids, COVID-19, ARDS

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The Role of Platelets in Premature Neonates with Intraventricular Hemorrhage: A Systematic Review and Meta-Analysis

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0039-3402687 ◽

2019 ◽

Vol 46 (03) ◽

pp. 366-378 ◽

Cited By ~ 1

Author(s):

Alexander K. Grevsen ◽

Claus V. B. Hviid ◽

Anne K. Hansen ◽

Anne-Mette Hvas

Keyword(s):

Intraventricular Hemorrhage ◽

Current Knowledge ◽

Meta Analysis ◽

Extremely Low Birth Weight ◽

Premature Neonates ◽

Platelet Counts ◽

Time Restrictions ◽

Increased Risk ◽

The Impact

AbstractIntraventricular hemorrhage (IVH) affects up to 22% of extremely low birth weight neonates. Impaired coagulation might contribute to the pathogenesis of IVH. The aims of this study were to summarize the current knowledge on the role of platelet indices in premature neonates with IVH and to provide an overview of secondary hemostasis parameters as well as fibrinolysis in premature neonates with IVH. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases PubMed, Embase, Scopus, and Web of Science were searched on March 7, 2019, without time restrictions. In total, 30 studies were included. Most studies investigated the significance of platelet counts and/or mean platelet volume (MPV). The meta-analysis showed that at day 1 of life, neither platelet count nor MPV differed significantly between neonates with or without IVH (standardized mean difference [SMD]: –0.15 × 109/L, 95% confidence interval [CI]: –0.37 to 0.07 and SMD: 0.22 fl, 95% CI: –0.07 to 0.51, respectively). However, platelet counts < 100 × 109/L were associated with an increased risk of IVH. Secondary hemostasis parameters did not differ between neonates with and without IVH. Fibrinolysis was only sparsely investigated. In conclusion, platelet counts < 100 × 109/L were associated with an increased risk of IVH in premature neonates. The impact of secondary hemostasis was only sparsely investigated but seemed to be minor, and the role of fibrinolysis in IVH in premature neonates needs further research. Whether reduced platelet function is associated with an increased risk of IVH in premature neonates remains to be investigated.

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Subarachnoid Hemorrhage and the Heart

Neurosurgery ◽

10.1227/00006123-198601000-00019 ◽

1986 ◽

Vol 18 (1) ◽

pp. 101-106 ◽

Cited By ~ 111

Author(s):

Donald W. Marion ◽

Ricardo Segal ◽

Mark E. Thompson

Keyword(s):

Subarachnoid Hemorrhage ◽

Intraventricular Hemorrhage ◽

Ventricular Arrhythmias ◽

Clinical Evidence ◽

Hypothalamic Stimulation ◽

Life Threatening ◽

Acute Increase ◽

Spontaneous Subarachnoid Hemorrhage ◽

Electrocardiographic Abnormalities

Abstract Electrocardiographic abnormalities, both morphological and rhythmic, are frequently seen in association with spontaneous subarachnoid hemorrhage. These changes, which often reflect subendocardial damage, seem to be caused by hypothalamic stimulation leading to an acute increase in sympathetic tone. As a result, potentially life-threatening ventricular arrhythmias may develop in subarachnoid hemorrhage patients. These arrhythmias have responded to sympathetic blocking agents, which may also have a protective effect on subendocardial tissue in this setting. There is no evidence that the prophylactic administration of propranolol or other autonomic blockers significantly alters outcome in these patients. Ultimate morbidity and mortality are clearly related to the degree of intracerebral-intraventricular hemorrhage and vasospasm. This article reviews experimental and clinical evidence regarding the causes of cardiac abnormalities after subarachnoid hemorrhage, the types of abnormalities most frequently seen, their relationship with subendocardial lesions, and the role of autonomic blockers.

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Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2013.janfeb01 ◽

2013 ◽

Vol 18 (1) ◽

pp. 1-18 ◽

Cited By ~ 1

Author(s):

Robert J. Barth

Keyword(s):

Health Outcomes ◽

Pain Perception ◽

Driving Forces ◽

Psychological Treatment ◽

Dominant Role ◽

Meta Analysis ◽

General Medicine ◽

Pain Syndrome ◽

Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

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