scholarly journals Heparin-induced thrombocytopenia is associated with a high risk of mortality in critical COVID-19 patients receiving heparin-involved treatment

2020 ◽  
Author(s):  
Xuan Liu ◽  
Xiaopeng Zhang ◽  
Yongjiu Xiao ◽  
Ting Gao ◽  
Guangfei Wang ◽  
...  
Keyword(s):  
Severe Disease ◽  
Fatal Outcome ◽  
Development Program ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Icu Patients ◽  
Heparin Induced Thrombocytopenia ◽  
Global Pandemic ◽  
Potential Risk Factors ◽  
High Level

SummaryBackgroundCoronavirus infectious disease 2019 (COVID-19) has developed into a global pandemic. It is essential to investigate the clinical characteristics of COVID-19 and uncover potential risk factors for severe disease to reduce the overall mortality rate of COVID-19.MethodsSixty-one critical COVID-19 patients admitted to the intensive care unit (ICU) and 93 severe non-ICU patients at Huoshenshan Hospital (Wuhan, China) were included in this study. Medical records, including demographic, platelet counts, heparin-involved treatments, heparin-induced thrombocytopenia-(HIT) related laboratory tests, and fatal outcomes of COVID-19 patients were analyzed and compared between survivors and nonsurvivors.FindingsSixty-one critical COVID-19 patients treated in ICU included 15 survivors and 46 nonsurvivors. Forty-one percent of them (25/61) had severe thrombocytopenia, with a platelet count (PLT) less than 50×109/L, of whom 76% (19/25) had a platelet decrease of >50% compared to baseline; 96% of these patients (24/25) had a fatal outcome. Among the 46 nonsurvivors, 52·2% (24/46) had severe thrombocytopenia, compared to 6·7% (1/15) among survivors. Moreover, continuous renal replacement therapy (CRRT) could induce a significant decrease in PLT in 81·3% of critical CRRT patients (13/16), resulting in a fatal outcome. In addition, a high level of anti-heparin-PF4 antibodies, a marker of HIT, was observed in most ICU patients. Surprisingly, HIT occurred not only in patients with heparin exposure, such as CRRT, but also in heparin-naïve patients, suggesting that spontaneous HIT may occur in COVID-19.InterpretationAnti-heparin-PF4 antibodies are induced in critical COVID-19 patients, resulting in a progressive platelet decrease. Exposure to a high dose of heparin may trigger further severe thrombocytopenia with a fatal outcome. An alternative anticoagulant other than heparin should be used to treat COVID-19 patients in critical condition.FundingThis investigation was supported by grants 2016CB02400 and 2017YFC1201103 from the National Major Research and Development Program of China.

scholarly journals Refractory vaccine-induced thrombotic thrombocytopenia (VITT) managed with delayed therapeutic plasma exchange (TPE)

2021 ◽  
Author(s):  
Ajay Major ◽  
Timothy Carll ◽  
Clarence W. Chan ◽  
Chancey Christenson ◽  
Geoffrey D. Wool ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Alcoholic Cirrhosis ◽  
Therapeutic Plasma Exchange ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Sustained Improvement ◽  
Vein Thrombosis ◽  
Hematologic Disorder

Abstract Vaccine-induced thrombotic thrombocytopenia (VITT) is a newly-described hematologic disorder which presents as acute thrombocytopenia and thrombosis after administration of adenovirus-based vaccines against COVID-19. Due to positive assays for antibodies against platelet factor 4 (PF4), VITT is managed similarly to autoimmune heparin-induced thrombocytopenia (HIT) with intravenous immunoglobulin (IVIG) and non-heparinoid anticoagulation. We describe a case of VITT in a 50-year-old man with antecedent alcoholic cirrhosis who presented with platelets of 7 × 103/µL and portal vein thrombosis 21 days following administration of the Ad26.COV2.S COVID-19 vaccine. The patient developed progressive thrombosis and persistent severe thrombocytopenia despite IVIG, rituximab and high-dose steroids and had persistent anti-PF4 antibodies over 30 days after his initial presentation. As such, delayed therapeutic plasma exchange (TPE) was pursued as salvage therapy, with a rapid and sustained improvement in his platelet count. Our case serves as proof-of-concept of the efficacy of TPE in VITT.

Mitoxantrone, fluorouracil, and high-dose leucovorin: an effective, well-tolerated regimen for metastatic breast cancer.

1991 ◽  
Vol 9 (10) ◽  
pp. 1731-1735 ◽  
Author(s):  
J D Hainsworth ◽  
M B Andrews ◽  
D H Johnson ◽  
F A Greco
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Symptomatic Relief ◽  
Metastatic Breast ◽  
Response Duration ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Median Response ◽  
Level Of Activity ◽  
High Level

Between September 1988 and August 1990, we treated 35 women with metastatic breast cancer with a novel regimen containing mitoxantrone, fluorouracil (5-FU), and high-dose leucovorin. This regimen was designed to take full advantage of the favorable toxicity profiles of these agents while maintaining a high level of activity. All patients had received previous chemotherapy (adjuvant only, 15 patients; at least one metastatic regimen, 20 patients). Seven patients had received previous doxorubicin, but none within 6 months of study entry. Of 31 assessable patients, 20 (65%) had objective responses (two complete, 18 partial), with a median response duration of 6 months (range, 3 to 16+ months). Four patients with bone metastases (abnormal bone scan only) and pain were not considered assessable by strict response criteria; two of these patients had sustained symptomatic relief for 6 and 8 months, respectively. Myelosuppression was the most frequent toxicity but was mild in most patients; only four hospitalizations for fever and neutropenia were required (2% of courses). No severe thrombocytopenia occurred and no RBC transfusions were required. Alopecia, mucositis, and nausea/vomiting were uncommon and were not severe in any patient. The combination of mitoxantrone, 5-FU, and high-dose leucovorin is well tolerated and active as a first- or second-line treatment for metastatic breast cancer. Comparison with other standard regimens for breast cancer is indicated.

scholarly journals Aerosolized Exposure to H5N1 Influenza Virus Causes Less Severe Disease Than Infection via Combined Intrabronchial, Oral, and Nasal Inoculation in Cynomolgus Macaques

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 345
Author(s):  
Petra Mooij ◽  
Marieke A. Stammes ◽  
Daniella Mortier ◽  
Zahra Fagrouch ◽  
Nikki van Driel ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Immune Activation ◽  
Influenza Infection ◽  
Severe Disease ◽  
Fatal Outcome ◽  
H5n1 Influenza Virus ◽  
Highly Pathogenic ◽  
H5n1 Influenza ◽  
Route Of Infection ◽  
High Level

Infection with highly pathogenic avian H5N1 influenza virus in humans often leads to severe respiratory disease with high mortality. Experimental infection in non-human primates can provide additional insight into disease pathogenesis. However, such a model should recapitulate the disease symptoms observed in humans, such as pneumonia and inflammatory cytokine response. While previous studies in macaques have demonstrated the occurrence of typical lesions in the lungs early after infection and a high level of immune activation, progression to severe disease and lethality were rarely observed. Here, we evaluated a routinely used combined route of infection via intra-bronchial, oral, and intra-nasal virus inoculation with aerosolized H5N1 exposure, with or without the regular collection of bronchoalveolar lavages early after infection. Both combined route and aerosol exposure resulted in similar levels of virus replication in nose and throat and similar levels of immune activation, cytokine, and chemokine release in the blood. However, while animals exposed to H5N1 by combined-route inoculation developed severe disease with high lethality, aerosolized exposure resulted in less lesions, as measured by consecutive computed tomography and less fever and lethal disease. In conclusion, not virus levels or immune activation, but route of infection determines fatal outcome for highly pathogenic avian H5N1 influenza infection.

scholarly journals Predicting Severity and Intrahospital Mortality in COVID-19: The Place and Role of Oxidative Stress

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Ivan Cekerevac ◽  
Tamara Nikolic Turnic ◽  
Nevena Draginic ◽  
Marijana Andjic ◽  
Vladimir Zivkovic ◽  
...  
Keyword(s):  
Heart Rate ◽  
Severe Disease ◽  
Fatal Outcome ◽  
Clinical Signs ◽  
Serum Levels ◽  
Severe Form ◽  
Cross Sectional ◽  
Global Pandemic ◽  
Clinical Center ◽  
Nitric Oxide Level

SARS-CoV-2 virus causes infection which led to a global pandemic in 2020 with the development of severe acute respiratory syndrome. Therefore, this study was aimed at examining its possible role in predicting severity and intrahospital mortality of COVID-19, alongside with other laboratory and biochemical procedures, clinical signs, symptoms, and comorbidity. This study, approved by the Ethical Committee of Clinical Center Kragujevac, was designed as an observational prospective cross-sectional clinical study which was conducted on 127 patients with diagnosed respiratory COVID-19 viral infection from April to August 2020. The primary goals were to determine the predictors of COVID-19 severity and to determine the predictors of the negative outcome of COVID-19 infection. All patients were divided into three categories: patients with a mild form, moderate form, and severe form of COVID-19 infection. All biochemical and laboratory procedures were done on the first day of the hospital admission. Respiratory ( p < 0.001 ) and heart ( p = 0.002 ) rates at admission were significantly higher in patients with a severe form of COVID-19. From all observed hematological and inflammatory markers, only white blood cell count ( 9.43 ± 4.62 , p = 0.001 ) and LDH ( 643.13 ± 313.3 , p = 0.002 ) were significantly higher in the severe COVID-19 group. We have observed that in the severe form of SARS-CoV-2, the levels of superoxide anion radicals were substantially higher than those in two other groups ( 11.3 ± 5.66 , p < 0.001 ) and the nitric oxide level was significantly lower in patients with the severe disease ( 2.66 ± 0.45 , p < 0.001 ). Using a linear regression model, TA, anosmia, ageusia, O2−, and the duration at the ICU are estimated as predictors of severity of SARS-CoV-2 disease. The presence of dyspnea and a higher heart rate were confirmed as predictors of a negative, fatal outcome. Results from our study show that presence of hypertension, anosmia, and ageusia, as well as the duration of ICU stay, and serum levels of O2− are predictors of COVID-19 severity, while the presence of dyspnea and an increased heart rate on admission were predictors of COVID-19 mortality.

R452 – Nasopharyngeal Yolk Sac Tumors: A Rare Pediatric Occurrence

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P196-P196 ◽  
Author(s):  
Lorraine M Smith ◽  
Ryan F Osborne
Keyword(s):  
Head And Neck ◽  
Clinical Presentation ◽  
Yolk Sac ◽  
High Dose ◽  
Presenting Symptoms ◽  
Mild Improvement ◽  
Pathologic Features ◽  
Yolk Sac Tumors ◽  
Infant Girl ◽  
High Level

Problem To report the rare occurrence of a yolk sac tumor of the nose and nasopharynx presenting as acute sinusitis and bilateral complete blindness. Methods The clinical presentation, pathologic features, and management of this 2-year-old infant girl is reviewed. We also performed a medical literature search in English using PUBMED and OVID databases. We then analyzed the literature with respect to clinical presentation, manifestations and therapies for other extra-gonadal yolk sac tumors presenting in the head and neck. Results The patient was treated with 4 courses of high dose cis-platinum, etoposide, bleomycin repeated every 3 weeks along with surgery. She had initial mild improvement in visual perception along with shrinkage of her tumor. The yolk sac malignancies of the head and neck are often, large, aggressive lesions on presentation that once treated have a tendency to recur. Conclusion Yolk sac tumors (endodermal sinus tumors) represent 3–5% of pediatric malignancies. They are rare malignancies in the head and neck, of germ cell origin. Successful treatment usually requires a combination of chemotherapy and surgical extirpation followed by postoperative chemotherapy. Significance Recurrent sinusitis and nasal obstruction in children should be evaluated carefully and with a high level of suspicion for rare nasal and nasopharyngeal malignancies. Early diagnosis and prompt treatment may alleviate many of the presenting symptoms and prolong life.

Hematologic Toxicity of High-Dose Iodine-131–Metaiodobenzylguanidine Therapy for Advanced Neuroblastoma

2004 ◽  
Vol 22 (12) ◽  
pp. 2452-2460 ◽  
Author(s):  
Steven G. DuBois ◽  
Julia Messina ◽  
John M. Maris ◽  
John Huberty ◽  
David V. Glidden ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Radiation Dose ◽  
Red Cells ◽  
Whole Body ◽  
High Dose ◽  
Hematologic Toxicity ◽  
Severe Thrombocytopenia ◽  
Hematopoietic Stem ◽  
Iodine 131 ◽  
Mibg Therapy

Purpose Iodine-131–metaiodobenzylguanidine (131I-MIBG) has been shown to be active against refractory neuroblastoma. The primary toxicity of 131I-MIBG is myelosuppression, which might necessitate autologous hematopoietic stem-cell transplantation (AHSCT). The goal of this study was to determine risk factors for myelosuppression and the need for AHSCT after 131I-MIBG treatment. Patients and Methods Fifty-three patients with refractory or relapsed neuroblastoma were treated with 18 mCi/kg 131I-MIBG on a phase I/II protocol. The median whole-body radiation dose was 2.92 Gy. Results Almost all patients required at least one platelet (96%) or red cell (91%) transfusion and most patients (79%) developed neutropenia (< 0.5 × 103/μL). Patients reached platelet nadir earlier than neutrophil nadir (P < .0001). Earlier platelet nadir correlated with bone marrow tumor, more extensive bone involvement, higher whole-body radiation dose, and longer time from diagnosis to 131I-MIBG therapy (P ≤ .04). In patients who did not require AHSCT, bone marrow disease predicted longer periods of neutropenia and platelet transfusion dependence (P ≤ .03). Nineteen patients (36%) received AHSCT for prolonged myelosuppression. Of patients who received AHSCT, 100% recovered neutrophils, 73% recovered red cells, and 60% recovered platelets. Failure to recover red cells or platelets correlated with higher whole-body radiation dose (P ≤ .04). Conclusion These results demonstrate the substantial hematotoxicity associated with high-dose 131I-MIBG therapy, with severe thrombocytopenia an early and nearly universal finding. Bone marrow tumor at time of treatment was the most useful predictor of hematotoxicity, whereas whole-body radiation dose was the most useful predictor of failure to recover platelets after AHSCT.

scholarly journals Toward a More Expansive Discourse in a Changing World: An Analysis of Political Leaders’ Speeches on Biodiversity

2021 ◽  
Vol 13 (5) ◽  
pp. 2899
Author(s):  
Sang Hun Lee ◽  
Yi Hyun Kang ◽  
Rong Dai
Keyword(s):  
Biodiversity Conservation ◽  
Policy Process ◽  
Biological Diversity ◽  
Convention On Biological Diversity ◽  
Decision Making Process ◽  
Political Leaders ◽  
Host Countries ◽  
Global Pandemic ◽  
The Subject ◽  
High Level

Speeches delivered in the Conference of the Parties (COPs) to the Convention on Biological Diversity represent leading discourses about biodiversity conservation. The discourse shared by high-level politicians is especially influential in the financing and decision-making process of global biodiversity governance. However, the speeches given in the COPs have not been the subject of systematic analyses until now. This study analyzes the host countries’ speeches given at the six most recent COPs and investigates which discourses have been expressed in the speeches. The regulatory discourse that views nature as a resource was found to be the dominant discourse, while other discourses that view nature as a scientific object or a spiritual entity were represented only marginally. As the need for a transformational policy for biodiversity conservation is growing amid a global pandemic, it is essential to deepen our understanding of the dynamics and complexity of nature and reflect it in the policy process. This study suggests that more balanced discourse on biodiversity may earn broader audiences’ consensus on biodiversity conservation.

A Successful Venous Thromboprophylaxis in a Patient with Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT): a case report of the first reported case in Thailand

2021 ◽  
Author(s):  
Archrob Khuhapinant ◽  
Tarinee Rungjirajittranon ◽  
Bundarika Suwanawiboon ◽  
Yingyong Chinthammitr ◽  
Theera Ruchutrakool
Keyword(s):  
Asian Population ◽  
High Dose ◽  
Severe Thrombocytopenia ◽  
Imaging Studies ◽  
Fatal Complication ◽  
Platelet Factor ◽  
High Dose Dexamethasone ◽  
Prophylactic Dose ◽  
Spontaneous Platelet Aggregation ◽  
Very High

Abstract BackgroundVaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but fatal complication of Coronavirus Disease 2019 vaccine. Many reports of VITT have mostly been in the Caucasian population. Here, we present first reported case from an oriental population.Case presentationA 26-year-old female who had severe headache and severe thrombocytopenia 8 days after administration of the ChAdOx1 nCoV-19 vaccine developed by AstraZeneca. Although no thrombosis was demonstrated by imaging studies, she had very highly elevated d-dimer level during hospitalization. Serology for antibody against platelet factor 4 was positive on several days with very high optical density readings. Furthermore, we found the antibody could induce spontaneous platelet aggregation without the presence of heparin. We decided to treat her with intravenous immunoglobulin, high-dose dexamethasone, and a prophylactic dose of apixaban. She improved rapidly and was discharged from the hospital 6 days after admission. Neither thrombocytopenia nor thrombosis was subsequently detected at three weeks follow-up.ConclusionsDespite lower rate of thrombosis, VITT can present in Asian population. Early detection and prompt treatment of VITT can improve patients’ clinical outcome. Thromboprophylaxis of non-heparin anticoagulants also results in prevention of clot formation.

POVERTY REDUCTION, UNEMPLOYMENT AND RURAL DEVELOPMENT; AFTERMATH OF COVID-19 PANDEMIC IN NIGERIA

2021 ◽  
Vol 9 (1) ◽  
pp. 36-49
Author(s):  
Oderinu Hassana ◽  
◽  
Kadir Mumini ◽  
Tijani Adebayo ◽  
Keyword(s):  
Economic Development ◽  
Rural Development ◽  
Rural Areas ◽  
Poverty Reduction ◽  
Design Method ◽  
Gear Up ◽  
Global Pandemic ◽  
High Level ◽  
Almost All ◽  
Self Administered Questionnaire

Nigeria has one of the countries whose experience of poverty and unemployment is on the high side makes this study to look into the effect of the economic lockdown during the global pandemic in the country, with the aim of making effort on how this effect can be translated into economic development. Survey research design method was adopted with self-administered questionnaire used to collect data. Findings revealed that in Nigeria COVID -19 outbreak effects was felt in almost all sectors and the aftermath greatly affected the country’s GDP and this adversely affect rural development in the country, which translated to a worrisome rate of poverty and unemployment. Hence, both individual and government have now seen that campaigning for economic diversification is not sufficient for economic development but rather a prompt swing into action by all is needed for sustainable development of rural areas to respond to the worrisome rate of unemployment and in turn high level of poverty caused by the COVID-19 lockdown in the country. It was recommended that government at all level as well as individuals and stakeholders should put in place actions that would gear up rural development and set policies at their various helms of affairs that would encourage economic participation of all citizens in all sector of the economy.

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