scholarly journals Complement Mediated Hemolytic Anemias in the COVID-19 Era: Case Series and Review of the Literature

2021 ◽  
Vol 12 ◽  
Author(s):  
Bruno Fattizzo ◽  
Raffaella Pasquale ◽  
Valentina Bellani ◽  
Wilma Barcellini ◽  
Austin G. Kulasekararaj
Keyword(s):  
Recent Literature ◽  
Case Series ◽  
Medical Attention ◽  
Complement Inhibitor ◽  
Cold Agglutinin Disease ◽  
Complement Inhibitors ◽  
Uremic Syndrome ◽  
Thrombotic Complications ◽  
The Subject ◽  
Active Investigation

The complex pathophysiologic interplay between SARS-CoV-2 infection and complement activation is the subject of active investigation. It is clinically mirrored by the occurrence of exacerbations of complement mediated diseases during COVID-19 infection. These include complement-mediated hemolytic anemias such as paroxysmal nocturnal hemoglobinuria (PNH), autoimmune hemolytic anemia (AIHA), particularly cold agglutinin disease (CAD), and hemolytic uremic syndrome (HUS). All these conditions may benefit from complement inhibitors that are also under study for COVID-19 disease. Hemolytic exacerbations in these conditions may occur upon several triggers including infections and vaccines and may require transfusions, treatment with complement inhibitors and/or immunosuppressors (i.e., steroids and rituximab for AIHA), and result in thrombotic complications. In this manuscript we describe four patients (2 with PNH and 2 with CAD) who experienced hemolytic flares after either COVID-19 infection or SARS-Cov2 vaccine and provide a review of the most recent literature. We report that most episodes occurred within the first 10 days after COVID-19 infection/vaccination and suggest laboratory monitoring (Hb and LDH levels) in that period. Moreover, in our experience and in the literature, hemolytic exacerbations occurring during COVID-19 infection were more severe, required greater therapeutic intervention, and carried more complications including fatalities, as compared to those developing after SARS-CoV-2 vaccine, suggesting the importance of vaccinating this patient population. Patient education remains pivotal to promptly recognize signs/symptoms of hemolytic flares and to refer to medical attention. Treatment choice should be based on the severity of the hemolytic exacerbation as well as of that of COVID-19 infection. Therapies include transfusions, complement inhibitor initiation/additional dose in the case of PNH, steroids/rituximab in patients with CAD and warm type AIHA, plasma exchange, hemodialysis and complement inhibitor in the case of atypical HUS. Finally, anti-thrombotic prophylaxis should be always considered in these settings, provided safe platelet counts.

scholarly journals COMPLEMENT INHIBITOR ECULIZUMAB IN ATYPICAL HEMOLYTIC-UREMIC SYNDROME: SINGLE CENTER CASE SERIES

2021 ◽  
Author(s):  
Monika Vitkauskaitė ◽  
Artūras Vinikovas ◽  
Marius Miglinas ◽  
Laurynas Rimševičius ◽  
Agnė Čerkauskaitė ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hemolytic Uremic Syndrome ◽  
Treatment Guidelines ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Case Series ◽  
Complement Inhibitor ◽  
Single Center ◽  
Positive Effects ◽  
Uremic Syndrome

Our case series showed that eculizumab is efficacious and safe in treating atypical hemolytic-uremic syndrome, as well as it has positive effects on quality of life. Further extensive studies are required to develop unified treatment guidelines.

Materials for Electron Beam Information Storage

1969 ◽  
Vol 27 ◽  
pp. 152-153 ◽  
Author(s):  
D. E. Speliotis
Keyword(s):  
Magnetic Field ◽  
Electron Beam ◽  
Recent Literature ◽  
Electron Beams ◽  
Information Storage ◽  
The Subject ◽  
The Magnetic Field

The interaction of electron beams with a large variety of materials for information storage has been the subject of numerous proposals and studies in the recent literature. The materials range from photographic to thermoplastic and magnetic, and the interactions with the electron beam for writing and reading the information utilize the energy, or the current, or even the magnetic field associated with the electron beam.

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

1996 ◽  
Vol 75 (02) ◽  
pp. 368-371 ◽  
Author(s):  
T Barbul ◽  
G Finazzi ◽  
A Grassi ◽  
R Marchioli
Keyword(s):  
Cancer Patients ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Hematopoietic Growth Factors ◽  
Patients With Cancer ◽  
Cytotoxic Treatment ◽  
Pertinent Data ◽  
Thrombotic Complications ◽  
Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

Physicianship and the Rebirth of Medical Education

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric Cassell ◽  
Abraham Fuks
Keyword(s):  
Medical Education ◽  
Educational Process ◽  
Medical Attention ◽  
Patient Centeredness ◽  
Goals Of Medicine ◽  
The Subject ◽  
Definition Of ◽  
And Function ◽  
William Osler ◽  
The Relationship

This book reimagines medical education and reconstructs its design. It originates from a reappraisal of the goals of medicine and the nature of the relationship between doctor and patient. The educational blueprint outlined is called the “Physicianship Curriculum” and rests on two linchpins. First is a new definition of sickness: Patients know themselves to be ill when they cannot pursue their purposes and goals in life because of impairments in functioning. This perspective represents a bulwark against medical attention shifting from patients to diseases. The curriculum teaches about patients as functional persons, from their anatomy to their social selves, starting in the first days of the educational program and continuing throughout. Their teaching also rests on the rock-solid grounding of medicine in the sciences and scientific understandings of disease and function. The illness definition and knowledge base together create a foundation for authentic patient-centeredness. Second, the training of physicians depends on and culminates in development of a unique professional identity. This is grounded in the historical evolution of the profession, reaching back to Hippocrates. It leads to reformulation of the educational process as clinical apprenticeships and moral mentorships. “Rebirth” in the title suggests that critical ingredients of medical education have previously been articulated. The book argues that the apprenticeship model, as experienced, enriched, taught, and exemplified by William Osler, constitutes a time-honored foundation. Osler’s “natural method of teaching the subject of medicine” is a precursor to the Physicianship Curriculum.

scholarly journals Guide-wire replacement of a mini-midline catheter with a central venous catheter: A retrospective study on 63 cases

2020 ◽  
pp. 112972982094406
Author(s):  
Lucio Brugioni ◽  
Elisabetta Bertellini ◽  
Mirco Ravazzini ◽  
Marco Barchetti ◽  
Andrea Borsatti ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Guide Wire ◽  
Case Series ◽  
Venous Catheter ◽  
Venous Access ◽  
Late Complications ◽  
Central Catheter ◽  
Central Venous ◽  
Single Lumen ◽  
Thrombotic Complications

Background: Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. Conclusion: According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.

The Burden of Stroke in Pakistan

2008 ◽  
Vol 3 (4) ◽  
pp. 293-296 ◽  
Author(s):  
Bhojo A. Khealani ◽  
Mohammad Wasay
Keyword(s):  
Risk Factors ◽  
Stroke Risk ◽  
Case Series ◽  
Stroke Care ◽  
Poor Control ◽  
Stroke Incidence ◽  
Treatment Practices ◽  
Stroke Risk Factors ◽  
The Subject ◽  
Artery Disease

Epidemiologic literature on stroke burden, patterns of stroke is almost non existent from Pakistan. However, several hospital-based case series on the subject are available, mainly published in local medical journals. Despite the fact that true stroke incidence and prevalence of stroke in Pakistan is not known, the burden is assumed to be high because of highly prevalent stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, dyslipidemia and smoking) in the community. High burden of these conventional stroke risk factors is further compounded by lack of awareness, poor compliance hence poor control, and inappropriate management/treatment practices. In addition certain risk factors like rheumatic valvular heart disease may be more prevalent in Pakistan. We reviewed the existing literature on stroke risk factors in community, the risk factor prevalence among stroke patients, patterns of stroke, out come of stroke, availability of diagnostic services/facilities related to stroke and resources for stroke care in Pakistan.

The Development of Diarthrodial Joints in Birds and Mammals

1890 ◽  
Vol 16 ◽  
pp. 258-261 ◽  
Author(s):  
David Hepburn
Keyword(s):  
Recent Literature ◽  
Human Foetus ◽  
Diarthrodial Joints ◽  
Mammalian Embryos ◽  
The Subject ◽  
The Common ◽  
Full Period

After giving a summary of recent literature on the subject, the author then proceeded to state the nature of the material which he had employed in the present investigation.The bird selected was the common fowl (Gallus domest.), and he had examined a series of microscopic sections through the limbs from the fourth day of incubation to the day of hatching.The mammalian embryos examined were mice and rabbits, and the fingers of the human fœtus from an embryo approaching the full period of uterogestation.

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