Engineered properties of polyurethane laden with beetroot and cerium oxide for cardiac patch application

The cardiac patch provides appropriate physicochemical properties and mechanical strength for the regeneration of damaged heart tissues. In this work, for the first-time, beetroot (BR) is blended with cerium oxide (CeO2) to produce nanofibrous polyurethane (PU) composite patch using electrospinning. The objective of this work is to fabricate the composite and examine its feasibility for cardiac patch applications. Morphological analysis revealed a dramatic reduction of fiber diameter of PU/BR (233 ± 175 nm) and PU/BR/CeO2 (331 ± 176 mm) compared to the pristine PU (994 ± 113 mm). Fourier transform infrared analysis (FTIR) analysis indicated functional peak intensities of the newly formed composite PU/BR and PU/BR/CeO2 were not similar to PU. The addition of beetroot rendered PU/BR hydrophilic (86° ± 2), whereas PU/BR/CeO2exhibited hydrophobic nature (99° ± 3). Atomic force microscopy (AFM) analysis depicted the reduced surface roughness of the PU/BR (312 ± 12 nm) and PU/BR/CeO2 (390 ± 125 nm) than the pristine PU (854 ± 32 nm). The incorporation of beetroot and CeO2 into PU enhanced the tensile strength compared with the pristine PU. The blood clotting time of PU/BR (APTT-204 ± 3 s and PT-103 ± 2 s) and PU/BR/CeO2 (APTT-205 ± 3 s and PT-105 ± 2s) were delayed significantly than the pristine PU(APTT-176 ± 2 s and PT-94 ± 2 s) as revealed in the coagulation study. Further, hemolysis assay showed the less toxic nature of the fabricated composites than the pristine PU. Hence, it can be inferred that the advanced physicochemical and blood compatible properties of electrospun PU/BR and PU/BR/CeO2 nanocomposite can be engineered successfully for cardiac patch applications.

Molecular and Cellular Biomarkers of COVID-19 Prognosis: Protocol for the Prospective Cohort TARGET Study

Background Since the beginning of the COVID-19 pandemic, the world’s attention has been focused on better understanding the relation between the human host and the SARS-CoV-2 virus, as its action has led to hundreds of thousands of deaths. Objective In this context, we decided to study certain consequences of the abundant cytokine release over the innate and adaptive immune systems, inflammation, and hemostasis, comparing mild and severe forms of COVID-19. Methods To accomplish these aims, we will analyze demographic characteristics, biochemical tests, immune biomarkers, leukocyte phenotyping, immunoglobulin profile, hormonal release (cortisol and prolactin), gene expression, thromboelastometry, neutralizing antibodies, metabolic profile, and neutrophil function (reactive oxygen species production, neutrophil extracellular trap production, phagocytosis, migration, gene expression, and proteomics). A total of 200 reverse transcription polymerase chain reaction–confirmed patients will be enrolled and divided into two groups: mild/moderate or severe/critical forms of COVID-19. Blood samples will be collected at different times: at inclusion and after 9 and 18 days, with an additional 3-day sample for severe patients. We believe that this information will provide more knowledge for future studies that will provide more robust and useful clinical information that may allow for better decisions at the front lines of health care. Results The recruitment began in June 2020 and is still in progress. It is expected to continue until February 2021. Data analysis is scheduled to start after all data have been collected. The coagulation study branch is complete and is already in the analysis phase. Conclusions This study is original in terms of the different parameters analyzed in the same sample of patients with COVID-19. The project, which is currently in the data collection phase, was approved by the Brazilian Committee of Ethics in Human Research (CAAE 30846920.7.0000.0008). Trial Registration Brazilian Registry of Clinical Trials RBR-62zdkk; https://ensaiosclinicos.gov.br/rg/RBR-62zdkk International Registered Report Identifier (IRRID) DERR1-10.2196/24211

Pathophysiology of coagulation during bleeding

Background. Analysis of 99 studies found that the predictor properties of various tests to determine the blood coagulation condition, including the newest ones (thromboelastography, rotational thromboelastometry), regarding the risk of intra- and postoperative bleeding are low. The results of prothrombin time or activated partial thromboplastin time measurements can be very variable depending on the concentration of reagents and the characteristics of the analysis. That is why standard methods of screening to assess the condition of the coagulation system in all patients in the preoperative period are not recommended. Objective. To describe the features of perioperative blood clotting and management of patients. Materials and methods. Analysis of literature data on this topic. Results and discussion. Before performing invasive procedures, a careful history should be taken to determine the presence and severity of previous bleeding and to ask about antithrombotic medications. If the general hemorrhagic history is favorable, further determination of coagulographic parameters is not required. If the history is unfavorable or there is evidence of potential risk factors for bleeding (e. g., liver disease), a comprehensive coagulation study should be performed. Bleeding coagulopathy is a component of the so-called lethal triad, which also includes hypothermia and acidosis. Active administration of infusion solutions can deepen or provoke coagulopathy due to hemodilution. The use of balanced infusion solutions reduces the risk of this complication. According to some authors, the fibrinogen level <2 g/L is the predictor of bleeding probability. The causes of this condition include hyperfibrinolysis, dysfunctional fibrinogen in case of the administration of colloid solutions, increased decomposition of fibrinogen due to acidosis. Colloidal solutions (hydroxyethyl starch) increase the risk of reoperation and the need for transfusions, so their routine use is not currently recommended. Hyperfibrinolysis is a condition in which the rate of blood clot breakdown exceeds the rate of blood clot formation. As a result, hemorrhagic shock worsens and coagulopathy develops. Hyperfibrinolysis develops due to fibrinolytic agents and hypoperfusion. Tranexamic acid is used for heavy bleeding, in particular, postpartum. The WOMAN study involved 20,600 women with postpartum haemorrhage who received 1 g of tranexamic acid or placebo. Mortality due to bleeding in the tranexamic acid group was 1.2 %, and in the placebo group – 1.7 % (p=0.008). Conclusions. 1. Routine use of colloid solutions should be avoided during bleeding. 2. It is necessary to detect and eliminate anemia, hypothermia and acidosis. 3. Detection and elimination of deficiency or dysfunction of coagulation factors, hyperfibrinolysis, thrombocytopenia is an important component of bleeding prevention. 4. Reducing bleeding and improving blood clotting leads to the less need for transfusions and better outcomes for the patient.

Treatment of Palm Oil Refinery Effluent Using Tannin as a Polymeric Coagulant: Isotherm, Kinetics, and Thermodynamics Analyses

The refining of the crude palm oil (CPO) generates the palm oil refinery effluent (PORE). The presence of high contents of biochemical oxygen demand (BOD), chemical oxygen demand (COD), turbidity, and suspended solids (SS) in PORE encourages the determination of an effective treatment process to minimize the environmental pollution and preserve aquatic life. In the present study, a biodegradable natural polymer, namely tannin, was utilized as a coagulant to treat PORE. The coagulation experiment was conducted using a jar test apparatus. The tannin coagulation efficiency was evaluated based on the BOD, COD, turbidity, and SS removal from PORE by varying the tannin dose (50–300 mg/L), pH (pH 4–10), treatment time (15–90 min), and sedimentation time (15–90 min). It was found that the maximum removal of BOD, COD, turbidity, and SS was 97.62%, 88.89%, 93.01%, and 90.21%, respectively, at pH 6, a tannin dose of 200 mg/L, 60 min of coagulation time, and 60 min of sedimentation time. Analyses of isotherm models revealed that the Freundlich isotherm model was well fitted with the coagulation study. Kinetics studies show that the pseudo-second-order kinetics model was the well-fitted kinetics model for the BOD, COD, turbidity, and SS removal from PORE using tannin as a polymeric coagulant. The determination of thermodynamics parameters analyses revealed that BOD, COD, turbidity, and SS removal from PORE was spontaneous, exothermic, and chemical in nature. The finding of the present study shows that tannin as a natural polymeric coagulant would be utilized in PORE treatment to avoid toxic sludge generation.

Comparison of PPT and APTT in Pre and Post-Hemodialysis Patients as the Heparin-Exposed Effect

Evaluations on Plasma Prothrombin Time (PPT) and Activated Partial Thromboplastin Time (APTT) are required in patients with Chronic Kidney Disease (CKD) stage V to determine the risk of bleeding after hemodialysis (HD) using heparin as the anticoagulant. This study aimed to compare the results of PPT and APTT in pre and post-hemodialysis patients with minimum dose of heparin. This was an observational-analytical study with cross-sectional design. The samples were collected in HD wards of Dr. Soetomo Hospital, Surabaya. There were 50 PPT and APTT samples collected from June to August 2017. The samples were evaluated using the tool CoaDATA 501. The examination of coagulation study was conducted in Clinical Pathology Laboratory of Dr. Soetomo Hospital, Surabaya. Paired t-test and Wilcoxon signed-rank test were performed in this study. In the 50 samples, pre-hemodialysis PPT ranged between 10.2-17.6 with the mean of 12.6±2.03 seconds, while for post-hemodialysis, the range was 10.1-20.9 with the mean of 13.41±2.43 seconds. Pre-hemodialysis APPT ranged between 19.5-75.2 with the mean of 30.32±10.43 seconds, while in post hemodialysis the range was 22.21-175 with the mean of 37.52±26.40 seconds. The results of PTT evaluation in pre and post-HD showed no significant difference (p=0.083), while those of APTT showed a significant difference (p=0.035 or p<0.05). Prolongation of APTT in post-HD is due to the use of heparin as an anticoagulant that increases PPT and APTT by inhibiting antithrombin III. HD procedures cause decreased activity of coagulation factors II, IX, X, XII leading to APTT prolongation in post-HD. A significant APTT prolongation was found in post-HD patients with CKD V.

The Association Between Sequential Organ Failure Assessment Scores and Mortality in Patients With Sepsis During the First Week: The JSEPTIC DIC Study

Objective: Predicting prognosis is a complex process, particularly in patients with severe sepsis or septic shock. This study aimed to determine the relationship between the Sequential Organ Failure Assessment (SOFA) scores for individual organs during the first week of admission and the in-hospital mortality in patients with sepsis. Methods: This study was a post hoc evaluation of the Japan Septic Disseminated Intravascular Coagulation study and included patients admitted to 42 intensive care units in Japan for severe sepsis or septic shock, between January 2011 and December 2013. We assessed the relationship between the organ and total SOFA scores on days 1, 3, and 7 following admission and the in-hospital mortality using logistic regression analysis. Results: We evaluated 2732 patients and found the in-hospital mortality rate was 29.1%. The mean age of the patients (standard deviation) was 70.5 (14.1) years, and the major primary site of infection was the abdomen (33.6%). The central nervous system (CNS) SOFA score exhibited the strongest relationship with mortality on days 1 (adjusted odds ratio [aOR]: 1.49, 95% confidence interval [CI]: 1.40-1.59), 3 (aOR: 1.75, 95% CI: 1.62-1.89), and 7 (aOR: 1.93, 95% CI: 1.77-2.10). The coagulation SOFA scores showed a weak correlation with mortality on day 1, but a strong correlation with mortality on day 7 (aOR: 2.04, 95% CI: 1.87-2.24). Conclusions: The CNS SOFA scores were associated with mortality in patients with severe sepsis on days 1, 3, and 7 following hospitalization. The coagulation SOFA score was associated with mortality on day 7. In clinical situations, the CNS SOFA scores during the acute phase and the CNS SOFA and coagulation SOFA scores during the subsequent phases should be evaluated in order to determine patient prognosis.

Haemostatic property of Chromolaena odorata leaf extracts: in vitro and in vivo evaluation in wistar rats

This study was designed to investigate the effects of aqueous, ethanol and crude extracts of <em>Chromolaena odorata</em> leaf on haemostatic mechanism of wistar rats and its possible <em>in vitro</em> use in coagulation study. Fifty wistar rats of both sexes weighing between 140-180 g were sorted into 10 groups each fed via oral gavage once daily for 21 days. Sample collection was done by cardiac puncture. Bleeding and clotting times were performed using Duke’s and Ivy’s methods, respectively. The prothrombin time was performed using the Quick’s one stage method, while the partial thromboplastin time using kaolin was done using Macpherson and Hardity method using Giess diagnosis reagent. Significant results were observed in the bleeding and clotting times of the three extracts in a dose-dependent manner. The 300-mg/kg ethanol extract decreased the bleeding time more than the other two extracts. Only the ethanol 150 and 300 mg/mL showed <em>in vitro</em> activity. The study showed the <em>in vivo</em> haemostatic properties of <em>Chromolaena odorata</em> leaf extracts and its possible use in <em>in vitro</em> coagulation study.

Neonatal hemophilia: a rare presentation

Hemophilia A is a X-linked hereditary condition that lead to decreased factor VIII activity, occurs mainly in males. Decreased factor VIII activity leads to increased risk of bleeding events. During neonatal period, diagnosis is made after post-partum bleeding complication or unexpected bleeding after medical procedures. Subgaleal hemorrhage during neonatal period is a rare, severe extracranial bleeding with high mortality and usually related to traumatic labor or coagulation disorders. Subgaleal hemorrhage complications result from massive bleeding. We present a neonate with unremarkable family history and uneventful pregnancy with a vaginal delivery with no instrumentation, presenting with severe subgaleal bleeding at 52 hours of life. Aggressive support measures were implemented and bleeding managed. The unexpected bleeding lead to a coagulation study and the diagnosis of severe hemophilia A. There were no known sequelae. This case shows a rare hemophilia presentation reflecting the importance of coagulation studies when faced with unexplained severe bleeding.