Blood Coagulation Tests Research Articles

A bacteriostatic and hemostatic medical dressing based on PEG modified keratin/carboxymethyl chitosan

Maintaining a moist wound environment facilitates the wound healing process. However, traditional dressings such as medical gauze are difficult to meet this condition and easy to cause wound infection when the gauze is replaced. In this paper, a novel multifunctional medical dressing based on keratin porous materials was prepared by the freeze-drying method. Keratin was first modified by poly (ethylene glycol) dimethacrylate (PEGDMA) to increase its hydrophilicity. Then, the carboxymethyl chitosan (CMCS) was mixed with keratin solution to further improve the pore-forming properties, and finally, the solution was dried through the freezing method to obtain the porous dressing. The performance of the dressing was detailed and studied using DPPH free radical scavenging ability, water retention, blood coagulation, and bacteriostasis tests. The results showed that PEGDMA grafting greatly improved moisture retention from 22 to 43. CMCS blending not only improved the uniform and compact of the pore structure, but also effectively improved blood coagulation and antibacterial properties. After blending with CMCS, the performance of the keratin porous material was greatly improved. Carboxymethyl chitosan is positively charged, which makes the negatively charged platelets easy to aggregate, so the coagulation performance is greatly improved, and the BCI decreased to 15%. At the same time, the antibacterial performance against Staphylococcus aureus was greatly improved, and the optimal condition was PEG-g-KR:CMCS = 6:4. The PEG-g-KR/CMCS dressing prepared in this method had the characteristics of promoting wound healing, good moisture absorption and water retention, excellent blood coagulation performance and strong bacteriostasis. It is of great significance to the research and application of composite dressings.

Safety and Efficacy of an Oncolytic Adenovirus as an Immunotherapy for Canine Cancer Patients.

The use of oncolytic viruses is an innovative approach to lyse tumor cells and induce antitumor immune responses. Eight dogs diagnosed with carcinoma/adenocarcinoma were intratumorally treated with ICOCAV15, an oncolytic canine adenovirus (CAV). To evaluate the treatment's safety, a blood count, biochemistry, and coagulation test were performed before treatment and during follow-up. Immune populations were analyzed by flow cytometry. Anti-adenovirus antibodies were also determined. The immune infiltration, vascularization, and viral presence in the tumor were determined by CD3, CD4, CD20, CD31 and CAV by immunohistochemistry. All the dogs maintained a good quality of life during follow-up, and some had increased median survival time when compared with dogs treated with chemotherapy. No treatment-related adverse effects were detected. The Response Evaluation Criteria In Solid Tumors criteria were also assessed: two patients showed a partial response and the rest showed stable disease at various times during the study. ICOCAV15 was detected inside the tumor during follow-up, and antiviral antibodies were detected in all patients. Furthermore, the tumor-infiltrating immune cells increased after viral administration. Therefore, we suggest that intratumorally administered ICOCAV15 could represent as a new tool for the treatment of canine carcinoma because it is safe, well-tolerated by dogs, and shows promising results.

Multifunctional hydrogels based on oxidized pectin and gelatin for wound healing improvement

Gelatin (G) cross-linked with oxidized pectin (OP) was studied as a potential scaffold material for tissue engineering. The effect of oxidation on the chemical properties of pectin was investigated by determining the carbonyl and carboxyl amounts. The OP treatment led to a significant decrease of all values (Mn, Mw, [η] and Rh) determined by size exclusion chromatography (SEC) coupled on line with multiangle light scattering and viscometer detectors. Cross-linking parameters were elucidated by FTIR and TNBS assay. In general, the degree of crosslinking increased with the oxidation of pectin. It was found that the presence of the crosslinking agents caused a reduction in swelling and in the gelatin release which was determined by the BCA kit assay. From the hemolysis test, the membrane of red blood cells was not disrupted by the contact of films and the rate of release of hemoglobin was lower than 5%. The coagulation properties were evaluated by the dynamic blood clotting test. The G/OP hydrogels manifested a good activity of wound healing in the albino rats' model. Moreover, the films did not produce any unwilling symptoms. So, it was concluded that studied films have the potentiality to be used as wound healing biomaterials.

Designing a new alginate-fibrinogen biomaterial composite hydrogel for wound healing

Wound healing is a complex process and rapid healing necessitates a proper micro-environment. Therefore, design and fabrication of an efficacious wound dressing is an impressive innovation in the field of wound healing. The fabricated wound dressing in this scenario was designed using a combination of the appropriate coagulating and anti-bacterial materials like fibrinogen (as coagulating agent), nisin (as anti-bacterial agent), ethylenediaminetetraacetic acid (as anti-bacterial agent), and alginate (as wound healing agent). Biophysical characterization showed that the interaction of fibrinogen and alginate was associated with minor changes in the secondary structure of the protein. Conformational studies showed that the protein was structurally stable at 42 °C, is the maximum temperature of the infected wound. The properties of the hydrogel such as swelling, mechanical resistance, nisin release, antibacterial activity, cytotoxicity, gel porosity, and blood coagulation were assessed. The results showed a slow release for the nisin during 48 h. Antibacterial studies showed an inhibitory effect on the growth of Gram-negative and Gram-positive bacteria. The hydrogel was also capable to absorb a considerable amount of water and provide oxygenation as well as incorporation of the drug into its structure due to its sufficient porosity. Scanning electron microscopy showed pore sizes of about 14–198 µm in the hydrogel. Cell viability studies indicated high biocompatibility of the hydrogel. Blood coagulation test also confirmed the effectiveness of the synthesized hydrogel in accelerating the process of blood clot formation. In vivo studies showed higher rates of wound healing, re-epithelialization, and collagen deposition. According to the findings from in vitro as well as in vivo studies, the designed hydrogel can be considered as a novel attractive wound dressing after further prerequisite assessments.

Reducing Laboratory Turnaround Time in Patients With Acute Stroke and the Lack of Impact on Time to Reperfusion Therapy.

Timely reperfusion improves the recovery of patients with acute ischemic stroke. Laboratory results are crucial to guide treatment decisions in patients when abnormal laboratory tests are suspected. To implement a new laboratory workflow for acute stroke patients and compare laboratory turnaround time (TAT) preimplementation and postimplementation. We conducted a retrospective pre-post intervention study of patients with suspected acute stroke during the 4-month periods before and after the implementation of a new laboratory workflow process. The improvement process included relocating the specimen registration site, laboratory notification before specimen arrival, a color-coding system on tubes, timing at all processes, and eliminating the smear review if platelets were normal. TATs of the laboratory and door-to-clinical intervention times before and after the improvement process were compared. Postintervention, median specimen transportation time decreased from 11 (interquartile range [IQR], 8.4-16.4) to 9 minutes (IQR, 6.3-12.8), P < .001. The intralaboratory and total TATs of complete blood cell count, coagulation tests, and creatinine significantly decreased (P < .001 for all). Blood drawn-to-laboratory reported time decreased from 43 (IQR, 36.0-51.5) to 33 minutes (IQR, 29.2-35.8, P < .001). However, door-to-needle time for thrombolysis and door-to-puncture time and door-to-recanalization time for mechanical thrombectomy were not statistically different (P = .11, .69, and .50, respectively). The new laboratory workflow significantly decreased transportation time, TAT of individual tests, and the blood drawn-to-laboratory reported time. However, the time to treatment of acute ischemic stroke patients was not different between preimplementation and postimplementation.

T257 Blood coagulation testing and hematological features of thalassemia carriers in pregnant

T257 Blood coagulation testing and hematological features of thalassemia carriers in pregnant

Pathogenetic Approach to Early Preeclampsia and the Feasibility of Pregnancy Prolongation

Aim. To evaluate the efficacy of cascade plasma filtration (CPF) for the correction of lipid profile and biochemical markers (sFlt-1, PIGF, sFlt-1/PIGF) in pregnant women with early preeclampsia. Materials and Methods. A prospective controlled study of 23 CPF procedures was conducted in 11 pregnant women with early preeclampsia at gestational ages 22 to 31 weeks. The evolution of clinical manifestations of preeclampsia (BP, urine output, and proteinuria), laboratory biochemical parameters (protein/creatinine ratio, lipid profile), blood coagulation tests, and thromboelastometry (ROTEM) were assessed. In addition, the effect of CPF on the level of preeclampsia markers (sFlt-1, PIGF, sFlt-1/PIGF-ratio) as predictors of endothelial aggression was analyzed. The efficacy of extracorporeal therapy was evaluated based on the duration of pregnancy prolongation. Results. The use of CPF as an adjunct for the treatment of early preeclampsia had a positive effect on the lipid profile by reducing cholesterol and LDL, which helped to decrease atherogenic aggression on the vascular endothelium. In addition, the extracorporeal therapy promoted reduction of the anti-angiogenic effect of sFlt-1, which was confirmed by a significant decrease in the sFlt-1/PIGF ratio from 515 [347; 750] to 378 [285; 557] (P = 0.013). The period of prolongation of pregnancy was longer in the main group (with CPF) and was 19 [5; 26] days, whereas in the comparison group (without CPF) it was 3 [1; 4] days (P &lt; 0.001). All newborns were discharged from the hospital in a stable condition. The paper is supplemented with a clinical observation of the effective use of CPF in early preeclampsia. Conclusion. The use of cascade plasma filtration in the treatment of early preeclampsia to prolong pregnancy could be a promising approach.

Wound Healing Functionality of Mangosteen Extracts on Viscose Fabric

The aim of this study was to introduce novel dressing with different extracts of mangosteen for quick blood clotting and wound healing. Insufficient use of natural biomaterials for blood clotting and wound healing in the medical textile sector has been observed. In order to improve the situation, viscose woven fabrics treated with mangosteen leaf, peel and pericarp extract were examined. Fresh mangosteens were collected from local market and different pastes were prepared by using an electric blender. The pretreated viscose woven fabrics were dyed with these pastes using glycerin as mordant. After the sample preparation, an antibacterial test, odor test, blood clotting test, strength test, color fastness tests were done. The treated samples exhibited good antibacterial activity against gram negative bacteria and mild antibacterial activity against gram positive bacteria, especially the fabrics treated with mangosteen leaf and pericarp. Besides, the treated samples did not create annoying odors as like the untreated one. To justify healing properties, implementations of the samples were done on a rabbit. Leaf and pericarp treated fabrics exhibited good blood clotting in comparison with untreated fabric. All the treated samples exhibited average to good color fastness to wash and rubbing properties with sufficient tensile strength. Morphological changes of the treated and untreated fibers were examined by SEM and FTIR analysis and the results clearly showed the differences in the untreated and treated samples. The experiments were carried out in an environment friendly way which indicates the production and processing of these dressing materials can have an enormous contribution to sustainable operations and products for the development of medical textiles sector.

Relation between Hematological and Biochemical Parameters per Days of Symptoms in Hospitalized Patients with flu-like syndrome and COVID-19

Beside the acute respiratory syndrome caused by COVID-19, the exacerbated inflammatory process leads to systemic coagulation disorders, acute cardiovascular disorders, acute renal failure, metabolic changes and other clinical manifestations, increasing the mortality of patients with severe forms of the disease. The development of effective vaccines and drugs for the adequate treatment of severe forms of the disease has become a priority for the scientific and medical community. Likewise, the discovery of possible predictors for the early identification of severe cases with a high risk of death are constantly being sought. Laboratory tests, such as blood count, coagulation tests, hormonal and biochemical tests, are performed on a daily basis in the hospital environment and have proved to be very useful in the search for these indicators. In our study, we evaluated the laboratory tests of 398 positive and negative patients for COVID-19 admitted to hospitals in Uberaba, from the Macroregion of Triângulo Sul, state of Minas Gerais, with a population of 800,000 inhabitants. In our results, it was observed that the patients who died presented anemia, neutrophilic leukocytosis, increased CRP, urea and creatinine from the 5th, 6th day of symptoms, and with lymphopenia on the 1st day. In blood gas analysis, pH, SaO2 and PO2 were reduced since the 1st day of symptoms in patients who died, and the pH remained reduced until the clinical outcome. Changes were also found in the dosage of LDH, aPTT, albumin and electrolytes. Given these results, laboratory tests can be useful as predictive signs of severity in the early days of symptoms.

Weight Based Heparin Dosage with Activated Clotting Time Monitoring Leads to Adequate and Safe Anticoagulation in Non-Cardiac Arterial Procedures

Unfractionated heparin has an unpredictable effect in an individual patient. The activated clotting time (ACT) can be used to measure the effect of heparin in the individual patient and guide additional heparin dosages. Previous cohort studies showed that a standardized bolus of 5,000 IU during noncardiac arterial procedures (NCAP) does not lead to an adequate ACT in the vast majority of patients. The aim of this study was to investigate whether an initial heparin dose of 100 IU/kg leads to an adequate but safe ACT, from 200 to 300s. In this multicenter prospective study, 186 patients undergoing NCAP were enrolled and received an initial heparin dose of 100 IU/kg. Target ACT was set at ≥250s initially; during the course of the study the target ACT was lowered to ≥200s. After the initialheparin dose, additional heparin dosages were administered depending on the ACT values following a heparin dose protocol. ACT measurements and complications were monitored. The mean baseline ACT was 134±17s. The mean ACT 5minutes after the initial heparin dose was 227±37s. After the initial dose of heparin, 78 and 46% of patients reached an ACT of 200 and 250s, respectively. Seven patients (4%) reached an ACT of 300s or more. Ninety-four patients (51%) received at least one additional dose of heparin. After one additional dose of heparin, 91% of patients reached an ACT of 200s and 13 patients (7%) reached an ACT of 300s or more. Arterial thromboembolic complications occurred in 4.3% and bleeding complications occurred in 9.7%. A bolus of 100 IU/kg of heparin during NCAP results in adequate coagulation in most patients. ACT measurements enable accurate additional dosing, ensuring the individual patient tailored and safe coagulation. anticoagulants; heparin; blood coagulation tests; vascular surgical procedures; peripheral vascular disease.

Significant changes in Complete Blood Count (CBC) and blood coagulation in SARS-CoV-2 infection: A retrospective study

Introduction: The aim of this work is to explore all the abnormalities of the hemogram and hemostasis tests in patients with severe COVID disease. Methods: A cohort of patients with COVID-19 admitted to Avicenna military hospital in Marrakech during the 6 months from April to October 2020 was retrospectively analyzed. The baseline data of laboratory tests, including complete blood count (CBC) and coagulation tests. Results: A total of 218 individuals were enrolled, with 82 patients meeting the criteria for severe covid and admitted to the intensive care unit, and 136 considered stable and admitted to the medicine departments. The average age of patients with severe covid is significantly higher than non-severe patients (65.21 ± 5.71 versus 49.13 ± 7.81, p = 0.038). Between the groups with severe and non-severe COVID-19: only platelets, lymphocytes and D-dimer showed statically significant difference (P= 0.0001, 0.003 and 0.0001 respectively). But the differences were relatively small for the other parameters. The calculated parameters NLR, d-NLR, and LMR did not differ statistically between the two study groups with the exception of PLR, which was positively correlated with the severity of COVID (P= 0,007). The ROC analysis showed that the best area under the curve (AUC) was obtained with platelet rate, D-dimer and PLR (0.86, 0.73 and 0.69 respectively) with the best cut-offs (250 g/L, 0.5mg/l and 300 correspondingly). Conclusion: Thrombocytopenia, lymphopenia, increased PLR and D-dimers are often encountered during severe Covid and can be used as a predictive marker for the severity of the disease.

A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study.

Snakebite is a neglected problem with a high mortality in India. There are no simple clinical prognostic tools which can predict mortality in viper envenomings. We aimed to develop and validate a mortality-risk prediction score for patients of viper envenoming from Southern India. We used clinical predictors from a prospective cohort of 248 patients with syndromic diagnosis of viper envenoming and had a positive 20-minute whole blood clotting test (WBCT 20) from a tertiary-care hospital in Puducherry, India. We applied multivariable logistic regression with backward elimination approach. External validation of this score was done among 140 patients from the same centre and its performance was assessed with concordance statistic and calibration plots. The final model termed VENOMS from the term "Viper ENvenOming Mortality Score included 7 admission clinical parameters (recorded in the first 48 hours after bite): presence of overt bleeding manifestations, presence of capillary leak syndrome, haemoglobin <10 g/dL, bite to antivenom administration time > 6.5 h, systolic blood pressure < 100 mm Hg, urine output <20 mL/h in 24 h and female gender. The lowest possible VENOMS score of 0 predicted an in-hospital mortality risk of 0.06% while highest score of 12 predicted a mortality of 99.1%. The model had a concordance statistic of 0·86 (95% CI 0·79-0·94) in the validation cohort. Calibration plots indicated good agreement of predicted and observed outcomes. The VENOMS score is a good predictor of the mortality in viper envenoming in southern India where Russell's viper envenoming burden is high. The score may have potential applications in triaging patients and guiding management after further validation.

A Case of Elephant Extremities in a Filipino Male: Primary Familial Pachydermoperiostosis

This is a rare case of primary pachydermoperiostosis (PDP). A 28-year-old Filipino male presented with a lifelong history of enlarged hands and feet. He eventually developed symmetrical swelling of the ankles and knees associated with leg heaviness and knee pain with difficulty with ambulation, hence consult. His eldest brother also had the same “elephant-like” extremities. He had cutis vertices gyrata with a thickened corrugated hair pattern, deep lines on the forehead, deepened nasolabial folds, enlarged extremities especially distally, with coarse, thick skin, and prominent clubbing. The nails were convex “watch crystal-like.” The wrists, knees, and ankles were tender and enlarged, with massive effusion of the knees. All joints were devoid of warmth and erythema.&#x0D; Skeletal survey favored hypertrophic osteoarthropathy over acromegaly, with periosteal thickening of the metaphysis and digital clubbing. The filarial smear was negative for blood parasites. Skin biopsy showed keratoderma. Synovial fluid was non-inflammatory while arthroscopic synovial biopsy showed chronic inflammation eosinophilic amorphous tissue. Electrocardiogram, echocardiogram, thyroid function tests, complete blood count, peripheral blood smear, serum chemistries, coagulation tests, urinalysis, urine electrolytes, fecalysis, and chest CT scan were unremarkable. Whole abdomen ultrasound revealed the liver parenchymal disease. Hepatitis profile revealed chronic infection with hepatitis B, with low infectivity. The three major criteria for PDP (pachydermia, periostitis, and digital clubbing) were fulfilled. Possible secondary causes were either excluded or were non-contributory.&#x0D; He was started on analgesics and anti-inflammatory medicines. Repeated arthrocenteses drained liters of synovial fluid per knee, and along with intra-articular steroid injections and compressive bandages, temporarily relieved his bilateral knee pain. He was referred to rehabilitation to maximize his range of motion and to address body image issues. The patient remains on regular follow-up for periodic arthrocentesis. The option of anti-VEGF treatment and arthrotomy was explored as possibilities but were not deemed practical.&#x0D; PDP is a rare genodermatosis. Life span is not affected but the quality of life is dismal without supportive management, as there is no known cure. A multidisciplinary team composed of a rheumatologist, dermatologist, orthopedic surgeon, plastic surgeon, rehabilitation physician, and a psychiatrist should be available to assist in the needs of these patients.

Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III\u2013IV calcaneal fractures

PurposeTo investigate whether local administration of epsilon-aminocaproic acid (EACA) is effective and safe in reducing the post-operative blood loss in surgery for Sanders III–IV calcaneal fractures.MethodsPatients with Sanders III–IV calcaneal fractures who were hospitalized in our hospital from January 2016 to February 2021 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the current study. Eighty five patients were randomly divided into two groups, EACA group (43) and control group (42). Twenty milliliters of 5% EACA solution or normal saline was perfused into the incision of patients in EACA group and control group, respectively. The volume of post-operative drainage was investigated as the primary outcome. Post-operative blood test, coagulation test, and wound complications were analyzed as the secondary outcomes.ResultsThe volume of post-operative drainage at 24 and 48 h was 164.8 ± 51.4 ml, 18.9 ± 3.8 ml for patients in EACA group, and 373.0 ± 88.1 ml, 21.2 ± 4.4 ml for patients in the control group, respectively. EACA greatly reduced the post-operative blood loss compared to the control (normal saline). The difference between the two groups was statistically significant. No statistically significant difference was found between EACA group and control group with regard to the pre-operative, baseline characteristics. Post-operative blood test results demonstrated that haemoglobin and hematocrit were significantly higher in EACA compared to those of control group. No significant difference was found between EACA group and control group in terms of the platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications.ConclusionLocal administration of EACA is effective in post-operative blood loss reduction in ORIF surgeries for Sanders III–IV types of calcaneal fractures without increasing the incidence of periwound complication.

The effects of fructose diphosphate on routine coagulation tests in vitro

To evaluate the effects of fructose diphosphate (FDP) on routine coagulation tests in vitro, we added FDP into the mixed normal plasma to obtain the final concentration of 0, 1, 2, 3, 4, 5, 6, 10, 15, 20, 25, 30 and 35 mg/mL of drug. Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (FBG) and thrombin time (TT) of samples were analyzed with blood coagulation analyzers from four different manufacturers(Sysmex, Stago, SEKISUI and Werfen) and their corresponding reagents, respectively. Before the experiment, we also observed whether there were significant differences in coagulation test results of different lots of reagents produced by each manufacturer. At the same time as the four routine clotting tests, the Sysmex blood coagulation analyzer and its proprietary analysis software were used to detect the change of maximum platelet aggregation rate in platelet-rich plasma after adding FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL). The results of PT, aPTT and TT showed a FDP (0–35 mg/mL) concentration-dependent increase and a FBG concentration-dependent decrease. The degree of change (increase or decrease) varied depending on the assay system, with PT and aPTT being more affected by the Sysmex blood coagulation testing instrument reagent system and less affected by CEKISUI, TT less affected by CEKISUI and more affected by Stago, and FBG less affected by Stago and more affected by Sysmex. The results of PT, aPTT and TT were statistically positively correlated with their FDP concentrations, while FBG was negatively correlated. The correlation coefficients between FDP and the coagulation testing systems of Sysmex, Stago, Werfen and SEKISUI were 0.975, 0.988, 0.967, 0.986 for PT, and 0.993, 0.989, 0.990 and 0.962 for aPTT, 0.994, 0.960, 0.977 and 0.982 for TT, − 0.990, − 0.983, − 0.989 and − 0.954 for FBG, respectively. Different concentrations of FDP (0, 1, 2, 3, 4, 5 and 6 mg/mL) had different effects on the maximum aggregation rate of platelet induced by the agonists of adenosine diphosphate (ADP, 5 µmol/L), arachidonic acid (Ara, 1 mmol/L), collagen (Col, 2.5 µg/mL) and epinephrine (Epi,10 µmol/L), but the overall downward trend was consistent, that is, with the increase of FDP concentration, the platelet aggregation rate decreased significantly. Our experimental study demonstrated a possible effect of FDP on the assays of coagulation and Platelet aggregation, which may arise because the drug interferes with the coagulation and platelet aggregation detection system, or it may affect our in vivo coagulation system and Platelet aggregation function, the real mechanism of which remains to be further verified and studied.

Inhibition of Russell’s Viper Venom using Silver Nanoparticle-Bovine Serum Albumin-Curcumin Conjugates

Russell’s viper being one of the most venomous snake species in Asia causes significant amount of snake bites and deaths due to neurotoxicity, coagulopathy, haemorrhage, cardiotoxicity, myotoxicity, hypotension, oedema, tissue damage and convulsion. Treatment with monoclonal antibodies, anti-snake venom is the only medically approved treatment available for snake envenomation and has many limitations and side effects such as anaphylactic shock, skin rashes, nausea to vomiting and fever, chills, hypotension, seizures, serum sickness, pruritus, urticaria, arthralgia, lymphadenopathy, encephalopathy etc. Recently, nanoscience and nanotechnology are playing an important role in medical field and has proven to be quite beneficial. In present study, chemically synthesized silver nanoparticles (40±3 nm) are used to inhibit Russell’s viper venom activity. The silver nanoparticles and albumin conjugated with curcumin was prepared and characterized using spectroscopic techniques. Venom inhibitory potency of the prepared conjugate was analysed using acidimetry, protease assay and whole blood clotting test. The ultravioletvisible spectra showed enhancement in absorbance of venom with significant hyperchromic shift and thus confirmed modification of venom by silver nanoparticles. This also led to the enhanced interaction with bovine serum albumin-curcumin conjugates. Fluorescence data also showed strong interaction between the conjugates and venom. Interestingly the activity of Russell’s viper venom was reduced to 75 %-96 %. The possible mechanism of action of bovine serum albumin-curcumin complex on venom treated with silver nanoparticles is explained at molecular level and biocompatibility of the same was also analysed. Blood agglutination by bovine serum albumin-curcumin complex showed its in vitro biocompatibility.

Real-life experience of edoxaban treatment for venous thromboembolism (VTE)/pulmonary embolism (PE) in patients with isolated positive Lupus Anticoagulant (LAC) during the COVID-19 pandemic lockdown in Italy.

Direct-acting oral anticoagulants (DOACs) have established indications, according to recent guidelines for the treatment and prevention of venous thromboembolism (VTE), including pulmonary embolism (PE), with a safer profile compared to vitamin K antagonist (VKA) in terms of a lower risk for major bleeding and no need of blood coagulation tests. However, DOACs are not indicated in the treatment of patients with triple-positive antiphospholipid syndrome (APS). This limitation is often extended in clinical practice to patients with isolated positivity. The COVID-19 pandemic has sometimes made it difficult to maintain a safe VKA treatment, due to the practical difficulties of performing INR. We evaluated 39 patients with a previous unprovoked VTE/PE, who were no longer eligible for VKA treatment due to the difficulty of performing INR during the COVID-19 pandemic lockdown, in Italy. All patients had a positive LAC and refused a long-term anticoagulation with low molecular weight heparin. They were shifted to edoxaban. Any recurrence of VTE/PE occurred during the observation period (up to eight months of treatment), while only one minor bleeding event was recorded (Hazard ratio=0.06, 95% confidence interval 0.03-0.11, p=0.094). No arterial events occurred during the observation period. Hemoglobin, platelets, and creatinine were unchanged during the observation period. Edoxaban treatment may be safe and effective in preventing the recurrence of VTE/PE in patients with isolated LAC positivity, without the occurrence of arterial events.

FEATURE OF CORONAVIRUS DISEASE IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Relevance. The combination of coronavirus disease (COVID-19) with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) is associated with decreased saturation, general clinical signs of inflammation, coagulopathies and worsens the course and prognosis of the disease. That is why it is important to identify all possible risk factors for complicated pathology for the prevention and timely treatment of this category of patients.&#x0D; Objective: to study the feature of coronavirus disease in patients with AH and COPD.&#x0D; Materials and methods. A total of 101 patients aged 30 to 80 years with COVID-19 were examined. The first group included 26 people with COVID-19 and COPD (GOLD 2, groups A, B), and the second group included 75 patients with COVID-19 and AH (I-III stages, 1-3 grade). The parameters of the general blood test, biochemical blood test, coagulation testing, D-dimer, C-reactive protein (CRP), and ferritin in the blood were studied.&#x0D; Results. Patients with COVID-19 and COPD had higher erythrocyte sedimentation rate (p&gt; 0,05) and leukocytosis (p &lt;0,05), as well as increased concentrations of creatinine (p &lt; 0,05) and urea (p &lt; 0,01) that indicates the presence of renal pathology. Patients with COVID-19 and AH had significantly lower prothrombin time (p &lt; 0,05) and international normalized ratio (p &lt; 0,05), as well as a higher prothrombin index (p &lt;0,05), which indicates the benefits of the procoagulant properties of blood in this category of patients. The level of D-dimer (p&gt; 0,05), CRP (p&gt; 0,05), and ferritin (p &lt;0,05) was higher in patients of the 2nd group, which indicates a more severe course of coronavirus disease, as well as more high risks of thromboembolic complications.&#x0D; Conclusions. The features of coronavirus disease in patients with hypertension indicate a more severe course of the pathology and a high risk of thromboembolic complications, as evidenced by the procoagulant properties of blood and a high level of D-dimer, CRP, and ferritin. According to the data of clinical and laboratory examinations in patients with COPD and COVID-19, there was a significant increase in creatinine, urea, and leukocytosis, which may indicate the addition of renal pathology.

Risk factors for death in patients with severe COVID-19 admitted to an intensive care unit

Aim. Severe COVID-19 is accompanied by reduced blood oxygen saturation, systemic inflammatory response syndrome and multiple organ failure, all causing a significant deterioration of homeostasis associated with death. Here we aimed to study the risk factors for death in patients with severe COVID-19 who have been admitted to an intensive care unit.Materials and Methods. The study included 144 consecutive patients with severe COVID-19 who have been admitted to an intensive care unit of Kuzbass Clinical Hospital from August to December 2020. Groups of survivors and non-survivors were equal in number (n = 72) and matched by gender (36 men and women) and age (median age 64 years, interquartile range 56-70 years in survivors and 58-69 years in non-survivors). Complete blood count, urinalysis, biochemical analysis, coagulation testing, and measurement of anti-SARS-CoV-2 IgM/IgG were carried out in all patients immediately upon the admission to intensive care unit.Results. Risk factors for death in severe COVID-19 at the admission to intensive care unit were arterial hypertension, chronic heart failure, peripheral atherosclerosis, impaired renal homeostasis (reduced glomerular filtration rate, elevated serum creatinine and urea, proteinuria, hematuria), augmented fasting blood glucose and lactate, neutrophilia (in men), lymphopenia and increased neutrophil-to-lymphocyte ratio (in women), and decreased IgM/IgG to SARS-CoV-2 (in women).Conclusion. We found both independent and gender-specific risk factors for death due to COVID-19.

Correlation between CYP2C9 gene polymorphism and warfarin dose in Chinese Han population with coronary heart disease.

This study aimed to explore the correlation between CYP2C9 gene polymorphism and warfarin dose in Chinese Han patients with coronary heart disease. The selection was made to the analysis of blood coagulation test of Chinese Han ethnic group, 200 cases of coronary heart disease patients as target group, the patients were satisfied taking warfarin INR target (in the range of 2.0 ~ 3.0), the other to select 200 cases proved by physical examination health as health group. The warfarin dose and the clinical laboratory INR after warfarin administration were taken, and the DNA of the patients was extracted and tested. The CYP2C9 genotype and allele frequency of patients in the standard group were observed, and the basic information and gene test results of the healthy group and the standard group were compared. Patients in the standard group were grouped according to the CYP2C9 and VKORC1 genotype, and the warfarin dosage was compared respectively. The number of cases of anticoagulant overdose in patients with different genotypes in the target group at the initial stage of warfarin treatment was compared. Results showed that CYP2C9*1/*2, *2/*2, *2/*3, *3/*3 genotypes were not found by detecting CYP2C9 genotype and allele frequency in the standard group. There were no significant differences in genotype and allele frequency between the standard group and the healthy group (P BBB 0 0.05). The mean daily dose of the CYP2C9*1/*3 genotype was lower than the mean daily dose of warfarin required by the CYP2C9*1/*1 genotype, and the difference was statistically significant (P < 0.05). There were significant differences in the incidence of anticoagulation overdose at the initial stage of treatment among different CYP2C9 genotypes (P < 0.05), and the incidence of an anticoagulation overdose in group *1/*3 was significantly higher than that in group *1/*1. In general, There was a correlation between CYP2C9 gene polymorphism and warfarin dose in Chinese Han population with coronary heart disease. Compared with the wilD-type (*1/*1) enzyme, the metabolic ability of warfarin in mutant CYP2C9 enzyme (mainly *1/*3 in Chinese population) decreases, and the patients were sensitive to warfarin treatment, and the dose required decreases.