Subglottic secretion suctioning is an effective measure for reducing aspiration pneumonia and is recommended as a crucial step in artificial airway management for tracheotomy patients. However, this method remains undervalued, and clinical practice is not always evidence-based. This project aimed to promote compliance with best practices for subglottic suctioning in adult tracheotomy patients in the Rehabilitation Department of a 3,000-bed tertiary hospital in China. This project was guided by the JBI Evidence Implementation Framework, which includes the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) methods. Evidence-based audit criteria were developed for the baseline and follow-up audits. A total of 168 tracheotomy patients took part in the audits. After the implementation of improvement strategies, a follow-up audit was conducted to measure changes in compliance. The follow-up results showed improvement in three criteria compared with baseline. For Criterion 1, compliance increased by 17.85% (77.38% to 95.23%); for Criterion 2, compliance increased by 96.42% (0% to 96.42%); and for Criterion 3, compliance increased by 46.43% (53.57% to 100%). The difference in nurses' knowledge scores for subglottic suctioning between baseline and follow-up was statistically significant (all p < 0.05). Moreover, the rate of aspiration pneumonia, airway mucosal bleeding, and subglottic tube blockage decreased from 27.38%, 20.23%, and 30.95% before implementation to 14.28%, 5.95%, and 10.71%, respectively, (all p < 0.05). Evidence-based practices can improve nurses' knowledge of standardized subglottic suction management practices for tracheotomy. Further studies are needed to ensure the sustainability of the project. http://links.lww.com/IJEBH/A556.

To systematically evaluate the association between anticoagulant therapy and long-term outcomes (all-cause mortality, stroke recurrence, and hemorrhage events) in elderly patients with cardiogenic stroke, thereby providing evidence for clinical decision-making. A retrospective cohort study design was adopted. A total of 567 elderly patients with cardiogenic stroke from Liang-xiang Hospital in Fangshan District, Beijing, were followed up for 4 years. The primary outcomes included all-cause mortality, stroke recurrence, and hemorrhage events (including intracranial hemorrhage, gastrointestinal bleeding, urinary system bleeding, gingival bleeding, and skin and mucosal hemorrhage). Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome. All statistical analyses were performed using R software (version 4.2.2). A total of 567 elderly patients were included in this study, with a mean age of (73.92±9.70) years and 49.74% being male. Among them, 142 patients (25.04%) received anticoagulant therapy. During the follow-up period, 266 deaths occurred (crude mortality rate: 46.91%), 107 patients had stroke recurrence (cumulative recurrence incidence: 18.87%), and 28 patients experienced bleeding events (cumulative hemorrhage incidence: 4.94%). Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death (OR=0.22, 95%CI: 0.12, 0.41, P < 0.001). No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage (P>0.05). Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke, and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage. The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with cardiogenic stroke, and larger prospective studies are still needed to further validate the findings.

Hemorrhagic Manifestations in Primary DENV-3 Infection: A Case of Dengue with Warning Signs in an Adolescent.

BACKGROUND Acute appendicitis is an infrequent etiology of lower gastrointestinal bleeding (LGIB), with approximately 20 reported cases globally. To the best of our knowledge, xanthogranulomatous appendicitis (XGA) presenting with LGIB has not been described in the literature. CASE SUMMARY The patient was a 41-year-old man admitted for blood in stool for 1 day. He had previously been healthy. One month ago, the patient underwent a routine health check-up, which revealed a hemoglobin (HGB) level of 145 g/L. Following hematochezia, repeat laboratory testing showed a quick decrease in HGB level to 94 g/L. Emergency colonoscopy revealed dark red blood throughout the intestinal lumen, with visible fresh red bleeding emanating from the appendiceal lumen. Bleeding was intermittent. After copious irrigation with normal saline, observation for approximately 3 minutes found persistent fresh red bleeding from the appendiceal lumen, while no blood staining was observed in the terminal ileum. The patient underwent laparoscopic appendectomy, and postoperative pathology suggested XGA with mucosal ulceration and hemorrhage. CONCLUSION XGA represents an unusual etiology of LGIB.

Meihuacao extract in eradicating H.pylori: Network pharmacology analyses and experiment validation.

Hantaviruses are rodent-borne viruses that cause two overlapping vascular syndromes in humans: hemorrhagic fever with renal syndrome, including nephropathia epidemica, and hantavirus pulmonary/cardiopulmonary syndrome. Although dermatologists are rarely central to hantavirus care, early visible abnormalities may occur on the skin, mucosa, and ocular surface. This narrative review synthesizes the dermatologic and mucocutaneous manifestations of human hantavirus disease, with emphasis on signs that should prompt diagnostic suspicion in dermatology, emergency, travel-medicine, and infectious-disease settings. The dermatologic signal is strongest in hemorrhagic fever with renal syndrome, where facial or upper-torso flushing, conjunctival and pharyngeal injection, petechiae, purpura, ecchymoses, and mucosal bleeding may appear during the febrile or hemorrhagic phases. These findings are not pathognomonic, but their diagnostic value increases when they occur with rodent or outbreak exposure, thrombocytopenia or coagulopathy, and renal abnormalities such as proteinuria, hematuria, or acute kidney injury. In hantavirus pulmonary/cardiopulmonary syndrome, particularly infections caused by New World hantaviruses, visible cutaneous involvement is less prominent and may be absent despite severe pulmonary endothelial disease. We propose a practical dermatology-oriented trigger for suspicion based on exposure history, abrupt febrile illness, nephro-pulmonary involvement, thrombocytopenia, and vascular mucocutaneous findings. Hantavirus should be considered when otherwise unexplained vascular skin or mucosal signs occur in a febrile patient with thrombocytopenia, renal involvement, hypoxemia, or compatible exposure. The skin rarely diagnoses hantavirus alone, but it may shorten time to testing, supportive care, and public-health notification.

Facial petechial hemorrhages after cardiopulmonary resuscitation in adults: A pilot study.

von Willebrand disease (vWD) is the most common inherited bleeding disorder. Various subtypes of vWD exist as either quantitative deficiencies or qualitative defects of the von Willebrand factor (vWF) protein and lead to an array of bleeding manifestations. Individuals with vWD typically have increased mucocutaneous bleeding including oral mucosal bleeding, epistaxis, and heavy menstrual bleeding. Other common bleeding manifestations including petechiae, easy bruising, surgical-related bleeding, postpartum hemorrhage, and trauma-induced bleeding. In more severe subtypes gastrointestinal bleeding, hemarthrosis, and intramuscular bleeding can occur. Given the spectrum of bleeding phenotypes, management can differ greatly from one individual to the next with the majority of individuals receiving on-demand treatment while more severely affected individuals may receive long-term prophylaxis. Common on-demand therapeutics include oral, intravenous, topical, and/or intranasal antifibrinolytics, intravenous, subcutaneous and/or intranasal desmopressin, and intravenous plasma-derived and recombinant-vWF replacement therapy. Long-term prophylactic regimens include hormonal therapies and regularly scheduled infusions of plasma-derived and recombinant-vWF concentrates. Over the past 100years the therapeutic landscape for individuals with vWD has changed significantly and continues to evolve. There are numerous studies currently underway to evaluate new treatments including several drugs administered via subcutaneous injection, and vagal nerve stimulation. Historically individuals with vWD have poorer health-related quality of life and higher healthcare resource utilization compared to the general population, emphasizing the ongoing need for improved therapeutics.

Clostridium perfringens is the primary causative agent of necrotic enteritis (NE), a gastrointestinal disease that leads to substantial economic losses in poultry. This study aims to characterize the intestinal microbiome of chickens and assess the effects of Bacillus velezensis on gut microbiota and recovery from necrotic enteritis, comparing its efficacy to antibiotic treatment. The experiment involved five groups, each consisting of 16 chickens. The first group, the start-of-challenge (DB) group, included day-old chicks. The second group, the post-challenge control (DS) group, was reared until the end of the trial. The third group was infected with C. perfringens (NE group). The fourth group received both C. perfringens and B. velezensis (BV group), while the fifth group was treated with C. perfringens and amoxicillin (AB group). All chickens were euthanized via cervical dislocation following the experimental infection. Fecal samples collected from the cecum underwent 16S rRNA gene-based metagenomic analysis, and the resulting data were statistically evaluated. Macroscopic examination after euthanasia revealed pathological changes in the intestines of chickens in the NE group, which had received only C. perfringens. Their intestines appeared swollen, with slight mild mucosal hemorrhage. In contrast, no macroscopic lesions were observed in the DB, DS, BV, or AB groups. Microbiome analysis showed a decline in microbial diversity within the NE group. The BV group exhibited a microbial composition most similar to that of healthy animals, followed by the AB group. The study concludes that B. velezensis could serve as an alternative to prophylactic antibiotics in mitigating the adverse effects of necrotic enteritis on the gut microbiome.

Puerto Rico's 2024-2025 dengue epidemic highlighted the need to understand how complementary surveillance systems capture cases and severity. We compared the Sentinel Enhanced Dengue Surveillance System (SEDSS) and the Passive Arboviral Disease Surveillance System (PADSS) in capturing characteristics of dengue cases during this epidemic and assessed their complementary roles in epidemic monitoring and public health preparedness. We analyzed laboratory-confirmed dengue cases reported in SEDSS and PADSS from January 1, 2024, through January 31, 2025. SEDSS recruits at sentinel sites, collecting clinical, epidemiological, and laboratory data, while PADSS relies on clinician-initiated reporting across the island. We used descriptive statistics, cross-correlation analyses, and generalized additive models to compare temporal trends, demographic characteristics, clinical features, and severe dengue outcomes. SEDSS enrolled 373 dengue patients (7.0% of tested patients), while PADSS reported 6488 dengue patients (60.1% of tested patients). Both systems showed aligned epidemic peaks, although PADSS detected more cases overall. Compared with PADSS patients, SEDSS patients were younger (median age = 22 vs 27 y) and had higher proportions of warning signs, including mucosal bleeding (21.7% vs 6.9%), hemoconcentration (4.4% vs 0.1%), and restlessness (31.1% vs 7.5%) (P < .001 for all). Severe dengue was more common in SEDSS patients (9.1% vs 5.6%; P = .02), likely due to more detailed clinical data, with the highest rates among patients aged 10 to 19 years (16.3%) and <10 years (10.5%). SEDSS captured severe plasma leakage (6.2%), which was not recorded in PADSS. PADSS provided broader geographic coverage. SEDSS captures detailed clinical data, whereas PADSS provides broader coverage and higher case counts. Integrating both systems strengthens epidemic response, resource allocation, and public health decision-making.

Renin-angiotensin-aldosterone system inhibition and haemocompatibility-related adverse events in patients with durable left ventricular assist device: the MOMENTUM-3 trial .

ABSTRACTThe etiology of IC/BPS is multifactorial; thus, pathophysiology‐based phenotyping is needed for tailored treatments of IC/BPS patients. In this regard, it is now generally agreed that, when focusing on inflammatory responses in the bladder mucosa, IC/BPS is divided into two major phenotypes. One is “interstitial cystitis (IC),” which is a chronic inflammatory disorder with Hunner lesions, and the other is “bladder pain syndrome (BPS),” in which inflammatory changes are minimal without Hunner lesions. However, as another important pathophysiological change in the IC/BPS bladder, angiogenetic responses including overexpression of angiogenic growth factors, such as platelet‐derived endothelial cell growth factor (PD‐ECGF), vascular endothelial growth factor (VEGF), and CD31 (platelet endothelial cell adhesion molecule; PECAM‐1), have been shown to correlate with symptom severity in Hunner‐type IC and non‐Hunner IC/BPS patients. In addition, previous studies in IC/BPS patients showed that glomerulations or mucosal bleeding during hydrodistension occur due to the rupture of bladder mucosal capillary vessels in association with PD‐ECGF and VEGF overexpression. Furthermore, upregulation of angiogenic factors and their signaling pathways has been detected in animal models of IC/BPS induced by bladder inflammation or psychological stress. Thus, angiogenic factor overexpression and immature microvessel formation in the bladder mucosa could be another important diagnostic criterion in addition to the inflammatory status for further phenotyping of IC/BPS.

Fecal occult blood concentration, fecal calprotectin (FC) level, serum C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) are valuable biomarkers for ulcerative colitis (UC). However, their clinical utility for longitudinal disease assessment remains unclear. This retrospective, observational study assessed correlations between biomarker changes and endoscopic activity scores in UC. Spearman's rank correlation coefficient analysis was applied to examine the relationship between longitudinal variations in endoscopic activity scores, including the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity (UCEIS), and sum of Mayo endoscopic subscores (S-MES), and corresponding biomarker changes in patients with UC. The study included 97 patients, contributing to 145 observation intervals (48 contributed two intervals each and 49 contributed one each). All endoscopic scores and biomarkers were significantly correlated with disease activity, with corresponding increases or decreases (p < 0.05). Changes in MES and S-MES correlated most strongly with FC level changes (r = 0.62 and 0.66, respectively). Changes in the UCEIS exhibited the strongest correlation with fecal occult blood concentration changes (r = 0.67). Changes in fecal occult blood and FC (r = 0.55) and in serum CRP and ESR (r = 0.58) were strongly correlated. All four biomarkers reflected endoscopic activity in UC. Changes in fecal occult blood concentration and FC level had stronger correlations with endoscopic score changes than blood biomarker concentration changes. FC assessment is valuable for monitoring inflammatory activity during remission maintenance, whereas fecal occult blood concentration reflects mucosal bleeding. Serum CRP level and ESR are useful adjunctive biomarkers, particularly in cases of increased disease activity.

Desmopressin acetate (DDAVP) is used as a hemostatic adjunct because it can improve primary hemostasis and increase Factor VIII- and von Willebrand factor-related variables. However, its effects in dogs under general anesthesia are not well defined. This study aimed to evaluate the effect of DDAVP on buccal mucosal bleeding time (BMBT) in anesthetized healthy dogs and to assess concurrent changes in plasma FVIII antigen (FVIII:Ag). Twenty-seven healthy Beagle dogs were randomly assigned to receive intravenous saline (control; n = 8) or DDAVP at 0.6 (n = 7), 1.2 (n = 6), or 1.8 µg/kg (n = 6) under isoflurane anesthesia. The BMBT was measured 30 minutes after administration. Blood samples were collected at baseline and at 30 and 60 minutes to measure FVIII:Ag, complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen, and electrolytes. Heart rate and arterial blood pressure were recorded at the same time points. At 30 minutes after administration, the BMBT values were 128.2 (92.1-157.7) seconds in the control group, 105.2 (72.4-122.0) seconds in the 0.6 µg/kg group, 74.1 (58.6-101.8) seconds in the 1.2 µg/kg group, and 47.2 (44.4-76.1) seconds in the 1.8 µg/kg group.BMBT was significantly shorter in the 1.2 and 1.8 µg/kg groups than in the controls, and in the 1.8 µg/kg group than in the 0.6 µg/kg group (p < 0.05). FVIII:Ag levels at 60 minutes were significantly higher in the 1.8 µg/kg group than in the control group (p < 0.05) and increased from baseline to 60 minutes in the 1.2 and 1.8 µg/kg groups (p < 0.05). No other significant differences were detected. DDAVP dose-dependently shortened BMBT and increased FVIII:Ag in 60 minutes in healthy anesthetized dogs. These findings provide preliminary data and support further investigation of DDAVP in patients undergoing surgery.

Infectious bursal disease (IBD) outbreaks significantly undermine chicken production. Syndromic surveillance based on lesion indicators is an established tool for monitoring the disease following reports of morbidity and mortality. This study aimed to develop an epidemiological profile of the IBD burden, including syndromic outbreak prevalence rates, yearly trends, mortality rates, and lesion patterns, used for surveillance. Records of IBD outbreaks from two veterinary hospitals in Maiduguri, Nigeria, were extracted from all reported disease outbreaks in chicken flocks between 2008 and 2018. IBD outbreaks accounted for 493 cases (7.6%; 95% confidence interval [CI]: 7.0&amp;ndash;8.3%) of 6,486 recorded disease outbreaks. Annual prevalence ranged from 1.6% (95% CI: 0.9&amp;ndash;2.3%) to 17.3% (95% CI: 12.9&amp;ndash;21.7%) and showed a linear trend (r = &amp;minus;0.73; p &lt; 0.01), with a significant association across years (p &lt; 0.001). Prevalence varied significantly with chicken type (p &lt; 0.05), with the highest rate observed in Noilers (25.0%), followed by cockerels (17.5%), local chickens (9.1%), broilers (7.2%), and layers (7.1%). Affected chickens were aged 2&amp;ndash;27 weeks, with a modal age of 4&amp;ndash;5 weeks and a mean age of 5.0 &amp;plusmn; 1.7 weeks. The overall mortality rate was 12.6% (95% CI: 12.3&amp;ndash;12.9) based on a total flock size of 38,485 from 2015 to 2018, the period for which flock size and mortality records were available. Key lesions used for syndromic detection of acute IBD included inflammatory swelling of the bursa of Fabricius (90.9%), hemorrhages in thigh, leg, and/or breast muscles (72.2%), mucosal hemorrhages at the proventriculus&amp;ndash;ventriculus junction, with and without enteritis (24.9%), and kidney lesions (7.7%). This syndromic surveillance system enables outbreak monitoring and can inform the planning of control measures to reduce disease-associated production losses.

This case report describes anewborn male presenting with mucosal bleeding and low Factor VIII activity, ultimately diagnosed with arare compound heterozygous form of von Willebrand Disease (VWD) involving both type 2A and type 2N variants through previously unknown pathogenic mutations. A single patient case report. Genetic testing revealed two heterozygous variants in the VWF gene c.2422_2424del [p.Cys808del] and c.2999A > G [p.Asp1000Gly]), previously described as variants of unknown significance, inherited in trans from each parent, resulting in a severe VWD phenotype marked by significantly reduced von Willebrand Factor (VWF) antigen, GpIbM activity, collagen binding, and FVIII activity. Laboratory analysis revealed abnormal VWF multimer patterns distinct from those of classic type 2A or 2N VWD. The patient was managed with emicizumab prophylaxis and intermittent antifibrinolytics. This case highlights the diagnostic and therapeutic challenges of atypical VWD presentations influenced by novel genetic variants. These findings underscore the importance of comprehensive clinical, laboratory, and genetic evaluation in complex bleeding disorders.

Acute ischemic stroke is a neurological emergency requiring prompt reperfusion therapy to prevent irreversible brain injury. Intravenous thrombolysis with alteplase has been shown to improve functional outcomes when administered within ≤4.5 hours of symptom onset. Door-to-Needle Time (DNT) is a key quality indicator directly associated with clinical prognosis. We report three cases of acute ischemic stroke (aged 57–66 years; two females and one male) who received intravenous thrombolysis at a tertiary care hospital. The respective DNTs were 43 minutes, 48 minutes, and 53 minutes. All patients presented with mild-to-moderate focal neurological deficits (hemiparesis, dysarthria/aphasia) within 4.5 hours of symptom onset. Two patients demonstrated clinical improvement without hemorrhagic complications. One patient developed mild mucosal bleeding without symptomatic intracranial hemorrhage, leading to early discontinuation of the infusion. Achievement of DNT ≤60 minutes in all three cases reflects effective multidisciplinary coordination through an established code stroke system. Clinical challenges, such as hypertensive emergencies, can be managed without prolonging DNT when standardized protocols are optimally implemented.

Glanzmann thrombasthenia (GT) is a rare inherited platelet function disorder characterized by a deficiency or dysfunction of the αIIbβ3 integrin, leading to impaired platelet aggregation. Platelet transfusion refractoriness (PTR) represents a therapeutic challenge, often resulting from alloimmunization against HLA antigens or the αIIbβ3 complex. We report the case of a patient with type I GT, who presented with recurrent mucosal hemorrhages and chronic anemia requiring repeated transfusions. By the age of 8 years, the patient developed transfusion refractoriness, with hemorrhagic episodes unresponsive to platelet transfusions. Immunologic investigations revealed anti-HLA and anti-αIIbβ3 antibodies. At 14 years of age, a severe hemorrhagic episode with rapid hemoglobin decline was successfully managed with recombinant activated factor VII (rFVIIa). Management of PTR in GT represents a major clinical challenge, frequently associated with anti-HLA or anti-αIIbβ3 antibodies. In high-resource settings, transfusion strategies are guided by antibody specificity: HLA-compatible or human platelet antigen-compatible platelets are used for patients with anti-HLA or anti-human platelet antigen antibodies, respectively, while rFVIIa is reserved for individuals with anti-αIIbβ3 antibodies. In LMIC such as Tunisia, prevention of alloimmunization through systematic leukoreduction is essential. When PTR occurs, donor selection by crossmatching, when feasible, and judicious use of rFVIIa for life-threatening hemorrhage remain key therapeutic options.

ABSTRACTBackground and AimStress‐related mucosal bleeding among critically ill patients in intensive care unit (ICU) contributes substantially to morbidity and mortality. Despite growing concerns globally over inappropriate stress ulcer prophylaxis (SUP) use, limited data exist from Ethiopia, particularly in ICU settings. The objective of this study was to assess the appropriateness of SUP indications and associated factors among ICU‐admitted patients in Northwest Ethiopia hospitals and to evaluate physicians' knowledge related to SUP prescribing practices.MethodsA multicenter cross‐sectional study was conducted from June to December 2024 across three comprehensive specialized hospitals in Northwest Ethiopia. The American Society of Health‐System Pharmacists (ASHP) criteria were applied to assess the appropriateness of SUP indications among ICU admitted adult patients. Additionally, a structured survey was administered to prescribers to evaluate their knowledge and attitudes regarding SUP. Binary logistic regression was used to identify factors associated with inappropriate SUP use, with a two‐sided significance level of p < 0.05% and 95% confidence intervals (CI).ResultsA total of 410 patients and 56 prescribers were included in the final analysis. Prescribers' knowledge regarding stress ulcer prophylaxis was suboptimal, with a mean knowledge score of 60.2%. Among patients receiving SUP, 64.4% of prescriptions were inappropriate, including 45.9% overutilization and 18.5% underutilization. Independent factors of inappropriate SUP use included older age ( ≥ 60 years) [AOR = 2.1; 95% CI: 1.2–3.3; p = 0.004] and longer hospital stays ( > 7days) [AOR = 3.1; 95% CI: 1.9–4.9; p = 0.001].ConclusionsInappropriate use of SUP was widespread among ICU patients in Northwest Ethiopia. Older age and prolonged hospitalization were significantly associated factors. Regular prescriber education, involvement of clinical pharmacists, and routine audit with feedback are recommended to reduce inappropriate SUP use, particularly among older patients and those with prolonged hospital stays.

In July 2024, an outbreak of acute febrile illness occurred in Chassi village, Gombe State, Nigeria, affecting over 30 individuals, primarily children, with symptoms including fever, jaundice, abdominal pain, and mucosal bleeding. The cause remained unidentified after conventional diagnostics excluded known viral hemorrhagic fevers, malaria, and bacterial infections. This study aimed to investigate the potential etiologic agent behind the outbreak using unbiased genomic techniques. We employed a metagenomic next-generation sequencing (mNGS) strategy with viral enrichment to analyze serum samples from 22 symptomatic patients. A novel complete 9.3 kb genome of Pegivirus C (GOMBE-017-2025) was reconstructed and phylogenetically compared to global sequences. Detection was validated using targeted PCR and Sanger sequencing. Environmental and microbial testing were conducted on local water sources. Pegivirus C was consistently detected in all 22 samples. The reconstructed genome showed 92.7% identity to a 2018 Nigerian strain and clustered with West African isolates. PCR and sequencing confirmed its presence. Environmental and bacterial sources were ruled out as causative agents. The uniform detection of Pegivirus C in this localized outbreak raises concern over its potential pathogenic or co-pathogenic role. These findings support the need for further investigation into its transmission dynamics, tropism, and clinical relevance.