Prothrombin Time Research Articles

Efficacy of therapeutic hypothermia on mild neonatal hypoxic-ischemic encephalopathy: a prospective randomized controlled study

To investigate the efficacy of therapeutic hypothermia on mild neonatal hypoxic-ischemic encephalopathy (HIE). A prospective study was performed on 153 neonates with mild HIE who were born from September 2019 to September 2023. These neonates were randomly divided into two groups: therapeutic hypothermia (n=77) and non-therapeutic hypothermia group (n=76). The short-term clinical efficacy of the two groups were compared. Barkovich scoring system was used to analyze the severity of brain injury shown on magnetic resonance imaging (MRI) between the two groups. There were no significant differences in gestational age, gender, birth weight, mode of birth, and Apgar score between the therapeutic hypothermia and non-therapeutic hypothermia groups (P>0.05). There were no significant differences in the incidence rates of sepsis, arrhythmia, persistent pulmonary hypertension and pulmonary hemorrhage and the duration of mechanical ventilation within the first 72 hours after birth between the two groups. The therapeutic hypothermia group had longer prothrombin time within the first 72 hours after birth and a longer hospital stay (P<0.05). Compared with the non-therapeutic hypothermia group, the therapeutic hypothermia group had lower incidence rates of MRI abnormalities (30% vs 57%), moderate to severe brain injury on MRI (5% vs 28%), and watershed injury (27% vs 51%) (P<0.05), as well as lower medium watershed injury score (0 vs 1) (P<0.05). Therapeutic hypothermia can reduce the incidence rates of MRI abnormalities and watershed injury, without obvious adverse effects, in neonates with mild HIE, suggesting that therapeutic hypothermia may be beneficial in neuroprotection in these neonates.

Using heart rate variability to evaluate the association between the autonomic nervous system and coagulation function in patients with endometrial cancer.

The incidence of endometrial cancer (EC) is increasing worldwide, but the specific mechanism of coagulation dysfunction in EC is not fully understood. The objective of the present study was to explore the relationship between autonomic nervous system function and coagulation function in patients with EC using heart rate variability (HRV) analysis. The study included 100 patients with EC who were treated at the Department of Gynecological Oncology of The First Affiliated Hospital of Bengbu Medical University (Bengbu, China) from December 2021 to March 2023. A 5-min resting electrocardiogram was collected from each patient to analyze HRV parameters, including the time domain parameters standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD), and the frequency domain parameters low-frequency power and high-frequency power (HF). Blood samples were submitted to biochemistry tests to measure coagulation markers, namely prothrombin time (PT), international normalized ratio of PT (PT-INR), prothrombin activity (PTA), activated partial thromboplastin time (APTT) and fibrinogen. Bivariate Spearman correlation analyses revealed that PT, PT-INR and APTT were significantly positively correlated with SDNN, RMSSD and HF, while PTA was significantly negatively correlated with RMSSD. Following adjustments for confounding factors, namely age, body mass index, menopause, ligation of the fallopian tubes, diabetes, hypertension, adjuvant chemotherapy and mean heart rate, linear regression analysis demonstrated that SDNN, RMSSD and HF were independent factors influencing PT and PT-INR in patients with EC. The findings of the present study indicate that certain HRV parameters correlate with coagulation markers in EC and provide new insight into the occurrence of cancer-associated coagulation dysfunction.

Role of paranasal abnormalities and systemic inflammation on primary acquired nasolacrimal duct obstruction

BackgroundTo determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries.Main bodyWe retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p < 0.05). Platelet, lymphocyte, neutrophil, PLR, MLR, NLR, and SII values did not differ significantly between the control and case groups (p > 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p < 0.05).Short conclusionThe incidence of PANDO may not be directly related to paranasal abnormalities and systemic inflammation. Low INR values may cause obstruction in the nasolacrimal duct. Age, gender, type of surgery, CT findings, and inflammation level do not affect the success of the surgery.

Etiology, Characteristics, and Outcomes of Neonatal Liver Failure: Lessons Learned Over the Last 3 Decades

To evaluate trends in etiology and outcomes of neonatal liver failure (NLF) over 30years retrospectively at a single institution. Inclusion criteria for this retrospective cohort study were babies presenting at a chronological age of ≤28days between 1991 and 2020 with prothrombin time≥20seconds and biochemical liver injury. Demographics, etiology, laboratory investigations, need for extrahepatic organ support, acute kidney injury, and intervention with liver transplant (LT) were recorded. Survival outcomes were measured as discharge from the hospital alive with native liver or LT. The study period was stratified into 3 10-year blocks. Trends were analyzed for hospital admissions, etiology, and survival outcomes. One hundred twenty-six babies met the NLF criteria. Admissions to the hospital increased from 21 in 1991-2000 to 65 in 2011-2020. An increasing trend in infectious and metabolic causes, while a decreasing trend in indeterminate etiology, was noted. Survival with native liver improved from 23.8% in 1991-2000 to 55.4% in 2011-20 (P=.021), and mortality reduced from 52.4% to 35.4% during the same periods (P=.213). Twenty-three (18.2%) neonates received LT. Post-LT survival outcomes were 100% for gestational alloimmune liver disease, 66.6% in the indeterminate group, and 25% for herpes simplex virus. Specific etiologies (gestational alloimmune liver disease, OR=0.07 [0-0.77, P=.048]), presence of acute kidney injury (OR=6.22 [1.45, 29.38, P=.015]) and need for inotropes (OR=6.22 [1.45, 29.38, P=.028]) influenced mortality in multivariable logistic regression analysis. In the last 30years, advances in diagnosis, treatment, and increasing experience with LT have improved survival in NLF.

Retrospective Evaluation of Inpatient Warfarin Management Practices in Patients Immediately Following Left Ventricular Assist Device Implantation.

Background: The International Society for Heart and Lung Transplantation recommends patients receive warfarin and aspirin following left ventricular assist device (LVAD) placement. Optimal warfarin management in this population has not been well established. Objectives: The objectives of this study were to evaluate warfarin practices in patients immediately post-LVAD implantation. Methods: This single-center, retrospective cohort study included patients 18 years and older following LVAD placement from August 1, 2012 to April 1, 2020. The primary outcome was to assess patient-specific risk factors affecting time to therapeutic range. Secondary outcomes included bleeding events, thrombotic events, and warfarin dosing patterns. Results: Of 104 included patients, 91% reached the therapeutic range at a median of 8 days. A higher proportion of patients started on 3.5 mg or higher reached therapeutic international normalized ratio (INR) and faster (96% vs 90%; 8 vs 5 days) compared to lower doses. Univariate analysis of associations with reaching therapeutic INR range included initial warfarin dose, cumulative warfarin, and warfarin dosing changes, whereas HAS-BLED and CHA2DS2VAC were associated with slower time to therapeutic INR. Overall, 44% of patients met Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) bleeding criteria. There were a total of 12 thrombotic events and no pump thrombotic events. Total weekly warfarin dosing was significantly lower post-LVAD (24.3 mg vs 35 mg, P = 0.0009). In addition, warfarin requirements were statistically higher after the first week of therapy (4.0 mg vs 2.89 mg, P < 0.0001). Conclusion: Based on the results, consider warfarin starting dose between 2.5 and 4 mg for patients on LVAD therapy, while balancing patient-specific risks for bleeding.

Value of Renal Artery Resistive Index in Nonazotaemic Cirrhotic Patients with Ascites

Background: Renal dysfunction is a common complication in patients with liver cirrhosis, with hepatorenal syndrome (HRS) being the most severe form. HRS is characterized by disturbances in both circulatory and kidney functions and is diagnosed by excluding other causes of renal failure. Objective: This study aimed to measure the renal artery resistive index (RI) in non-azotaemic cirrhotic patients with ascites to predict early renal haemodynamic dysfunction. Methodology: A prospective study was conducted involving 30 cirrhotic patients with ascites and 15 healthy controls. Renal artery RI was measured using Duplex Doppler ultrasonography. Inclusion criteria for patients included normal renal function, as indicated by serum creatinine ≤ 1.2 mg/dl and creatinine clearance rate ≥ 50 ml/min. Results: The mean renal artery RI was significantly higher in cirrhotic patients with ascites (70% had RI ≥ 0.70) compared to controls (all had RI &lt; 0.70). Significant differences were observed in serum bilirubin, SGPT, SGOT, and prothrombin time between cases and controls (p &lt; 0.05). Conclusion: Renal Doppler ultrasonography is a valuable noninvasive method for detecting early renal haemodynamic dysfunction in cirrhotic patients with ascites. Elevated renal artery RI can serve as an indicator of renal dysfunction, aiding in early diagnosis and management.

Metabolic pathways altered by air pollutant exposure in association with coagulation function among the rural elderly

Air pollution exposure has been linked with coagulation function. However, evidence is limited for the relationships between air pollution, coagulation function and metabolomics in humans. We recruited a panel of 130 rural elderly from the Chayashan township in China, all of whom were free of pre-existing cardiovascular diseases and had provided residential address information. We conducted clinical examinations and collected blood samples from these rural elderly for the detection of coagulation biomarkers (e.g, activated partial thromboplastin time, fibrinogen, thrombin time, and prothrombin time) and untargeted metabolites in both December 2021 and August 2022. We used mini ambient air quality monitor to measure the mean levels of five air pollutants (e.g., PM2.5, SO2, NO2, CO and O3) during 1 to 2 weeks before blood sample collection. The Mummichog pathway analysis was used to identified potential metabolic features and pathways. In this study, we identified 5 pathways associated with both air pollution and coagulation function, and further pinpointed eight metabolic features within these pathways. The majority of these features were lipids, including arachidonic acid and linoleic acid. Overall, the findings of this study offer insights into potential mechanisms, particularly lipid metabolism, that may underlie the association between air pollution and coagulation function.

Adaption of in vitro and in chemico phototoxicity tests for tattoo pigments and the effect of adsorption of the phototoxic contaminant benzo[a]pyrene to carbon black

Phototoxicity plays an important role in tattoo toxicology due to the skin's daily exposure to sunlight and the permanent deposition of pigments in skin. Here, we investigated in chemico reactive oxygen species generation using 2′,7′-dichlorodihydrofluorescein diacetate and in vitro phototoxicity towards skin fibroblasts based on the OECD Test Guideline 432.Proficiency substances, titanium dioxide (TiO2, anatase 30 nm, anatase 100 nm, rutile 30 nm), pigment red 22 (PR 22) with and without purification and carbon black (CB) were investigated. Phototoxic properties of benzo[a]pyrene (B[a]P) were investigated with and without adsorption to CB. Pigments were characterised by dynamic light scattering.All proficiency substances except for norfloxacin were predicted successfully and only TiO2 anatase exhibited phototoxicity in the cell-based approach. B[a]P showed the expected phototoxicity in contrast to B[a]P bound to carbon black. Upon UVA irradiation, only TiO2 pigment anatase and PR 22 generated ROS in the cell-free assay. DLS measurements showed a high degree of polydispersity/agglomeration.OECD Test Guideline 432 should be applied with an incubation time of 24 h when testing highly insoluble pigments. The in chemico ROS assay introduced below might serve as a quick screening test but may be further adapted to predict the in vitro outcome.

Phytonadione Utilization and the Risk of Bleeding in Chronic Liver Disease.

Purpose: To determine the safety and efficacy of phytonadione in patients with an elevated international normalized ratio (INR) secondary to chronic liver disease without active bleeding. Methods: This retrospective chart review compared hospitalized patients from 2015 to 2022 with a diagnosis of chronic liver disease, a baseline INR of 1.2 to 1.9, and without active bleeding who did or did not receive phytonadione. The primary outcome was the incidence of new bleeding. The incidence of thrombosis and change in INR were also evaluated. Results: A total of 133 patients were included, of which 46 received phytonadione (mean 2.46 doses and mean dose 7.95 mg, 72.74% intravenously). Child-Pugh scores were higher in phytonadione patients (8.7 vs 9.93, P = .0003). There was no difference in the incidences of new bleeding (9.20 vs 13.04%, P = .492) or thrombosis (3.45 vs 0%, P = .203) between the control and phytonadione groups. After phytonadione administration, there was no change in INR, while INR increased by 0.24 in the control group (P = .025). Conclusion: In chronic liver disease patients who were not bleeding, phytonadione did not reduce INR or the incidence of new bleeding.

Chemical composition and antioxidant activity of Physalis angulata L. (Solanaceae) and its effect on blood clotting and biofilm formation of some wound bacterial isolates

Physalis angulata a member of the Solanaceae family, is a plant recognized for its significant nutritional and medicinal properties. Widely distributed across tropical and subtropical regions, this plant has garnered attention for its diverse biological activities. The ethanol extract from the plant is being used in this study to investigate its biological and antioxidant properties. The ability of the extract to reduce free radicals was also tested using the compound phenyl-1-picrylhydrazyl). The DPPH method was used because it is a modern color method and is considered the most common and easy to apply, in addition to its speed and superior sensitivity in testing antioxidants for samples of plant extracts, and the values were compared with the value of ascorbic acid IC50. The study also looks at the extract's ability to prevent the formation of biofilms by different pathogens, including E. coli and Staphylococcus strains that were isolated from community labs and Ramadi Teaching Hospital. The ethanol extract demonstrated a noteworthy ability to inhibit the formation of cellular membranes in staphylococcal bacteria and E. coli. The efficacy of the extract at different concentrations (150, 200, 250 mg/mL) was also assessed, revealing that a concentration of 250 mg/mL resulted in significant inhibition rates (74.3% and 61.45% for E. coli). Furthermore, the study explores the impact of ethanol extract on blood coagulation. At high concentrations (150, 200, 250 mg/mL), the extract exhibited properties akin to aspirin and warfarin, extending the clotting times in both total and partial coagulation tests (Prothrombin time, Partial thromboplastin time) at lower concentrations (100, 50, 10 mg/mL), the extract appeared to promote blood clot formation, suggesting a concentration-dependent effect on hemostasis. This dual action positions P.angulate as a potential therapeutic agent, warranting further investigation into its biomedical applications.

Undetected intraabdominal sepsis due to prolonged corticosteroid therapy in systemic lupus erythematosus: a case report and literature review

Gastrointestinal manifestations are not included in the criteria for diagnosing systemic lupus erythematosus (SLE) by the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2019, however, gastrointestinal disorders are one of the potentially fatal complications of SLE. Mesenteric vasculitis and thrombosis are the two main mechanisms that cause gastrointestinal disorders in SLE patients. Long-term immunosuppressants used by SLE patients might alter the immune system’s response to infection, leading to immunoparalysis. The delay in recognizing might cause sepsis, thus increasing the mortality risk. A 47-year-old woman with a history of SLE complained of hematochezia. The patient had been consistently consuming 12 mg of methylprednisolone every day for the past five years without doctor’s supervision. Past medical history of congestive heart failure (CHF) caused by coronary arterial disease (CAD). After 24 days hospitalized for observation of hematochezia, an emergency laparotomy was performed due to deterioration caused by peritonitis. Intraoperative, 60 cm of jejunal necrosis was identified and intestinal resection was done. The patient’s condition improved in two days after emergency laparotomy and intensive treatment. The undetected intraabdominal sepsis caused by jejunal infarction and gut necrosis due to long-term use of corticosteroid that masked the manifestations of severe infection in the gastrointestinal tract infarction and necrosis. Abbreviations: NLR - neutrophil to lymphocyte ratio; SGOT - serum glutamic oxaloacetic transminase; SGPT - serum glutamic pyruvic transminase; eGFR - estimated glomerular filtration rate; PT - prothrombin time; APTT - activated partial thromboplastin time; INR - international normalized ratio Keywords: Systemic lupus erythematosus, Intraabdominal sepsis, Immunoparalysis, Corticosteroid Citation: Leman YE, Irawany V, Manggala SK. Undetected intraabdominal sepsis due to prolonged corticosteroid therapy in systemic lupus erythematosus: a case report and literature review. Anaesth. pain intensive care 2024;28(4):765−771; DOI: 10.35975/apic.v28i4.2525 Received: March 13, 2024; Reviewed: May 17, 2024; Accepted: May 21, 2024

Does liver cirrhosis affect outcomes in non-metastatic esophageal squamous cell carcinoma (ESCC) undergoing radiotherapy-based treatment?

89 Background: Liver cirrhosis frequently coexists with esophageal squamous cell carcinoma (ESCC), as both conditions share alcohol consumption as a common etiological factor. Surgical intervention is often contraindicated or associated with significant morbidity in patients with non-metastatic ESCC and liver cirrhosis. Consequently, radiotherapy-based therapy is commonly employed. This study aims to investigate prognostic factors for overall survival in such patients undergoing radiotherapy-based therapy. Additionally, we will evaluate predictors for the 90-day mortality rate, proposed as a measure to mitigate treatment-related toxicity and prevent unwarranted or excessive medical interventions. Methods: From January 2001 to December 2021, we conducted a retrospective review of the medical records of 1298 patients diagnosed with esophageal squamous cell carcinoma (ESCC). Within this cohort, we identified 103 patients with concomitant liver cirrhosis, diagnosed through abdominal ultrasonography, computerized tomography, and/or liver biopsy, as appropriate. Of these individuals, 78 patients with non-metastatic ESCC and liver cirrhosis were included in our analysis. We collected clinicopathologic parameters and examined their correlation with overall survival and the 90-day mortality rate. Results: Univariate analysis revealed several factors significantly associated with inferior overall survival: Child-Pugh classification B/C (P&lt;0.001, compared to A), radiotherapy alone (P=0.03, compared to chemoradiotherapy), prothrombin time prolonged by ≥2 seconds (P=0.024), albumin levels ≤3.5g/dl (P&lt;0.001), controlled/refractory ascites (P=0.01, compared to no ascites), and total bilirubin levels ≥1.5mg/dl (P=0.004). In multivariate analyses, albumin levels ≤3.5g/dl (P=0.001, odds ratio: 2.500) and total bilirubin levels ≥1.5mg/dl (P=0.019, odds ratio: 2.012) were identified as independent prognostic factors. Among the 78 patients receiving radiotherapy-based therapy, the 90-day mortality rate was 10.3% (n=8). Clinical 8th AJCC stage IVA (P=0.02), clinical T classification T3/4 (P=0.049), prothrombin time prolonged by ≥4 seconds (P=0.009), and albumin levels ≤3.5g/dl (P=0.027) were significantly correlated with higher 90-day mortality rate. The logistic model indicated that albumin levels ≤3.5g/dl (P=0.015, odds ratio: 16.129) and clinical 8th AJCC stage IVA (P=0.012, odds ratio: 17.544) were independently associated with higher 90-day mortality rate. Conclusions: In patients undergoing radiotherapy-based therapy for non-metastatic esophageal squamous cell carcinoma (ESCC) and liver cirrhosis, pretreatment hypoalbuminemia has been associated with increased 90-day mortality and unfavorable prognosis.

А COMPREHENSIVE STUDY OF PATIENTS WITH ISCHEMIC HEART DISEASE: AGE, GENDER, AND COMORBIDITY ASPECTS

The purpose of the study was to analyze the clinical characteristics, comorbid status, individual biochemical indicators, and systemic inflammation activity in patients with ischemic heart disease (IHD) depending on age, gender distribution, and diagnosis influence.Materials and methods. The study included 144 patients with IHD, who were divided into two groups – the main and the control. The main group comprised 120 patients with stable angina pectoris (SAP) II-III functional class (FC). The control group consisted of 24 patients with STEMI. All patients underwent a comprehensive examination: general clinical, anthropometric, laboratory (complete blood count, biochemical analysis), and instrumental (office blood pressure measurement, heart rate, and echocardiography). The comorbid profile of patients with IHD was assessed using the Charlson comorbidity index. The severity of systemic inflammation syndrome in the selected patient groups was assessed by the cellular composition of peripheral blood upon admission to the hospital, and based on the obtained data, the values of leukocyte inflammatory markers were calculated.Results. Patients in the main group were younger than those in the control group (54.78 ± 1.11 vs. 63.50 ± 1.82) (p&lt;0.001). A statistically significant predominance of men over women was found among the cohort of IHD patients (63.33% and 36.67%, respectively) (p&lt;0.001), with a tendency towards male predominance among patients with SAP II-III FC compared to those with STEMI (p = 0.074). Patients in the main group compared to those in the control group had significantly higher left ventricular ejection fraction (p&lt;0.001), systolic blood pressure (p&lt;0.001), and diastolic blood pressure (p=0.001). In the control group compared to the main group, more cases of patients with high levels of comorbidity were found (p&lt;0.001). Lower levels of creatinine, fibrinogen, prothrombin time, and glucose were observed in patients in the main group. Patients with SAP II-III FC compared to those with STEMI had lower levels of leukocyte inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR) (p&lt;0.001), systemic immune inflammation index (SII) (p=0.002), systemic inflammation response index (SIRI) (p=0.007), and aggregate index of systemic inflammation (AISI) (p=0.011).Conclusions. The study underscores the need for an individualized approach to each patient with ischemic heart disease, considering their age, gender, and comorbid characteristics, as well as laboratory peculiarities, to improve therapy outcomes and prevent complications.

The Additive to Mass Manufacturing Process of Mixed Potential Electrochemical Sensors

Additive manufacturing allows for quick turn around and low cost of production of small numbers of parts. These attributes lend the technology to prototype development, where design changes are many and production numbers are low [1]. Once design parameters have been nailed down, additive manufacturing’s low throughput and poor reproducibility limit application to high volume production.Here, we discuss the implementation of direct-write extrusion of ceramic pastes and metal inks for prototype manufacturing of mixed potential electrochemical sensors and the transition to tape casting and screen printing for high volume production. Throughout the prototyping phase, direct write extrusion enabled quick and easy production of low numbers of parts, enabling various changes in sensor design and material to improve sensor performance. Sensor design evolved from a disk shape (Fig. 1 a) to a stick with integrated heater (Fig. 1 b, c). Direct write extrusion of substrate enabled quick testing of various stabilized zirconia ceramics to improve the sensitivity of the device [2]. Limitations of additive manufacturing became apparent when attempting to integrate the heater into the device, the inconsistent linewidths led to areas of high resistance and hot spots (Fig. 1 c). Tape-casting and screen printing of the devices was adopted for three reasons, first, to improve line fidelity, which is vitally important when printing small electrodes as well as heater traces (Fig. 1 d), second, to further decrease conductivity of substrate by laminating multiple layers of different ceramic materials, and finally to increase manufacturing throughput (Fig. 1 d, e).This work was supported by US Department of Energy Award DE-FE0031864References[1] T. D. Ngo, A. Kashani, G. Imbalzano, K. T. Q. Nguyen, and D. Hui, “Additive manufacturing (3D printing): A review of materials, methods, applications and challenges,” Compos. Part B Eng., vol. 143, pp. 172–196, Jun. 2018, doi: 10.1016/j.compositesb.2018.02.012.[2] S. Halley, K. Ramaiyan, F. Garzon, and L. Tsui, “Massive enhancement in sensitivity of mixed potential sensors towards methane and natural gas through magnesia stabilized zirconia low ionic conductivity substrate,” Sens. Actuators B Chem., vol. 392, p. 134031, Oct. 2023, doi: 10.1016/j.snb.2023.134031. Figure 1

The relationship of age, sex and prothrombin time related to the severity of COVID-19 patients with diabetes mellitus: a systematic review and meta analysis

Background SARS-CoV-2 first appeared in Wuhan, China, in December 2019. Looking at the prevalence data in the world and in Indonesia, the highest mortality rate due to COVID-19 involves age, gender and comorbidities such as diabetes mellitus. Severity of the condition also refers to coagulation abnormalities, such as abnormal prothrombin time values. Methods This systematic review study and meta-analysis used online literature sourced from PubMed, Science Direct, EBSCO, Cochrane and Google Scholar. The literature used here is literature that has data on age, sex and prothrombin time of COVID-19 patients with diabetes mellitus whose quality is assessed by the NOS (Newcastle-Ottawa Scale) criteria and processing data using Review Manager 5.4. Results Out of 8711 literatures that were traced from various search sources, there were 45 literatures that were included in this study. The results of the analysis on age showed the Standardized Mean Difference (SMD) value of 0.45 and P &lt;0.0001 (95% CI: 0.23–0.68), the gender analysis showed an Odds Ratio (OR) value of 3.28 and P = 0.01 (95% CI: 1.26–8.52) and the prothrombin time analysis showed SMD values of 0.41 and P = 0.07 (95%CI = -0.03–0.85). Conclusion Patients with COVID-19 who have DM have a higher risk compared to those without DM. Among COVID-19 patients with DM admitted to hospitals, they were older compared to those without DM and prothrombin time values similar but slightly higher in COVID-19 patients with DM.

Changes in blood biochemistry thrombosis parameters 24 hours after stent-assisted endovascular treatment of intracranial aneurysms.

This study aims to elucidate the early changes in blood biochemistry thrombosis parameters following stent-assisted endovascular treatment of intracranial aneurysms. Consecutive patients with unruptured aneurysms undergoing stent implantation during endovascular treatment were included in this prospective study with approval from the local ethics committee. Blood samples were collected immediately before and 24 h after the procedure for biochemical analysis, including basic thrombosis indicators, bleeding tests, and a complete blood count. The study included 80 patients (60 women, 20 men) with 134 aneurysms. A total of 135 stents (110 flow-diverting, 25 standard) were used. Additionally, intrasaccular coiling was utilized in 28 aneurysms among 27 patients. Following the procedure, there was a significant decrease in activated partial thromboplastin time, fibrinogen, hemoglobin, and platelet levels, and a significant increase in prothrombin time, D-dimer, von Willebrand factor (vWF) activity/antigen ratio, and leukocyte levels in all patients. Correlation analyses revealed significant positive associations between platelet and fibrinogen levels, and a negative association between D-dimer and fibrinogen levels in the coil (-) group. Additionally, there was a significant negative correlation between aneurysm volume and vWF activity/antigen ratio, and procedure duration and thrombocyte count, while a positive association was found between aneurysm number and leukocyte count in the coil (-) group. Analysis of blood chemistry alterations indicates that intravascular thrombosis occurs in the intracranial circulation following stent-assisted endovascular treatment of intracranial aneurysms. This thrombotic process is more pronounced in patients whose aneurysms were left open (i.e. flow-diverting stent alone).

Designing 3D-printed concrete structures with scaled fabrication models

This article proposes using scaled fabrication models to assist the design research of 3D-printed discrete concrete structures where full-scale fabrication tests are costly and time-consuming. A scaled fabrication model (SFM) is a scaled model 3D-printed the same way as in actual construction to reflect its fabrication details and acquire alike layer line textures. The components of a 1:10 SFM can be easily produced by consumer-level desktop 3D printers with minimal modification. SFMs assist the design communication and make possible quick tests of distinct fabrication designs that are hard to assess in digital modeling during the conceptual design phase. A case study of a discrete compression-dominant funicular floor derived from graphic statics is presented to illustrate the contribution of SFM to the design research of force-informed toolpathing where the printing direction of a component is aligned to the principal stress line. The design iterations encompass a sequence of component, partial, and full model SFM printing tests to explore and optimize the fabrication schemes where parallel, non-parallel, and creased slicing methods to create toolpaths are compared and chosen to adapt different discrete components.

Predictors of Mortality in Crimean-Congo Hemorrhagic Fever Patients Admitted at a Tertiary Care Hospital in Pakistan over the Last 10 Years: A Case-Control Study.

The objective was to identify predictors of mortality in hospitalized patients with Crimean-Congo hemorrhagic fever (CCHF). A case-control study was conducted on patients hospitalized with CCHF from 2012 to 2022. Risk factors for mortality in CCHF patients were analyzed using logistic regression. A total of 86 patients with a median age of 36 years (interquartile range [IQR], 27-36 years) were included, and the majority were males (78, 90.7%). Thirty-one patients (36%) were cases, whereas 55 (64%) were control patients. Based on univariate logistic regression analysis, patients who were in an age group of ≥40 years (odds ratio [OR]: 4.85; 95% CI: 1.8-12.4) or with presence of gum bleeding (OR: 2.66; 95% CI: 1.0-6.8), unit increase in white blood cell count (WBC) (OR: 1.09; 95% CI: 1.00-1.07), serum glutamate-pyruvate transaminase of ≥500 U/L (OR: 3.68; 95% CI: 1.4-9.3), serum glutamic-oxaloacetic transaminase (SGOT) of ≥1,000 U/L (OR: 8.72; 95% CI: 2.6-28.3), prothrombin time (PT) of ≥120 seconds (OR: 9.85; 95% CI: 3.2-29.8), international normalized ratio of ≥5 (OR: 15.8; 95% CI: 2.0-125.3), or acute respiratory distress syndrome (ARDS) (OR: 28.27; 95% CI: 5.84-136.9) were found to be significantly associated with mortality in CCHF. Factors found to be independently associated with mortality on multivariate analysis included ARDS (adjusted OR [aOR]: 27.7; 95% CI: 4.0-190.5), unit increase in WBC (aOR: 1.02; 95% CI: 1.02-1.26), SGOT of ≥1,000 U/L (aOR: 23.6; 95% CI: 2.32-241.7), and PT of ≥120 seconds (OR: 10.2; 95% CI: 2.00-52.4). CCHF is a rare but fatal disease, and patients with ARDS and increased WBC, high SGOT level, and increased PT indicative of liver injury and coagulopathy at the time of hospitalization are at high risk for mortality.

Risk factors for secondary infection after liver failure and effect of comprehensive nursing intervention.

In patients with liver failure (LF), the high rate of secondary infections, which are associated with poor prognosis, highlights the clinical significance of understanding the underlying risk factors and implementing targeted intervention programs. To investigate risk factors for secondary infections in patients with LF and evaluate the effectiveness of comprehensive nursing interventions. This retrospective study included 64 patients with LF, including 32 with and 32 without secondary infections. A questionnaire was used to collect data on age; laboratory parameters, including total and direct bilirubin, prothrombin time, blood ammonia, and other biochemical parameters; invasive procedures; and complications. Patients with secondary infections received comprehensive nursing intervention in addition to routine nursing care, whereas those without secondary infections received only routine nursing care to compare the effect of nursing intervention on outcomes. The infection rate, which was not associated with age or complications, was significantly associated with biochemical parameters and invasive procedures (P < 0.05). The infection rate was 61.6% in patients who had undergone invasive procedures and 32.1% in those who had not undergone invasive procedures during the hospital stay. The infection rate was also significantly associated with the type of LF (P < 0.05), with the lowest rate observed in patients with acute LF and the highest rate observed in those with subacute LF. The nursing satisfaction rate was 58.3% in the uninfected group and 91.7% in the infected group, indicating significantly higher satisfaction in the infected group (P < 0.05). In patients with LF, the rate of secondary infections was high and associated with biochemical parameters and type of LF. Comprehensive nursing intervention can improve patient satisfaction.

An Investigative Study of Prothrombin Time, Activated Partial Thromboplastin Time and Antithrombin Levels in Patients with Ischaemic Stroke

Background: The haemostatic system maintains a balance between prothrombotic and antithrombotic components in the body. The role of this system in ischaemic stroke is not certain. Objective: Prothrombin time (PT) and Activated Partial Thromboplastin Time(APTT) are widely used screening tests to assess the haemostatic cascade. We sought to evaluate the relevance of these test and antithrombin (AT) levels in patients with ischaemic stroke. Methods: AT, platelet count, PT and APTT tests were carried out for 65 patients with ischaemic stroke and 65 controls with no history of stroke. Results: The mean age of stroke subjects was 60.4 ± 12.3yrs. PT and APTT in the test and control groups were similar and Antithrombin levels did not show significant difference. But there was a significant association between functional AT deficiency and diabetes mellitus in the ischaemic stroke group. A significant negative correlation existed between functional AT activity and prothrombin and between AT Ag levels and APTT Conclusion: There was no difference in the Antithrombin levels, PT and APTT values in patients with ischaemic stroke and those without a history of stroke and carrying out these tests routinely to assess hypercoagulable states in ischaemic stroke patients may not have any diagnostic value in our population.