Pathogenic Aspects of Inherited Platelet Disorders

Inherited platelet disorders (IPDs) constitute a large heterogeneous group of rare bleeding disorders. These are classified into: (1) quantitative defects, (2) qualitative disorders, or (3) altered platelet production rate disorders or increased platelet turnover. Classically, IPD diagnostic is based on clinical phenotype characterization, comprehensive laboratory analyses (platelet function analysis), and, in former times, candidate gene sequencing. Today, molecular genetic analysis is performed using next-generation sequencing, mostly by targeting enrichment of a gene panel or by whole-exome sequencing. Still, the biochemical and molecular genetic characterization of patients with congenital thrombocytopathias/thrombocytopenia is essential, since postoperative or posttraumatic bleeding often occurs due to undiagnosed platelet defects. Depending upon the kind of surgery or trauma, this bleeding may be life-threatening, e.g., after tonsillectomy or in brain surgery. Undiagnosed platelet defects may lead to additional surgery, hysterectomy, pulmonary bleeding, and even resuscitation. In addition, these increased bleeding symptoms can lead to wound healing problems. Only specialized laboratories can perform the special platelet function analyses (aggregometry, flow cytometry, or immunofluorescent microscopy of the platelets); therefore, many IPDs are still undetected.

Risk of Severe Bleeding With Extended Rivaroxaban to Prevent Venous Thromboembolism in Acute Medically Ill Patients With Bronchiectasis

Background: Bronchiectasis is a chronic inflammation of the bronchi with recurrent infections and hemoptysis. The MAGELLAN study compared oral rivaroxaban, 10 mg once daily (QD), for 35 ± 4 days with subcutaneous enoxaparin 40 mg QD for 10 ± 4 days followed by placebo for 25 ± 4 days to prevent venous thromboembolism in patients hospitalized with an acute medical illness. MAGELLAN included a subset of patients with bronchiectasis. In a post hoc analysis, we evaluated the incidence and severity of pulmonary bleeding in patients with bronchiectasis who were hospitalized for an acute medical illness. This analysis included MAGELLAN patients diagnosed with bronchiectasis at baseline. Patients were evaluated by treatment group for International Society on Thrombosis and Haemostasis major bleeding, non-major clinically relevant (NMCR) bleeding, and the composite of the 2 (ie, clinically relevant bleeding). Results: Medically ill patients with bronchiectasis were randomized to rivaroxaban (n = 60) or enoxaparin/placebo (n = 61). There were 2 fatal pulmonary bleeds and 1 fatal gastrointestinal bleed in the rivaroxaban arm and no fatal or major bleeding in the enoxaparin/placebo arm. The incidence of major bleeding was 5% in the rivaroxaban arm. One NMCR bleed occurred in the rivaroxaban arm and 2 NMCR bleeds occurred in the enoxaparin/placebo arm. The incidence of clinically relevant bleeding was 6.7% versus 3.3% in the rivaroxaban and enoxaparin/placebo groups, respectively (relative risk = 2.06 [95% confidence interval: 0.351-12.046]). Conclusion: In-patients hospitalized with bronchiectasis and an acute medical illness, clinically relevant bleeding, including fatal pulmonary hemorrhage, occurs more frequently with extended rivaroxaban thromboprophylaxis than with enoxaparin followed by placebo.

The history of the formation of phthisiology as a science

Humanity has been familiar with tuberculosis for a long time: the confirmation of this was found during archaeological excavations and the discovery of traces of damage to the remains of people who lived more than 5 thousand years ago. Scientists associate this fact with the high prevalence of mycobacteria among animals, as well as the extreme duration of the disease and the high degree of chronicity of the process. The first descriptions of tuberculous lesions were found in the writings of Hippocrates. The most characteristic symptom of the disease, as in the present days, was considered hemoptysis, and the extreme degree of exhaustion and pulmonary bleeding was quite typical for this category of patients. This disease was initially called consumption, or phthisi. Subsequently, it gave the name to the science that studies various clinical manifestations in the tuberculosis process, their diagnosis and treatment. Today, phthisiology is a clinical discipline that studies the etiology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis of pulmonary and extrapulmonary forms of tuberculosis, as well as the main approaches to etiotropic and pathogenetic treatment.

Viruso-bacterial pneumonia, complicated by lightness pulmonary bleeding with death

Despite the significant achievements and successes of medical science, the incidence of influenza, its complications and socio-economic damage do not decrease, remaining at a high level. In the clinic of Mechnikov North-Western State Medical University from December 2018 to February 2019, from 89 hospitalized patients with pneumonia/acute bronchitis viral etiology was determined in 29 (32%). In 27 (97%) patients it was virus A (H1N1), in 2 cases A (H3N2). 9 (31%) patients were sever and were hospitalized in intensive care unit. The case of severe viral pneumonia caused by A (H3N2) complicated by fulminant pulmonary hemorrhage with a lethal outcome is presented.

Ozone as a complement therapy in the treatment of COVID-19

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) called “coronavirus 2019” (COVID-19), has become a threat to the general population and health professionals worldwide [1]. The clinical features of COVID-19 is like that of other respiratory viruses, with specifically, fever, generally dry cough, tiredness and, in more severe cases, dyspnea, pulmonary bleeding, severe lymphopenia and renal failure [2].For diagnosis, the World Health Organization (WHO) recommends the collection of samples from the upper or lower respiratory tract. In the laboratory, the amplification of the genetic material extracted from the saliva or mucus sample is carried out by means of a reverse transcription followed by a polymerase chain reaction (RT-PCR), which involves the synthesis of a double-stranded DNA molecule from of an RNA template, in the search for conserved parts of the coronavirus genetic code. In patients with a confirmed diagnosis, the laboratory test should be repeated to assess the release of viral particles, before leaving the isolation [3]. The clinical manifestation and severity of the disease is directly related to the health condition of the infected individual. Symptoms are often mild as in a common cold or flu and it can progress to pneumonia. Ventilatory support therapy such as oxygen therapy and/or mechanical ventilation is necessary as an intervention method in the most severe cases of the disease [4]. Individuals with chronic respiratory diseases and other comorbidities can present the most severe form of COVID-19 and, for this reason, care with prevention should be emphasized [5]...

USING OF ENDOVASCULAR CATHETER METHODS IN SURGICAL TREATMENT PATIENTS WITH LUNG BLEEDING

The aim: Improve the results of the treatment of patients with pulmonary bleeding. Materials and methods: We examined 57patients with lung bleeding different etiology, who were hospitalized in the department of Thoraco-Abdominal Surgery. All patients were divided into two groups – of the main group 27patients and the comparison group 30 patients, depend of ages, sex, nosological form, level of lung bleeding. Patients aged from 27 to 78 years, including 34 men (62,5%) and 23 women (37,5%.). The test diseases includes: bronchiectasis disease – in 21 (37,1 %), pulmonary fibrosis with malformation BA – in 14 (24,7 %), abscess of the lung – in 9 (15,9 %), polycystic lung disease – in 6 (12,7 %), chronic obstructive pulmonary disease – in 5 (9,6 %). Results: As a result of complete physical examination of patients with LB, it has been established that hemorrhage was the result of obstructive bronchitis in 14 patients (42%), there was chronic obstructive pulmonary disease in 7 (21%) and bronchiectasis was diagnosed in 6 (18%) patients. In 2 (6%) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12%) patients. Conclusions: Bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases. Endovascular occlusion of bronchial arteries permits: to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumor; to perform effective endovascular hemostasis.