Coagulopathy and derangements in the coagulation parameters are significant features of COVID-19 infection, which increases the risk of disseminated intravascular coagulation, thrombosis, and hemorrhage in these patients, resulting in increased morbidity and mortality. In times of COVID-19, special consideration should be given to patients with concurrent chronic kidney disease (CKD) and COVID-19 (CKD/COVID-19 patients) as renal dysfunction increases their risk of thrombosis and hemorrhage, and falsely affects some of the coagulation factors, which are currently utilized to assess thrombosis risk in patients with COVID-19. Hence, we believe extra attention should be given to determining the risk of thrombosis and bleeding and optimizing the timing and dosage of anticoagulant therapy in this unique population of patients. CKD/COVID-19 patients are considered a high-risk population for thrombotic events and hemorrhage. Furthermore, effects of renal function on paraclinical and clinical data should be considered during the evaluation and interpretation of thrombosis risk stratification. Individualized evaluation of clinical status and kidney function is necessary to determine the best approach and management for anticoagulant therapy, whereas there is a lack of studies about the population of CKD/COVID-19 patients who need anticoagulant therapy now.
Aim: There is a correlation between the number of resected lymph nodes (LNs) and survival as well as staging in patients with colorectal cancer (CRC). This cohort discussed the effect of the number of dissected LNs on the prognosis [survival, disease-free survival (DFS)] of patients with stage II and III CRC. Methods: In this historical prospective cohort study, the records of 946 patients with CRC operated in the Seyyed-Al-Shohada hospital in Isfahan from 1998 to 2014 were enrolled. Then the impact of LNs on the overall survival (OS) and DFS were analyzed. Results: The number of removed LNs was higher among males [mean difference = 1.38, t (944) = 2.232, P-value = 0.02]. The median of the DFS for the patients with 1 to 20 LN removal was 104 months [95% confidence interval (CI): 90.97–117.03], while this number for the patients with more than 20 nodes was 166 months (95% CI: 140.41–191.58). DFS between two groups of CRCs, LN removal 1–20, and greater than 20. Age and number of LN removal were significant predictors of the DFS. There was a strong and statistically significant correlation between DFS and OS among CRC patients. Conclusions: This study shows that if the number of resected LNs in patients with CRC is more than 20, it will increase in DFS and OS.
Background: The coronavirus disease 2019 (COVID-19) presents various phenotypes from asymptomatic involvement to death. Disseminated intravascular coagulopathy (DIC) is among the poor prognostic complications frequently observed in critical illness. To improve mortality, a timely diagnosis of DIC is essential. The International Society on Thrombosis and Hemostasis (ISTH) introduced a scoring system to detect overt DIC (score ≥5) and another category called sepsis-induced coagulopathy (SIC) to identify the initial stages of DIC (score ≥4). This study aimed to determine whether clinicians used these scoring systems while assessing COVID-19 patients and the role of relevant biomarkers in disease severity and outcome. Materials and Methods: An exhaustive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Cochrane, CINAHL, and PubMed until August 2020. Studies considering disease severity or outcome with at least two relevant biomarkers were included. For all studies, the definite, maximum, and minimum ISTH/SIC scores were calculated. Results: A total of 37 papers and 12,463 cases were reviewed. Studies considering ISTH/SIC criteria to detect DIC suggested a higher rate of ISTH ≥5 and SIC ≥4 in severe cases and nonsurvivors compared with nonsevere cases and survivors. The calculated ISTH scores were dominantly higher in severe infections and nonsurvivors. Elevated D-dimer was the most consistent abnormality on admission. Conclusion: Higher ISTH and SIC scores positively correlate with disease severity and death. In addition, more patients with severe disease and nonsurvivors met the ISTH and SIC scores for DIC. Given the high prevalence of coagulopathy in COVID-19 infection, dynamic monitoring of relevant biomarkers in the form of ISTH and SIC scoring systems is of great importance to timely detect DIC in suspicious patients.
Purpose The commonly used 24‐hour collection technique has been the mainstay of diagnosis for supersaturation but has some certain limitations. Hence, superiority of multiple short urine collections as a new alternative in precipitation risk assessment was assessed compared to the standard 24‐hour urine collection among healthy subjects. Materials and Methods Individual urine samples of 26 healthy subjects were acquired every 2 to 3 hours throughout the 24 hours. Urine samples were obtained and the time and volume of each sample were recorded. Urinary constituents involved in precipitation including, sodium‐potassium, chloride, calcium, phosphate, citrate, magnesium, urea, creatinine and pH were measured. A simulated 24‐hour collection was recalculated by the totalling of all shorter urine collections volume and urinary constituents excretions throughout the day. Results Urine pH, urine creatinine and precipitation rate had a significantly lower values in 24‐hours urine collection compared to one individual value of multiple urine collections by −0.769 (P < .0001), −7.305 (P < .0001), and − 12.838 (P < .0001), respectively. However, calcium (2.697, P < .0001), citrate (3.54, P < .0001), total phosphate (19.961, P < .0001) and total creatinine (9.579, P < .0001) had statistically significantly higher values in the 24‐hours urine collection compared to individual value of multiple urine collections. Conclusion Based on the results, individual analysis of multiple shorter urine collections throughout the day improves the ability of identifying supersaturation points, precipitation risk zones and may potentially improve risk assessment compared to the 24‐hour urine collection method.
Background: One of the important causes of mortality and morbidity in kidney transplanted patients is Post Transplant Lymphoproliferative Disease (PTLD), which is due to immunosuppression therapy and viral activity. It seems that Rapamycin, with dual antineoplastic and immunosuppressive effects, may have a pivotal role in the treatment of PTLD patients and preserving transplanted kidneys. Methods and Materials: Twenty patients with PTLD were enrolled. Immunosuppressive therapy was reduced or ceased, and Rapamycin was initiated at the time of PTLD diagnosis. We evaluated the effects of switching immunosuppressive drugs to Rapamycin on graft status, the response of tumor, and 6, 12 months, and 5-year survival in patients. Results: PTLD remission was achieved in 14 patients, while six patients died; no relapse was detected in recovered patients. The median of PTLD free time was 25 months, and the mean overall survival in patients with PTLD treated by Rapamycin was 84.8 (95% CI=61.3-108.23).The five-year survival rate was 67%, 12 months survival was 73.8%, and six months' survival was 80%. The response rate to Rapamycin and immunosuppression reduction alone was 46.6%. Four out of 13 Diffuse Large B-Cell Lymphoma patients achieved a complete response just only after the reduction of immunosuppressive drugs and the consumption of Rapamycin. Conclusion: The present study demonstrated the effectiveness of conversion from immunosuppressive medication, particularly of Calcineurin inhibitors to Rapamycin in PTLD patients. However, more research is needed to confirm the Rapamycin effect on patients with PTLD.
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