Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective:To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.Methods:This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022.Coagulation tests including prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(aPTT),fibrinogen,and D-dimer were performed.Patients were monitored for bleeding manifestations.Results:Coagulation abnormalities were reported in 42.8%of the patients.Overall,prolonged aPTT was the most common coagulation abnormality(40.8%),followed by low fibrinogen(38.7%),raised D-dimer(31.2%),raised INR(26.0%)and prolonged PT(19.2%).Bleeding manifestations were present in 19.9%patients.PT,INR,aPTT and D-dimer levels were significantly higher(P<0.01)and fibrinogen level was significantly lower(P<0.001)in patients with bleeding compared to patients without bleeding.Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding(P<0.01).Conclusions:Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding.Patients with dengue should be assessed for coagulation abnormalities.

Pregnancy Complicated With a Giant Pancreatic Tumor and Decompensation of Liver Cirrhosis:A Case Report and Literature Review

Pregnancy with solid pseudopapillary tumor of the pancreas(SPTP)is rare.Because pregnancy hormones may cause tumor progression,the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment.We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP.Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis.Medical termination of pregnancy was performed.The patient has lived with the tumor until now without surgery.We retrieved the published case reports,summarized the clinical characteristics of pregnancy with SPTP,and explored its management during the perinatal period.Most patients with SPTP have a good prognosis with good maternal and fetal outcomes,and it is important to choose an appropriate treatment method and timing.However,pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.

Protective Effect of Tanshinone Ⅱ A on Lipopolysaccharide-induced Lung Injury in Rats

Objective To explore the protective effect of tanshinone Ⅱ A on lipopolysaccharide （LPS）-induced lung injury in rats, and possible mechanism. Methods： LPS （O111： B4） was used to produce a rat model of acute lung injury. Sprague-Dawley rats were randomly divided into 3 groups （8 in each group）： the control group, the model group （ALl group）, and the tanshinone Ⅱ A treatment group. Expression of adhesion molecule CD18 on the surface of polymorphonuclear neutrophil （PMNCD18） in venous white blood cells （WBC）, and changes in coagulation-anticoagulant indexes were measured 6 h after injection of LPS or normal saline. Changes in malondialdehyde （MDA） content, wet and dry weight （W/D） ratio and morphometry of pulmonary tissue as well as PMN sequestration in the lung were also measured. Results： （1） When compared with the control group, expression of PMNCD18 and MDA content were enhanced in the ALl group with a hypercoagulable state （all P〈0.01） and an increased W/D ratio （P〈0.05）. Histopathological morphometry in the lung tissue showed higher PMN sequestration, wider alveolar septa; and lower alveolar volume density （Vv） and alveolar surface density （Sv）, showing significant difference （P〈0.01）. （2） When compared with the ALl group, the expression of PMN-CD18, MDA content, and W/D ratio were all lower in Tanshinone Ⅱ A treatment group （P〈0.05） with ameliorated coagulation abnormality （P〈0.01）. Histopathological morphometry in the lung tissue showed a decrease in the PMN sequestration and the width of alveolar septa （both P〈0.01）, and an increase in the Vv and Sv （P〈0.05, P〈0.01）. Conclusion： Tan Ⅱ A plays a protective role in LPS-induced lung injury in rats through improving hypercoagulating state, decreasing PMN-CD18 expression and alleviating migration, reducing lipid peroxidation and alleviating pathological changes.