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background: Pregnancy induces a hypercoagulable state, likely as an adaptive response to sustain placental function and mitigate excessive bleeding during childbirth, but it may elevate the risk of thromboembolism in predisposed women. This study evaluated hemostatic parameters across different trimesters in normal pregnancies and compared them with those in non-pregnant women. Methods: This prospective cross-sectional study involved 148 participants. The control group of 37 non-pregnant women was matched with 37 pregnant women in each trimester (1st, 2nd, and 3rd trimesters). Hemostatic parameters assessed included prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count (PLT), and fibrinogen (Fb). Data were expressed as means and standard deviations, and statistical analyses were conducted using Student's t-test and ANOVA, with SPSS software version 19. A p-value of <0.05 was deemed significant. Results: The PT showed a significant reduction in the third trimester compared to non-pregnant controls, with a gradual decline from the first to the third trimester. The aPTT was significantly lower across all trimesters compared to non-pregnant controls. PLT significantly decreased in the second and third trimesters compared to controls. Fb levels significantly increased in all trimesters relative to non-pregnant controls. Conclusion: The findings suggest that normal pregnant Indian women exhibit changes in the coagulation system indicative of a persistent low-grade intravascular coagulation process, particularly in the third trimester. Consequently, coagulation studies are recommended for all pregnant women, especially those at risk for hypercoagulable states.

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Resumen Introducción. En Argentina la información sobre la disponibilidad de los recursos en hemostasia y trombosis es muy escasa. El grupo Promoción del Acceso a los Recursos del grupo CAHT (Cooperativo Argentino de Hemostasia y Trombosis) desarrolló un amplio relevamiento de los recursos en Argentina para conocer el estado de situación de la especialidad. Objetivos. Describir la disponibilidad de los recursos humanos y físicos (diagnósticos y terapéuticos) en hemostasia y trombosis en los centros asistenciales de Argentina en 2022 e identificar diferencias regionales y/o entre los sectores privado y público. Materiales y métodos. Estudio de cohorte transversal. Se incluyeron centros asistenciales de la República Argentina: instituciones con internación, centros ambulatorios y laboratorios. Se obtuvieron datos respecto a la disponibilidad de recursos humanos, diagnósticos, y terapéuticos en hemostasia y trombosis, en algún momento del año 2022, mediante una encuesta a profesionales de la salud. En los recursos analíticos se definió disponibilidad cuando la prueba se realizaba en la institución o se derivaba la muestra/paciente. Resultados. En el estudio se incluyeron 215 centros de 77 ciudades argentinas. El 85,5% de los centros contaban con internación. La mediana de especialistas en hematología por institución fue de 3 (RIC 1-5). Se encontraron diferencias entre las medianas de las regiones: CABA-Ciudad Autónoma de Buenos Aires-(5), Centro/Cuyo (3,5) GBA/LP-Gran Buenos Aires/La Plata-(2), NOA-Noroeste Argentino-(2), NEA-Nordeste Argentino-(1) y SUR (1). El 27% de los centros contaban con 1 ("trabajo solitario") o ningún especialista en hematología. El 59% de los centros reportaron que contaban con bioquímicos especialistas en hemostasia/hematología. La región con menor porcentaje de centros con especialistas fue GBA/LP (37%). Se observó una alta disponibilidad de pruebas básicas de la coagulación. Por el contrario, en las estudios de mayor complejidad la disponibilidad fue subóptima y se detectaron marcadas asimetrías regionales (GBA/LP, NOA y NEA presentaron la menor proporción de centros con los recursos). Algunas pruebas, como la agregación plaquetaria o el anti-factor plaquetario 4 / heparina (anti-PF4/hep), no estuvieron disponibles en amplias áreas del país. En la mayoría de los recursos terapéuticos se detectó una mayor disponibilidad en el sector privado. Conclusiones. Detectamos una disponibilidad sub-óptima de los recursos físicos de alta complejidad y disparidades público-privada y regionales. Consideramos que el establecimiento de redes integradas es una estrategia que permitirá reducir las inequidades de acceso. Desde su lugar, las sociedades científicas podrían realizar valiosos aportes para obtener esa meta.

Abstract Introduction. In Argentina, information regarding the availability of resources in hemostasis and thrombosis is very scarce. The "Grupo Promoción del Acceso" del grupo CAHT (Cooperativo Argentino de Hemostasia y trombosis) conducted an extensive survey of resources in Argentina to understand the current state of the specialty. Objectives. To describe the availability of human and physical resources (diagnostic and therapeutic) in hemostasis and thrombosis in healthcare centers across Argentina in 2022 and to identify regional differences or disparities between the private and public sectors. Materials and methods. Cross-sectional cohort study. Healthcare centers from the Argentine Republic were included: institutions with inpatient services, outpatient centers, and laboratories. Data regarding the availability of human, diagnostic, and therapeutic resources in hemostasis and thrombosis were obtained at some point during the year 2022 through surveys conducted among healthcare professionals. Availability in analytical resources was defined when the test was performed within the institution or when the sample/patient was referred elsewhere for testing. Results. The study included 215 centers from 77 cities across Argentina. 85.5% of the centers had inpatient services. The median number of hematologists per institution was 3 (IQR 1-5). Differences were found among the median numbers across regions: CABA-Ciudad Autónoma de Buenos Aires-(5), Centro/Cuyo (3.5), GBA/LP-Gran Buenos Aires/La Plata-(2), NOA-Noroeste Argentino-(2), NEA-Nordeste Argentino-(1), and SUR (1). 27% of the centers had 1 or no hematologist. 59% of the centers reported employing specialized biochemists in hemostasis/ hematology. The region with the lowest percentage of centers with specialists was GBA/LP (37%). There was a high availability of basic coagulation tests observed. Conversely, for more complex tests, availability was suboptimal and marked regional asymmetries were detected (GBA/LP, NOA, and NEA presented the lowest proportion of centers with resources). Some tests, such as platelet aggregation or anti-platelet factor 4/heparin, were not available in wide areas of the country. In most therapeutic resources, greater availability was detected in the private sector. Conclusions. We identified suboptimal availability of high-complexity physical resources and public-private and regional disparities. We believe that the establishment of integrated networks is a strategy that will help reduce access inequities. Scientific societies, from their position, can make valuable contributions to achieve this goal.

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Acute fatty liver of pregnancy (AFLP) is a condition that occurs during the third trimester of pregnancy, typically manifesting around 36 weeks of gestation. It represents a critical obstetric emergency with considerable neonatal mortality. To manage AFLP disease, a multidisciplinary approach is essential which helps meaningfully in the improvement of its prognosis during the post-partum period. Historically, it was considered a fatal disease for both mother and fetus. Nowadays, the prognosis is improved by rapid diagnosis, early delivery and administration of treatment. We reported three cases of Moroccan women diagnosed with AFLP in our hospital who received a multi-disciplinary care with good prognosis. The first and third parturient gave birth by vaginal delivery and the second one by caesarean section.

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Objective To investigate the relevant risk factors for endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis,and establish and validate a nomogram prediction model to facilitate early selection of appropriate hemostasis methods in clinical practice.Methods Clinical data of 228 elderly patients with unilateral acute epistaxis from January 2018 to December 2022 were collected.There were two groups,the electrocoagulation group(n = 112)and the conservative packing group(n = 116),based on whether they received endoscopic electrocoagulation hemostasis.Analysis was performed to explore the independent risk factors for requiring endoscopic electrocoagulation hemostasis.A nomogram prediction model was established based on the multivariate results,and receiver operator characteristic curve(ROC curve),calibration curve and clinical decision curve analysis(DCA)were used to evaluate the predictive performance and consistency of the model.Results According to the research results,the univariate analysis showed that age,hypertension,cardiovascular disease,anticoagulant use,and bleeding site were associated with endoscopic electrocoagulation hemostasis(P<0.05).The multivariate binary Logistic regression analysis revealed that older age,the presence of hypertension,long-term use of anticoagulants,and bleeding sites located in the posterior nasal region or unknown location were associated with a higher likelihood of undergoing endoscopic electrocoagulation hemostasis(P<0.05).Based on these independent risk factors,a nomogram model for predicting endoscopic electrocoagulation hemostasis for acute epistaxis in elderly patients was established,the area under the curve(AUC)was 0.856(95%CI:0.805～0.907).The calibration curve and DCA showed that the use of the nomogram model could benefit patients over a wide range of diagnostic threshold probabilities.Conclusion A nomogram model based on age,hypertension,anticoagulant use,and bleeding site to predict the risk of endoscopic electrocoagulation hemostasis in elderly patients with acute epistaxis has a good predicted performance.

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Objective:To investigate the clinical effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding.Methods:A total of 150 patients with cerebral infarction complicated by stress-induced gastrointestinal bleeding who were admitted to the Intensive Care Unit of Lishui City People's Hospital from October 2020 to October 2021 were included in this study. These patients were randomly divided into a control group and an observation group using the random number table method, with 75 patients in each group. Patients in the control group received routine clinical treatment, while those in the observation group received endoscopic injection of norepinephrine in addition to routine clinical treatment. The hemostatic time, blood transfusion volume, and length of hospital stay were compared between the two groups. The stress index and inflammatory index were compared between the two groups before and after treatment. The hemostatic effect and adverse reactions were evaluated in each group.Results:The hemostatic time, blood transfusion volume, and length of hospital stay in the observation group were (16.16 ± 4.36) hours, (385.35 ± 41.28) mL, and (5.35 ± 1.28) days, respectively, which were significantly shorter or less than (27.27 ± 6.34) hours, (447.07 ± 32.07) mL, and (7.07 ± 2.07) days in the control group ( t = 12.50, 10.22, 6.12, all P < 0.001). After treatment, the levels of cortisol, norepinephrine, antidiuretic hormone, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-α in the observation group were (288.33 ± 19.53) mmol/L, (29.17 ± 4.26) μg/L, (4.08 ± 1.08) mU/L, (38.27 ± 8.72) ng/L, (6.69 ± 1.35) μg/L, and (6.37 ± 1.51) mg/L, respectively, which were significantly lower than (327.22 ± 22.01) mmol/L, (39.32 ± 5.54) μg/L, (5.36 ± 1.22) mU/L, (51.24 ± 13.23) ng/L, (8.67 ± 2.29) μg/L, and (11.44 ± 3.13) mg/L in the control group ( t = 11.44, 12.57, 6.80, 7.08, 6.45, 12.63, all P < 0.001). The overall response rate of hemostasis in the observation group was 94.67% (71/75), which was significantly higher than 82.67% (62/75) in the control group ( χ2 = 5.37, P < 0.05). The incidence of adverse reactions in the observation group was 8.00% (6/75), which was slightly, but not significantly, lower than 14.67% (11/75) in the control group ( χ2 = 1.66, P > 0.05). Conclusion:Endoscopic injection of norepinephrine for the treatment of cerebral infarction complicated by stress-induced gastrointestinal bleeding can rapidly stop bleeding, effectively reduce inflammation,improve stress index, and be highly safe.

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@#Objective To evaluate the short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. Methods The patients undergoing modified Bentall procedure with the remnant aortic wall as a sleeve to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis between March 2021 and March 2022 in Shenzhen Fuwai Hospital were enrolled. Short-term results were assessed by cardiopulmonary bypass time, aortic clamping time, mechanical ventilation time, ICU stay, postoperative hospital stay, effusion drainage on the first postoperative day, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), and follow-up results. Results A total of 14 patients were collected, including 12 males and 2 females, with a mean age of 55.33±10.57 years. There was no postoperative or follow-up death. Cardiopulmonary bypass time was 147.90±21.29 min, aortic clamping time was 115.70±15.23 min, mechanical ventilation time was 19.42±8.98 h, ICU stay was 99.08±49.42 h, and postoperative hospital stay was 16.33±2.74 d. Thoracic drainage volume was 333.33±91.98 mL on the first postoperative day. Only 2 patients required blood transfusion (4.5 U and 2 U, respectively). During the follow-up of 6.17±3.69 months, there was no death, no aortic or valve-related complications. There was statistical difference in the LVEDD between preoperation and before discharge after surgery (P＜0.001), and between half a year after surgery and before discharge after surgery (P＜0.001). There was a little decrease of LVEF before discharge after surgery compared with preoperative LVEF, but there was no statistical difference (P=0.219). There was no statistical difference in the LVEF half a year after operation compared with that before operation (P=1.000). Conclusion Sleeve wrapping technique using remnant aortic wall in modified Bentall procedure has good short-term results. This modification may be a simple, effective way in controlling proximal bleeding.

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Perioperative bleeding is closely related to the prognosis of patients, and massive blood loss can lead to serious adverse events. Tranexamic acid, a lysine derivative, exerts anti-fibrinolytic effects by competitively blocking lysine binding sites on plasminogen to achieve hemostasis. Perioperative use of tranexamic acid can effectively reduce the risk of bleeding and the need for blood transfusion, and reduce the risk of bleeding related complications and death. At present, the use of tranexamic acid for perioperative hemostasis is increasingly widespread, and it is gradually entering the consensus and guidelines in more surgical fields. In this paper, the mechanism of action, perioperative application and adverse reactions of tranexamic acid were reviewed, and the effectiveness and safety of tranexamic acid in different surgical types were discussed, so as to provide reference for the application and research of tranexamic acid in China.

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Abstract Hemostasis is a complex set of biological processes responsible for blood fluidity within normal vessels and for the physiological interruption of bleeding in cases of vascular injury. Bothrops moojeni snake venom is rich in bioactive compounds of pharmacological and clinical interest since its protein components are capable of interfering with many points of the hemostatic process. Here, we present the B. moojeni venom proteins that affect hemostasis and discuss their pharmacological and clinical potential. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Data were obtained from the CAPES Journal Portal database, using the terms "Bothrops" AND "hemostasis", in a search for scientific articles made available in the last 20 years. Many components isolated from B. moojeni snake venom are characterized for their effect on hemostasis and possible application in the diagnosis and treatment of hemostatic disorders.

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Introduction : La thrombopénie est la deuxième cause de troubles sanguins pendant la grossesse après l'anémie. Elle complique 7 à 10 % des grossesses et expose la gestante à un risque hémorragique de degré variable. Les étiologies sont multiples. Elle peut parfois entraîner une hémorragie post-partum (HPPI) mettant en jeu le pronostic vital maternel et fœtal, nécessitant ainsi une admission en réanimation obstétricale pour une surveillance rapprochée. Objectif : Étudier l'épidémiologie de la thrombopénie chez les patientes hospitalisées en réanimation obstétricale au CHU-MEL de Cotonou. Patientes et méthode : Il s'agissait d'une étude analytique avec collecte rétrospective des données sur une période d'un an (du 1er janvier au 31 décembre 2020). Un échantillon a été sélectionné parmi les gestantes ayant réalisé une numération formule sanguine (NFS) complète. Résultats : Parmi les 1 174 gestantes suivies au CHU-MEL durant la période d'étude, nous avons enregistré 199 cas de thrombopénie, soit une prévalence de 17 %. L'âge moyen des patientes était de 28 ans, avec des extrêmes allant de 14 à 41 ans. Les patientes étaient majoritairement des paucigestes (45,71 %) et des paucipares (31,2 %). Des antécédents d'HPPI ont été notés chez une gestante et de pré-éclampsie sévère chez 16 gestantes (8 %), avec des cas référés dans 64,8 % des cas. Les principales causes de thrombopénie étaient : la thrombopénie gestationnelle (67,8 %), la pré-éclampsie sévère et ses complications (22,1 %), le paludisme (3,5 %), le syndrome HELLP (2,5 %), la thrombopénie d'origine virale (2 %) et le purpura thrombopénique idiopathique (1,5 %). Les suites de couches et les suites opératoires ont été marquées par l'anémie sévère dans 12,6 % des cas, l'hypertension artérielle sévère persistante dans 9 % et l'HPPI dans 3 %. Le taux de létalité périnatale était de 20,6 %. L'abstention thérapeutique a été observée dans 82,9 % des cas, tandis que 17,1 % des patientes ont bénéficié d'une prise en charge médicamenteuse, incluant des produits sanguins labiles. Les moyens chirurgicaux utilisés étaient principalement la césarienne (44,2 %) et l'hystérectomie d'hémostase. Conclusion : La thrombopénie est une complication fréquente de la grossesse au Bénin. Le diagnostic repose sur la numération formule sanguine (NFS). Un suivi rigoureux de la grossesse, du début jusqu'à l'accouchement, permet d'identifier et de traiter certaines étiologies à haut risque.

Introduction: Thrombocytopenia is the second most common cause of blood disorders in pregnancy, after anemia. It complicates 7 to 10% of pregnancies and exposes the pregnant woman to a hemorrhagic risk of variable severity. There are multiple etiologies. Thrombocytopenia can sometimes lead to post-partum hemorrhage (PPH), which may be life-threatening for both the mother and fetus, requiring their admission to obstetric intensive care for close monitoring. Objective: To study the epidemiology of thrombocytopenia during pregnancy at the University Hospital of the Mother and Child Lagoon (CHU-MEL) in Cotonou. Patients and Methods: This was an analytical study with retrospective data collection over a period of one year (January 1 to December 31, 2020). The sample was selected from pregnant women who had undergone a complete blood count (CBC). Results: Among the 1,174 pregnant women followed at CHU-MEL during the study period, we recorded 199 cases of thrombocytopenia, yielding a prevalence of 17%. The mean age of the patients was 28 years, with extremes ranging from 14 to 41 years. The patients were predominantly paucigravida (45.71%) and paucipara (31.2%). A history of post-partum hemorrhage (PPH) was noted in one patient and severe pre-eclampsia in 16 patients (8%), with 64.8% being referred. The main causes of thrombocytopenia were: gestational thrombocytopenia (67.8%), severe pre-eclampsia and its complications (22.1%), malaria (3.5%), HELLP syndrome (2.5%), viral origin thrombocytopenia (2%), and idiopathic thrombocytopenic purpura (ITP) (1.5%). Postpartum and postoperative follow-up was characterized by severe anemia (12.6%), persistent severe hypertension (9%), and PPH (3%). The perinatal mortality rate was 20.6%. Treatment abstention was observed in 82.9% of cases, while 17.1% received medication and labile blood products. Surgical interventions included cesarean section (44.2%) and hemostatic hysterectomy. Conclusion: Thrombocytopenia is a frequent complication of pregnancy in Benin and is diagnosed by a complete blood count (CBC). Proper follow-up of pregnancy from early stages to delivery allows for the identification and management of high-risk etiologies.

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Abstract Hemostasis plays a critical role in surgical procedures and is essential for a successful outcome. Advances in hemostatic agents offer new approaches to controlling bleeding thereby making surgeries safer. The appropriate choice of these agents is crucial. Volume replacement, another integral part of Patient Blood Management (PBM), maintains adequate tissue perfusion, preventing cellular damage. Individualization in fluid administration is vital with the choice between crystalloids and colloids depending on each case. Colloids, unlike crystalloids, increase oncotic pressure, contributing to fluid retention in the intravascular space. Understanding these aspects is essential to ensure safe and effective surgery, minimizing complications related to blood loss and maintaining the patient's hemodynamic status.

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Introducción: Entre los Lepidoptera, pertenecientes a la clase Insecta solo las formas larvales del género Lonomia pueden causar reacciones sistémicas en humanos. Hasta el momento, solo dos especies se han relacionado formalmente con accidentes por envenenamiento: Lonomia achelous y Lonomia obliqua. Su veneno está compuesto por proteínas, serina proteasas y otros componentes con actividad inflamatoria, procoagulante y hemolítica. Objetivo: Describir un caso de síndrome hemorrágico asociado a contacto con Lonomia achelous. Intentando así proveer información sobre una condición de gran relevancia clínica y sanitaria para la región de Latinoamérica. Caso clínico: Paciente de 12 años, proveniente de área rural, sin antecedentes familiares o personales de relevancia, quien posterior a contacto con oruga en antebrazo izquierdo, presentó dolor local, fiebre, hematomas en región submentoniana, extremidad superior derecha y en ambas extremidades inferiores. En analítica sanguínea, se evidenciaron tiempos de coagulación prolongados. Por lo que se consideró el diagnóstico accidente lonómico. Se administraron 2 unidades de plasma fresco congelado y ácido ε-aminocaproico, presentando mejoría clínica y analítica progresiva, con normalización de los parámetros de coagulación al quinto día de su ingreso. Conclusiones: Para su diagnóstico fue importante el cuadro clínico presentado por el paciente junto con la observación de la oruga. La administración de suero antilonómico es el tratamiento recomendado en Brasil, sin embargo, en este caso se obtuvieron buenos resultados con la administración de ácido ε-aminocaproico. Dada su presentación en diferentes países de Latinoamérica, es importante proveer de conocimiento a los profesionales de salud sobre su diagnóstico y manejo terapéutico.

Introduction: Among the Lepidoptera, belonging to the class Insecta, only the larval forms of the genus Lonomia can cause systemic reactions in humans. So far, only two species have been formally linked to poisoning accidents: Lonomia achelous and Lonomia obliqua. Its venom is composed of proteins, serine proteases, and other components with inflammatory, procoagulant, and hemolytic activity. Objective: Describe a case of hemorrhagic syndrome associated with contact with Lonomia achelous. Thus, trying to provide information on a condition of great clinical and health relevance for the Latin American region. Clinical case: A 12-year-old patient, from a rural area, with no relevant family or personal history, who after contact with a caterpillar on the left forearm, presented local pain, fever, bruising in the submental region, right upper extremity and both lower extremities. In blood analysis, prolonged coagulation times were evidenced. Therefore, the diagnosis was considered lonomic accident. Two units of fresh frozen plasma and ε-aminocaproic acid were administered, presenting progressive clinical and analytical improvement, with normalization of coagulation parameters on the fifth day after admission. Conclusions: For its diagnosis, the clinical manifestations presented by the patient with the observation of the caterpillar was important. The administration of antilonomic serum is the recommended treatment in Brazil, however, in this case good results were obtained with the administration of ε-aminocaproic acid. Due to his presentation in different Latin American countries, it is important to provide health professionals with knowledge about its diagnosis and therapeutic management.

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Resumen: Introducción: Las pruebas de coagulación carecen de valor para determinar el riesgo de sangrado perioperatorio. Material y métodos: Se realizó un estudio observacional, descriptivo, y transversal en 2,114 pacientes en la consulta de Anestesiología del Hospital Universitario «Dr. Celestino Hernández Robau¼, los resultados se evaluaron mediante estadística descriptiva. Resultados: El tiempo de coagulación y sangrado se realizó en 100% de los casos y el conteo de plaquetas en 93.99%, mientras que el tiempo de protrombina y tiempo de tromboplastina parcial activado se efectuó en 66.27 y 55.62% de los casos respectivamente. De 8.834 exámenes realizados se encontraron 49 alterados en 0.55%. Los pacientes con exámenes alterados fueron 33 en 1.56%, los enfermos en riesgo de sangrado por exámenes de coagulación fueron 30 en 1.42% y los pacientes en riesgo sin antecedentes de sangrados detectados por exámenes de coagulación fueron tres en 0.14%. Se reportó sangrado perioperatorio en 16 pacientes en 0.76%, siete pacientes con interrogatorio positivo y exámenes normales y nueve pacientes con interrogatorio negativo y exámenes normales. Conclusiones: La historia clínica y el examen físico del paciente son las mejores herramientas para predecir el riesgo de sangrado quirúrgico y los exámenes aislados de coagulación no constituyen un buen predictor del sangrado perioperatorio.

Abstract: Introduction: Coagulation tests are no value to determine the risk of perioperative bleeding. Material and methods: An observational descriptive cross-sectional study was carried out in 2,114 patients in the anesthesiology consultation of the University Hospital «Dr. Celestino Hernández Robau¼. Results: The clotting and bleeding time was performed in 100% of cases, the platels count in 93.99%. While the prothrombin time and activated partial tromboplastin time were performed in 66.27 and 55.62% respectively. Of 8,834 tests carried out, 49 were found to be altered for 0.55%. Patients with altered tests were for 1.56%, patients at risk of bleeding from coagulation tests were 30 for 1.42% and patients at risk with no history of bleeding detected by coagulation tests were three for 0.14%. Perioperative bleeding was reported in 16 patients for 0.76%, seven patients with positive questioning and normal tests and nine patients with negative questioning and normal tests. Conclusions: The patient's medical history and physical examination are the best tools to predict the risk of surgical bleeding and isolated coagulation tests do not constitute a good predictor of perioperative bleeding.

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Aim: The study intents to compare the safety & ef?cacy of topical application versus intranasal injection of epinephrine during endoscopic sinus surgery(ESS) under general anaesthesia(GA) Materials and Methods: This is a tertiary hospital based ,1 year prospective study conducted in 200 patients randomly divided into 2 groups,with group I receiving topical application of 1:2000 epinephrine and group II receiving intranasal in?ltration of 1:1,00,000 epinephrine,within age group of 10-60 years of both sexes who underwent ESS at GGH,Kurnool from January 2022 to December 2022.Intraoperative hemostatic and hemodynamic parameters following topical application and intranasal injection of epinephrine were analyzed Results: There were no signi?cant hemodynamic changes or electrocardiographic abnormalities following topical application of 1:2000 epinephrine.There was increase in heart rate,Systolic and Diastolic blood pressure and mean arterial pressure following intranasal injection of epinephrine in study population(P<0.001).12% of study population developed electrocardiogram variation in form of sinus tachycardia following local in?ltration with 1:1,00,000 epinephrine.Using a standardised scale -Fromme-Boezaart grading to assess hemostasis,no statistical difference in the 2 groups was observed(P>0.05) Conclusion: Topical application of 1:2000 dilution of epinephrine gives similar hemostatic effects compared to intranasal in?ltration of 1: 1,00,000 dilution of adrenaline during ESS,and is safe due to no signi?cant hemodynamic abnormalities and thus we can avoid the systemic adverse events such as tachycardia,arrhythmia and mean arterial pressure changes due to epinephrine in?ltration

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Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure with a high risk of complications. Hepatic subcapsular hematoma is an infrequent complication, with few cases reported in the international literature. Treatment can be conservative with the patient under close surveillance in an intensive care unit and surgical management is reserved for failure of conservative treatment and cases with hemodynamic instability. We present a case of subcapsular and intraparenchymal hepatic hematoma in an adult male who presented sudden hemodynamic instability, associated with hemoglobin decrease, which required surgical management. The challenge in the therapeutic decision due to sudden hemodynamic instability is clearly demonstrated; therefore, there was a need for surgical treatment as the best measure of hemorrhage control. Conservative management should be reserved for hemodynamically stable patients and invasive management by interventional radiology or surgery for cases of acute abdomen associated with hemodynamic instability.

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El manejo del sangrado en CEF es fundamental, ya que aumenta la tasa de complicaciones. El principal objetivo del manejo perioperatorio es lograr una buena hemostasia, es por esto que se realizó una revisión de las principales recomendaciones de la literatura internacional, que incluye medidas preoperatorias, intraoperatorias y postoperatorias.

Bleeding is an important factor in FESS since it increases the rate of complications. The main objective of perioperative management is to achieve good hemostasis. This is a review of the main recommendations of the international literature, that includes preoperative, intraoperative and postoperative measures.

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Bites of Bitis Rhinoceros (Viperidae) usually cause a hemorrhagic syndrome in the victims. This is a medical emergency. Antivenom immunotherapy remains effective. However, its availability and cost still limiting its use in Africa in general and in Côte d'Ivoire particularly. The roots of a plant of the Annonaceae family (Annona senegalensis) are used in Côte d'Ivoire to treat cases of envenomations by Viperidae. The objective of this work is to study the modulation of the effect of Bitis rhinoceros venom on coagulation parameters by the hydroethanol extract of Annona senegalensis leaves. The phytochemical study of the plant was carried out by monitoring effect of the venom on three blood coagulation parameters (PT, APTT, Fibrinogen) from healthy individuals in the presence and absence of the hydro-ethanolic extract. Phytochemistry revealed the presence of saponins, tannins, and polyphenolic compounds including flavonoids in this plant. The study of the effect of the venom showed that at the concentration of 10-2 mg/mL the venom of Bitis rhinoceros modifies some coagulation parameters by the decrease of half of the prothrombin rate, the increase of the coagulation time. It has no effect on the fibrinogen level. The effect of this venom is inhibited by 1 mg/mL of the hydroethanol extract. The leaves of Annona senegalensis contain molecules that could neutralize the action of the venom in the coagulation disorder.

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Epistaxis is a common otorhinolaryngological emergency with complex etiological factors and varied clinical manifestations. The key to epistaxis treatment is accurate diagnosis and adequate hemostasis. Electrocoagulation is a reliable, safe and effective treatment for epistaxis. However, there are still several deficiencies in application of the commonly used electrocoagulation surgical products. This paper introduces a new type of radiofrequency head incorporating the dynamic circulatory functions of drip, irrigation, hemostasis and aspiration. We aim to achieve noninvasive, effective and accurate hemostasis in the treatment of epistaxis or nasal sinus surgery.

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Objective:To Explore the value of prolonging compression hemostasis time in reducing bleeding related complications after ultrasound guided percutaneous renal biopsy.Methods:A retrospective analysis was conducted on the clinical data of 405 patients who underwent ultrasound guided percutaneous renal biopsy at the Guangzhou First People′s Hospital. Three groups were divided based on whether to immediately compress and stop bleeding after renal biopsy and the compression time. The group A was treated with no compression and stop bleeding, the group B was treated with compression and stop bleeding for 2 minutes, and the group C was treated with compression and stop bleeding for 5 minutes. The patient′s gender, age, preoperative blood pressure, coagulation, hemoglobin, platelets, and other indicators were recorded. The number of punctures and the immediate postoperative perirenal hematoma and bleeding at the puncture site were recorded. The perirenal hematoma and gross hematuria were re-examined 24 hours after surgery.Results:Compared with the group A and the group B, the incidence of postoperative bleeding related complications in the group C was lower. The incidence of perirenal hematoma 24 hours after surgery in the group A was 62.09%, the group B was 62.50%, and the group C was 44.09%, with a statistically significant difference ( P=0.003); The incidence of gross hematuria 24 hours after surgery in the group A was 8.79%, the group B was 7.29%, and the group C was 1.57%, with a statistically significant difference ( P=0.030). The incidence of immediate postoperative perirenal hematoma in the group A was 52.20%, 53.12% in the group B, and 38.58% in the group C, with a statistically significant difference ( P=0.033). Conclusions:Immediate compression hemostasis for 5 minutes after ultrasound guided percutaneous renal biopsy can effectively reduce postoperative perirenal hematoma and gross hematuria, alleviate postoperative pain, shorten bed rest time, and improve surgical safety.

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Rapid and effective hemostasis and wound healing are essential for life saving and improved quality of life. At present, traditional materials for hemostasis and wound healing have limited effects, with limitations such as unsatisfactory tissue adhesion effect, immunogenicity, secondary damage and infection risk, so it is urgent to develop new and efficient materials. Protein-based hydrogels have attracted more and more attention in the field of hemostasis and wound healing because of their good biocompatibility, biodegradability, injectability, adjustable mechanical properties and wet bonding. The authors review the definition of protein-based hydrogels and the research progress in various protein-based hydrogels in promotion of hemostasis and wound healing, in order to provide a reference for the application of protein-based hydrogels in wound repair.

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Objective To explore the effect of endoscopic hemostasis combined with octreotide on hemodynamics and clinical outcome of patients with acute upper gastrointestinal bleeding.Methods From January 2019 to June 2022,80 patients with acute upper gastrointestinal bleeding in Xinyu Yinhe Hospital of Jiangxi Province,and according to random number table method,40 cases each in the control group and 40 cases in the observation group.The control group was treated with conventional endoscopic,while the observation group was treated with octreotide on this basis.The clinical efficacy,high sensitivity C-reactive protein(hs-CRP),cortisol(Cor)levels and hemodynamic changes[cardiac output(CO),heart rate(HR),mean arterial pressure(MAP)]were compared between the two groups.Results The total effective rate of the observation group was significantly higher(P<0.05).After treatment,hs-CRP and Cor levels in 2 groups were lower than before,and hs-CRP and Cor levels in observation group were significantly lower(P<0.05).After treatment,the levels of CO,HR and MAP in the two groups were decreased,and the levels of CO,HR and MAP in the observation group were significantly lower(P<0.05).Conclusion Endoscopic hemostasis combined with octreotide can promote the hemodynamic indexes of patients with acute upper gastrointestinal bleeding to return to normal,improve the levels of hs-CRP and Cor,and improve clinical efficacy.