A review of COVID-19-related thrombosis and anticoagulation strategies specific to the Asian population.

The coronavirus disease 2019 (COVID-19) pandemic has placed an immense burden on healthcare systems worldwide. There is intensive research targeted at better understanding of the virus pathogenicity, development of effective treatment strategies and vaccines against COVID-19. It is increasingly being recognised that the pathogenicity of COVID-19 extends beyond the respiratory system. In severe cases, there can be widespread activation of the immune system, vascular injury and a resultant pro-thrombotic state. Severe COVID-19 is widely regarded as a risk factor for venous thromboembolism. Interim European and American guidelines have been created to guide anticoagulation strategies in COVID-19 patients. However, it is unclear if these guidelines can be extrapolated directly to Asians, in whom there are differences in the baseline risk of thrombosis and bleeding. Our review article aimed to summarise the current understanding of arteriovenous thromboembolic complications in COVID-19 and discuss management strategies for prevention and treatment of thrombotic events in Asian COVID-19 patients.

Refractory Hypotension Following Elective Total Hip Replacement Surgery in a Patient Treated With Herbal Medicine: A Case Report.

We describe refractory postoperative hypotension due to adrenal insufficiency in a patient treated with steroid-adulterated herbal medicine. A 62-year-old man underwent an elective total hip replacement. Surgery was uneventful, but he became profoundly hypotensive 8 hours later, requiring intensive care unit admission, intubation, vasopressor support, and renal replacement therapy. Subsequent workup revealed that he had been consuming a herbal medication adulterated with prednisolone. Adrenal insufficiency secondary to chronic exogenous steroids was diagnosed following cortisol measurements and an adrenocorticotropic hormone stimulation test. He responded well to steroid therapy and made a full recovery. The use of herbal medicine should not be overlooked.

The impact of multidrug resistance on the outcomes of critically ill patients with Gram-negative bacterial pneumonia.

Multidrug resistance (MDR) in Gram-negative bacteria is on the rise, but its effect on patient outcomes is not well established. The outcomes of 129 adult surgical intensive care unit (SICU) patients treated for Gram-negative pneumonia were evaluated in relation to demographics, bacterial etiology, and infections due to MDR bacteria (defined as resistant to all agents except for aminoglycosides and polymyxins). The mean (SD) age and acute physiology and chronic health evaluation (APACHE) II scores were 63.8 (14.6) years and 20.8 (8.2), respectively. Forty-one patients (31.8%) were infected with MDR bacteria. Infection-attributed mortality was associated with baseline APACHE II scores (odds ratio [OR] 1.093; 95% confidence interval [CI] 1.029-1.162), MDR (OR 4.628; 95% CI 1.533-13.973), and infection with Stenotrophomonas maltophilia (OR 13.465; 95% CI 2.896-62.614). In SICU patients with Gram-negative pneumonia, MDR was associated with a higher rate of infection-attributed mortality, after adjusting for the severity of illness. Our results warrant further investigations with a prospective study.

Anesthetic management for a five-day separation of craniopagus twins.

UNLABELLED: Craniopagus twinning is a rare form of the already uncommon entity of conjoint twins. With advances in medical technology and expertise, future attempts at surgical separation of these increasingly complex cases are likely to occur. Despite this, medical literature on the anesthetic management of these cases is sparse. The following case report details the anesthetic management and planning leading to and including the 5-dy separation of 11-mo-old craniopagus twins. The report emphasizes the importance of teamwork, communication, and advanced planning required in cases such as this. IMPLICATIONS: The following case report documents the anesthetic planning and management leading to and including a 5-day separation of twins joined at the head. This case report also details the difficulties encountered during the unique combination of a rarely performed procedure and a long operating time.