Complex and prolonged hypercoagulability in coronavirus disease 2019 intensive care unit patients: A thromboelastographic study.

BACKGROUND: A high number of thrombotic complications have been reported in critically ill patients with coronavirus disease 2019 (COVID-19) and appear to be related to a hypercoagulable state. Evidence regarding detection, management, and monitoring of COVID-19-associated coagulopathy is still missing. We propose to describe the thrombus viscoelastic properties to investigate the mechanisms of hypercoagulability in patients with COVID-19. METHODS: Thromboelastography (TEG) was performed in 24 consecutive patients admitted to a single intensive care unit for COVID-19 pneumonia, and 10 had a second TEG before being discharged alive from the intensive care unit. RESULTS: Compared with a group of 20 healthy participants, patients with COVID-19 had significantly decreased values of reaction time, coagulation time, and lysis index and increased values of α angle, maximum amplitude, clot strength, and coagulation index. Velocity curves were consistent with increased generation of thrombin. These values persisted in surviving patients despite their good clinical course. DISCUSSION: In patients with COVID-19, TEG demonstrates a complex and prolonged hypercoagulable state including fast initiation of coagulation and clot reinforcement, low fibrinolysis, high potential of thrombin generation, and high fibrinogen and platelet contribution. The antithrombotic strategy in patients with COVID-19 during intensive care hospitalisation and after discharge should be investigated in further studies.

Two Cases of Leptospirosis in French Travelers Returning From Koh Samui, Thailand.

We report the first two cases of leptospirosis in French travelers returning from Koh Samui, a famous tourist island in Thailand, in September 2014 and March 2015. The first patient developed a severe form of the disease including hemodynamic instability, interstitial pneumonia, rhabdomyolysis with renal impairment, and deep thrombocytopenia. The second patient had a milder disease, with severe muscle pain, jaundice, and renal impairment. The two patients reported bathing in fresh water in Namuang waterfall.

[Role of whole-body ultrasound in severe pre-eclampsia and post-partum hemorrhage]. / Pré-éclampsie sévère et hémorragie post-partum: apport de l'échographie « corps entier ¼

PURPOSE: Management of severe pre-eclamptic patients is a challenge for the staff on obstetrical wards. We demonstrate that ultrasound applied to several organs performed at a patient's bedside gave the information required for the patient's management, without the need to transfer her to the radiology department or to call external consultants. CLINICAL FEATURES: A 29-yr-old severely pre-eclamptic patient with HELLP syndrome (hemolysis, cytolysis, thrombopenia) presented, in the post-partum period, with an occult uterine hemorrhage diagnosed with bedside abdominal/pelvic ultrasound. Ultrasound was also used to insert a central venous catheter. After undergoing a hysterectomy to control hemorrhage and receiving activated factor VII, the patient recovered uneventfully. Hemodynamic management was optimized non-invasively using pulmonary and cardiac ultrasound, when the patient developed hemorrhagic shock followed by pulmonary edema. Volume replacement was guided by cardiac ultrasound findings, and we were able to detect incipient interstitial pulmonary edema and follow its course using pulmonary ultrasound. CONCLUSION: Practitioners must be aware of the role of whole-body ultrasound in the diagnosis and treatment of complex, multi-organ conditions such as pre-eclampsia. Moreover, ultrasound helps in the management of global hemodynamics. The training of anesthesiologists in a variety of ultrasound techniques should be encouraged.