Review: Viral infections and mechanisms of thrombosis and bleeding

Viral infections are associated with coagulation disorders. All aspects of the coagulation cascade, primary hemostasis, coagulation, and fibrinolysis, can be affected. As a consequence, thrombosis and disseminated intravascular coagulation, hemorrhage, or both, may occur. Investigation of coagulation disorders as a consequence of different viral infections have not been performed uniformly. Common pathways are therefore not fully elucidated. In many severe viral infections there is no treatment other than supportive measures. A better understanding of the pathophysiology behind the association of viral infections and coagulation disorders is crucial for developing therapeutic strategies. This is of special importance in case of severe complications, such as those seen in hemorrhagic viral infections, the incidence of which is increasing worldwide. To date, only a few promising targets have been discovered, meaning the implementation in a clinical context is still hampered. This review discusses non‐hemorrhagic and hemorrhagic viruses for which sufficient data on the association with hemostasis and related clinical features is available. This will enable clinicians to interpret research data and place them into a perspective. J. Med. Virol. 84:1680–1696, 2012. © 2012 Wiley Periodicals, Inc.

Outcome of patients with esophageal carcinoma and suspicious celiac lymph nodes as determined by endoscopic ultrasonography

BACKGROUND AND STUDY AIMS

The management of patients with esophageal cancer with malignant celiac lymph nodes (CLNs) is controversial. In this study we evaluated the management and survival of patients with positive CLN findings on endoscopic ultrasonography (EUS) and compared the outcome in surgically treated patients with that of nonsurgically treated patients.

PATIENTS AND METHODS

The EUS database of the Academic Medical Center was retrospectively searched for patients with esophageal carcinoma and EUS-positive CLN. Follow-up comprised the review of medical charts and contact with general practitioners.

RESULTS

From 1993 through 2000, 78 patients with esophageal carcinoma and suspicious CLN were eligible for inclusion in this study. The median survival of patients with CLN size < 2 cm was 13.5 months vs. 7.0 months for patients with CLN size >2 cm ( P = 0.01). In a multivariate model, CLN size was the only predictive factor for poor patient survival. Of the 78 study patients, 13 underwent a surgical resection and 65 received nonsurgical treatment. The surgical group was significantly younger and all patients in this group had CLN size < 2 cm. The median survival for the surgical group was 13.7 months vs. 13.5 months for the nonsurgical group with CLN size < 2 cm ( P = 0.63).

CONCLUSIONS

In this retrospective study, CLN size was a significant predictor for poor survival. The surgically treated patients had a medium-term survival similar to that of nonsurgically treated patients with a CLN size < 2 cm. These findings underline the prognostic value of CLN size in patients with esophageal carcinoma.

Prolactin is involved in the systemic inflammatory response in myocardial infarction

Prolactin may contribute to an atherogenic phenotype. Furthermore, previous studies have shown that prolactin levels increase in situations of acute stress and inflammation. We therefore aimed to investigate the relationship between prolactin, acute stress and inflammation in patients with myocardial infarction. We performed a case-control study in 40 patients with myocardial infarction and 39 controls, aged 41-84 years. Blood for assessment of prolactin and high sensitive C-reactive protein (hsCRP) was drawn at inclusion, that is, during the acute phase of the event, and 2-3 weeks later. Unexpectedly, prolactin levels at inclusion did not differ between cases and controls (7.0 ng/ml and 6.0 ng/ml, respectively, p=0.28). 2-3 weeks later prolactin levels in cases had not decreased. However, univariate regression analysis indicated that hsCRP is associated with prolactin levels (regression coefficient β 0.11; [95% CI 0.01; 0.21]; p=0.03) in cases during the acute phase of myocardial infarction. Our findings may suggest that prolactin is involved in the systemic inflammatory response, which takes place during myocardial infarction; however, this association may not be strong enough to induce higher prolactin levels in patients with myocardial infarction.

One-year epidemiology of fever at the Emergency Department

BACKGROUND

Although fever is recognised as a major presentation symptom at Emergency Departments (EDs) and is often used as a rationale for the institution of antibiotics, few studies describing patients with fever as the sole inclusion criterion at the ED of a general hospital have been performed. The objective of this study is to describe epidemiology of non-surgical febrile patients at the ED and to identify risk factors for adverse outcome.

METHODS

Blood, sputum, urine and faeces cultures, urine sediments and throat swaps for viral diagnostics were obtained from febrile ED patients. Outcome parameters were bacterial/viral infection, non-bacterial/non-viral infection, non-infectious febrile disease&semi; mortality, hospital admission, admission to the intensive care unit (ICU) and length of hospital stay.

RESULTS

213 Patients were included (87.8% were hospitalised, 8.5% were admitted to ICU, 4.2% died). In 75 patients (35.2%), bacterial infection was confirmed&semi; in 78 patients (36.6%) bacterial infection was suspected. In nine patients (4.2%), viral diagnosis was confirmed; in six patients (2.8%), a viral condition was suspected. The most frequently encountered infection was bacterial pneumonia (58 patients, 27.2%). Only older age was correlated with mortality (ρ=0.176, p=0.01).

CONCLUSION

A majority of the febrile patients were admitted to the hospital, mostly for bacterial infection. An overall mortality rate of 4.2% was registered. Only a few risk factors for adverse outcome could be identified in this cohort. Overall, the outcome of patients presenting with fever at the ED is rather benign.