Examining variability in the diagnosis and management of people with bleeding disorders of unknown cause: communication from the ISTH SSC Subcommittee on von Willebrand Factor.

Background: Bleeding disorder of unknown cause (BDUC) is characterized by a bleeding phenotype in the setting of normal hemostatic testing. No standardized diagnostic criteria or treatment algorithms exist for people with BDUC. To address the unmet need, the International Society on Thrombosis and Haemostasis von Willebrand Factor Scientific Subcommittee performed a real-world survey aimed at addressing knowledge gaps, developing consensus pathways, and ultimately improving care.

Standardization of definition and management for bleeding disorder of unknown cause: communication from the SSC of the ISTH.

In many patients referred with significant bleeding phenotype, laboratory testing fails to define any hemostatic abnormalities. Clinical practice with respect to diagnosis and management of this patient cohort poses significant clinical challenges. We recommend that bleeding history in these patients should be objectively assessed using the International Society on Thrombosis and Haemostasis (ISTH) bleeding assessment tool.

Direct oral anticoagulants or vitamin K antagonists in emergencies: comparison of management in an observational study.

Background: Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage (MH) or before surgical intervention has changed, with the replacement of vitamin K antagonist (VKA) with direct oral anticoagulants (DOACs).

Objectives: To observe the difference in urgent hemostatic management between patients on VKA and those on DOACs.

Methods: A multicenter observational study evaluated the variation in laboratory testing, hemostatic management, mortality, and hospital length of stay (LOS) in patients on VKA or DOACs presenting with MH or urgent hemostatic restoration.

Uptake of Best Medical Therapy: Secondary Prevention of Cardiovascular Disease in Vascular Surgical Patients in Western Australia.

Best medical therapy (BMT) for peripheral arterial disease (PAD), carotid artery stenosis (CAS) and abdominal aortic aneurysm (AAA) involving concomitant use of antiplatelets, lipid-lowering agents, and blood pressure control, improves patient survival and prevents clinical cardiovascular disease (CVD). We performed a single-center cross-sectional study, over a 4-year period, describing BMT use in Western Australian patients with symptomatic PAD, CAS and AAA in the community. Overall, 45.

Eradication of post-lobectomy mucormycosis and bacterial empyema with intrapleural antimicrobial therapy in a patient with surgically resected (non-tuberculous Mycobacteria) pulmonary infection.

Empyema thoracis is a collection of pus in the pleural space associated with pleural fibrin deposition. Treatment involves systemic antimicrobials, pleural drainage, intrapleural enzymes and sometimes decortication. Our case is a 57-year-old gentleman who developed chronic mucormycosis () and bacterial (.

Low von Willebrand Disease: A Bleeding Disorder of Unknown Cause?

von Willebrand disease (VWD) represents the most common inherited bleeding disorder. The majority of VWD cases are characterized by partial quantitative reductions in plasma von Willebrand factor (VWF) levels. Management of patients with mild to moderate VWF reductions in the range of 30 to 50 IU/dL poses a common clinical challenge.

Splanchnic venous thrombosis: aetiologies and a review of the literature.

Background: Splanchnic vein thrombosis (SVT) is an uncommon yet potentially life-threatening manifestation of venous thromboembolism. The aim of this study was to present a retrospective analysis of a cohort of Western Australian patients diagnosed with SVT on imaging study, and a review of the literature surrounding the aetiology, location, anticoagulation treatment and outcomes of SVT.

Methods: All patients diagnosed with SVT over a five-year period from 2015 to 2020 in three tertiary hospitals in Western Australia were identified by using an electronic search engine of imaging reports.

Examining international practices in the management of pregnant women with von Willebrand disease.

Background: The management of pregnant women with von Willebrand disease (VWD) is complex as physiological pregnancy-induced increases in plasma von Willebrand factor (VWF) may be blunted or absent. Women with VWD experience a heightened risk of postpartum hemorrhage (PPH) and special consideration must be given regarding neuraxial anesthesia (NA) and the need for prophylaxis at time of delivery. These challenges are compounded by a lack of robust evidence to guide clinical decision-making.

How I treat bleeding disorder of unknown cause.

Recent studies have demonstrated that only 30% of patients referred for assessment of a possible bleeding tendency will eventually be diagnosed with a mild bleeding disorder (MBD) such as von Willebrand disease (VWD) or platelet function defect (PFD). Rather, most of these patients will be diagnosed with bleeding disorder of unknown cause (BDUC). There remains an important unmet need to define consensus regarding the clinical and laboratory criteria necessary for a formal BDUC diagnosis.

Control of OSA in a patient with CCC of soft palate using bilateral hypoglossal nerve stimulation.

Patients with complete concentric collapse of the redropalatal airway are excluded from unilateral hypoglossal nerve stimulation. This case report shows good control of OSA in a patient with CCC with a new bilateral hypoglossal nerve stimulator.

Ruptured mycotic common iliac aneurysm due to Capnocytophaga canimorsus, acquired from dog saliva: A case report.

Introduction: Mycotic arterial aneurysm occurs secondary to infection of the arterial wall Dubois et al. (2010). It is a serious clinical condition associated with significant morbidity and mortality.

A comparison of two intravesical bladder instillations for interstitial cystitis/bladder pain syndrome.

Objective: Bladder pain syndrome (BPS) is a chronic pain condition associated with injury to the glycosoaminoglycan (GAG) layer. We aimed to prospectively evaluate iAluRil® with multi-centre tertiary urogynaecology collaboration. We hypothesised that iAluRil® (a GAG therapy) would demonstrate equivalent symptom, pain and QOL scores compared to DMSO controls.

Late renal artery stent fracture with pseudoaneurysm after fenestrated endovascular abdominal aortic aneurysm repair.

We report the case of an 81-year-old man incidentally found to have a complete transverse stent fracture of a left renal artery covered stent associated with a pseudoaneurysm while being investigated with digital subtraction angiography for an arterial cause of a nonhealing ulcer on his right great toe. He had a fenestrated endovascular abdominal aortic aneurysm repair 11 years ago with covered stenting of both renal arteries. Although he was asymptomatic, a second left renal artery covered stent was successfully placed across the fractured stent to eliminate the risk of rupture.

Trauma-intrusive hallucinations and the dissociative state.

Background: Research has supported a model of dissociation mediating the experience of hearing voices in traumatised individuals.

Aims: To further understand this model by examining subtypes of the dissociative experience involved in trauma-intrusive hallucinations.

Method: The study involved four hospitals, 11 psychiatrists and 69 participants assessed using the Psychotic Symptoms Rating scale, the PTSD Symptoms Scale Interview and the Dissociative Subtype of PTSD Score.

Where pseudo-hallucinations meet dissociation: a cluster analysis.

Objectives: The possible link between cognitive areas of perception and integration of consciousness was examined using assessments of hallucinations and derealisation/depersonalization.

Methods: Sixty-five subjects in three main diagnostic groups - posttraumatic stress disorder (PTSD), borderline personality disorder (BPD) and schizophrenia - identified by their treating psychiatrist as hearing voices were surveyed regarding characteristics of hallucinations, derealisation/depersonalization, delusions and childhood/adult trauma.

Results: A cluster analysis produced two clusters predominantly determined by variables of hallucinations measures, childhood sexual abuse and derealisation/depersonalization scores.

Primary Axillary Venous Aneurysm Associated with Local Neurological Complications.

Primary axillary venous aneurysms (VAs) are rare, and there are only a handful of cases reported previously. The patient can be either asymptomatic or symptomatic and can present with local axillary swelling, dilated venules in overlying skin associated with local discomfort, peripheral neuropathy, or pulmonary embolisms. A 30-year-old man presented with a 4-month history of an uncomfortable lump in his left armpit that was associated with paresthesia radiating down to his left forearm and hand.

Endometrial Synovial-like Metaplasia Associated With Levonorgestrel-releasing Intrauterine System.

The levonorgestrel-releasing intrauterine system (L-IUS) is widely used in contraception and in the treatment of menorrhagia, dysmenorrhea, adenomyosis, and endometriosis. L-IUS is also increasingly considered in the management of endometrial neoplasia and its precursors. Histologic changes in the endometrium can be due to the effects of high-dose progestogen or may be caused by the local irritant or mechanical effects of an intrauterine foreign body.

Pulmonary Sporotrichosis: An Evolving Clinical Paradigm.

In recent decades, sporotrichosis, caused by thermally dimorphic fungi Sporothrix schenckii complex, has become an emerging infection in many parts of the world. Pulmonary infection with S. schenckii still remains relatively uncommon, possibly due to underrecognition.

Use of non-pharmaceutical interventions to reduce the transmission of influenza in adults: A systematic review.

During seasonal influenza epidemics and pandemics, virus transmission causes significant public health concern. Reduction of viral transmission by non-pharmaceutical interventions (NPI) has a significant appeal and is often recommended. However, the efficacy of such interventions is unclear.

Asynchronous glands in secretory pattern endometrium: clinical associations and immunohistological changes.

Aims: The significance and pathogenesis of irregular or asynchronous maturation within endometrial glands remains uncertain. The aim of this study was to investigate differences in epithelial hormone receptor immunoreactivity and stromal cell calretinin, CD34 and p16 expression in morphologically normal secretory endometrium and in asynchronous (non-secretory) endometrial glands (AEGs).

Methods And Results: Nineteen consecutive endometrial specimens showing AEGs were examined.

Bivalirudin in acute coronary syndromes and percutaneous coronary intervention: should we use it?

Major bleeding remains a major risk factor for percutaneous coronary intervention of acute coronary syndromes and is associated with higher morbidity, mortality, prolonged hospital stay and costs. With the recognition that bleeding is an important factor in patient outcomes, the prevention of bleeding has become as important a goal as the prevention of ischaemia. The direct thrombin inhibitor bivalirudin has been shown to reduce ischaemia and importantly, is associated with less bleeding.

Impact of experience when using the Rapid Upper Limb Assessment to assess postural risk in children using information and communication technologies.

The Rapid Upper Limb Assessment (RULA) is an observation-based screening tool that has been used to assess postural risks of children in school settings. Studies using eye-tracking technology suggest that visual search strategies are influenced by experience in the task performed. This study investigated if experience in postural risk assessments contributed to differences in outcome scores on the RULA and the visual search strategies utilized.