Thrombotic complications in patients with COVID-19 : pathophysiological mechanisms, diagnosis, and treatment

Introduction Emerging evidence points to an association between severe clinical presentation of COVID-19 and increased risk of thromboembolism. One-third of patients hospitalized due to severe COVID-19 develops macrovascular thrombotic complications, including venous thromboembolism, myocardial injury/infarction and stroke. Concurrently, the autopsy series indicate multiorgan damage pattern consistent with microvascular injury. Prophylaxis, diagnosis and treatment COVID-19 associated coagulopathy has distinct features, including markedly elevated D-dimers concentration with nearly normal activated partial thromboplastin time, prothrombin time and platelet count. The diagnosis may be challenging due to overlapping features between pulmonary embolism and severe COVID-19 disease, such as dyspnoea, high concentration of D-dimers, right ventricle with dysfunction or enlargement, and acute respiratory distress syndrome. Both macro- and microvascular complications are associated with an increased risk of in-hospital mortality. Therefore, early recognition of coagulation abnormalities among hospitalized COVID-19 patients are critical measures to identify patients with poor prognosis, guide antithrombotic prophylaxis or treatment, and improve patients’ clinical outcomes. Recommendations for clinicians Most of the guidelines and consensus documents published on behalf of professional societies focused on thrombosis and hemostasis advocate the use of anticoagulants in all patients hospitalized with COVID-19, as well as 2-6 weeks post hospital discharge in the absence of contraindications. However, since there is no guidance for deciding the intensity and duration of anticoagulation, the decision-making process should be made in individual-case basis. Conclusions Here, we review the mechanistic relationships between inflammation and thrombosis, discuss the macrovascular and microvascular complications and summarize the prophylaxis, diagnosis and treatment of thromboembolism in patients affected by COVID-19

Organised crime and international aid subversion: evidence from Colombia and Afghanistan

Scholarly attempts to explain aid subversion in post-conflict contexts frame the challenge in terms of corrupt practices and transactions disconnected from local power struggles. Also, they assume a distinction between organised crime and the state. This comparative analysis of aid subversion in Colombia and Afghanistan reveals the limits of such an approach. Focusing on relations that anchor organised crime within local political, social and economic processes, we demonstrate that organised crime is dynamic, driven by multiple motives, and endogenous to local power politics. Better understanding of governance arrangements around the organised crime-conflict nexus which enable aid subversion is therefore required

Fatal flaws in the UK asylum decision-making system: an analysis of Home Office refusal letters

The process of deciding who is in need of international protection is well established most western liberal democracies, and has been subject to critical scrutiny for decades. And yet asylum seekers remain vulnerable to serious and ongoing flaws in that system. In this paper, based on research conducted in Afghanistan 2012–2018, Schuster explores a number of shortcomings in the asylum decision-making process, specifically with regard to the rejection of claims from Afghans. The analysis of Reasons for Refusal Letters, allows Schuster to examine the use of key tools in that process (previous cases and country of origin reports). Schuster argues that the current adversarial approach, which seeks to prove an applicant is not credible or does not need protection, undermines the legitimacy of the asylum and risks refusing protection to those in need and or condemning others to years of damaging appeals before they are granted asylum. She concludes by arguing for a shift to a more investigative approach, one that seeks to identify those in need of protection, rather than to keep numbers low

Learning in the chaos: A political economy analysis of education in Afghanistan

© 2018, The Author(s) 2018. Afghanistan is often characterised as a ‘failed’ or ‘fragile’ state in terms of state ‘functionality’, lacking in capacity to provide security and wellbeing to its citizens and failing to prevent violent conflict and terrorism. Since 2001, education has become a major victim of Afghanistan’s protracted crisis that involves international military interventions, fragile democracy and growing radicalisation. Drawing upon qualitative interviews with educational officials and practitioners in Afghanistan and critically examining the literature in education and conflict, we argue that Afghanistan’s education is caught in the nexus between deteriorating security conditions, weak governance and widespread corruption, resulting in rebel capture of educational spaces for radicalisation and violent extremism. More broadly, we contend that education faces the risk of capture for radicalisation in contexts where state fragility and fundamentalism intersect. Finally, we highlight some critical issues relating to educational programming in conflict-affected contexts

High tie versus low tie of the inferior mesenteric artery: a protocol for a systematic review

In anterior resection of rectum, the section level of inferior mesenteric artery is still subject of controversy between the advocates of high and low tie. The low tie is the division and ligation to the branching of the left colic artery and the high tie is the division and ligation at its origin at the aorta. We intend to assess current scientific evidence in literature and to establish the differences comparing technique, anatomy and physiology. The aim of this protocol is to achieve a meta-analysis that tests safety and feasibility of the two procedures with several types of outcome measures

Power balances, transnational elites, and local economic governance: The political economy of development in Medellín

Applying a non-linear political economy analysis of power balances, institutional mechanisms, and elite structures, this study sheds light on the characteristics of Medellín’s economic development since the early 2000s. Elites with minimal technological capabilities and interests in promoting the advancement of transnational capitalism have successfully secured access to sources of power. These conditions (re)produce neoliberal logics of local governance that focus on economic growth in sectors with perceived global comparative advantages and on sustaining the particular power balances in Medellín’s political settlement. This has led to failures of generating positive forward and backward linkages for productivity growth of local firms, a local labour market marked by low wages and high employment elasticities, and large income inequalities. The local governance model that perpetuates productivity and inequality problems of the city is adopted as an opportunistic discourse of Medellín’s transnationalised capitalist elite in the larger neoliberal context of Colombia’s polity and economic policy agenda. In the absence of structural reforms targeting low wages and incentivising firms to develop technological capabilities, Medellín’s low productivity and high inequality problems are likely to persist