Retrospektive Erhebung der Polytraumadaten von 2007 - 2010 an der Berufsgenossenschaftlichen Unfallklinik Tübingen und am Universitätsklinikum Tübingen - Untersuchung prognostischer Faktoren im Hinblick auf Outcome -

480 Traumapatienten mit einem ISS >= 16 wurden ohne Altersbeschränkung in die Studie eingeschlossen. Der ISS-Mittelwert lag bei 30,2. Dieses Patientenkollektiv entsprach bei der Alters- und Geschlechtsverteilung sowie bei der Verteilung der Unfallarten den Angaben anderer Studien und des TR-DGU. Im Einklang mit der Literatur ließen sich im Schockraum als wichtige Prognosefaktoren im Hinblick auf Letalität Alter, ISS, GCS, Hb, Quick, PTT, BE, Laktat, pH und EK-Gabe bestätigen. Auch hinsichtlich der Entwicklung von Spätkomplikationen wie MOV und Sepsis zeigten sich in der hier vorliegenden Untersuchung diese Parameter mit Ausnahme des Alters und des BE als gute prognostische Faktoren. Außerdem ließen sich beim Vergleich der erhobenen Befunde mit den TR-DGU-Jahresberichten 2011 - 2013 für das Gesamtkollektiv des TR-DGU bzw. für die Patienten des TZT die bereits in den letzten Jahren in der Literatur beschriebenen Tendenzen in der Schwerverletzten-Versorgung weitgehend erkennen, wie zunehmendes Patientenalter, Abnahme des ISS-Mittelwertes, Zunahme des GCS-Mittelwertes am Unfallort, Rückgang der präklinischen Intubationsrate, Rückgang der präklinisch gegebenen Volumenmenge mit Verbesserung der Gerinnungssituation (Quick, PTT) und des Hb-Wertes bei Klinikaufnahme, Rückgang der Bluttransfusionen im Schockraum, Rückgang der Intensiv- und Beatmungszeit, Verbesserung des Outcomes nach GOS 2 - 5 sowie Rückgang der Letalität (GOS 1)

Correction: Factors associated with tuberculosis treatment delay in patients co-infected with HIV in a high prevalence area in Brazil.

[This corrects the article DOI: 10.1371/journal.pone.0195409.]

Univariate survival analysis of factors associated health care delay^** (n = 201).

<p>Univariate survival analysis of factors associated health care delay^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0195409#t004fn002" target="_blank">**</a>} (n = 201).</p

Multivariate survival analysis of factors associated health care delay^** (n = 201).

<p>Multivariate survival analysis of factors associated health care delay^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0195409#t006fn002" target="_blank">**</a>} (n = 201).</p

Descriptive statistics of baseline characteristics of study participants.

<p>Descriptive statistics of baseline characteristics of study participants.</p

Baseline characteristics of study participants (n = 201).

<p>Baseline characteristics of study participants (n = 201).</p

Pragmatic recommendations for the management of anticoagulation and venous thrombotic disease for hospitalized patients with COVID-19 in low- And middle-income countries

New studies of COVID–19 are constantly updating best practices in clinical care. Often, it is impractical to apply recommendations based on high-income country investigations to resource limited settings in low- and middle-income countries (LMICs). We present a set of pragmatic recommendations for the management of anticoagulation and thrombotic disease for hospitalized patients with COVID-19 in LMICs. In the absence of contraindications, we recommend prophylactic anticoagulation with either low molecular weight heparin (LMWH) or unfractionated heparin (UFH) for all hospitalized COVID-19 patients in LMICs. If available, we recommend LMWH over UFH for venous thromboembolism (VTE) prophylaxis to minimize risk to healthcare workers. We recommend against the use of aspirin for VTE prophylaxis in hospitalized COVID-19 and non–COVID-19 patients in LMICs. Because of limited evidence, we suggest against the use of “enhanced” or “intermediate” prophylaxis in COVID-19 patients in LMICs. Based on current available evidence, we recommend against the initiation of empiric therapeutic anticoagulation without clinical suspicion for VTE. If contraindications exist to chemical prophylaxis, we recommend mechanical prophylaxis with intermittent pneumatic compression (IPC) devices or graduated compression stockings (GCS) for hospitalized COVID-19 patients in LMICs. In LMICs, we recommend initiating therapeutic anticoagulation for hospitalized COVID-19 patients, in accordance with local clinical practice guidelines, if there is high clinical suspicion for VTE, even in the absence of testing. If available, we recommend LMWH over UFH or Direct oral anticoagulants for treatment of VTE in LMICs to minimize risk to healthcare workers. In LMIC settings where continuous intravenous UFH or LMWH are unavailable or not feasible to use, we recommend fixed dose heparin, adjusted to body weight, in hospitalized COVID-19 patients with high clinical suspicion of VTE. We suggest D-dimer measurement, if available and affordable, at the time of admission for risk stratification, or when clinical suspicion for VTE is high. For hospitalized COVID-19 patients in LMICs, based on current available evidence, we make no recommendation on the use of serial D-dimer monitoring for the initiation of therapeutic anticoagulation. For hospitalized COVID-19 patients in LMICs receiving intravenous therapeutic UFH, we recommend serial monitoring of partial thromboplastin time or anti-factor Xa level, based on local laboratory capabilities. For hospitalized COVID-19 patients in LMICs receiving LMWH, we suggest against serial monitoring of anti-factor Xa level. We suggest serial monitoring of platelet counts in patients receiving therapeutic anticoagulation for VTE, to assess risk of bleeding or development of heparin induced thrombocytopenia

Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV

Antiretroviral therapy (ART) has represented a major advancement in the care of people living with HIV (PLWHH), resulting in significant reductions in morbidity and mortality through immune reconstitution and attenuation of homeostatic disruption. Importantly, restoration of immune function in PLWH with opportunistic infections occasionally leads to an intense and uncontrolled cytokine storm following ART initiation known as immune reconstitution inflammatory syndrome (IRIS). IRIS occurrence is associated with the severe and rapid clinical deterioration that results in significant morbidity and mortality. Here, we detail the determinants underlying IRIS development in PLWH, compiling the available knowledge in the field to highlight details of the inflammatory responses in IRIS associated with the most commonly reported opportunistic pathogens. This review also highlights gaps in the understanding of IRIS pathogenesis and summarizes therapeutic strategies that have been used for IRIS

Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV

Antiretroviral therapy (ART) has represented a major advancement in the care of people living with HIV (PLWHH), resulting in significant reductions in morbidity and mortality through immune reconstitution and attenuation of homeostatic disruption. Importantly, restoration of immune function in PLWH with opportunistic infections occasionally leads to an intense and uncontrolled cytokine storm following ART initiation known as immune reconstitution inflammatory syndrome (IRIS). IRIS occurrence is associated with the severe and rapid clinical deterioration that results in significant morbidity and mortality. Here, we detail the determinants underlying IRIS development in PLWH, compiling the available knowledge in the field to highlight details of the inflammatory responses in IRIS associated with the most commonly reported opportunistic pathogens. This review also highlights gaps in the understanding of IRIS pathogenesis and summarizes therapeutic strategies that have been used for IRIS