Clot characterization by multidisciplinary approach: biochemical and imaging parameters in a hypocoagulative setting. A pilot study.

Background: Clot characterization is, to the present days, a multimodal approach: scanning the clot by electron microscopy (SEM) is helpful for the visualization of fibrin structure along with laboratory parameters such as the clot waveform analysis (CWA) and thrombin generation in different settings of clot abnormalities. This study aimed to assess whether the coagulative parameters were consistent with the clot images texture acquired by SEM, and therefore to propose a more generalist and integrative approach to clots classification.Design and Methods: In this pilot study, the examined population consists of eight healthy subjects, seven patients affected by Acquired Hemophilia A (AHA) and seven patients treated with Vitamin K Antagonists (VKAs), similar for age and gender. We studied the velocity and acceleration (1st and 2nd derivative of the aPTT) of clot formation (CWA), the thrombin generation, and the clots' scanning by SEM. Images acquired with SEM were then analyzed with the MATLAB software with the "Texture Analysis" methods to perform classification. Among the various texture parameters, we reported Contrast and Energy.Results: Significant differences among healthy subjects, patients with AHA and those treated with VKAs were detected for the coagulative parameters. We found no differences between VKAs and AHA patients. Contrast and energy highlighted a significant difference among the three groups in agreement with the laboratory's parameters. We found no significant differences between VKAs and AHA patients.Conclusions: The use of SEM, CWA and thrombin generation parameters may be a starting point for studies aimed to demonstrate the general characteristics of clot formation in different clinical conditions with a multiparametric approach

COVID-19 IN THE MEDITERRANEAN AREA: EPIDEMIOLOGY AND MAIN DISEASE CHARACTERISTICS - A NARRATIVE REVIEW

In December 2019, Chinese researchers identified a novel coronavirus in humans that caused acute respiratory syndrome— officially called coronavirus disease (COVID-19) as of February 11, 2020. At the beginning of the outbreak, the Mediterranean countries seemed to be spared from the health and social disaster happened in China. Quickly the spread of the virus ran faster than forecasts and Italy was unfortunately followed by Spain, France and other countries counting many cases and deaths. The World Health Organization declaring COVID-19 a pandemic on March 11th, 2020. A retrospective analysis of big data from Google Trend, using an infodemiology approach, shows how internet traffic search on COVID-19 may figure on the spread curve. The clinical aspects of COVID-19 raises from poor of mild symptomatic patients to severe respiratory disease which can quickly lead patients to respiratory failure and admission to intensive care units. Multi-organ symptoms and different types of involvement other than respiratory have been described. Nowadays the vaccination is still under investigation and there is not a specific treatment approved for COVID–19, but the literature highlights the role of Cloroquine and its less toxic derivative Hydroxychloroquine in the therapeutical management of COVID-19. Those drugs have been proposed as a potential treatment for COVID-19 and clinical trials are undergoing to evaluate this drug. However these drugs have known oxidative properties that could decrease glutathione levels and may cause severe hemolysis in G6PD-deficient patients. Deficient G6PD alleles are distributed worldwide; a conservative estimate is that at least 400 million people carry a mutation in the G6PD gene causing deficiency, the Mediterranean most frequent variant is a class II allele (1-10% of residual activity). With worldwide spread of COVID-19, also in regions with a high prevalence of G6PD deficiency, physicians should be aware of this possible correlation