High frequency of endoluminal thrombus in patients with ischaemic stroke following AARS-CoV-2 infection.

BACKGROUND: Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS: Data were collected retrospectively on consecutive patients with COVID-19 who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

High frequency of endoluminal thrombus in patients with ischaemic stroke following SARS-CoV-2 infection. / Alta frecuencia de trombo endoluminal en pacientes con ictus isquémico tras la infección por coronavirus 2019.

BACKGROUND: Ischaemic stroke may be a major complication of SARS-CoV-2 infection. Studying and characterising the different aetiological subtypes, clinical characteristics, and functional outcomes may be valuable in guiding patient selection for optimal management and treatment. METHODS: Data were collected retrospectively on consecutive patients with SARS-CoV-2 infection who developed acute focal brain ischaemia (between 1 March and 19 April 2020) at a tertiary university hospital in Madrid (Spain). RESULTS: During the study period, 1594 patients were diagnosed with COVID-19. We found 22 patients with ischaemic stroke (1.38%), 6 of whom did not meet the inclusion criteria. The remaining 16 patients were included in the study (15 cases of ischaemic stroke and one case of transient ischaemic attack). Median baseline National Institutes of Health Stroke Scale score was 9 (interquartile range: 16), and mean (standard deviation) age was 73 years (12.8). Twelve patients (75%) were men. Mean time from COVID-19 symptom onset to stroke onset was 13 days. Large vessel occlusion was identified in 12 patients (75%). We detected elevated levels of D-dimer in 87.5% of patients and C-reactive protein in 81.2%. The main aetiology was atherothrombotic stroke (9 patients, 56.3%), with the predominant subtype being endoluminal thrombus (5 patients, 31.2%), involving the internal carotid artery in 4 cases and the aortic arch in one. The mortality rate in our series was 44% (7 of 16 patients). CONCLUSIONS: In patients with COVID-19, the most frequent stroke aetiology was atherothrombosis, with a high proportion of endoluminal thrombus (31.2% of patients). Our clinical and laboratory data support COVID-19-associated coagulopathy as a relevant pathophysiological mechanism for ischaemic stroke in these patients.

Granular parakeratosis

This is a report of a 60 year-old black female patient presenting with pruritic brownish crusted plaques on both axillae of one month evolution. Histopathology revealed findings characteristic of axillary granular parakeratosis. This entity was first described by Northcutt et al in 1991. Since then, involvement of other intertriginous areas have also been reported. A review of the literature was performed and the term granular parakeratosis is suggested to emphasize its pathognomonic histopathologic features

[Inactivation of BVDV (experimental model for hepatitis C) using low pH and heat treatment in intravenous human immunoglobulins]. / Inactivación del VDVB (modelo experimental del virus de la hepatitis C) por pH bajo y tratamiento por calor en inmunoglobulinas humanas endovenosas.

PURPOSE: To measure the capability of heat (60 degrees C for 10 hr) and low pH to inactivate BVDV (a model of HCV) in human intravenous immunoglobulins. MATERIALS AND METHODS: The study was carried out on three batches of immunoglobulins produced by the Cohn method and contaminated with a known amount of BVDV. These mixtures, with and without 33% sorbitol, were submitted to heat treatment at 60 degrees C for 10 hours. The same immunoglobulin batches were manufactured at pH 4.25 and 4.5 and stored at 4 degrees C and 4 degrees C and 21 degrees C for 28 days. Samples of the two experiments were taken at the beginning and the end. The viral infectiousness was calculated by the standard microtiration method in 96-well plates, using the CPE, and the reduction factor was measured for each experiment. RESULTS: Complete viral inactivation was achieved with the heat treatment after 4 hours, and the 33% sorbitol decreased the formation of aggregates. Treatment by pH 4.5, at 21 degrees C for 28 days, decreased the viral load by approximately 2 log; no viral inactivation was achieved in samples stored at 4 degrees C. CONCLUSION: Heat is an effective method for inactivating HCV in final batches of human intravenous immunoglobulins when 33% sorbitol is added. The use of low pH at 21 degrees C as a method of viral inactivation must be evaluated case by case, since, according to the present results, it only achieved a 2 log inactivation.