Intrinsic or Nonintrinsic End-stage Liver Disease and Its Association With Thromboelastography-based Coagulation States in Patients Undergoing Liver Transplantation: A Retrospective Cohort Study.

OBJECTIVES: Perioperative coagulation management in liver transplantation recipients is challenging. Viscoelastic testing with rotational thromboelastography (TEG) can help quantify hemostatic profiles. The current work aimed to investigate whether the etiology of end-stage liver disease, pretransplant disease severity, or pretransplant thrombotic or bleeding complications are associated with specific TEG patterns. DESIGN: Retrospective cohort study. SETTING: Single quaternary care hospital. PARTICIPANTS: A total of 1,078 adult liver transplant patients. INTERVENTIONS: The primary exposure was the etiology of end-stage liver disease classified as either intrinsic or nonintrinsic (eg, biliary obstruction or cardiovascular). Secondary exposures were patients' preoperative Model for End-Stage Liver Disease (MELD) score, Child-Pugh class, presence of major preoperative thrombotic complications, and major bleeding complications. MEASUREMENTS AND MAIN RESULTS: Patients with intrinsic liver disease (84%) showed higher odds of hypocoagulable (odds ratio [OR]: 3.70, 95% confidence interval [CI]: 1.94-7.07, p < 0.0001) and mixed TEG patterns (OR: 4.59, 95% CI: 2.07-10.16, p = 0.0002) compared with those with nonintrinsic disease. Increasing MELD scores correlated with higher odds of hypocoagulable (OR: 1.14, 95% CI: 1.08-1.19, p < 0.0001) and mixed TEG patterns (OR: 1.08, 95% CI: 1.03-1.14, p = 0.0036). Child-Pugh class C was associated with higher odds of hypocoagulable (OR: 8.55, 95% CI: 3.26-22.42, p < 0.0001) and mixed patterns (OR: 12.48, 95% CI: 3.89-40.03, p < 0.0001). Major preoperative thrombotic complications were not associated with specific TEG patterns, although an interaction with liver disease severity was observed. CONCLUSIONS: Liver transplantation candidates with intrinsic liver disease tend to exhibit hypocoagulable TEG patterns, while nonintrinsic disease is associated with hypercoagulability. Increasing end-stage liver disease severity, as evidenced by increasing MELD scores and higher Child-Pugh classification, was also associated with hypocoagulable TEG patterns.

Knowledge, attitudes, and practices of Lebanese university students related to sexually transmitted diseases: a cross-sectional study.

AIM: To appraise Lebanese university students' knowledge, attitudes, and practices related to sexually transmitted diseases (STDs). METHODS: This cross-sectional study was conducted in March and April 2020. A total of 402 students (67.9% women) from ten universities located in different Lebanese regions were recruited through convenient sampling. RESULTS: Pursuing a major in non-health sciences compared with a major in health sciences (adjusted odds ratio [aOR]=0.08) was significantly associated with lower odds of having better knowledge of STDs. Older age (aOR=1.09) was significantly associated with higher odds of having better knowledge of STDs. Having good vs poor knowledge (aOR=3.88) was significantly associated with higher odds of having favorable attitudes toward STDs, whereas pursuing a major in non-health sciences compared with a major in health sciences (aOR=0.28) was significantly associated with lower odds of having favorable attitudes toward STDs. Women compared with men (aOR=2.21) had higher odds of having healthier practices related to STDs. Attitude did not mediate the association between knowledge and practice. CONCLUSION: Attitude did not significantly mediate the association between knowledge and practice. Therefore, educational programs and awareness campaigns should be implemented in secondary schools and among vulnerable non-medical students. Such efforts can help students identify the symptoms of STDs, seek medical attention, and make informed decisions to protect themselves.