Take a very, very, very Close Look at this Nature Publication - or- What a Presidential Portrait Has to Do with a Heap of Feces
While this website concentrates on finding relevant publications from the world of Critical Care, there are always papers from other fields that attract our attention.
Recently, a remarkable detail from a publication of an even more remarkable journal has been brought to our notice. I admit I rarely read articles on 'Nature', but this article is worth a very close look after all.
Chiou L. et al. have published an article about a noninvasive genomic sequencing of populations from feces in this years January issue of Scientific Reports of 'Nature'. In this article they deal with the problem that it is difficult to obtain high quality samples for genomic studies from wild animals. They therefore describe a cost-effective method for enriching host DNA from noninvasive fecal samples.
And in fact it is worthwhile to have a closer look at the feces sample in this article as Nature has placed a portrait of Mr. Trump in a rather delicate position.
Finding the hidden Trump-Portrait, here's how:
Anticoagulated patients are common and the amount of available oral anticoagulants is becoming more diverse and confusing. Anticoagulation is the cornerstone in the treatment of thrombosis and thromboembolic complications in a variety of diseases. Lixiana, Pradaxa, Eliquis and Xarelto are some of these pretty-sounding drugs that many doctors know but find difficult to keep up.
So if you work in an emergency room, anesthesia or intensive care, there's a good chance you will be facing an anticoagulant patient with a potentially critical bleeding that could require urgent treatment... And this leaves you with the following questions:
- What is a critical bleed (apart from obvious massive bleeding)? Does this bleeding need imminent reversal?
- Do I need any laboratory testing before?
- What treatment should I actually give the patient?
If you do not have a guideline in your institution, it may be time to create one, and the following publication is indeed very useful for this purpose!
The 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants very nicely summarises current evidence and expert opinion on these issues. But the very best are their excellent figures, providing all the answers you need: simple and very understandable!
What is a Critical Bleeding?