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Background: COVID-19 infection is characterised, among other features, by a prothrombotic state with high rate of venous thromboembolism (VTE), D-dimer, and fibrinogen levels. Clinical observations have also highlighted that these patients have elevated von Willebrand factor (vWF) and factor VIIIc., Methods: 24 consecutive COVID-19 positive patients were selected from the intensive care unit (ICU) or the high acuity ward of Brighton and Sussex University Hospitals NHS Trust., Results: The rate of VTE was 25% and mortality rate was 16.7%. Fibrinogen and D-Dimers were elevated, 7.9 (1.6) g/L and 2.4 (2.02) ug/ml respectively. Factor VIIIc and von vWF antigen levels were both extremely elevated at 279 (148) u/dL and 350 (131) % respectively, which are comparable to levels seen in ICU patients with severe sepsis. vWF levels were significantly higher in patients that died (p=0.017) and showed a positive correlation with age. There was a statistically significant association between COVID-19 disease and non-O blood group (p=0.02); 80% (4/5) of COVID-19 patients with VTE were blood group A., Conclusion: Very high levels of vWF and factor VIIIc are common in COVID-19 patients, comparable to levels in severely septic non-COVID ICU patients. This could contribute to the hypercoagulable state and increased VTE rate in COVID-19. Further studies are needed to evaluate the use of vWF for stratifying thrombotic risk in COVID-19 and to determine if elevated vWF is contributing to disease pathogenesis., (© Royal College of Physicians 2020. All rights reserved.)

Objective: To determine the distribution of semen parameters among adolescent and adult males presenting for fertility preservation., Methods: A retrospective, cross-sectional cohort study of adolescent males age 11-19 who underwent semen analysis for fertility preservation at 3 centers in 2 countries with a comparison cohort of adult men presenting for fertility preservation. Prevalence of azoospermia and distribution of semen parameters was compared across groups., Results: A total of 197 adolescents and 95 adults underwent semen analysis for fertility preservation. Azoospermia was present in 17 (8.6%) adolescents and 3 (3.2%) adults. There was decline in the prevalence of azoospermia with increasing age. After exclusion of patients with azoospermia, the adolescent and adult cohorts were comprised of 180 and 92 patients, respectively. Median age at presentation among adolescents vs adults was 16.5years (interquartile range [IQR] 15.2-17.6) and 30.8years (IQR 22.7-43.8), respectively. Median semen volume was 1.0mL (IQR 0.5-2.0) vs 2.5mL (IQR 1.5-3.5), P <.001. Median sperm concentration was 30million/mL (IQR 10-57) vs 39million/mL (IQR 14-57), P = .2. Median sperm motility was 39% (IQR 20-55) vs 45% (IQR 35-55), P = .01. Median total motile sperm count was 11million (IQR 1.4-33) for adolescents vs 29million (IQR 13-69) for adults, P <.001., Conclusion: Young adolescent males had higher prevalence of azoospermia and lower semen parameters compared to adults. In conjunction with physical examination, Tanner stage, and specific clinical context, these data can help to inform patients and their families about potential for fertility preservation, even in very young adolescent patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To quantify delays during management of children with suspected meningitis., Design: Multicentre prospective cohort study., Setting: Three UK tertiary paediatric centres; June 2011-June 2012 PATIENTS: 388 children aged <16 years hospitalised with suspected meningitis or undergoing lumbar puncture (LP) during sepsis evaluation., Main Outcome Measures: Time of prehospital and in-hospital assessments, LP, antibiotic treatment and discharge; types of prehospital medical assessment and microbiological results. Data collected from hospital records and parental interview., Results: 220/388 (57%) children were seen by a medical professional prehospitalisation (143 by a general practitioner). Median times from initial hospital assessment to LP and antibiotic administration were 4.8 hours and 3.1 hours, respectively; 62% of children had their LP after antibiotic treatment. Median time to LP was shorter for children aged <3 months (3.0 hours) than those aged 3-23 months (6.2 hours, P<0.001) or age ≥2 years (20.3 hours, P<0.001). In meningitis of unknown cause, cerebrospinal fluid (CSF) PCR was performed for meningococcus in 7%, pneumococcus in 10% and enterovirus in 76%. When no pathogen was identified, hospital stay was longer if LP was performed after antibiotics (median 12.5 days vs 5.0 days, P=0.037)., Conclusions: Most children had LP after antibiotics were administered, reducing yield from CSF culture, and PCRs were underused despite national recommendations. These deficiencies reduce the ability to exclude bacterial meningitis, increasing unnecessary hospital stay and antibiotic treatment., Competing Interests: Competing interests: SK has received support to attend scientific meetings from GlaxoSmithKline. DFK has received research funding from GlaxoSmithKline and received support from GlaxoSmithKline and Sanofi-Pasteur to attend scientific meetings. PTH received a grant from Pfizer towards the submitted work. He is also an investigator for clinical trials done on behalf of St George’s, University of London, UK, sponsored by vaccine manufacturers and has been a consultant to Novartis and Pfizer on Group B Streptococcus vaccines, but received no payments for this. SN has acted as a consultant to Novartis Vaccines on serogroup B meningococcal vaccine and has received honoraria from Novartis and Pfizer for consultancy work paid into an educational and administrative fund. MS has received grants from Pfizer outside of the submitted work. AJP has received grants from Novartis, Pfizer and Okairos, outside of the submitted work. His department received unrestricted educational grants from Pfizer, GSK and Astra Zeneca in July 2016 for a course on Infection and Immunity in Children. AJP has previously conducted clinical trials of meningococcal meningitis vaccines on behalf of the University of Oxford, funded by vaccine manufacturers, but no longer does so and he received no personal payments from them. AJP is chair of the UK Department of Health’s Joint Committee on Vaccines and Immunisation, chair of the European Medicine Agency’s Scientific Advisory Group on Vaccines and a member of the WHO’s SAGE. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health, the EMA, or the WHO., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)