Análise dos desfechos maternos e fetais relacionados à COVID-19 durante a gestação / Analysis of maternal and fetal outcomes related to COVID-19 during pregnancy

O SARS-CoV-2 é um vírus RNA transmitido pelo contato direto ou indireto por gotículas infectadas. No que se refere à COVID-19 e à gestação, referências apontam que nesse período as mulheres possuem maior susceptibilidade a complicações obstétricas e perinatais. O presente estudo objetiva compreender e compilar aspectos da infecção e os principais desfechos negativos maternos e fetais documentados na literatura atual, relacionados à infecção pelo novo coronavírus durante a gestação. Trata-se de uma revisão integrativa de literatura embasada pela análise de 2.441 artigos no total, dos quais 62 foram incluídos na pesquisa, sendo 38 deles da base de dados PubMed e 24 da BVS (Biblioteca Virtual em Saúde), nos idiomas inglês e português. Em conclusão, mulheres grávidas com diagnóstico da patologia podem precisar de assistência de alta complexidade. A associação à doença pode apresentar riscos ou complicações como coagulopatias, pré-eclâmpsia, prematuridade e outros desfechos negativos que serão abordados neste artigo.(AU)

SARS-CoV-2 is an RNA virus, transmitted by direct or indirect contact by infected droplets. Regarding to COVID-19 and pregnancy, references indicate that during this period, women are more susceptible to obstetric and perinatal complications. This study aims to understand and compile aspects of infection and the main negative maternal and fetal outcomes documented in the current literature, related to the infection by the new coronavirus during pregnancy. This is an integrative literature review based on the analysis of 2,441 articles in total, of which 62 were included in the survey, 38 from the PubMed database and 24 from BVS (Biblioteca Virtual em Saúde) in English and Portuguese languages. In conclusion, pregnant women diagnosed with the pathology may need highly complex assistance. The association with the disease may present risks for complications such as coagulopathies, pre-eclampsia, prematurity and other negative outcomes that will be addressed in this article.(AU)

Incidencia de trombosis venosa profunda en pacientes diagnosticados con neoplasias útero- ováricas: Un estudio de centro único / Incidence of deep vein thrombosis in patients diag-nosed with utero-ovarian neoplasms: A single center study / Incidência de trombose venosa profunda em pacientes com diagnóstico de neoplasias utero-ovarianas: um estudo de centro único

Introducción: El trombo embolismo venoso (TEV), una complicación frecuente en pacientes con cáncer ginecológico. El objetivo del estudio fue determinar la incidencia de TEV profunda en pacientes diagnosticados con neoplasias útero ováricas en un centro de referencia oncológica en Guayaquil-Ecuador en el año 2019 (enero-diciembre). Metodología: El presente estudio observacional, de fuente retrospectiva se realizó en el servicio de estadística del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" de la Sociedad de Lucha contra el Cáncer-SOLCA, Guayaquil Ecuador. El cálculo del tamaño muestral fue probabilístico de 237 pacientes. Se incluyeron casos de pacientes con neoplasias útero ováricas y endometriales. Las variables fueron edad, localización de la neoplasia, incidencia de TEV en base a evidencia Ultrasonográfica de TEV, criterios Wels, dímero D. Se utilizó estadística descriptiva. Los porcentajes se presentan con intervalo de confianza. Resultados: Se incluyeron 237 pacientes, el grupo etario más frecuente de 40 a 59 años con el 46.4%, seguido de 60 y más años con el 34.6%; el 88.6% de los casos tuvieron cáncer de útero (cérvix ­ endometrio) y el 11.4% con cáncer de ovario. Por la clasificación de Wells, el 92% presentó riesgo moderado de TVP y 8% riesgo alto. La incidencia de trombosis venosa profunda en pacientes con cáncer útero ­ ovario fue del 6.75% (IC 6.54-6.96%). La incidencia fue estadísticamente más prevalente (P=0.01) en el grupo de mujeres con Ca de Útero que en el grupo de Ca de ovario. Conclusión: Las neoplasias útero ováricas tienen alta incidencia de trombosis venosa profunda.

Introduction: Venous thrombus embolism (VTE), a frequent complication in patients with gynecological cancer. The objective of the study was to determine the incidence of deep VTE in patients diagnosed with uterine-ovarian neoplasms in an oncology referral center in Guayaquil-Ecuador in 2019. Methodology: The present observational study, from a retrospective source, was carried out in the statistics service of the National Oncological Institute "Dr. Juan Tanca Marengo" from the Society for the Fight Against Cancer-SOLCA, Guayaquil Ecuador. The calculation of the sample size was probabilistic of 237 patients. Cases of patients with uterine-ovarian and endometrial neoplasms were included. The variables were age, location of the neoplasm, incidence of VTE based on ultrasound evidence of VTE, Wels criteria, D-dimer. Descriptive statistics were used. The percentages are presented with a confidence interval. Results: 237 patients were included, the most frequent age group 40 to 59 years with 46.4%, fol-lowed by 60 and over with 34.6%; 88.6% of the cases had uterine cancer (cervix - endometrium) and 11.4% with ovarian cancer. According to the Wells classification, 92% had a moderate risk of DVT and 8% had a high risk. The incidence of deep vein thrombosis in patients with uterine-ovarian cancer was 6.75% (CI 6.54-6.96%). The incidence was statistically more prevalent (P=0.01) in the group of wom-en with Uterus Ca than in the ovarian Ca group. Conclusion: Utero-ovarian neoplasms have a high incidence of deep vein thrombosis.

Introdução: Embolia por trombo venoso (TEV), uma complicação frequente em pacientes com câncer ginecológico. O objetivo do estudo foi determinar a incidência de TEV profundo em pacientes com diagnóstico de neoplasias uterino-ovarianas em um centro de referência em oncologia em Guayaquil-Equador em 2019 (janeiro-dezembro). Metodologia: O presente estudo observacional, de fonte retrospectiva, foi realizado no serviço de estatística do Instituto Oncológico Nacional "Dr. Juan Tanca Marengo "da Sociedade de Luta contra o Câncer-SOLCA, Guayaquil, Equador. O cálculo do tamanho da amostra foi probabilístico de 237 pacientes. Foram incluídos casos de pacientes com neoplasias uterino-ovarianas e endometriais. As variáveis ​​foram idade, localização da neoplasia, incidência de TEV com base em evidências ultrassonográficas de TEV, critérios de Wels, dímero D. Foi utilizada estatística descritiva. As porcentagens são apresentadas com intervalo de confiança. Resultados: foram incluídos 237 pacientes, a faixa etária mais frequente de 40 a 59 anos com 46,4%, seguida de 60 e mais anos com 34,6%; 88,6% dos casos tiveram câncer de útero (colo do útero - endométrio) e 11,4% de câncer de ovário. De acordo com a classificação de Wells, 92% apresentaram risco moderado de TVP e 8% risco alto. A incidência de trombose venosa profunda em pacientes com câncer de útero-ovário foi de 6,75% (IC 6,54-6,96%). A incidência foi estatisticamente mais prevalente (P = 0,01) no grupo de mulheres com Ca no útero do que no grupo de Ca ovariana. Conclusão: As neoplasias útero-ovarianas apresentam alta incidência de trombose venosa profunda.

Consenso Colombiano para la prevención, diagnóstico y manejo de condiciones trombóticas en pacientes adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adult patients with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

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Abstract Recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. In this context, the aim was to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: A rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: Recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Consenso colombiano para la prevención, el diagnóstico y el tratamiento de condiciones trombóticas en adultos con COVID-19: aplicando el Marco de la Evidencia a la Decisión (EtD) GRADE / Colombian consensus for the prevention, diagnosis and treatment of thrombotic conditions in adults with COVID-19: applying GRADE Evidence to Decision (EtD) Frameworks

Introducción estudios recientes han reportado fenómenos trombóticos o coagulopatía en pacientes con COVID-19. Hay posiciones divergentes en cuanto a la prevención, el diagnóstico y el tratamiento de estos fenómenos, y la práctica clínica actual está basada únicamente en deducciones por extensión a partir de estudios retrospectivos, series de casos, estudios observacionales y guías internacionales desarrolladas previas a la pandemia. Objetivo establecer una serie de recomendaciones sobre prevención, diagnóstico y manejo de las complicaciones trombóticas asociadas a COVID-19. Métodos se desarrolló una guía rápida en la que se aplicó el marco de la evidencia a la decisión (EtD) de GRADE y un sistema de participación iterativo, con análisis estadísticos y cualitativos de sus resultados. Resultados se generaron 31 recomendaciones clínicas enfocadas a: a) Pruebas de coagulación en adultos sintomáticos con sospecha de infección o infección confirmada por SARS-CoV-2; b) Tromboprofilaxis en personas adultas con diagnóstico de COVID-19 (escalas de riesgo, tromboprofilaxis de manejo ambulatorio, intrahospitalario y duración de tromboprofilaxis después del egreso de hospitalización), c) Diagnóstico y tratamiento de las complicaciones trombóticas y d) Manejo de personas con indicación previa a usar agentes anticoagulantes. Conclusiones las recomendaciones clínicas de este consenso orientan la toma de decisiones clínicas respecto a prevención, diagnóstico y tratamiento de fenómenos trombóticos en pacientes con COVID-19, y representan un acuerdo que ayudará a disminuir la dispersión en las prácticas clínicas acorde con el desafío que impone la pandemia.

Abstract Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection; b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.

Isquemia arterial aguda de las extremidades: ¿cómo abordarla? / Acute arterial limb ischemia: ¿How to approach it?

La isquemia arterial aguda de las extremidades se define como la interrupción abrupta del flujo sanguíneo a determinado tejido, lo cual afecta la integridad, la viabilidad de la extremidad, o ambas. Las causas son múltiples y pueden resumirse en dos procesos fisiopatológicos, trombóticos o embólicos, con lo que se puede establecer el pronóstico y el tratamiento según su causa. El cuadro sindrómico es variable, y típicamente, se identifica con las cinco "P" de Pratt (pain, pallor, pulselessness,paralysisand paresthesia); se cuenta con múltiples ayudas diagnósticas, pero la arteriografía sigue siendo el método estándar para el diagnóstico. Con el advenimiento de los avances tecnológicos y los procedimientos vasculares, el salvamento de las extremi-dades ha venido en aumento y ha disminuido la extensión de las amputaciones, lo cual conlleva una mayor tasa de rehabilitación y de reincorporación a la vida social

Acute arterial ischemia of the extremities is defined as the abrupt interruption of blood flow to certain tissue which affects the integrity and/or viability of the limb. The causes are multiple and can be summarized in two pathophysiological processes, thrombotic or embolic, with which the prognosis and management can be established depending on the cause. The syndromic picture is variable, typically identified with the Pratt's five "P" (pain, pallor, pulselessness, paralysis and paresthesia); there is an arsenal of diagnostic tools but arteriography remains the gold standard for diagnosis. With the advent of technological advances and vascular procedures, limb salvage has been increasing with a decrease in the extent of amputations represented by a higher rate of rehabilitation and reincorporation into social life

Fenômenos tromboembólicos associados a mamoplastia no Serviço de Cirurgia Plástica do Hospital PUC-Campinas / Thromboembolic phenomena associated with mammoplasty at the PUC-Campinas Hospital Plastic Surgery Service

Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.

Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.

Comunicación breve: aspirina en la prevención primaria de la enfermedad ateroesclerótica cardiovascular y su automedicación: Un problema por solucionar / Brief communication: aspirin in primary prevention of cardiovascular atherosclerotic disease and its self-medication A problem to solve

Millones de personas, sin indicación médica, toman aspirina para la prevención primaria de la enfermedad ateroesclerótica cardiovascular. La Sociedad Europea de Cardiología no la recomienda para prevención primaria de esta entidad y las Guías del ACC/ AHA sobre Prevención Primaria de la Enfermedad Ateroesclerótica Cardiovascular la recomiendan solo en personas con riesgo cardiovascular aumentado. El beneficio de la aspirina en pacientes con enfermedad cardiovascular establecida sobrepasa el riesgo de sangrado. Ese beneficio se debe al efecto antiinflamatorio y anti-plaquetario, que reduce el riesgo de aterotrombosis, pero con riesgo de sangrado particularmente en individuos susceptibles de sangrar. El papel de esta medicación en individuos sin enfermedad cardiovascular establecida es controversial en especial si tienen riesgo de sangrado. En esta comunicación se discuten las En las Guías del ACC/AHA, el estudio ASCEND en diabéticos, el ASPREE en ancianos sanos y el ARRIVE en pacientes con moderado a alto riesgo y otros para que sirva de alarma a los médicos generales y especialistas, a fin de que indaguen sobre el uso de aspirina en sus pacientes, y al mismo tiempo discutan sobre el balance entre el daño y los beneficios, particularmente en los pacientes ancianos y en aquellos con riesgo de sangrado. Se sugiere realizar un estudio para obtener la evidencia del número de personas que ingieren aspirina automedicada, realizar su seguimiento, y evolución una vez conocidas ampliamente e implementadas las presentes recomendaciones(AU)

Millions of people, without medical indication, take aspirin for the primary prevention of cardiovascular atherosclerotic disease. The European Society of Cardiology does not recommend it for primary prevention, and the ACC/AHA Guidelines on Primary Prevention of Cardiovascular Atherosclerotic Disease recommend it only in people with increased cardiovascular risk. The benefit of aspirin in patients with established cardiovascular disease outweighs the risk of bleeding. This benefit is due to the anti-inflammatory and anti-platelet effect, which reduces the risk of atherothrombosis, but with the risk of bleeding, particularly in individuals susceptible to bleeding. However, the role of this medication as primary prevention in individuals without established cardiovascular disease is controversial especially if they are at risk of bleeding. Despite the recommendations of the ACC/AHA and the European guidelines aspirin continues to be auto medicated for a large number of subjects. In this communication we discuss the ACC / AHA Guidelines, the ASCEND study in diabetics, the ASPREE in healthy elderly and the ARRIVE in patients with moderate to high risk and others to serve as an alarm to general practitioners and specialists, in order for them to inquire about the use of aspirin in their patients, and at the same time discuss the balance between the harm and the benefits, particularly in elderly patients and those at risk of bleeding. It is suggested to conduct a study to obtain evidence of the number of people who take self-medicated aspirin, follow up, and evolution once these recommendations are widely known and implemented(AU)

Remoras and spontaneous echocardiographic contrast / Remoras e contraste ecocardiográfico espontâneo

The term "Remora" (hindrance) ­ re (again)/mora (delay) -originally designated a family of fishes ­ the suckerfishes. In ancient Greece and Rome and up to the early 19th century, these fishes were believed to slow down ships by attaching to them. Medicine adopted the term "remora" to describe fluid/blood stasis. Intracardiac blood stasis, or remora, especially in the left atrial appendage, is associated with thrombogenesis and responsible for cardioembolic phenomena. The slow and swirling movement of blood causes the appearance of spontaneous echocardiographic contrast (SEC). I briefly narrate the Naval Battle of Actium, whose result was mythically attributed to the remora fishes, and make a short review of remoras. I also describe Laennec's discussion about intracardiac blood stasis and give a short account of SEC, its original descriptions and importance

Neuromiopatia isquêmica em cinco cães (2008-2016) / Ischemic neuromyopathy in five dogs (2008-2016)

O objetivo deste estudo foi apresentar dados epidemiológicos, clínicos e anatomopatológicos de cinco cães com neuromiopatia isquêmica secundária a trombose ou tromboembolismo aórtico. Os cães eram fêmeas, com idade ≥11 anos, que apresentavam paraplegia (80%) ou monoplegia (20%) de membro pélvico. Em 40% dos casos (n=2) foi relatada claudicação previamente à disfunção motora. Os principais achados clínicos foram ausência de pulso femoral uni ou bilateral, extremidade de membros pélvicos frias, dor muscular acima da articulação do joelho e ausência de nocicepção (dor profunda) nos dígitos dos membros pélvicos. Quatro cães foram submetidos à eutanásia devido ao prognóstico desfavorável e um veio a óbito em menos de 24 horas de internação. Na necropsia foi encontrada alteração cardíaca em três cães, neoplásica em um e, sem causa determinante em outro caso. Os trombos estavam localizados na aorta abdominal e se estendiam até as artérias ilíacas. Mesmo sendo baixa a incidência, a neuromiopatia isquêmica deve ser incluída no diagnóstico diferencial de cães com claudicação, paraparesia ou paraplegia uni ou bilateral, quando os sinais neurológicos são compatíveis com lesão de neurônio motor inferior (L4-S3) e de evolução aguda ou crônica. A avaliação do pulso femoral digital e/ou por doppler vascular deve ser empregada e pode auxiliar no diagnóstico da doença evitando que os animais iniciem tratamento para outras afecções.(AU)

This study aimed to present epidemiological, clinical and anatomopathological data of five dogs with ischemic neuromyopathy secondary to aortic thrombosis or thromboembolism. The dogs were females, with eleven years of age or more, that had paraplegia (80%) or hind limb monoplegia (20%). Forty percent of the cases (n=2) had lameness previously the motor disfunction. The main clinical findings include absence of unilateral or bilateral femoral pulse, cool hind limbs extremities, muscle pain above the knee joint and absence of nociception (deep pain) on the hind limbs digits. Four dogs were euthanized due to the poor prognosis, and the last one died within 24 hours of hospital admission. The necropsy findings were cardiac lesions in three dogs, neoplastic disease in one, and unknown cause on the other. The thrombi were located on the abdominal aorta, extending to the iliac arteries. Even with low incidence, the ischemic neuromyopathy should be included in the differential diagnosis of dogs with lameness, paraparesis, or unilateral or bilateral paraplegia, when neurological signs are compatible with lower motor neuron lesion (L4-S3) and acute or chronic progression. The digital and/or vascular doppler evaluation of the femoral pulse must be used and can assist on the disease diagnosis, avoiding treatments for other illnesses.(AU)

Profilaxis tromboembólica en pacientes posparto. Estudio de corte transversal en tres instituciones en Colombia / Thromboembolic prophylaxis in post-partum patients. Cross-sectional study in three institutions in Colombia

Describir el nivel de riesgo de enfermedad tromboembólica en pacientes posparto y hacer una aproximación al uso actual de la tromboprofilaxis.Materiales y métodos: estudio descriptivo de corte transversal. Se incluyeron pacientes que fueron hospitalizadas para atención de parto entre agosto de 2012 y abril de 2013 en tres instituciones generales de alta complejidad en Bogotá y Medellín. Se aplicó la Guía de manejo del Royal College Obstetrics & Gynecology (RCOG) para establecer el riesgo de enfermedad tromboembólica. Las pacientes fueron evaluadas en el posparto y clasificadas en alto, intermedio y bajo riesgo. Se midió la frecuencia real de aplicación de tromboproilaxis. Los resultados se presentan como proporciones.Resultados: se evaluaron un total de 3516 pacientes, el 1,9 % de las pacientes fueron clasificadas como de alto riesgo, 42 % de riesgo medio y 56,1 % de riesgo bajo. La tromboprofilaxis solo se aplicó a un 7,4 % de las pacientes con alto riesgo y riesgo intermedio.Conclusión: según los criterios de la Guía del RCOG, un 43,9 % de las pacientes tendrían indicación de tromboprofilaxis; sin embargo, solo un 7,4 % de ellas la recibió. Se requieren estudios complementarios para evaluar los riesgos y beneficios del uso de la tromboprofilaxis según la guía del Reino Unido...

To describe the risk of thromboembolic disease in post-partum patients and examine the current use of thromboprophylaxis.Materials and methods: Descriptive cross-sectional study that included patients admitted for delivery care between August 2012 and April 2013 in three high-complexity general healthcare institutions in Bogotá and Medellín. The Royal College of Obstetrics & Gynaecology (RCOG) Management Guideline was applied for determining the risk of thromboembolic disease. Patients were assessed during the post-partum period and classified as high, intermediate and low risk. The actual frequency of the use of prophylaxis was measured. Results are presented as proportions.Results: Overall, 3516 patients were assessed and 1.9 % were classified as high risk, 42 % as intermediate risk and 56.1 % as low risk. Thromboprophylaxis was only used in 7.4 % of patients with high or intermediate risk.Conclusion: According to the criteria of the RCOG guidelines, 43.9 % of the patients had an indication for thromboprophylaxis and yet only 7.4 % of them received it. Further studies are required to assess the risk and evaluate the benefits and risks of giving thromboprophylaxis in accordance with the United Kingdom guidelines...

Trombose venosa profunda: perfil dos pacientes tratados em regime hospitalar / Deep venous trombosis: profile of the patients treated in hospital regimen

Objetivo: analisar o perfil dos pacientes com diagnóstico de trombose venosa profunda TVP tratados em regime hospitalar.Método: estudo transversal, incluindo os pacientes com diagnóstico de TVP confirmado pela ultrassonografia Collor-Dopller tratados em regime hospitalar pela Clínica de Cirurgia Vascular do Hospital do Servidor Público Municipal deSão Paulo, período de maio a outubro de 2008. Foram analisados dados epidemiológicos e clínicos desses pacientes.Resultados: vinte e quatro pacientes foram internados no serviço, sendo 12 indivíduos de cada sexo, com média de idadede 59 anos, entre os quais 23 apresentaram TVP de membros inferiores e 1 de membro superior. Edema e dor foramos sinais e/ou sintomas mais referidos pelos pacientes. A ultrassonografia Collor-Dopller foi capaz de correlacionar alocalização dos sintomas com as veias comprometidas em todos os casos. A cirurgia representou o principal fator derisco para TVP. O uso de heparina não-fracionada HNF associada à Varfarina foi o tratamento instituído em 83,34% doscasos, com baixos índices de complicações (sangramentos em 8,33% dos casos). O tempo médio de internação foi de8,25 dias. Conclusões: a TVP é uma doença que acomete ambos os sexos e tem maior incidência em indivíduos commais de 40 anos. Os membros inferiores são os mais acometidos e a cirurgia foi o principal fator de risco. O tratamentoé seguro e com baixos índices de complicações.

Objective: to evaluate profile of patients diagnosed with DVT and treated in hospital regimen. Methods: prospectiveand observational study, all the patients had DVT diagnosed by duplex ultrasound and began the treatment duringhospital internment. Patients were treated by the vascular team of the Hospital do Servidor Público Municipal de SãoPaulo between May and October of 2008. An evaluation of clinical and epidemiological data of the patients was made.Results: twenty-four patients were admitted during the period of the study, twelve of each gender, the mean age was 59years old. Twenty-three patients had DVT on inferior limbs and one on superior limb. Edema and pain were the mostreferred symptoms. The duplex ultrasound was able to establish a relation between the symptoms and the vein locationin all cases. Surgery was the most important risk factor for DVT. Heparin associated to warfarin was the treatment usedin 83.34% of the cases, with low complications rates (bleeding in 8.33%). The mean hospital internment period was8.25 days. Conclusions: DVT is a disease that occurs on both genders and is most common in patients over forty yearsold. It occurs most frequently on the inferior limbs and surgery was the major risk factor. Treatment is safe and has lowcomplication rates.

Dímero D' en pacientes hospitalizados con alto riesgo de trombosis venosa profunda y embolia pulmonar / Dímero D' in patients hospitalized with high risk of deep veined thrombosis and Lung Clot

Los cuadros tromboembólicos son complicaciones frecuentes en pacientes hospitalizados, como lo demuestra la literatura norteamericana revisada. En el presente trabajo multicéntrico realizado en 500 pacientes de riesgo trombótico alto, asintomático paratrombosis, provenientes de diferentes hospitales de la capital y de dos ciudades importantes, se utilizó el Test del Dímero D como marcador plasmático para Trombosis Venosa Profunda y Embolia Pulmonar. Se encontró una positividad de 295 (59 por ciento) casos y 205 (41 por ciento) negativos, como resultados generales. En las especialidades médicas 56 por ciento de positividad y en las quirúrgicas 66,8 por ciento. Hallazgos que demuestran que los pacientes hospitalizados de alto riesgo para trombosis, poseen una elevada incidencia de este marcador plasmático y nos induce a pensar que en su mayoría están produciendo cierto grado de trombosis aun sin sintomatología evidente.

Isquemia mesentérica aguda: experiencia clínica en 12 años / Acute mesenteric ischemia: clinical experience in 12 years

Se presenta la experiencia de 8 años en la Unidad de Emergencia del Hospital Clínico de la Universidad de Chile, en una revisión retrospectiva de 48 casos de lsquemia Mesentérica Aguda (IMA). El promedio de edad fue de 72,4 años, 52 por ciento hombres. Los diagnósticos de ingreso más frecuentes fueron: IMA (35,4 por ciento) y obstrucción intestinal (14,5 por ciento), siendo la hipertensión arterial (25 por ciento) la patología agregada más común. En cuanto a la semiología destacan dolor abdominal (89,5 por ciento) y distensión abdominal (77 por ciento). Un 1/3 presentaba taquicardia e hipotensión y más de la mitad, leucocitosis e hipoxia. La etiologías más frecuentes fueron: embolia arterial (60 por ciento) y trombosis arterial (29,1 por ciento). El 78 por ciento de los pacientes fueron operados, siendo los procedimientos más utilizados la laparotomía exploradora (54 por ciento) y la resección intestinal (32,4 por ciento). La mortalidad general del grupo fue de 72,9 por ciento; ésta disminuye a 64,8 por ciento al considerar sólo aquellos que por su condición general permitieron una exploración quirúrgica. En los pacientes que sobreviven la etiología más frecuente fue la embolia arterial (76,9 por ciento)

Pautas para el manejo y tratamiento del infarto agudo de miocardio y sus complicaciones / Clues to acute myocardial infartion and its complications

El presente artículo pretende establecer pautas o rutinas básicas de conducta y tratamiento de los pacientes con IAM. Pretende también establecer las indicaciones para el estudio cinecoronario-gráfico, angioplastía coronaria y cirugía de revascularización post IAM.