Fibrinolytic therapy in patients with COVID-19 and ARDS: protocol for a systematic review and meta-analysis.

INTRODUCTION: In COVID-19-related acute respiratory distress syndrome (ARDS), the clot play a role in gas exchange abnormalities. Fibrinolytic therapy can improve alveolar ventilation by restoring blood flow. In this systematic review and meta-analysis protocol, we aim to assess the safety and efficacy of fibrinolytic therapy in such a population. METHODS: We will perform a systematic search in MEDLINE, EMBASE, Cochrane CENTRAL and LILACS databases without language restrictions for relevant randomised controlled trials (RCTs) and quasi-RCTs. Two review authors will independently perform data extraction and quality assessments of data from included studies. In case of divergence, a third author will be contacted. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis, a descriptive analysis will be performed. DISCUSSION: This systematic review and meta-analysis protocol will provide current evidence about the safety and efficacy of fibrinolytic therapy in patients with COVID-19 and ARDS. These findings will provide if fibrinolytic therapy might be an option for a desperate clinical setting, where all medical efforts have been used. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020187482. ETHICS AND DISSEMINATION: Ethics committee approval is not necessary. We intend to update the public registry, report any protocol amendments and publish the results in a widely accessible journal.

Pulmonary embolism with bilateral pulmonary infarction after surgical correction of Achilles tendon - a rare complication.

INTRODUCTION: Pulmonary embolism (PE) is a potentially fatal disorder that occurs as a result of a thrombus formed in the deep venous system that detaches and obstructs the pulmonary artery or one of its branches. Herein we report a rare, bilateral PE after surgical correction of the Achilles tendon. OBJECTIVES: To report a bilateral PE after calcaneus tendon repair, and to review the literature on this rare condition. MATERIALS AND METHODS: A search of the literature was carried out in electronic databases and a review of medical records. CONCLUSION: PTE, although rare, is a serious and potentially fatal complication, requiring adequate and early treatment. Pharmacological prophylaxis in these situations is still controversial in the medical literature; however, there is consensus for the use of intermittent pneumatic compression in the postoperative period.

DUPLICITY OF THE FEMORAL VEIN AS A RISK FACTOR FOR DEEP VENOUS THROMBOSIS - DIAGNOSIS BY ULTRASONOGRAPHY.

Femoral vein duplication is an anatomical abnormality with high prevalence in general population. Its diagnosis is through imaging exams, with greater emphasis on Doppler ultrasonography. The identification is crucial because it masks the clinical symptoms of deep vein thrombosis. Besides being an important anatomical pathway and, while in duplicity, it can be used as a possible vascular substitute, therefore making the knowledge of the anatomical path and its variants essential. Ultrasonography has attractive advantages over other methods, collecting data from patients in physiological conditions with- out the need of contrast, or exposure to ionizing radiation, providing anatomical details of the venous system and anatomical variations. When thrombus is suspected in a duplicated segment, examination of the lower limb with anatomical variation should not be used to justify the presence of duplication in the contralateral limb.

THORACIC KIDNEY THROUGH RIGHT BOCHDALEK FORAMEN.

Ectopic thoracic kidney corresponds to less than 5% of all renal ectopia. An asymptomatic 81-year-old woman performed an x-ray which demonstrated a heterogeneous opacity in the right hemithorax. An ultrasonography showed a thoracic right kidney, and a computed tomography demonstrated the right kidney in her right hemithorax through Bochdalek foramen. Physicians must be aware that asymptomatic patients do not need any treatment or invasive procedures due to this malformation, although surgical interventions may be due in severe cases.

Treatment of nonalcoholic fatty liver disease with dapagliflozin in non-diabetic patients.

Steatosis, a condition characterized by excessive lipid deposition. Although usually a benign condition, steatosis mays progress to cirrhosis or hepatocellular carcinoma. Recent evidence suggests that SGLT2 inhibitors suppress the development of nonalcoholic steatohepatitis in humans, as well as in rodent models and that SGLT2 inhibitors alleviate hepatic steatosis or steatohepatitis in obese type 2 diabetic rats or mice. 14 Patients with nonalcoholic fatty liver disease used a fixed dose of 10 mg of dapagliflozin for an average of 75 days. ALT, AST, GGT, insulin, HOMA-IR, and weight levels were significantly lower after treatment. There was no significant correlation between the reduction in HOMA and the reduction in ALT values or weight reduction obtained during treatment and ALT values.

Bullosis diabeticorum ­ una lesión poco común / Bullosis diabeticorum ­ an uncommon lesion

IINTRODUCCIÓN: el bullosis diabeticorum forma parte del espectro de manifestaciones cutáneas de la diabetes mellitus, descrito por Kramer en 1930 y nombrado como bullosis diabeticorum por Cantwell y Martz. Es una enfermedad conocida, pero bastante rara (0.5 a 2% de la población diabética) siendo dos veces más común en hombres. Es una lesión espontánea y no está relacionada con trauma o causa fisiológica evidente, como infección, 3 que no causa dolor o se asocia a signos flogísticos. Se asocia principalmente a las extremidades, pudiendo ser una lesión única o múltiples lesiones. Puede ocurrir en la diabetes mellitus tipo 1 (DM1) y en el tipo 2. Las lesiones típicamente se curan espontáneamente de 2 a 6 semanas, pero pueden ocurrir en el mismo lugar nuevamente. El pronóstico es bueno, sin tratamiento específico necesario o seguimiento diagnóstico con biopsia. Se relata un caso de esta rara patología con documentación por resonancia magnética.

Bullosis diabeticorum is part of the spectrum of cutaneous manifestations of diabetes mellitus, described by Kramer in 1930 and named bullosis diabeticorum by Cantwell and Martz. It is a known disease, but quite rare (0.5 to 2% of the diabetic population) and is two times more common in men. Bullosis diabeticorum is a spontaneous lesion and not related to trauma or obvious physiological cause, such as infection that does not cause pain or is associated with inflammatory signs. Occurs at the limbs and may be single or multiple. It can occur in diabetes mellitus type 1 (DM1) and type 2, usually in the advanced stages. The lesions heal spontaneously typically in 2 to 6 weeks, but they may happen again on the same site. The prognosis is good with no need of special treatment or further diagnosis with biopsy. We report a case of this rare complication with magnetic resonance imaging.