Undiagnosed scrotal swelling in a 36-year-old man: A congenital arteriovenous malformation.

We have reported the case of a 36-year-old man with severe scrotal swelling that had remained undiagnosed after multiple diagnostic tests. The patient had presented with scrotal swelling, multiple weeping ulcers on the dorsal aspect of the scrotum, and worsening pain affecting his day-to-day functioning. Duplex ultrasound showed low- to no-flow hypervascularity and dependent edema suspicious for a vascular malformation. Treatment included sequential Gelfoam (Pfizer, New York, NY) embolization using ultrasound-guided direct cannulation and traditional angiography. The scrotal circumference decreased by 65%, with moderate relief of his pain. The details from the present case have highlighted the significance of vascular malformations, various diagnostic and therapeutic techniques used, and value of endovascular embolization.

[VENOUS THROMBO-EMBOLISM IN BURNS: INCIDENCE AND RISK FACTORS]. / MALADIE THROMBOEMBOLIQUE VEINEUSE CHEZ LE BRÛLÉ : INCIDENCE ET FACTEURS DE RISQUE.

Venous thromboembolic disease (VTE) in burn patients is an under-diagnosed and potentially serious complication. Its incidence varies according to studies performed. This retrospective and descriptive study conducted in an intensive burn care department in Tunisia over a period of 22 months (January 1, 2021 to October 30, 2022) included 24 patients who presented a thromboembolic complication among a total of 785 admissions (incidence of 3%): pulmonary embolism in 15 cases and deep venous thrombosis (DVT) in 9 cases. The mean age of the patients was 43.8 years, with a male:female sex ratio of 2:1. Two thirds of patients (n=17) had a pathological history: hypertension (n=3); diabetes (n=2) and neoplasia (n=2). Three patients were obese. The average TBSA was 29%. Burns involved lower limbs in 19 patients (79%). The mean time to onset of VTE was 27.8 days. Acute dyspnea was present in 1/2 of cases and tachycardia in 1/3 of cases. The association hypoxia-hypocapnia was found in 5 patients. The diagnosis was confirmed by: thoracic angioscan (n=14), pulmonary scintigraphy (n=1), venous Doppler ultrasound of the lower limbs (n=2) and phleboscan of lower limbs (n=7). Factors correlated with thromboembolic risk in our study were: TBSA 20% - 39% (p=0,029; RR=4), with lower limb involvement (p=0,068), catheterization duration ≥7 days (p=0,048; RR=3) and number of catheters >1 (p=0,01; RR=3). The outcome was favorable in 13 patients and fatal in 11 patients.

Accurately identifying incident cases of venous thromboembolism in the electronic health record: Performance of a novel phenotyping algorithm.

BACKGROUND: Accurate identification of incident venous thromboembolism (VTE) for quality improvement and health services research is challenging. The purpose of this study was to evaluate the performance of a novel incident VTE phenotyping algorithm defined using standard terminologies, requiring three key indicators documented in the electronic health record (EHR): VTE diagnostic code, VTE-related imaging procedure code, and anticoagulant medication code. METHODS: Retrospective chart reviews were conducted to assess the performance of the algorithm using a random sample of phenotype(+) and phenotype(-) diagnostic encounters from primary care practices and acute care sites affiliated with five hospitals across a large integrated care delivery system in Massachusetts. The performance of the algorithm was evaluated by calculating the positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity, using the phenotype(+) and phenotype(-) diagnostic encounters sample and target population data. RESULTS: Based on gold-standard manual chart review, the algorithm had a PPV of 95.2 % (95 % CI: 93.1-96.8 %), NPV of 97.1 % (95 % CI: 95.3-98.4 %), sensitivity of 91.7 % (95 % CI: 90.8-92.6 %), and specificity of 98.4 % (95 % CI: 98.1-98.6 %). The algorithm systematically misclassified a low number of specific types of encounters, highlighting potential areas for improvement. CONCLUSIONS: This novel phenotyping algorithm offers an accurate approach for identifying incident VTE in general populations using EHR data and standard terminologies, and accurately identifies the specific encounter and date of diagnosis of the incident VTE. This approach can be used for measurement of incident VTE to drive quality improvement, research to expand the evidence, and development of quality metrics and clinical decision support to improve the diagnostic process.

Assessing the Readability of English and Spanish Online Patient Educational Materials for Deep Venous Thrombosis.

INTRODUCTION: Online patient educational materials (OPEMs) help patients engage in their health care. The American Medical Association (AMA) recommends OPEM be written at or below the 6th grade reading level. This study assessed the readability of deep venous thrombosis OPEM in English and Spanish. METHODS: Google searches were conducted in English and Spanish using "deep venous thrombosis" and "trombosis venosa profunda," respectively. The top 25 patient-facing results were recorded for each, and categorized into source type (hospital, professional society, other). Readability of English OPEM was measured using several scales including the Flesch Reading Ease Readability Formula and Flesch-Kincaid Grade Level. Readability of Spanish OPEM was measured using the Fernández-Huerta Index and INFLESZ Scale. Readability was compared to the AMA recommendation, between languages, and across source types. RESULTS: Only one (4%) Spanish OPEM was written at an easy level, compared to 7 (28%) English OPEM (P = 0.04). More English (28%) OPEM were easy to read compared to Spanish (4%), with a significant difference in reading difficulty breakdown between languages (P = 0.04). The average readability scores for English and Spanish OPEM across all scales were significantly greater than the recommended level (P < 0.01). Only four total articles (8%) met the AMA recommendation, with no significant difference between English and Spanish OPEM (P = 0.61). CONCLUSIONS: Nearly all English and Spanish deep venous thrombosis OPEM analyzed were above the recommended reading level. English resources had overall easier readability compared to Spanish, which may represent a barrier to care. To limit health disparities, information should be presented at accessible reading levels.

1H Nuclear Magnetic Resonance Spectroscopy Reveals Changes in Metabolic Phenotype Associated with Disease Stage in Patients with Chronic Venous Disease.

OBJECTIVE: Chronic venous disease (CVD) is a condition presenting a great burden to patients and society, with poorly characterised pathophysiology. Metabolic phenotyping can elucidate mechanisms of disease and identify candidate biomarkers. The aim of this study was to determine differences in the metabolic signature between symptomatic patients with CVD and asymptomatic volunteers using proton nuclear magnetic resonance spectroscopy (1H-NMR). METHODS: This was a prospective case-control study of consecutive patients with symptomatic CVD and asymptomatic volunteers recruited from a single centre. Participants underwent clinical assessment, venous duplex ultrasound, and blood and urine sampling. Disease stage was defined according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. 1H-NMR experiments were performed, with data analysed via multivariate statistical techniques. RESULTS: A total of 622 participants were recruited, including 517 symptomatic patients with CVD (telangiectasia [C1] 0.6%, varicose veins [C2] 48.5%, swelling [C3] 12.0%, skin changes [C4] 27.7%, healed or active ulceration [C5/6] 11.2%) and 105 asymptomatic participants (no disease [C0] 69.5%, telangiectasia [C1] 29.6%). Multivariate analysis revealed differences between the metabolic profile of the symptomatic CVD and asymptomatic groups, and between CEAP clinical classes in the CVD group. Serum aromatic amino acids positively correlated with increasing CEAP clinical class (p < .001). Urinary formate, creatinine, glycine, citrate, succinate, pyruvate, and 2-hydroxyisobutyrate negatively correlated with increasing CEAP clinical class (p < .001). These metabolites are involved in the tricarboxylic acid cycle, hypoxia inducible factor pathway, and one carbon metabolism. CONCLUSION: Untargeted biofluid analysis via 1H-NMR has detected metabolites associated with the presence and severity of CVD, highlighting biological pathways of relevance and providing candidate biomarkers to explore in future research.

L-PRF in extra-oral wound care.

Leukocyte- and platelet-rich fibrin (L-PRF), a by-product of centrifuged autologous whole blood, contains high concentrations of platelets, leukocytes, and fibrin (the latter spontaneously creating a strong 3-D network (a membrane)). L-PRF membranes possess several characteristics essential in wound healing, including a barrier function, an antibacterial and analgesic activity, and the release of growth factors enhancing tissue regeneration and neo-vasculogenesis. This review investigated the role of L-PRF in treating non-responding chronic wounds such as diabetic foot, venous leg ulcers, pressure ulcers, complex wounds, leprosy ulcers (Hansen's Disease), and other demanding wounds. Chronic wounds affect millions worldwide, negatively impacting their quality of life, productivity, and life expectancy while incurring high treatment costs for themselves and private and public health systems. L-PRF has demonstrated clear adjunctive advantages in treating chronic skin wounds, shortening the time to complete wound closure, and improving patient-reported outcome measures (including reducing pain and minimizing the need for analgesics). Also, in other demanding wounds, L-PRF facilitates healing. To help clinicians, this article also proposes recommendations for the use of L-PRF in the treatment of extra-oral wounds.

Current state of education in venous diseases within vascular surgery training programs in Italy: A national web-based survey among residents.

BACKGROUND: To analyze the perception of vascular surgery trainees from Italian schools of Vascular Surgery regarding the level of practical and theoretical education in venous diseases. METHODS: An anonymous electronic survey was sent to Italian vascular surgery residents affiliated with 19 universities, asking about their training and experience in the management of venous diseases. The survey gathered information on the residents' personal and demographic details, their university's teaching program, operative experience in phlebology, as well as their confidence levels in performing various venous procedures, with the goal of analyzing the training and learning programs provided by Italian vascular surgery schools. RESULTS: The analysis showed that 28% of programs do not include phlebology in the curriculum, and more than 40% of residents are unable to independently perform venous duplex ultrasound or treat venous ulcers. Additionally, most residents (over 70%) have limited weekly exposure to phlebology cases, with only 5% having access to a dedicated phlebology operating room. The vast majority of residents (96%) expressed a strong desire to deepen their knowledge and skills in this field, particularly in areas such as endovascular ablation techniques, venous duplex ultrasound, and management of deep venous disease. CONCLUSIONS: The survey reveals significant limitations in phlebology education and hands-on experience within the current training programs, highlighting the need to standardize and enhance venous disease management education in order to ensure that future vascular surgeons are adequately equipped to provide high-quality care for patients with a wide range of venous disorders.

A composite risk assessment model for venous thromboembolism.

OBJECTIVE: Venous thromboembolism (VTE) is a preventable cause of hospitalization-related morbidity and mortality. VTE prevention requires accurate risk-stratification. Federal agencies mandated VTE risk-assessment for all hospital admissions. We have shown that the widely used Caprini (30 risk-factors) and Padua (11 risk-factors) VTE risk-assessment models (RAMs) have limited predictive ability for VTE when used for all general hospital admissions. Here we test whether combining the risk-factors from all 23 available VTE RAMs improves VTE risk-prediction. METHODS: We analyzed data from the first hospitalizations of 1,282,014 surgical and non-surgical patients admitted to 1,298 Veterans Affairs facilities nationwide between January 2016 and December 2021. We used logistic regression to predict VTE within 90 days of admission using risk-factors from all 23 available VTE RAMs. Area under the receiver-operating characteristic curves (AUC), sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were used to quantify the predictive power of our models. The metrics were computed at two diagnostic thresholds that maximized 1) the value of sensitivity + specificity-1 and 2) PPV, and were compared using McNemar's test. The Delong-Delong test was used to compare AUCs. RESULTS: After excluding those with missing data, 1,185,633 patients (mean age 66 years, 93% male, and 72% white) were analyzed, of whom 33,253 (2.8%) had a VTE (DVT [deep venous thrombosis], n=19,218, 1.6%; PE [pulmonary embolism], n=10,190, 0.9%; PE+DVT, n=3,845, 0.3%). Our composite RAM included 102 risk-factors and improved prediction of VTE compared to the Caprini RAM risk-factors (AUC Composite model: 0.74; AUC Caprini risk-factor model: 0.63; p<0.0001). When the sum of sensitivity and specificity-1 was maximized, the composite model demonstrated small improvements in sensitivity, specificity and PPV; NPV was high in both models. When PPV was maximized, the PPV of the composite model was improved but remained low. The nature of the relationship between NPV and PPV precluded any further gain in PPV by sacrificing NPV and sensitivity. CONCLUSIONS: Using a composite of 102 risk-factors from all available VTE RAMs, we improved VTE prediction in a large, national cohort of >1 million general hospital admissions. However, neither model has a sensitivity or PPV that permits it to be a reliable predictor of VTE. We demonstrate the limits of currently available VTE risk prediction tools; no available RAM is ready for widespread use in the general hospital population.

Incidence and clinical course of chronic thromboembolic pulmonary hypertension with or without a history of venous thromboembolism in Denmark.

INTRODUCTION: A considerable number of patients with chronic thromboembolic pulmonary hypertension (CTEPH) lack a history of venous thromboembolism (VTE). We examined the annual incidence and prevalence of CTEPH in Denmark and compared the rate of VTE, bleeding and mortality in patients with CTEPH with versus without a history of VTE. METHODS: The Danish National Patient Registry covering all Danish hospitals was used to identify all CTEPH cases between 2009 and 2018, based on combinations of discharge diagnoses using ICD-10 codes for CTEPH and relevant diagnostic and/or therapeutic interventions. Incidence rates of CTEPH per 100,000 person-years, rates of VTE and bleeding, and 5-year survival estimates were calculated. RESULTS: 509 CTEPH patients were identified, of whom 82% had a history of VTE. The yearly incidence rate of CTEPH was 0.5-0.8/100,000 person-years during the study period. Patients with a history of VTE experienced a 2.5-fold rate of VTE compared to those without prior VTE (2571 versus 980/100,000 person-years), while the rate of bleeding events was lower (5008 versus 7139/100,000 person-years, respectively). The 5-year survival of CTEPH patients with a VTE history was 65% (95% confidence interval (CI) 58-71) compared to 45% (95%CI 31-58) in patients without a history of VTE. CONCLUSION: The Danish incidence rate of CTEPH was comparable to that of other European countries. We identified notable differences in the prognosis of patients with CTEPH with or without a history of VTE. These findings may support generation of hypotheses regarding the pathophysiology of CTEPH and inform current patient care.

Pediatric venous thromboembolism: incidence and patient profile in a single Brazilian institution.

BACKGROUND: As the diagnosis of Pediatric venous thromboembolism has dramatically increased in recent decades, this study aims to evaluate these patients, determining the incidence and describing their biological and clinical characteristics. METHODS: An observational, cross-sectional study was conducted at a Brazilian quaternary hospital between January 2022 and February 2023. Under 18-year-old hospitalized patients with a confirmed diagnosis of venous thromboembolism were included, while those with arterial or chronic thrombosis were excluded. Data on biological and clinical characteristics, diagnosis and treatment were evaluated. A descriptive data analysis was performed and the incidence of hospital-associated thrombosis was calculated. RESULTS: Thirty-nine pediatric patients were evaluated. The incidence of hospital-associated thrombosis was 19.9 cases per 10,000 pediatric hospitalizations. Median age at diagnosis was four months (range: 12 days-17 years). Most of the patients (66.7%) were asymptomatic, with venous thromboembolism being diagnosed incidentally. In all cases, at least one risk factor was identified and in 74.6% of cases four or more factors were present. The principal risk factors were the presence of a central venous catheter (89.7%) and infection (89.7%). Thrombogenic comorbidities, particularly congenital heart disease, were present in 48.7% of patients. CONCLUSIONS: The incidence of venous thromboembolism found in the present study was lower than rates reported in developed countries. The principal characteristics of this sample were a greater frequency of central venous catheter and infection as risk factors, and the fact that the cases consisted mainly of newborns and individuals with heart disease.

A nomogram predicting venous thromboembolism risk in primary liver cancer patients.

Cancer frequently causes venous thromboembolism (VTE), a leading cause of cancer-related mortality. Primary liver cancer (PLC) is prevalent and highly fatal, with an increased risk of venous thrombotic complications. Thus, we aimed to develop a nomogram model for predicting VTE in patients with PLC. We retrospectively analyzed 1,565 patients diagnosed with PLC between January 2018 and December 2022 at Chongqing University Cancer Hospital. Univariate logistic analysis and multivariate logistic regression identified eight significant risk factors: activated partial thromboplastin time (APTT) ≤ 32.20 s, D-dimer > 1.44 mg/L, lymphocyte count (LYM) ≤ 1.18 × 109/L, monocyte count (MONO) > 0.42 × 109/L, transarterial chemoembolization (TACE), surgical intervention, immunotherapy, and ß2-microglobulin. The nomogram model exhibited strong discriminatory power, with C indices of 0.753 and 0.710 for the training and validation cohorts, respectively. The calibration curve showed a strong correlation between predicted and actual probabilities. Additionally, decision curve analysis (DCA) and clinical impact curves (CIC) confirmed the model's clinical utility. This nomogram facilitates the identification of high-risk PLC patients, allowing for timely preventive and therapeutic interventions to reduce the risk of thrombosis.

Psychological aspects in young people with venous thromboembolic disease, preliminary report.

BACKGROUND: The decline in the mental well-being of young adults following an episode of venous thromboembolism may be related to the uncertainty of long-term health and fear of recurrence. In recent years, post-pulmonary embolism syndrome has gained acceptance, however, less attention has been given to the psychological impact on young patients after venous thromboembolism. This study explores the prevalence, type, and severity of psychological disorders of patients following venous thromboembolism. METHODS: A retrospective observational cohort study was performed of over 18-year-old patients diagnosed with venous thromboembolism followed in the Vascular Medicine Service at Hospital Privado de Córdoba, Argentina from July 2020 to October 2021. Due to the COVID-19 pandemic, virtual interviews were conducted using two pre-established questionnaires administered by the same psychiatrist. The first questionnaire gathered personal data, clinical history, and mental health information, while the second, evaluated mood disorders using the Mini International Neuropsychiatric Interview. Patients with a positive MINI score underwent further assessment using the Hamilton Scale. Patients were considered young if ≤45 years. RESULTS: A total of 50 patients were assessed, 56 % were women, and 54 % were ≤45 years. Major depression was documented in 11 (22 %) patients, eight (72 %) in the younger group, and three (28 %) in the older group. Eight (16 %) patients had an anxiety disorder, four in the younger group, and ten (20 %) patients had post-traumatic stress disorder, seven (70 %) of the younger patients. Generalized anxiety disorder was identified in 20 (40 %) patients with similar proportions in both groups. CONCLUSION: Psychological and emotional symptoms are common following an episode of venous thromboembolism. Post-traumatic stress disorder and depression appear to be numerically more prevalent in the young.

Pipeline embolization device as a standalone curative approach for recurrent sigmoid sinus DAVF.

Dural arteriovenous fistulas (dAVFs) can occur as complications after surgical procedures, especially following the resection of meningiomas near the dural sinus. This case report presents a 74-year-old male who developed a recurrent sigmoid dAVF following meningioma resection. Initially treated with transvenous embolization and middle meningeal artery embolization, the dAVF recurred with worsening clinical symptoms. Conventional treatment options, including sinus sacrifice and transarterial embolization, were unsuitable due to the critical role of the patient's dominant right sigmoid sinus in cerebral venous drainage. Consequently, a reconstructive approach was employed using a pipeline embolization device (PED) construct. The PED successfully occluded the dAVF while preserving the function of the sigmoid sinus. A follow-up angiogram confirmed stable occlusion and normalization of intracranial venous drainage. This case underscores the potential of flow diversion as a viable treatment option for dAVFs, particularly in scenarios where preserving venous sinus function is paramount.

Venous sinus stenosis intracranial hypertension, rethinking idiopathic intracranial hypertension in the setting of venous sinus stenosis: A call for new nomenclature and diagnostic precision.

Idiopathic intracranial hypertension (IIH) is traditionally characterized by elevated intracranial pressure without an identifiable cause, primarily affecting obese women. However, recent evidence suggests that venous sinus stenosis may play a significant role in the pathophysiology of IIH, challenging its designation as "idiopathic." This editorial discusses the limitations of the current nomenclatures and diagnostic criteria, highlighting the importance of routine venography in detecting venous sinus abnormalities, irrespective of a patient's demographic profile. We propose a new nomenclature of this subset of patients to venous sinus stenosis intracranial hypertension in order to promote more accurate diagnosis and targeted treatment, including potential endovascular interventions.

Knowledge, attitude and practices of surgeons regarding venous thromboembolism prophylaxis in tertiary healthcare hospitals of the Rawalpindi Districts.

Objective: To assess doctors' knowledge, attitudes and practices regarding venous thromboembolism prophylaxis. METHODS: The cross-sectional study was conducted from April to September 2021 in three public-sector hospitals affiliated with the Rawalpindi Medical University: Holy Family Hospital, Benazir Bhutto Hospital and Rawalpindi District Headquarters Hospital, Rawalpindi, Pakistan, and comprised physicians of either gender who were actively involved in patient care. Data was collected using a predesigned questionnaire regarding venous thromboembolism. Data was analysed using SPSS 25. RESULTS: All the 220(100%) subjects approached responded positively to the study questionnaire. There were 144(65.45%) general surgeons, 50(22.72%) gynaecologists and 26(11.81%) orthopaedic surgeons. Overall, there were 26(11.81%) senior consultants, 65(29.54%) postgraduate residents and 129(58.63%) house officers. There were 150(68.2%) doctors who reported having witnessed deep-vein thrombosis in their patients, and 113(51.4%) had witnessed deaths related to pulmonary embolism. Among the methods employed for DVT diagnosis, the use of clinical criteria was the most common 136(36.1%), while venography was the least common technique used by 8(2.2%). While 210(95.5%) subjects expressed the desire for adopting an institute-wide regimen for venous thromboembolism prophylaxis, only 66(30%) were currently following such a regimen.

A haemodialysis catheter misplaced due to central venous stenosis: A case report.

Chronic kidney disease has become a significant global health issue, with some individuals progressing to endstage renal disease (ESRD) and requiring renal replacement therapy. For ESRD patients undergoing haemodialysis, the first step is to establish vascular access. In emergency situations, inserting a haemodialysis catheter (HDC) into the central vein is often the most appropriate approach; the right internal jugular vein (IJV) is considered the optimal site for catheterisation. However, catheter placement in the right IJV can sometimes lead to inadvertent entry into an abnormal position. Herein, we present a unique case in which the tip of the HDC was noted to have misplaced into the left IJV due to the patient's multiple central venous stenosis (CVS). This case highlights the clinical manifestation of HDC misplacement, with CVS being the underlying cause. Therefore, healthcare providers should pay adequate attention to CVS.

Surgical Treatment of Superior Vena Cava Syndrome in a Preterm Neonate.

Superior vena cava syndrome is rare and challenging clinical entity in neonates. Medical treatment options are usually effective. However, when failed, surgery is warranted. Herein, we present a preterm neonate with SVC syndrome and associated chylothorax. When 2 weeks old, he underwent successful open thrombectomy and SVC reconstruction under cardiopulmonary bypass. Immediately after the operation findings of SVC syndrome and chylotorax were completely resolved. To our knowledge, this patient is the smallest baby underwent open SVC reconstruction with cardiopulmonary bypass.

The use of a multimodal wound matrix to treat a variety of hard-to-heal wounds: a case series surveillance.

OBJECTIVE: This case series examines the use of a multimodal wound matrix (MWM) trialled in a selection of clinical practice settings and on a variety of hard-to-heal wounds. The objective was to evaluate the effects of MWM and its performance in managing such wounds, regardless of clinical setting and ulcer type. METHOD: Treatment of the MWM was conducted by independent wound care practitioners on wounds that were of >4 weeks duration. Treatment was once a week. Assessment was taken after four weeks and at week 12 of the study to assess percentage area reduction (PAR) compared to baseline measurements taken at the first treatment visit. Complete (100%) re-epithelialisation was also recorded. RESULTS: A total of 63 wounds were treated with MWM, and ulcer types were grouped as: diabetic foot ulcers (n=21); venous leg ulcers (n=18); pressure injuries (n=10); and others (n=14). Of the wounds, 78% had 100% re-epithelialisation, with an average PAR of 57% at four weeks and 86% at 12 weeks. The average time to resolution for those wounds that closed was 7.9 weeks. CONCLUSION: Results from this series of independent case studies support the application of MWM to potentially benefit healing in hard-to-heal wounds of different aetiologies of any duration and in a variety of clinical settings.

Association between COVID-19 Vaccination (ChAdOx1-S) and Thromboembolic, Thrombocytopenic, Hemorrhagic Events: A Systematic Review and Meta-analysis of Analytical Epidemiological Studies.

We conducted a systematic review of analytical epidemiological studies to assess the association between ChAdOx1-S vaccination and thromboembolic, thrombocytopenic, and hemorrhagic events. We searched Medline, Embase, Google Scholar, WHO-COVID-19 database, and medRxiv for studies evaluating the association between ChAdOx1-S and vascular events. Primary outcomes of interest were cerebral venous sinus thrombosis, peripheral venous thrombosis (PVT), and thrombocytopenia. Two independent reviewers screened for eligible studies, extracted data, and assessed the risk of bias. The DerSimonian-Laird random effects model was used to pool the incidence rate ratios (IRRs) separately for the first and second doses. Heterogeneity was assessed using I2 statistics. Twenty studies were included, of which 11 were self-controlled case series, and nine were cohort studies (254 million participants). Pooling of 17 studies showed a higher risk of cerebrovascular thrombosis (IRR = 3.5, 95% CI = 2.2-5.4, I2 = 79%), PVT (IRR = 2.0, 95% CI = 1.1-3.5, I2 = 95%) and thrombocytopenia (IRR = 1.6, 95% CI = 1.4-1.9, I2 = 93%) among those who received ChAdOx1-S vaccination as compared to controls. No increased risk was seen after the second dose or for secondary outcomes. There is moderate-to-high certainty of the evidence for the increased risk of cerebral venous sinus thrombosis, PVT, and thrombocytopenia following the first dose of the ChAdOx1-S vaccine. Systematic Review Registration: PROSPERO CRD42022372768.

Validation of a Clinical Scale for Early Detection of Infections at the Exit Site of Central Venous Catheters for Hemodialysis.

Introduction: Exit-site infections (ESI) of central venous catheters for hemodialysis (CVC-HD) has been associated with early catheter removal and an increased risk of CVC-HD related bacteremia. No specific clinical scales to predict ESI have previously been validated. Methods: A multicenter prospective cohort study was performed to validate the proposed scale, which is based on the following 5 signs and symptoms: (i) pain at exit site during interdialytic period; (ii) hyperemia or erythema ≥2 cm from exit site; (iii) inflammation, induration, or swelling at exit site; (iv) fever ≥38 °C not attributable to other causes, and (v) obvious abscess or purulent exudate at the exit site. Adult patients with a tunneled CVC-HD for at least 1 month after insertion has been included. During each hemodialysis session, the exit site was assessed with the proposed scale by nurses. If any item was present, a pericatheter skin swab culture was collected: positive results were gold standard. The scale was validated using receiver operating characteristic (ROC) curves and logistic regression analysis. For this purpose, the logit function was applied, and the ESI probability calculated, as elogit ESI/1 + elogit ESI. Results: Three hundred thirty-seven CVC-HDs from 310 patients were analyzed, producing 515 cultures (117 infected and 398 healthy). The final version of the scale includes the following 3 signs and symptoms, which present the greatest predictive capacity: (i) pain at exit site during interdialytic period, (ii) hyperemia or erythema ≥2 cm from exit site, and (iii) abscess or purulent exudate at the exit site. The final version generated an area under the ROC curve (AUC) of 88.3% (95% confidence interval [CI]: 85.2%-91%; P < 0.001), Youden index 0.7557 ≈ 1, sensitivity 80.34% (95% CI: 71.36%-87.71%) and specificity 95.23% (95% CI: 92.73%-97%). Conclusions: The validation shows that the scale has good predictive properties, detecting approximately 90% of ESI with very acceptable validity parameters.