A CASE REPORT OF RIGHT UNILATERAL PULMONARY ARTERY ATRESIA (UPAA) MISDIAGNOSED AS RIGHT CHRONIC PULMONARY THROMBO-EMBOLISM

Unilateral pulmonary artery atresia is a rare condition with clinical presentation as exercise intolerance, recurrent infections, hemoptysis to asymptomatic state with incidental diagnosis. Common modalities of management include medical management for pulmonary hypertension , angioembolisation of collaterals followed by pneumonectomy. However surgical reconstruction of atretic pulmonary artery segment is an uncommon surgical management strategy employed in our case with satisfactory outcome

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism

ABSTRACT Objective: Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. Materials and methods: This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Results: Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Conclusion: Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

Anticoagulación en enfermedad renal crónica G4-5 en una red de hospitales de Bogotá

Contexto: la anticoagulación en pacientes con enfermedad renal crónica es un reto terapéutico debido a que la evidencia médica es escasa y los beneficios son discutibles, además, el riesgo de sangrado en estos pacientes es mayor. Objetivo: describir los pacientes con enfermedad renal G4-5 que recibieron terapia anticoagulante oral durante por lo menos tres meses en la Subred Centro Oriente de Bogotá. Metodología: estudio analítico de pacientes con enfermedad renal crónica G4-5 en un hospital de referencia entre enero del 2018 y diciembre del 2021, en el cual se analizaron variables sociodemográficas, clínicas y se realizó una regresión logística sobre los anticoagulantes y la frecuencia de eventos (hemorrágicos o embólicos). Resultados: se evaluó a 75 pacientes con diagnóstico de enfermedad renal crónica G4-5 anticoagulados, donde el anticoagulante más usado fue warfarina (76 %), seguido de apixabán (16 %) y rivaroxabán (8 %). El sangrado mayor se presentó con warfarina (8,47 %), apixabán (10%) y rivaroxabán (16,6 %). No se encontraron diferencias significativas entre el sangrado mayor con warfarina (OR: 2,8; IC 95 %: 0,46-16,9; p = 0,262) y rivaroxabán (OR: 1,86; IC 95 %: 0,18-18,7; p = 0,596), además, el sangrado no mayor y clínicamente relevante fue del 28,9 % con warfarina. Solo se presentó una complicación trombótica en un paciente que recibió rivaroxabán. Conclusiones: en los pacientes con enfermedad renal G4-5 que recibieron warfarina y los anticoagulantes orales directos no se encontraron diferencias significativas en cuanto a la presentación de sangrado mayor y no mayor, clínicamente relevantes.

Background: Anticoagulation in patients with chronic kidney disease is a therapeutic challenge since the medical evidence is scarce and the benefits are debatable since the risk of bleeding in these patients is greater. Purpose: To describe patients with G4-5 kidney disease who received oral anticoagulant therapy for at least 3 months in the central-eastern subnetwork of Bogotá. Methodology: Analytical study of patients with G4-5 chronic kidney disease, in a reference hospital between January 2018 and December 2021, in which sociodemographic and clinical variables were analyzed, and a logistic regression was performed on anticoagulants and the frequency of events (hemorrhagic or embolic). Results: 75 anticoagulated patients diagnosed with G4-5 chronic kidney disease were evaluated. The most commonly used anticoagulant was warfarin (76%), apixaban (16%), and rivaroxaban (8%). Major bleeding occurred with warfarin (8.47%), apixaban (10%), and rivaroxaban (16.6%). There are no significant differences between major bleeding with warfarin (OR: 2.8; 95% CI: 0.46;16.9; p= 0.262), and rivaroxaban (OR: 1.86; 95% CI: 0.18;18.7; p=0.596). Clinically relevant non-major bleeding was 28.9% with warfarin. A thrombotic complication only occurred in one patient who received rivaroxaban. Conclusions: In patients with G4-5 kidney disease who received warfarin and direct oral anticoagulants, no significant differences were found in terms of the presentation of clinically relevant major and non-major bleeding.

A Case of Thromboembolism and Deep Venous Thrombosis after Transfemoral Amputation with Short Stump / The Japanese Journal of Rehabilitation Medicine

An 82-year-old patient underwent a left transfemoral amputation due to a malignant soft tissue tumor. He developed symptoms of chest pain and hypoxia on the 32nd day after the operation. These symptoms were caused by deep venous thrombosis (DVT) of the stump and acute pulmonary thromboembolism (PTE), for which he was treated with anticoagulant therapy. Shortly after treatment he could resume a rehabilitation therapy. Patients with a lower extremity amputation have a higher risk of developing a DVT because of immobility and increased venous pooling in the residual limb. Even with a short stump as in this case, it is important to actively train the range of motion of the joint and try to prevent DVT.

A Case of Thromboembolism and Deep Venous Thrombosis after Transfemoral Amputation with Short Stump / The Japanese Journal of Rehabilitation Medicine

An 82-year-old patient underwent a left transfemoral amputation due to a malignant soft tissue tumor. He developed symptoms of chest pain and hypoxia on the 32nd day after the operation. These symptoms were caused by deep venous thrombosis (DVT) of the stump and acute pulmonary thromboembolism (PTE), for which he was treated with anticoagulant therapy. Shortly after treatment he could resume a rehabilitation therapy. Patients with a lower extremity amputation have a higher risk of developing a DVT because of immobility and increased venous pooling in the residual limb. Even with a short stump as in this case, it is important to actively train the range of motion of the joint and try to prevent DVT.

Comparison of CT Values between Thrombus and Postmortem Clot Based on Cadaveric Pulmonary Angiography / 法医学杂志

OBJECTIVES@#To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy.@*METHODS@#Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically.@*RESULTS@#The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05).@*CONCLUSIONS@#CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.

Chronic Thromboembolic Pulmonary Hypertension and ChronicThromboembolic Pulmonary Disease / 罕见病研究

Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) are diseases that occur after acute pulmonary embolism resulting from residual and organized intra-pulmonary thrombus, with or without pulmonary hypertension(PH). The prognosis of these diseases has been dramatically improved with the continuous progress of treatment and the updated concept of the comprehensive treatment strategy. However, there is a lack of awareness of these diseases among medical practitioners, and a lack of epidemiological data in China, with unknown pathogenesis and non-specific clinical manifestations. Therefore, it is easy to misdiagnosis, underdiagnosis and delay diagnosis in clinical practice. To enhance the understanding of medical personnel, this paper summarizes the definition, epidemiology, pathology, pathogenesis, diagnosis and treatment of CTEPH and CTEPD.

Tromboembolismo pulmonar como posible reacción adversa a Quetiapina Reporte de caso / Pulmonary thromboembolism as a possible adverse reaction to Quetiapine Case report

Resumen Algunos estudios sugieren que existe una relación entre el uso de antipsicóticos y el riesgo de tromboembolismo venoso (TEV) y embolia pulmonar (EP). Sin embargo, los resultados siguen sin ser concluyentes. Se trata del caso de un Masculino de 23 años con antecedentes de Esquizofrenia y Depresión tratado quetiapina 800 mg, el cual es encontrado muerto en la cama de un hotel. En la necropsia sin lesiones traumáticas visibles, hallazgos histológicos de tromboembolismo pulmonar masivo con infartos pulmonares secundarios. Laboratorio de Toxicología detectó la presencia de quetiapina, no se detectó alcohol o drogas de abusos. Mediante el Algoritmo De Karch & Lasagna Modificado el tromboembolismo pulmonar fue una reacción adversa con una probabilidad de relación causal posible. Se han informado muchos casos de muerte súbita causada por EP con la exposición a antipsicóticos, pero la relación de su uso y el riesgo de TEV y EP sigue siendo controvertida.

Abstract Some studies suggest a relationship between antipsychotic use and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, the results remain inconclusive. This is the case of a 23-year-old male with a history of schizophrenia and depression treated with quetiapine 800 mg, who was found dead in a hotel bed. At necropsy with no visible traumatic lesions, histological findings of massive pulmonary thromboembolism with secondary pulmonary infarcts. Toxicology laboratory detected the presence of quetiapine, no alcohol or drugs of abuse were detected. Using the Modified Karch & Lasagna Algorithm, pulmonary thromboembolism was an adverse reaction with a probable causal relationship. Many cases of sudden death caused by PE have been reported with exposure to antipsychotics, but the relationship of their use and the risk of VTE and PE remains controversial.

Trombo en tránsito entre la aurícula derecha y la vena cava inferior en un paciente con contraindicación absoluta para trombólisis / Thrombus in transit between the right atrium and the inferior vena cava in a patient with an absolute contraindication for thrombolysis

Resumen La tromboembolia venosa es una condición relativamente común que se identifica en los servicios de urgencias y que representa morbilidad y mortalidad significativas en la población. Su desenlace más grave es la tromboembolia pulmonar, la cual desencadena una serie de procesos fisiopatológicos que pueden terminar en paro cardiaco y en la muerte posterior del paciente. Un trombo en las cavidades cardiacas derechas o en la vena cava es poco detectable; esta condición se conoce en la literatura como trombo en tránsito, y su hallazgo se asocia con alta mortalidad hospitalaria. A continuación, se presenta el caso de un paciente de sexo femenino, de 64 años de edad, con antecedente de cáncer uterino activo, hospitalizada por trombosis venosa profunda y en quien se tomó un ecocardiograma transtorácico de control que mostró un trombo en tránsito de alta movilidad en el límite entre la aurícula derecha y la vena cava inferior.

Abstract Venous thromboembolism is a relatively common condition that is identified in the emergency services and represents significant morbidity and mortality in the population. Its most severe outcome is pulmonary thromboembolism, which triggers several pathophysiological processes that can end in cardiac arrest and subsequent death of the patient. A thrombus found in the right cavities or in the vena cava is an undetectable process, this condition is known like ongoing thrombus. The finding of thrombus in transit has been associated with high hospital mortality. We present the case of a 64-year-old female patient with a history of active uterine cancer, who was hospitalized for deep vein thrombosis and in whom a control transthoracic echocardiogram is taken, showing evidence of a highly mobile thrombus in transit between the right atrium and inferior vena cava compatible with ongoing thrombus at this level.

Desenlace fatal en embarazadas contagiadas con la COVID-19 / Fatal outcome wiht pregnant and COVID-19

Introducción: Múltiples han sido las muertes y contagios por el nuevo coronavirus. En medio de este contexto el contagio de la enfermedad en pacientes embarazadas ha sido bien documentado. Objetivo: Presentar los eventos ocurridos en embarazadas para transmitir la experiencia a quienes tratan estas pacientes. Presentación del caso: Se expone el caso de una gestante de 24 años, obesa, con embarazo de 25 semanas. Fue ingresada con neumonía por COVID-19 y evolución hacia la insuficiencia respiratoria grave que fallece durante la cesárea. Se recibió en el quirófano con hipoxemia e hipercapnia, taquicardia, cianosis, oliguria y ventilada a presión positiva con oxígeno al 100 %. Se conduce con ketamina, fentanilo y rocuronio. A los 35 min, y posterior a la histerotomía, presentó bradicardia progresiva, por lo que se inicia compresiones torácicas externas y tratamiento farmacológico. Se recuperó el ritmo sinusal a los 12 min, pero recidiva la parada en asistolia a los 20 min, con cianosis en esclavina. Se implementó compresiones y administración de epinefrina hasta fallecer 30 min después por no recuperación de ritmo y signos ciertos de la muerte. Conclusiones: La atención multidisciplinaria mejora las condiciones de tratamiento en todas las etapas. El manejo anestésico individualizado ofrece una estrategia invaluable en casos como estos, independientemente del resultado. El tromboembolismo pulmonar en la gestante es un riesgo latente y asociado a la COVID-19, incrementa, exponencialmente, su letalidad.

Introduction: Multiple deaths and infections due to the new coronavirus have occurred. In the midst of this context, the spread of the disease in pregnant patients has been well documented. Objective: Present the events that occurred in pregnant women, in order to share the experience with those who treat these patients. Presentation of the case: The case of a 24-year-old pregnant woman, obese, with a pregnancy of 25 weeks is presented. She was admitted with COVID-19 pneumonia and evolution towards severe respiratory failure led to her death during cesarean section. She was received in the operating room with hypoxemia and hypercapnia, tachycardia, cyanosis, oliguria and ventilated at positive pressure with 100% oxygen. She was treated with ketamine, fentanyl and rocuronium. At 35 min, and after hysterotomy, she presented progressive bradycardia, so external chest compressions and pharmacological treatment were initiated. The sinus rhythm was recovered at 12 min, but the asystole stop relapsed at 20 min, with cyanosis. Compressions and administration of epinephrine were implemented until death 30 minutes later due to non-recovery of rhythm and certain signs of death. Conclusions: Multidisciplinary care improves treatment conditions at all stages. Individualized anesthetic management offers an invaluable strategy in cases like these, regardless of the outcome. Pulmonary thromboembolism in pregnant women is a latent risk associated with COVID-19, exponentially increasing its lethality.

Hipertensión pulmonar en Enfermedad de Graves Basedow. Discusión de un caso y puesta al día / Pulmonary Hypertension in Graves-Basedow Disease. Discussion of one case and Update

Resumen Se presenta una paciente con Enfermedad de Graves Basedow que desarrolla signos clínicos de hipertiroidismo, trastornos de coa gulación, hepáticos e hipertensión pulmonar que mejora con el tratamiento de la enfermedad. Se revisan los potenciales mecanismos fisiopatológicos implicados.

Abstract Patient with Graves-Basedow disease who develops clinical signs of hyperthyroidism, coagulation and liver disorders, and pulmonary hypertension. The patient gets better with the treatment for this disease. Review of potential physiopathological mechanisms involved.

A Surgical Experience of Popliteal Venous Aneurysm Associated with Acute Pulmonary Thromboembolism / 日本心臓血管外科学会雑誌

Popliteal venous aneurysm (PVA) is recognized as source of fatal pulmonary embolism ; surgical treatment is indicated. A 79-year-old woman presented with acute shortness of breath. A cardiac ultrasound echography showed right heart overload and pulmonary hypertension. A contrast enhanced CT revealed multiple pulmonary artery emboli and right popliteal venous aneurysm. She was immediately started anticoagulation therapy with oral factor Xa inhibitor and her dyspnea improved. As thrombus in venous aneurysm was considered the cause of the pulmonary embolism, we recommended surgical treatment. Tangential aneurysmectomy with lateral venorrhaphy for the saccular venous aneurysm was performed. Postoperative contrast enhanced CT showed good morphology and she was discharged without complication. Surgical treatment of symptomatic popliteal venous aneurysm is considered useful strategy.

Trauma-induced pulmonary thromboembolism: What's update? / 中华创伤杂志(英文版)

Trauma-induced pulmonary thromboembolism is the second leading cause of death in severe trauma patients. Primary fibrinolytic hyperactivity combined with hemorrhage and consequential hypercoagulability in severe trauma patients create a huge challenge for clinicians. It is crucial to ensure a safe anticoagulant therapy for trauma patients, but a series of clinical issues need to be answered first, for example, what are the risk factors for traumatic venous thromboembolism? How to assess and determine the status of coagulation dysfunction of patients? When is the optimal timing to initiate pharmacologic prophylaxis for venous thromboembolism? What types of prophylactic agents should be used? How to manage the anticoagulation-related hemorrhage and to determine the optimal timing of restarting chemoprophylaxis? The present review attempts to answer the above questions.

Successful systemic fibrinolysis in a patient with Covid-19: Case report / Fibrinólisis sistémica exitosa en un paciente con Covid- 19: Reporte de Caso

Abstract The new coronavirus 2019-nCov or SARS-Cov-2 is responsible for the most important pandemic in the 21st century: the coronavirus disease (COVID-19). The 2019-nCov infection elicits a hyper-coagulable state, conditioning a worse outcome in these patients. The pathophysiology of the exaggerated coagulation activation in these patients is still unknown, and probably involves several mechanisms, different from those involved in sepsis-associated coagulopathy. This article discusses the case of a patient with no remarkable medical history, who after 7 days of fever, diarrhea and epigastric pain was diagnosed with COVID-19 bilateral pneumonia, further aggravated by severe Acute Respiratory Distress Syndrome. In this context, the patient experienced a massive acute pulmonary thromboembolism accompanied by an acute thrombus in the heart's right ventricle, leading to hemodynamic instability. For the first time in our center in these patients, systemic fibrinolysis was successfully performed, with resolution of the intracavitary thrombus and the acute hemodynamic shock.

Resumen El nuevo coronavirus 2019-nCov o SARS-Cov-2 es responsable de la pandemia más importante del siglo XXI: la enfermedad del coronavirus (COVID-19). La infección por 2019-nCov produce un estado de hipercoagulabilidad, que promueve peores desenlaces en estos pacientes. La fisiopatología de la exagerada activación de la coagulación en estos pacientes aún se desconoce y posiblemente involucre varios mecanismos, diferentes a los participan en la coagulopatía asociada a sepsis. El presente artículo presenta el caso de un paciente sin antecedentes médicos y quien luego de 7 días de fiebre, diarrea y dolor epigástrico, fue diagnosticado con neumonía bilateral por COVID-19, agravada por la presencia de Síndrome de Dificultad Respiratoria Aguda. En este contexto, el paciente desarrolla un tromboembolismo pulmonar agudo masivo, acompañado de un trombo agudo en el ventrículo derecho, produciéndole inestabilidad hemodinámica. Por primera vez en nuestro centro, se realizó exitosamente una fibrinólisis sistémica, con resolución del trombo intracavitario y del shock hemodinámico agudo.

Epidemiological characteristics and changes of D-D and FIB levels in patients with high-altitude pulmonary thromboembolism / 公共卫生与预防医学

Objective The epidemiological characteristics of high-altitude pulmonary thromboembolism (PTE) were investigated, and to enhance people's cognitive level of high-altitude PTE. Methods A tatal of 286 patients with PTE admitted to our hospital from May 2017 to October 2019 were selected and divided into study group (n = 143) living at high altitude of 2500 ~ 4500 m and control group (n=143) living at low altitude of 1500~2450m according to altitude.The clinical data, D-D, FIB levels, and laboratory routine examinations were compared between the two groups, and the risk factors were analyzed using univariate analysis and the independent risk factors were analyzed by multivariate logistic regression. Results The levels of D-D and FIB in the control group were significantly increased (P 0.05). Conclusion  Those were independent risk factors affecting the incidence of PTE at high altitude，including multivariate logistic regression analysis indicated that red blood cell level, HGB level, DVT, D-D, and FIB. The higher the plasma D-D and FIB levels, the recurrence interval, especially the related diseases of patients at high altitude need regular monitoring.

Tromboembolismo pulmonar y accidente cerebrovascular isquémico en paciente con covid-19, a propósito de un caso en hospital de baja complejidad / Pulmonar y embolism and ischemic stroke in a covid-19 patient. A clinical case in a low complexity hospital

Introducción: La enfermedad por coronavirus 2019 (COVID-19) tiene varias presentaciones clínicas. Es un estado protrombóticoquegeneracomplicacionesvascularesendiferentesórganos. Se presenta un caso de paciente con COVID-19 que cursa con tromboembolismo pulmonar (TEP) y accidente cerebrovascular (ACV), se realiza una revisión del tema. Caso clínico: Mujer de 71 años hospitalizada por neumonía por COVID-19, evoluciona estable, pero por destete dificultoso se solicita angioTAC de tórax que confirma TEP bibasal, se inicia anticoagulación subcutánea. A las 36 horas cursa con compromiso cuantitativo de conciencia súbito, TAC de cerebro confirma ACV isquémico de tronco. Por condiciones de paciente se realiza adecuación de esfuerzo terapéutico y fallece. Discusión: COVID-19 es una enfermedad sistémica con un compromiso difuso del endotelio vascular y una intensa respuesta inflamatoria, generando una coagulopatía caracterizada por tendencia a la trombosis venosa, de la microcirculación, y en menor medida arterial, siendo parte esencial de la fisiopatología de la insuficiencia respiratoria y elevado riesgo de tromboembolismo. Esta paciente presentaba factores de riesgo para TEP y ACV(edad, hipertensión arterial, obesidad), sin embargo, COVID-19 fue un factor de riesgo adicional a pesar de ya haber superado el cuadro agudo respiratorio y estando con tromboprofilaxis y posterior anticoagulación. Conclusiones: COVID-19 es un factor de riesgo adicional para enfermedad tromboembólica, por lo que se debe indicar tromboprofilaxis a dosis habituales hasta disponer de nueva evidencia que avale dosis mayores. Se debe estar atento a la presencia de estas complicaciones incluso tras haber superado el cuadro agudo de la infección respiratoria.

Introduction: Coronavirus 2019 disease (COVID-19) has various clinical presentations. It is a prothrombotic state causing vascular complications in different organs. We present the case of a COVID-19 patient who suffers a pulmonary embolism (PE) and a stroke; the topicis reviewed. Clinical case: 71 year old woman hospitalized for COVID-19 pneumonia, stable clinical course. Because of difficulty in weaning, chest CT angiography is done confirming bibasilar PE, and subcutaneous anti- coagulation is initiated. 36 hours later she suffers an abrupt loss of consciousness, and a cerebral CT scan confirms a brain stem stroke. Therapy is adjusted because of the patient's deterioration and the patient dies. Discussion: COVID-19 is a systemic disease with diffuse involvement of vascular endothelium and has an intense inflammatory response, generating a coagulopathy characterized by atendency to thrombosis of the veins, micro-circulation and, to a lesser extent, arteries, being an essential part of the pathophysiology of respiratory failure and the high risk of thromboembolism. This patient had risk factors for PE and stroke (age, hypertension, obesity), however, COVD-19 constituted an additional risk factor despite having overcome the acute respiratory infection and receiving thromboprophylaxis and, later, anti-coagulation. Conclusions: COVID-19 is an additional risk factor for thromboembolic disease and thromboprophylaxis should be given at the usual dose until new evidence supports the administration of higher doses. These complications should be borne in mind, even after the initial respiratory infection has been overcome.

Síndrome antifosfolipídico, lupus eritematoso sistémico y tromboembolismo pulmonar / Antiphospholipid syndrome, systemic lupus erythematosus and pulmonary thromboembolism. Case presentation

El síndrome antifosfolipídico o de Hughes, como también se le conoce, puede aparecer de manera aislada o asociado a otras enfermedades autoinmunes como el lupus eritematoso sistémico. La asociación de ambas entidades puede causar varias complicaciones, como el tromboembolismo pulmonar. Se presenta el caso de una paciente de 28 años de edad, con antecedentes de abortos a repetición y óbito fetal, ingresada en esta ocasión, debido a una trombosis venosa profunda del miembro superior derecho, confirmada mediante ecografía Doppler. Se comprobó el diagnóstico de síndrome antifosfolipídico secundario a lupus eritematoso sistémico, sustentado por los elementos clínicos e inmunitarios presentes. La paciente evolucionó satisfactoriamente, con el protocolo terapéutico empleado en fase aguda: heparina de bajo peso molecular del tipo clexane (enoxaparina) 1 mg/kg cada 12 h y dicumarínicos del tipo warfarina 5 mg con una razón normalizada internacional (INR) de 3. Se mantiene actualmente con una dosis de 10 mg/día e hidroxicloroquina 200 mg diarios. Conclusiones: Se resalta la importancia de diagnosticar el síndrome antifosfolipídico, ante toda paciente con abortos espontáneos o muertes perinatales inexplicables. El tratamiento debe ser multidisciplinario y se debe realizar una búsqueda sistemática de afecciones secundarias (particularmente enfermedades difusas del tejido conectivo) antes de calificar al síndrome como primario(AU)

The antiphospholipid or Hughes syndrome, as it is also known, can appear in isolation or in association with other autoimmune diseases such as systemic lupus erythematosus. The association of both entities can cause various complications, such as pulmonary thromboembolism. We present the case of a 28-year-old patient, with a history of repeated abortions and stillbirth, admitted on this occasion due to deep vein thrombosis of the right upper limb, confirmed by Doppler ultrasound. The diagnosis of antiphospholipid syndrome secondary to systemic lupus erythematosus was confirmed, supported by the clinical and immune elements present. The patient evolved satisfactorily, with the therapeutic protocol used in the acute phase, where she initially received treatment with low molecular weight heparin of the type clexane (enoxaparin) 1 mg x kg every 12 hours, and discoumarin drugs of the warfarin type, which she currently maintains at a 5mg dose with an INR of 3. Initially prednisone was placed at a dose of 1mg x kg with good therapeutic response, currently maintaining a 10mg dose. He is also currently on hydroxychloroquine 200 mg daily. Conclusions: The importance of diagnosing the antiphospholipid syndrome is highlighted in all patients with spontaneous abortions or unexplained perinatal deaths. Treatment should be multidisciplinary and a systematic search for secondary conditions (particularly diffuse connective tissue diseases) should be conducted before qualifying the syndrome as primary(AU)

Utilidad diagnóstica del dímero D cuantitativo / Diagnostic usefulness of quantitative D-dimer

Introducción: El dímero D es un marcador de la generación de trombina y plasmina. Constituye el producto final de la degradación de un trombo rico en fibrina mediada por la acción secuencial de 3 enzimas: trombina, factor FXIIIa y plasmina. Las pruebas disponibles en la actualidad para el diagnóstico del dímero D son variadas y no son uniformes. Objetivo: Analizar las evidencias disponibles sobre la utilidad de diferentes pruebas rápidas de dímero D. Métodos: Se realizó una revisión de la literatura de los últimos diez años, en inglés y español, utilizando motores de búsqueda como Google Académico y Pubmed que permitió el acceso a artículos relacionados en revistas arbitradas. Se agrupó y organizó información sobre las posibles utilidades del dímero D. Desarrollo: La determinación en el laboratorio del dímero D, se usa como prueba rápida y sencilla, posee un lugar definido en los algoritmos de exclusión de la enfermedad tromboembólica venosa, en el diagnóstico de coagulación intravascular diseminada y con aplicación en la predicción de la recidiva de trombosis venosa profunda, en los últimos años. Existen diversos ensayos para la determinación de la concentración plasmática de dímero D que utilizan distintas metodologías, diferentes anticuerpos y sensibilidades. Conclusiones: La determinación de dímero D por los métodos cuantitativos en pacientes con trastornos trombóticos es muy importante para determinar su sensibilidad, y fundamentar el desarrollo del algoritmo diagnóstico de las mencionadas entidades(AU)

Introduction: D-dimer is a marker of thrombin and plasmin generation. It is the final product of the degradation of a fibrin-rich thrombus mediated by the sequential action of three enzymes: thrombin, factor XIIIa and plasmin. The tests currently available for D-dimer diagnosis are varied and not uniform. Objective: Analyze the evidence available about the usefulness of a number of D-dimer rapid tests. Methods: A review was conducted of the literature published in English and Spanish in the last ten years, using search engines such as Google Scholar and PubMed, which allowed access to papers about the topic in peer-reviewed journals. Data about the possible uses of D-dimer were grouped and organized. Discussion: Laboratory D-dimer determination is a rapid and simple test that has occupied a definite place in the exclusion algorithms for venous thromboembolic disease, the diagnosis of disseminated intravascular coagulation, and the prediction of deep venous thrombosis recurrence in recent years. A number of assays are available to determine D-dimer plasma concentration. These are based on different methodologies, antibodies and sensitivity values. Conclusions: D-dimer determination by quantitative methods is very important in patients with thrombotic disorders to determine their sensitivity and substantiate the development of the diagnostic algorithm for the aforementioned conditions(AU)

Caso clínico: tromboembolismo pulmonar secundário em um paciente com COVID-19 / Clinical case: secondary pulmonary embolism in a patient with COVID-19

RESUMO: A COVID-19 é a doença infecciosa cujo agente etiológico é um betacoronavirus, o SARS-CoV-2. Sua emergência se deu em uma província chinesa em dezembro de 2019, tornando-se uma pandemia que desafia a saúde pública global. Habitualmente, apresenta-se como uma síndrome gripal, com possibilidade de evolução para síndrome respiratória aguda grave. Além disso, pode provocar alterações na coagulação e resposta inflamatória do indivíduo, levando a complicações tromboembólicas. Este artigo relata o caso de um paciente de 58 anos, diagnosticado com COVID-19, que seguia em isolamento domiciliar e, evoluiu com dispneia e hemoptise no quarto dia de doença. O diagnóstico do tromboembolismo pulmonar (TEP) foi confirmado através de tomografia contrastada de tórax. O paciente foi internado para tratamento clínico, necessitando de acompanhamento em Unidade de Terapia Intensiva (UTI) entre o terceiro e quinto dia de internação. Após alta da UTI, o paciente evoluiu sem demais intercorrências, recebendo alta no décimo dia de internação hospitalar. (AU)

ABSTRACT: The Coronavirus disease 2019 (COVID-19) whose etiologic agent is a betacoronavirus, SARS-CoV-2. Emerged in a chinese province in December of 2019, becoming a pandemic that challenges global public health. It usually presents as a flu-like syndrome, with the possibility of progressing to severe acute respiratory syndrome. In addition, it can lead to cytokine storm syndrome that results in hyperinflammation, exacerbates immune response and may generate changes in the individual's coagulation, causing thromboembolic complications. This article reports the case of a 58-year-old patient diagnosed with COVID-19, who was still in-home isolation and developed dyspnea and hemoptysis on the fourth day of illness. The diagnosis of pulmonary thromboembolism (PTE) was confirmed by contrast-enhanced pulmonary artery tomography. The patient was admitted for clinical treatment, requiring follow-up in the Intensive Care Unit (ICU) between the third and fifth day of hospitalization. After discharge from the ICU, the patient evolved without further complications, being discharged on the tenth day of hospitalization. (AU)