Catheter-related thrombosis in a neonatal intensive care unit: a case-control study / Trombose relacionada a cateter em unidade de terapia intensiva neonatal: um estudo de caso-controle

INTRODUCTION: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. OBJECTIVE: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. METHODS: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. RESULTS: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. CONCLUSION: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

INTRODUÇÃO: A trombose relacionada ao cateter (TRC) é responsável pela maioria dos eventos trombóticos no neonato. OBJETIVO: Investigar a frequência da TRC, a associação com os dias de uso do cateter até o diagnóstico e o número de cateteres utilizados em uma Unidade de Terapia Intensiva Neonatal unicêntrico. MÉTODOS: Estudo caso-controle que incluiu 14 casos e 42 controles. A coleta de dados ocorreu entre janeiro de 2017 e dezembro de 2020 em uma UTIN pública. Foram calculadas razões de chances brutas (COR). O estudo respeitou os padrões éticos das diretrizes nacionais. RESULTADOS: Duzentos e noventa e quatro neonatos utilizaram cateter venoso central, dos quais 14 (4,7%) foram diagnosticados com TRC. O cateter em uso no momento do diagnóstico foi o cateter central inserido centralmente em 8 (57,1%). Antes do diagnóstico, o tempo acumulado de uso do cateter foi de 34,5 dias e a mediana do número de cateteres utilizados foi de três. Um maior número de dias de uso do cateter >30 (COR 19,11; IC 95% 2,28-160,10; p=0,007) e número de cateteres utilizados >3 (COR 7,66; IC 95% 1,51-38,70; p=0,01). CONCLUSÃO: Os casos de TRC foram associados à gravidade clínica; número de cateteres e dias cumulativos de uso do cateter. Sugerimos que o rastreamento de trombose seja realizado em neonatos que necessitem de longo tempo de uso do cateter e mais de três cateteres. Reduzir a duração e o número de cateteres venosos usados ajudará a reduzir a TRC.

Serial values of hematologic variables and deep venous thrombosis: Red cell distribution width is associated with deep venous thrombosis

Abstract Introduction As 30 to 50% of deep venous thrombosis (DVT) cases remain idiopathic, an increased focus on hematologic variables may therefore reveal novel correlates of DVT. Very few studies have investigated the association of hematological parameters with DVT and the causal relationship between them is still to be elucidated. Therefore, we aimed to investigate the association between serial values of hematologic variables and DVT. Methods Complete blood count parameters were serially measured at baseline and then at approximately 3-month intervals for 12 months in 152 adults with the first episode of DVT and 152 age- and sex-matched controls. The odds ratio (OR) with the 95% confidence interval (95%CI) was calculated as a measure of association between hematological parameters and DVT. Results The red cell distribution width (RDW) was the only hematologic variable which showed an independent and consistent association with DVT at all time points (multivariable-adjusted OR [95%CI] 3.38 [1.28 - 8.91] at baseline, 2.24 [0.85 - 5.92] at 3 months and 2.12 [0.81 - 5.55] at 12 months for RDW > 14.0%). This association was higher for provoked DVT than unprovoked DVT and for DVT plus pulmonary embolism than DVT alone. No significant correlation was found between the high RDW and classical thrombotic risk factors, except malignancy. Conclusions We demonstrated an independent and consistent association of the high RDW with the first episode of DVT in adult patients. The study was probably underpowered to evaluate the association between the high RDW and recurrent DVT. Further large studies with long follow-up are needed to confirm this association.

Características clínicas y demográficas de pacientes con trombosis venosa profunda en un hospital de referencia de Paraguay durante la pandemia de COVID-19 (2020-2023) / Clinical and demographic characteristics of patients with deep vein thrombosis in a referral hospital in Paraguay during the COVID-19 pandemic (2020-2023)

Introducción. La enfermedad tromboembólicavenosa, que incluye la trombosis venosa profunda (TVP), es la tercera enfermedad cardiovascular más frecuente a nivel mundial, con importante morbimortalidad. Objetivo. Describir las características clínicas y demográficas de los pacientes con Trombosis Venosa Profunda (TVP) internados en un hospital de referencia de Paraguay durante la pandemia de COVID-19 (2020-2023). Materiales y métodos. Estudio observacional, descriptivo, retrospectivo y de corte transversal. Se incluyeron 80 pacientes mayores de 18 años con diagnóstico confirmado de TVP, seleccionados mediante muestreo no probabilístico de casos consecutivos. Se recolectaron datos demográficos, clínicos y de tratamiento de los expedientes clínicos. Resultados. La edad media fue de 52 ± 17 años, con predominio del sexo femenino (55%, IC 95%: 44-66%). La enfermedad por COVID-19 fue la patología subyacente más frecuente (29%, IC95%: 19-39%). Según la escala de Wells, el 62.5% (IC95%: 51-73%) presentó riesgo moderado de TVP. La asimetría de miembro (65%, IC95%: 54-75%) y el dolor en pantorrilla (61.25%, IC95%: 50-72%) fueron los síntomas más frecuentes. El 72.5% (IC95%: 62-82%) recibió heparina de bajo peso molecular durante la internación. Conclusión. La TVP en este centro afectó predominantemente a mujeres de mediana edad, con COVID-19 como factor de riesgo emergente. Estos hallazgos subrayan la necesidad de una vigilancia activa de TVP en pacientes con COVID-19 y sugieren la importancia de estrategias de prevención y tratamiento adaptadas al contexto pandémico en Paraguay. Palabras clave: trombosis venosa profunda; COVID-19; anticoagulantes; heparina de bajo peso molecular; factores de riesgo

Introduction. Venous thromboembolic disease, which includes deep vein thrombosis (DVT), is the third most common cardiovascular disease worldwide, with significant morbidity and mortality. Objective. To describe the clinical and demographic characteristics of patients with Deep Vein Thrombosis (DVT) admitted to a referral hospital in Paraguay during the COVID-19 pandemic (2020-2023). Materials and methods.Observational, descriptive, retrospective, cross-sectional study. 80 patients over 18 years of age with a confirmed diagnosis of DVT were included, selected by non-probabilistic sampling of consecutive cases. Demographic, clinical, and treatment data werecollected from medical records. Results.The mean age was 52 ± 17 years, with a predominance of females (55%, 95% CI: 44-66%). COVID-19 disease was the most frequent underlying pathology (29%, 95% CI: 19-39%). According to the Wells scale, 62.5% (95% CI: 51-73%) presented moderate risk of DVT. Limb asymmetry (65%, 95% CI: 54-75%) and calf pain (61.25%, 95% CI: 50-72%) were the most frequent symptoms. 72.5% (95% CI: 62-82%) received low molecular weight heparin during hospitalization. Conclusion.DVT in this center predominantly affected middle-aged women, with COVID-19 as an emerging risk factor. These findings underline the need for active surveillance of DVT in patients with COVID-19 and suggest the importance of prevention and treatment strategies adapted to the pandemic context in Paraguay. Key words: deep vein thrombosis;COVID-19; anticoagulants;low molecular weight heparin;risk factors

Reconstrucción de ligamento cruzado anterior: incidencia de infecciones y trombosis venosa profunda en una serie de 714 casos consecutivos / ACL reconstruction. Incidence of Infection and deep venous thrombosis. 714 case series

Introducción: La reconstrucción artroscópica del ligamento cruzado anterior (LCA) tiene un bajo índice de complicaciones postoperatorias. Cuando se presenta una infección en el postoperatorio inmediato, tanto el cirujano como el paciente se enfrentan a un escenario complejo y de difícil aceptación, que en algunos casos tiene consecuencias graves. En este contexto es importante conocer la incidencia reportada en la literatura para compararla con lo que ocurre en nuestras instituciones. El objetivo del presente trabajo es evaluar la incidencia de infección en una serie de casos consecutivos de reconstrucciones de LCA. Materiales y métodos: se realizó un estudio retrospectivo del período comprendido entre enero de 2015 y diciembre de 2017, donde se evaluó la incidencia de infección en una serie consecutiva de reconstrucciones de LCA. Fueron evaluados un total de setecientos catorce pacientes: seiscientos veintinueve masculinos y ochenta y cinco femeninos con un promedio de edad de veintiocho años (15-50).Resultados: de los setecientos catorce casos analizados, se encontraron seis infecciones postquirúrgicas (dos profundas y cuatro superficiales). Conclusiones: la incidencia de infección aguda postoperatoria luego de reconstrucción artroscópica del LCA fue del 0.84%, similar a lo reportado en la literatura. Se observó un franco predominio de infecciones en las reconstrucciones de LCA con injerto de isquiotibiales con respecto al resto de los injertos. Nivel de Evidencia: IV

Introduction: Complication rate of arthroscopic anterior cruciate ligament (ACL) reconstruction is low. Post-operative infection place both, the surgeon and patient in a difficult situation with an unknown outcome and possible serious sequalae. It is important to investigate the incidence of these complications in our institutions to compare them with existing literature. The aim of this study is to report the incidence of infection in a consecutive case series of ACL reconstruction. Materials and methods: retrospective study of consecutive ACL reconstructions performed between January 2015 to December 2017. The incidence of infection was evaluated in 714 cases, 629 males and 85 females, with average age of 28 years (15-50).Results: six post-operative infections were found (four superficial and two deep infections). Conclusions: the incidence of infection was 0.84% in this case series. Most of the infections were in patients with autologous gracilis-semitendinous grafts. Level of Evidence: IV

Síndrome de Balint y trombosis de senos venosos cerebrales: reporte de caso / Balint syndrome and cerebral venous sinus thrombosis: Case report

Introducción: El síndrome de Balint es un trastorno neurológico infrecuente, de etiología diversa, cuya presentación incluye la triada clásica de: simultagnosia, ataxia óptica y apraxia oculomotora, síntomas secundarios asociados a lesiones parieto-occipitales, con pronóstico variable según la etiología que se encuentre. A continuación, se reporta un caso secundario a una trombosis de senos venosos. Presentación del caso: Mujer de 66 años que ingresa a urgencias por cefalea aguda asociada a síntomas neurológicos progresivos con compromiso visual. Presentó tensión arterial elevada, simultagnosia, ataxia óptica y apraxia oculomotora. Los estudios imagenológicos reportaron hemorragia subaracnoidea por trombosis de seno sigmoideo izquierdo, por lo que se inició anticoagulación, antihipertensivo, con adecuada evolución del cuadro clínico. Discusión: A pesar de que el síndrome de Balint es un trastorno poco común, de etiología diversa, con escasos reportes a escala global, el caso comentado concordó con las características descritas en la literatura. El abordaje de la paciente en su atención inicial permitió la sospecha diagnóstica oportuna y la indicación de ayudas diagnósticas imagenológicas pertinentes. Tales ayudas soportaron un manejo temprano y la adecuada evolución y resolución del cuadro, en el contexto de la asociación del síndrome a una trombosis de senos venosos cerebrales (una etiología infrecuente). Conclusión: Mediante una historia clínica completa y minuciosa, junto a un adecuado examen neurológico, es posible hacer un acercamiento diagnóstico temprano que permita generar la sospecha del síndrome de Balint y la solicitud temprana de imágenes diagnósticas que orienten en el estudio de su etiología y manejo oportuno, con mejores desenlaces en el paciente.

Introduction: Balint Syndrome is a rare neurological disorder with multiple etiologies. The physical signs include a classic triad (simultagnosia, optic ataxia, and oculomotor apraxia). These symptoms are associated with parieto-occipital lesions, and the prognosis depends on the etiology. This article reports a case secondary to venous sinus thrombosis. Presentation of the case: A 66-year-old woman presented to the emergency room with acute headache associated with progressive neurological symptoms and visual impairment. She had high blood pressure, simultanagnosia, optic ataxia, and oculomotor apraxia. Imaging studies revealed subarachnoid hemorrhage due to thrombosis of the left sigmoid sinus, for which anticoagulation and antihypertensive therapy were started. The patient had a favorable clinical outcome. Discussion: Although Balint syndrome is a rare disorder of diverse etiology with few clinical cases reported globally, the case discussed here was consistent with the characteristics described in the literature. The patient's initial assessment allowed for timely diagnostic suspicion and appropriate imaging studies, which supported early management and the appropriate evolution and resolution of the condition, given the association of the syndrome with an uncommon cause as cerebral venous sinus thrombosis. Conclusion: A complete and thorough medical history, along with a proper neurological exam, can lead to an early diagnostic approach that raises suspicion of Balint's syndrome and prompts timely imaging studies to guide the investigation of its etiology and management, ultimately leading to better outcomes for the patient.

Deep Vein Thrombosis after a Supracondylar Fracture of the Humerus in a Child - A Rare Complication / Trombose venosa profunda após uma fratura supracondilar do úmero em uma criança - Uma complicação rara

Abstract Deep vein thrombosis in the upper extremities is uncommon, especially in the pediatric population and in the trauma setting. The diagnosis is challenging, due to its rarity, requiring a high degree of suspicion. We describe a rare case of humeral vein thrombosis after a displaced supracondylar fracture of the humerus in a 7-year-old girl. The risk factors for thromboembolism and sequelae are also discussed. The early detection and treatment are mandatory to prevent poor outcomes, such as fatal thromboembolism.

Resumo Trombose venosa profunda nas extremidades superiores é incomum, especialmente na população pediátrica e no ambiente do trauma. O diagnóstico é desafiador, devido a sua raridade, exigindo alto grau de suspeita. Descrevemos um caso raro de trombose venosa úmera após uma fratura supracondilar deslocada do úmero em uma menina de 7 anos. Os fatores de risco para tromboembolismo e sequelas também são discutidos. A detecção e o tratamento precoces são obrigatórios para evitar desfechos ruins, como tromboembolismo fatal.

Factores de riesgo de trombosis venosa profunda en el personal administrativo de una universidad ecuatoriana / Risk factors for deep vein thrombosis in the administrative staff of an ecuadorian university / Fatores de risco para trombose venosa profunda no pessoal administrativo de uma universidade equatoriana

Objetivo: describir los factores de riesgo de trombosis venosa profunda en el personal administrativo de una universidad ecuatoriana. Método: investigación cuantitativa, transversal y descriptiva, con una muestra censal de 71 trabajadores del área administrativa, en Ambato, Ecuador. Para la recolección de datos se utilizó el test que evalúa el manejo de la insuficiencia venosa crónica entre los niveles de atención a la salud. El análisis de datos se realizó mediante estadística descriptiva y el método multivariante de análisis de componentes principales para definir nuevos factores asociados. Resultados: los factores a la TVP son la bipedestación, consumo de tabaco y alcohol, sedestación, coagulación sanguínea, várices congénitas, enfermedades catastróficas, edema, algia, cirugía, anticonceptivos y uso de corticoesteroides. Conclusión: el riesgo de estos pacientes para desarrollar TVP está relacionado con el lugar de trabajo, la movilidad, signos y síntomas que la enfermedad puede causar. En el caso del personal administrativo los factores más asociados a la TVP se relacionan con la posición por largas jornadas de trabajo, no obstante factores de coagulación, patologías previas, signos notorios de la patología, consumo de alcohol y tabaco y el uso de corticoesteroides también aportan en un menor porcentaje al desarrollo.

Objective: to describe the risk factors for deep vein thrombosis in the administrative staff of an ecuadorian university. Method: quantitative, cross-sectional and descriptive research, with a census sample of 71 workers in the administrative area, in Ambato, Ecuador. For data collection, the test that evaluates the management of chronic venous insufficiency between levels of health care was used. Data analysis was performed using descriptive statistics and the multivariate method of principal component analysis to define new associated factors. Results: risk factors for DVT are standing, smoking and drinking alcohol, sitting, blood clotting, congenital varicose veins, catastrophic disease, edema, pain, surgery, contraceptives, and use of corticosteroids. Conclusion: the risk of these patients to develop DVT is related to the workplace, mobility, signs and symptoms that the disease can cause. In the case of administrative staff, the factors most associated with DVT are related to the position due to long working hours, however coagulation factors, previous pathologies, notorious signs of the pathology, alcohol and tobacco consumption, and the use of corticosteroids also contribute to development in a lower percentage.

Prevalencia de Complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato y su impacto a corto plazo en la función renal / Prevalence of clinical and surgical complications in immediate post-renal transplantation and their short-term impact on renal function

INTRODUCCIÓN. La enfermedad renal crónica es definida como la pérdida progresiva, permanente e irreversible de la función renal, uno de los tratamientos es el trasplante renal el mismo que aumenta la calidad de vida de los pacientes que presentan esta patología, sin embargo, a pesar de ser uno de las mejores terapias no está exento de complicaciones especialmente las que se presentan posterior al acto quirúrgico ya que afectan al buen funcionamiento del injerto y afecta la supervivencia del mismo. OBJETIVO. Determinar la prevalencia de complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato con el fin de identificar las principales complicaciones que ocasionan mayor deterioro en la función renal a corto plazo. MATERIAL Y MÉTODOS. Estudio Observacional descriptivo transversal, de pacientes trasplantados que se encuentran en seguimiento desde enero del 2015 hasta diciembre del 2018 en el servicio de Trasplante renal del Hospital de Especialidades Carlos Andrade Marín. La muestra será los 211 pacientes trasplantados de donante cadavérico. Los análisis se realizaron con el paquete estadístico IBM SPSS versión 25, para lo cual se empleó estadísticas descriptivas, utilizando tablas y representando los valores absolutos y relativos de las variables cualitativas, así como medidas de tendencia central y de variabilidad para las variables cuantitativas. RESULTADOS. Se estudiaron 193 pacientes trasplantados de los cuales el 49.66% tuvieron complicaciones, de los mismos el 33.16% fueron complicaciones clínicas y 16,5% complicaciones quirúrgicas; de las clínicas la infección de tracto urinario fueron las más prevalentes con 15%, seguida por el rechazo agudo 6,7%, las infecciones por virus poliomavirus BK fueron un porcentaje de 6,2%, la necrosis tubular aguda el 3,16% terminando con el rechazo hiperagudo en el 1,5% y la toxicidad por calcineurínicos 1,04%. Mientras tanto las complicaciones quirúrgicas las urológicas son las más prevalentes 8,8% seguida por las colecciones liquidas con el 6,74% finalmente la trombosis vascular con el 1,04%. CONCLUSIONES. Las complicaciones más prevalentes son las clínicas vs las quirúrgicas, afectando de igual forma la función renal al año sin diferencia estadísticamente significativa.

INTRODUCTION. Chronic kidney disease is defined as the progressive, permanent and irreversible loss of renal function, one of the treatments is renal transplantation, which increases the quality of life of patients with this pathology, however, despite being one of the best therapies, it is not free of complications, especially those that occur after surgery, since they affect the proper functioning of the graft and affect its survival. OBJECTIVE. To determine the prevalence of clinical and surgical complications in immediate post-renal transplantation in order to identify the main complications that cause greater deterioration in short-term renal function. MATERIAL AND METHODS. Cross-sectional descriptive observational study, of transplanted patients under follow-up from January 2015 to December 2018 in the Renal Transplant service of the Hospital de Especialidades Carlos Andrade Marín. The sample will be the 211 cadaveric donor transplanted patients. The analyses were performed with the IBM SPSS version 25 statistical package, for which descriptive statistics were used, using tables and representing the absolute and relative values of qualitative variables, as well as measures of central tendency and variability for quantitative variables. RESULTS. We studied 193 transplanted patients of whom 49.66% had complications, of which 33. Of the clinical complications, urinary tract infection was the most prevalent with 15%, followed by acute rejection 6.7%, polyomavirus BK infections were 6.2%, acute tubular necrosis 3.16%, ending with hyperacute rejection in 1.5% and calcineurin toxicity 1.04%. Meanwhile, urological surgical complications are the most prevalent 8.8% followed by liquid collections with 6.74% and finally vascular thrombosis with 1.04%. CONCLUSIONS. The most prevalent complications are clinical vs. surgical, affecting renal function at one year with no statistically significant difference.

Características de la trombosis venosa cerebral en pacientes de dos hospitales universitarios de Colombia en el período 2018-2020 / Characteristics of cerebral venous thrombosis in patients from two university hospitals in Colombia between 2018-2020

Introducción. La trombosis venosa cerebral es una causa infrecuente de enfermedad cerebrovascular que viene en aumento a nivel mundial. A pesar de ello, actualmente, en Colombia no se cuenta con estudios suficientes que nos permitan caracterizar epidemiológicamente la enfermedad en nuestra población para identificar los factores de riesgo y las complicaciones más frecuentes en nuestro medio. Objetivo. Describir las características clínicas, demográficas y radiológicas, y los factores de riesgo de una serie de pacientes con trombosis venosa cerebral de dos hospitales de Colombia. Materiales y métodos. Es un estudio descriptivo retrospectivo de pacientes hospitalizados, atendidos en el servicio de neurología de dos hospitales de Bogotá desde diciembre de 2018 hasta diciembre del 2020. Resultados. Se incluyeron 33 pacientes. Las frecuencias más altas correspondieron a mujeres en edad fértil, en puerperio (n=7; 33,3 %) y pacientes con patologías autoinmunes (n=10; 30,3 %). El síntoma inicial más común fue la cefalea (n=31; 93,9 %), seguido de focalización neurológica (n=9; 27,2%) y crisis epiléptica (n=8; 24,2 %). El 51 % (n=17) de los pacientes tuvo un examen físico normal. El infarto venoso cerebral se presentó en el 21,1 % (n=7), la hemorragia subaracnoidea en el 12,1 % (n=4) y el hematoma intraparenquimatoso en el 9 % (n=3) del total de pacientes. El 60,6 % (n=20) quedó con nivel independiente en la escala funcional de Barthel. Ningún paciente falleció. Conclusiones. Se encontraron características sociodemográficas, clínicas y radiológicas similares a lo reportado en la literatura mundial. Con respecto a las diferencias, se encontró en nuestro estudio compromiso de la circulación venosa cerebral profunda en un porcentaje ligeramente mayor a lo descrito, pero sin aumento de complicaciones, ni mortalidad.

Introduction. Cerebral venous thrombosis is an uncommon cause of cerebrovascular disease, which has been increasing worldwide. In Colombia, there are not enough recent studies that allow us to determine epidemiological characteristics of the disease in our population to identify more frequent risk factors and complications according to our living conditions. Objective. To describe clinical, demographic, and radiographic characteristics, and risk factors in a cohort of patients with cerebral venous thrombosis attended at two hospitals in Colombia. Materials and methods. Retrospective descriptive study with patients treated in the hospitalization neurology service of two hospitals in Bogotá, Colombia from December 2018 to December 2020. Results. Thirty-three patients were included. There was a higher incidence of cerebral venous thrombosis in women of childbearing age in the puerperium (n=7; 33.3%) and associated with autoimmune diseases (n=10; 30.3%). The most common initial symptom was headache (n=31; 93.9 %), followed by neurological focal signs (n=9; 27.2%) and seizures (n=8; 24.2%). Fifty-one percent (n=17) of the patients had a normal physical examination. Cerebral venous infarction occurred in 21.1 % (n=7), subarachnoid hemorrhage in 12.1 % (n=4), and intraparenchymal hematoma in 9 % (n=3) of all the patients. Sixty-point six percent (n=20) of the patients had a total independent Barthel functional scale. None of those died. Conclusions. We found similar sociodemographic, clinical, and radiography characteristics to those reported in the world literature. Regarding the differences, deep cerebral venous circulation was higher than that described in previous studies but without complications increase or mortality.

Tromboembolismo pulmonar asociado a COVID-19 en paciente con síndrome de May-Thurner / COVID-19-associated Pulmonary Thromboembolism in a Patient with May-Thurner Syndrome

Introducción: El síndrome de May-Thurner es una enfermedad cuya prevalencia real es desconocida. Suele ser asintomática y las manifestaciones clínicas aparecen en el contexto de las complicaciones asociadas a la enfermedad. La aproximación diagnóstica se realiza por medio de imágenes, donde se identifican alteraciones patognomónicas que permiten descartar diagnósticos diferenciales. Se ha demostrado que la COVID-19 genera un estado protrombótico, que en contexto del síndrome de May-Thurner puede derivar en complicaciones tromboembólicas. Objetivo: Comparar la clínica y la posible relación de la enfermedad tromboembólica venosa en el curso de la COVID-19 en pacientes con SMT. Caso clínico: Mujer de 24 años, secretaria de profesión y residente en Bucaramanga. Presentó un cuadro clínico de 20 días de evolución que inició con rinorrea hialina, tos ocasional y mialgias; cinco días después manifestó fiebre no cuantificada y tos con expectoración hemoptoica. Conclusiones: Dentro de la fisiopatología de la infección por SARS-CoV-2 se desarrollan mecanismos procoagulantes, lo cual incrementa el riesgo de eventos trombóticos en pacientes con o sin factores de riesgo(AU)

Introduction: May-Thurner syndrome is a disease whose actual prevalence is unknown. It is usually asymptomatic and clinical manifestations appear in the context of complications associated with the disease. The diagnostic approach is performed by imaging, where pathognomonic alterations are identified to rule out differential diagnoses. It has been demonstrated that COVID-19 generates a prothrombotic state, which particularly in patients with May-Thurner syndrome would lead to thromboembolic complications. Objective: To compare the clinical and possible relationship of venous thromboembolic disease in the course of COVID-19 in patients with May-Thurner syndrome. Clinical case: 24-year-old woman, secretary by profession and resident in Bucaramanga, Colombia. She presented a clinical picture of 20 days of evolution that began with hyaline rhinorrhea, occasional cough and myalgias; five days later she manifested unquantified fever and cough with hemoptotic expectoration. Conclusions: Within the pathophysiology of SARS-CoV-2 infection, procoagulant mechanisms develop, which increases the risk of thrombotic events in patients with or without risk factors(AU)

Current state of non-hematologic cancer-associated thrombosis at a tertiary care hospital in India

Abstract Introduction Cancer-associated thrombosis is a leading cause of morbidity and mortality in malignancy patients. Prophylactic anticoagulation is under-utilized and the cost of low-molecular-weight heparin (LMWH) and direct oral anticoagulants is a major barrier in developing countries. Material and methods A retrospective analysis was performed of all cancer-associated thrombosis patients attending the thrombosis clinic at a tertiary-level referral hospital based in North India between 2011 and 2015. Patient demographics and disease-related parameters were collected and analyzed. Results A total of 771 patients attended the thrombosis clinic during study period, of which 64 cases were malignancy-associated. Of these, 56% of the patients were female and 20% were bedridden. The median age was 48.5 years, adenocarcinoma (48%) being the most common histological subtype. Gynecological malignancies (30%) were the most common malignancies, followed by genitourinary (11%) malignancies. Most of the cases occurred during first year of diagnosis (51%), and only 14% occurred after 3 years. Most of the patients were on combined treatment. Almost 40% of the patients developed thrombosis within 30 days of surgical treatment. Lower limb thrombosis was the most commonly seen type (56%), while abdominal and pulmonary thrombosis were both seen in 5%. Patients were managed with LMWH and vitamin K antagonists (84.3%) and only 6.25% with LMWH alone. Direct oral anticoagulants were not commonly used during the study period. Discussion At the hospital studied, most of the cases occurred early in the disease course. Postoperative prophylaxis could have contributed towards reducing thrombosis in the peri-operative period. Early suspicion and prompt treatment can improve quality of life in such patients.

Plantar vein thrombosis: an uncommon cause of plantar foot pain / Trombose venosa plantar: uma causa incomum de dor em região plantar

INTRODUCTION: Plantar vein thrombosis is a rare condition that can lead to pain, edema, and walking difficulties. It presents a series of predisposing factors, such as recent surgeries, the use of oral contraceptives, and local trauma, among others. Imaging tests are essential for the right diagnosis, and ultrasonography is the modality of choice. As for treatment, there is no consensus in the literature. REPORT: Case of a 30-year-old patient who sought emergency medical care complaining of sudden severe pain in the plantar region of her right foot with walking difficulties. On physical examination, hyperalgesia was observed in the plantar region, irradiating to the calf, associated with swelling. Color Doppler imaging identified an acute thrombus in the medial plantar vein. Rivaroxaban was initially prescribed and replaced by acetylsalicylic acid after three months. The treatment was effective, and the patient was discharged after 11 months. CONCLUSION: Plantar vein thrombosis is a rare condition and has a wide range of differential diagnoses so physicians must maintain a high level of clinical suspicion. To improve diagnosis and treatment, it would be necessary to include plantar veins in the investigation protocols of patients suspected of having Deep Venous Thrombosis, besides additional clinical research for improving treatment.

INTRODUÇÃO: A trombose de veias plantares é uma condição rara que pode cursar com dor, edema e dificuldade na deambulação. Apresenta uma série de fatores predisponentes, como cirurgias recentes, uso de anticoncepcional oral, trauma local, entre outros. A realização de exame de imagem é essencial para o diagnóstico, sendo a ultrassonografia a modalidade de escolha. Quanto ao tratamento, não há consenso na literatura. RELATO: Relatamos o caso de uma paciente de 30 anos que procurou atendimento médico de urgência com queixa de dor de forte intensidade, súbita, em região plantar do pé direito com dificuldade de deambulação. Ao exame físico, observou-se hiperalgesia em região plantar com irradiação para panturrilha, associada a empastamento da mesma. O ecodoppler colorido identificou trombo agudo em veia plantar medial. Optou-se pela prescrição de rivaroxabana, a qual foi substituída por ácido acetilsalicílico após três meses. A paciente evoluiu bem e recebeu alta do tratamento após 11 meses. CONCLUSÃO: A trombose de veias plantares é rara e tem uma alta gama de diagnósticos diferenciais, de forma que o profissional médico deve manter um alto nível de suspeição clínica. Para aperfeiçoar seu diagnóstico e tratamento, seria necessária a inclusão das veias plantares aos protocolos de investigação de pacientes com suspeita de Trombose Venosa Profunda, e pesquisas clínicas que elucidassem os melhores métodos terapêuticos.

Complicaciones en accesos venosos vasculares: estudio descriptivo de catéteres venosos centrales y catéteres de línea media / Complications in vascular venous access: descriptive study of central venous catheters and midline catheters

[RESUMEN]. Los accesos vasculares venosos son dispositivos elementales para el tratamiento hospitalario de diversas condiciones. Está bien documentada la tasa de complicaciones para catéteres venosos centrales (CVC) y catéteres de línea media (MD), pero existe un solo trabajo que los compara directamente. Por ello realizamos el presente trabajo con el objetivo de establecer las tasas generales y comparativas de complicaciones en ambos tipos de catéteres. Se realizo un estudio descriptivo retrospectivo donde se reclutaron 168 pacientes, los cuales recibieron 268 catéteres (120 accesos venosos centrales y 148 midline), con una media de edad de 45 años, con leve predominio del sexo femenino (51,2%). De estos, la principal comorbilidad fue neoplasia (57,1%). En el 29,8% el principal motivo de colocación fue la infusión de quimioterapia. Como resultados, la prevalencia de complicaciones fue del 19%: infecciosas en el 7,5% de los casos (con una tasa de infecciones asociadas a catéter de 4.9/1000 días catéter), 1,9% trombóticas y 9,7% mecánicas. La tasa de complicaciones fue mayor para los catéteres venosos centrales, no alcanzando una diferencia estadísticamente significativa: infecciosas (10.8% vs. 4,7%; p: 0,059; OD: 2.47; IC 95%: 0.94 - 6.34) y mecánicas (5.8% vs. 12,8%; p: 0,054; OD: 0.42; IC 95%: 0.17 ­ 1.03) para CVC y MD, respectivamente. Las complicaciones trombóticas fueron similares en ambos (1,6% en CVC y 2% en MD, p: 0,82).

[ABSTRACT]. Venous vascular accesses are fundamental devices for in hospital treatment of various conditions. Complication rates for central venous catheters (CVC) and midline catheters (MD) are well-documented, but there is only one study in wich both devices were compared. Therefore, we conducted the present study with the aim of establishing the overall and comparative complication rates of both types of catheters. We conducted a retrospective descriptive study recruiting 168 patients who received 268 catheters (120 central venous accesses and 148 midlines). The mean age was 45 years, with a slight predominance of females (51.2%). Among these, the main comorbidity was neoplasia (57.1%). In 29.8% of cases, the main reason for catheter placement was chemotherapy infusion. As a result, the prevalence of complications was 19%: infectious complications in 7.5% of cases (with a catheter-associated infection rate of 4.9/1000 catheter days), thrombotic 1,9%, and mechanical 9,7%. Complication rate were higher for central venous accesses, although the difference did not reach statistical significance: infectious (10.8% vs. 4.7%; p: 0.059; OR: 2.47; 95% CI: 0.94 - 6.34) and mechanical (5.8% vs. 12.8%; p: 0.054; OR: 0.42; 95% CI: 0.17 ­ 1.03) for CVC and MD, respectively.Thrombotic complications were similar in both (1.6% in CVC and 2% in MD, p: 0.82).

Superior ophthalmic vein and cavernous sinus thrombosis associated with COVID-19: a case report / Trombose de veia oftálmica superior e seio cavernoso associada à COVID-19: relato de caso

ABSTRACT Cavernous sinus and superior ophthalmic vein thrombosis is a rare clinical condition, and little described in the literature. The clinical presentation is nonspecific and highly variable, and symptoms may include red eye, ophthalmoplegia, coma, and death. The main etiology results from infection of the paranasal sinuses. The final diagnosis must be made through imaging tests such as magnetic resonance imaging. We describe a case of cavernous sinus and superior ophthalmic vein thrombosis after COVID-19 infection in a 64-year-old patient with persistent ocular hyperemia and pain on eye movement. Ophthalmological examination showed preserved visual acuity, conjunctival hyperemia, dilation of episcleral vessels and retinal vascular tortuosity in the right eye. Magnetic resonance imaging confirmed the diagnosis. The association with the COVID-19 was raised, excluding other infectious causes. Enoxaparin and Warfarin were started with significant improvement in the ocular clinical presentation and maintenance of initial visual acuity after 12 months of follow-up.

RESUMO A trombose de seio cavernoso e veia oftálmica superior é uma condição clínica rara e pouco descrita na literatura. A apresentação clínica é inespecífica e altamente variável. Os sintomas podem incluir olho vermelho, oftalmoplegia, coma e morte. A etiologia principal resulta da infecção dos seios paranasais. O diagnóstico final deve ser efetuado por meio de exames de imagem, como ressonância magnética. Descrevemos um caso de trombose de seio cavernoso e veia oftálmica superior após COVID-19 em paciente de 64 anos e com quadro de hiperemia ocular persistente e dor à movimentação ocular. Ao exame oftalmológico, observou-se acuidade visual preservada, hiperemia conjuntival, dilatação de vasos episclerais e tortuosidade vascular retiniana em olho direito. A ressonância confirmou o diagnóstico. A associação com a COVID-19 foi levantada, excluindo-se demais causas infecciosas. Prescrevemos enoxaparina e varfarina, com melhora do quadro clínico ocular e manutenção da acuidade visual inicial após 12 meses de acompanhamento.

Estudio de prevalencia de factores de riesgo para enfermedad tromboembólica en pacientes quirúrgicos adultos y las medidas preventivas implementadas / Prevalence study of risk factors for thromboembolic disease in adult surgical patients and preventive measures implemented

INTRODUCTION: Deep vein thrombosis (DVT) is a complication in surgical patients. Factors such as age, prolonged rest, and use of oral contra- ceptives, among others, have been described as increasing the risk of DVT. Within the prevention strategies, the individual risk level of the patient must be identified, and pharmacological and non-pharmacological measures administered. The objective of this study is to determine the risk level of surgical patients for DVT and to evaluate compliance with prevention measures. MATERIAL AND METHOD: A cross-sectional study is carried out. A sample of 270 surgical patients in a high complexity hospital was evaluated, registering their risk factors, and evaluating compliance with preventive measures. RESULTS: The population at greatest risk is concentrated in those over 55 years of age, male, obese, with major surgery, resting for more than 72 hours, with a history of DVT, hip, pelvic or leg fracture. 18.5% of the patients presented compliance with the prevention measures in all their risk classifications; Of the patients who presented non-compliance with measures, 60.9% complied only with the pharmacological measures for the prevention of DVT. CONCLUSIONS: The population studied has risk factors that have been described as risk for DVT. There is evidence of non-compliance with prevention measures for DVT, at the expense of non-pharmacological measures.

INTRODUCCIÓN: La trombosis venosa profunda (TVP) es una complicación en pacientes quirúrgicos. Se han descrito factores como edad, reposo prolongado, uso de anticonceptivos orales, entre otros, que aumentan el riesgo de TVP. Dentro de las estrategias de prevención, se debe identificar el nivel de riesgo individual del paciente y administrar medidas farmacológicas y no farmacológicas. El objetivo de este estudio es determinar el nivel de riesgo de pacientes quirúrgicos para TVP y evaluar el cumplimiento de las medidas de prevención. MATERIAL Y MÉTODO: Se realiza un estudio descriptivo y transversal. Se evaluó una muestra de 270 pacientes quirúrgicos en un hospital de alta complejidad registrando sus factores de riesgo y evaluando el cumplimiento de medidas de prevención. RESULTADOS: La población de mayor riesgo se concentra en mayores de 55 años, sexo masculino, obesidad, con cirugía mayor, reposo mayor de 72 h, con antecedentes de TVP, fractura de cadera, pelvis o pierna. El 18,5% de los pacientes presentaron cumplimiento de las medidas de prevención en todas sus clasificaciones de riesgo. De los pacientes que presentan incumplimiento de medidas, el 60,9% cumple sólo con las medidas farmacológicas para prevención de TVP. CONCLUSIONES: La población estudiada posee factores de riesgo que han sido descritos como riesgo para TVP. Se evidencia incumplimiento de las medidas de prevención para TVP, a expensas de las medidas no farmacológicas.

Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty: a randomized controlled trial / 中国针灸

OBJECTIVE@#To investigate the clinical effect of aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban for lower extremity venous thrombosis after total knee arthroplasty and the influence on hypercoagulation.@*METHODS@#Seventy-three patients of knee osteoarthritis with lower extremity venous thrombosis after total knee arthroplasty (KOA) were randomly divided into an observation group (37 cases, 2 cases dropped off) and a control group (36 cases, 1 case dropped off). The patients in the control group took orally rivaroxaban tablets, 10 mg a time, once a day. On the basis of the treatment as the control group, the aconite-isolated moxibustion was applied to Yongquan (KI 1) for the patients of the observation group, once daily and 3 moxa cones were used in each treatment. The duration of treatment was 14 days in both groups. Before treatment and 14 days into treatment, the ultrasonic B test was adopted to determine the conditions of lower extremity venous thrombosis in the two groups. Before treatment, 7 and 14 days into treatment, the coagulation indexes (platelet [PLT], prothrombin time [PT], activated partial prothrombin time [APTT], fibrinogen [Fib] and D-dimer[D-D]), the blood flow velocity of the deep femoral vein and the circumference of the affected side were compared between the two groups separately, and the clinical effect was evaluated.@*RESULTS@#Fourteen days into treatment, the venous thrombosis of the lower extremity was relieved in both groups (P<0.05), and that of the observation group was better than the control group (P<0.05). Seven days into treatment, the blood flow velocity of the deep femoral vein was increased compared with that before treatment in the observation group (P<0.05), and the blood flow rate in the observation group was higher than that in the control group (P<0.05). Fourteen days into treatment, PT, APTT and the blood flow velocity of the deep femoral vein were increased in the two groups compared with those before treatment (P<0.05); and PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all reduced in the two groups (P<0.05). Compared with the control group 14 days into treatment, the blood flow velocity of the deep femoral vein was higher (P<0.05), PLT, Fib, D-D and the circumference of the limb (knee joint, 10 cm above the patella and 10 cm below the patella) were all lower in the observation group (P<0.05). The total effective rate was 97.1% (34/35) in the observation group, higher than 85.7% (30/35) in the control group (P<0.05).@*CONCLUSION@#Aconite-isolated moxibustion at Yongquan (KI 1) combined with rivaroxaban can effectively treat lower extremity venous thrombosis after total knee arthroplasty, relieve hypercoagulation, accelerate the blood flow velocity and alleviate swelling of the lower extremity in the patients with knee osteoarthritis.

Efficacy evaluation of novel oral anticoagulants in patients with cirrhosis accompanied with portal vein thrombosis: a meta-analysis / 中华肝脏病杂志

Objective: To analyze the safety and efficacy of using novel oral anticoagulants (rivaroxaban and others) in patients with cirrhosis accompanied with portal vein thrombosis (PVT). Methods: Clinical research literature published from the establishment of the database to June 20, 2021, was retrieved from PubMed, Web of Science, CNKI, Wanfang, and Weipu databases by combining subject terms and free words. RevMan software was used for the random group meta-analysis model. Results: In terms of PVT recanalization, the novel oral anticoagulants (such as low molecular weight heparin and others) had a higher recanalization rate than traditional anticoagulants (OR = 13.75, 95%CI 3.58-52.9, P = 0.000 1). In terms of bleeding, the novel oral anticoagulants did not increase the risk of bleeding compared with traditional anticoagulants (OR = 2.42, 95%CI 0.62-9.41, P = 0.20). Conclusion: The novel oral anticoagulant drugs are superior to traditional anticoagulants in terms of the occurrence of PVT recanalization; however, there is no statistically significant difference in terms of the occurrence of bleeding between the two groups.

Clinical Comparison of the Efficacy of Systemic Thrombolysis,Catheter-Directed Thrombolysis,and AngioJet Percutaneous Mechanical Thrombectomy in Acute Lower Extremity Deep Venous Thrombosis / 中国医学科学院学报

Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.