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1.
Frontiers in Pharmacology ; 13 (no pagination), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2199118

RESUMO

Due to the fact that coronavirus disease 2019 (COVID-19) is still prevalent, and current reports show that some parts of the world have seen increase in incidence, it is relevant that health professionals and scientists know about recent or novel trends, especially drug treatments. Additionally, the safety profiles of these drug treatments need to be documented and shared with the public. Some studies have demonstrated the clinical benefits of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in COVID-19 treatment. On the contrary, others have also reported that NSAIDs and corticosteroids may worsen symptoms associated with COVID-19. While some researchers have suggested that corticosteroids may be helpful if used in the early stages of COVID-19, there are still some conflicting findings regarding the use of corticosteroids in certain viral infections. Our review suggests that methylprednisolone, dexamethasone, and ibuprofen have therapeutic potential in reducing mortality due to COVID-19 among hospitalized patients. This review also highlights the fact that the use of NSAIDs is not associated with adverse outcomes of COVID-19. In reality, evidence suggests that NSAIDs do not increase the risk of COVID-19 infections. Also, the literature reviewed suggests that corticosteroid treatment in COVID-19 was linked with a decrease in all-cause mortality and disease progression, without increase in adverse events when compared to no corticosteroid treatment. Copyright © 2022 Amponsah, Tagoe, Adams and Bugyei.

2.
Neurology ; 93(23 Supplement 2):S30, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2196703

RESUMO

Objective The goal of this study is to compile published data reporting neurological immune-related adverse events following COVID-19 vaccination, not including those relating to hematologic abnormalities such as thrombosis or hemorrhage. Background COVID-19 vaccination has been repeatedly shown to reduce the incidence and severity of COVID-19 infection. The expedited timeline of these vaccines has given rise to many discussions pertaining to their safety. Many neurological and non-neurological adverse events have been linked to COVID-19 vaccination including acute MI, anaphylaxis, appendicitis, Bell's palsy, deep vein thrombosis, disseminated intravascular coagulation, encephalomyelitis, transverse myelitis, and many others. Design/Methods The following databases were searched in April 2021 using different keywords: PubMed, Medline, Embase, Scopus, Web of Science, Science, Direct, MedRxiv, and Lens.org. Studies were included if they reported any adverse immune-related neurological events secondary to COVID-19 vaccination. Studies were excluded if they were not in English, included self-reported events only, or did not report primary data. Screening and extraction were conducted by 2 different reviewers using Covidence. Results The search strategy yielded 18 studies which reported a total of 61 patients who had received a COVID-19 vaccination and experienced = 1 neurological adverse events. Most reported adverse events were facial nerve palsy (52.5%), reactivation of herpes zoster (11.5%), Guillian-Barre syndrome (6.6%), demyelinating disease (6.6%), and neuropathy (11.5%). Other reported adverse effects were delirium, periauricular vesicular rash, bilateral sensorineural hearing loss, visual disturbance, gait disturbance, serotonin syndrome, and vestibular ataxia (16.4%). Conclusions The symptoms were time-limited and self-resolving in nature. In addition, the incidence of the reported events following COVID-19 vaccination compared to the general population is similar. Hence, there is little to no evidence suggesting a causal relationship between COVID-19 vaccination and neurological adverse events.

3.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1) (no pagination), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2196562

RESUMO

Background: COVID-19 vasculopathy is a critical condition that impacts the disease prognosis including vasculitis and thromboembolic complications. This study aimed to provide the Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic and to collectively include the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial vascular complications. Result(s): This is a multi-center retrospective analysis of 3500 PCR-proved COVID-19 infection between March 2020 and December 2021. A cohort of 282 consecutive patients with COVID-19 vasculopathy was considered for inclusion. They included 204 males and 78 females (72:28%). The mean age was 68 years, and age ranged from 48 to 90 years. Five radiologists evaluated the different imaging examinations in consensus including computed tomography (CT), CT-angiography (CTA), CT-perfusion (CTP), magnetic resonance imaging (MRI), MR-arteriography (MRA), and MR-venography (MRV). 244/282 (86.5%) patients suffered from non-hemorrhagic cerebral ischemic infarctions. 13/282 (4.6%) patients suffered from hemorrhagic cerebral infarctions. 5/282 (1.8%) patients suffered from cerebral vasculitis. Pulmonary vascular angiopathy was detected in 10/282 (3.5%) patients, including pulmonary embolism in 10/10 patients, pulmonary infarctions in 8/10 patients, pulmonary vascular enlargement in 5/10 patients, and vascular "tree-in-bud" sign in 2/10 patients. Intestinal ischemia and small bowel obstruction were detected in 3/282 patients (1%) while GIT bleeding was encountered in 4/282 patients (1.4%). Lower limb arterial ischemia was found in 3/282 patients (1%). Additionally;39/282 (13.8%) patients developed peripheral deep venous thrombosis (DVT) due to prolonged ICU recumbence while 28/282 (10%) patients developed jugular vein thrombosis sequel to prolonged catheterization. A p value (0.002) and (r) = 0.8 statistically proved strong significant relation between COVID-19 vasculopathy and D-dimer levels. Conclusion(s): Multi-system vasculopathy was a serious complication of COVID-19 which impacted the patients' morbidity and mortality. An Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic was provided. It encountered the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial COVID-19 vascular complications. Copyright © 2022, The Author(s).

4.
Journal of Intensive Care ; 10(1) (no pagination), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2196496

RESUMO

Background: Extracorporeal membrane oxygenation (ECMO) is an integral method of life support in critically ill patients with severe cardiopulmonary failure;however, such patients generally require prolonged mechanical ventilation and exhibit high mortality rates. Tracheostomy is commonly performed in patients on mechanical ventilation, and its early implementation has potential advantages for favorable patient outcomes. This study aimed to investigate the association between tracheostomy timing and patient outcomes, including mortality, in patients requiring ECMO. Method(s): We conducted a single-center retrospective observational study of consecutively admitted patients who were supported by ECMO and underwent tracheostomy during intensive care unit (ICU) admission at a tertiary care center from April 2014 until December 2021. The primary outcome was hospital mortality. Using the quartiles of tracheostomy timing, the patients were classified into four groups for comparison. The association between the quartiles of tracheostomy timing and mortality was explored using multivariable logistic regression models. Result(s): Of the 293 patients treated with ECMO, 98 eligible patients were divided into quartiles 1 (<= 15 days), quartile 2:16-19 days, quartile 3:20-26 days, and 4 (> 26 days). All patients underwent surgical tracheostomy and 35 patients underwent tracheostomy during ECMO. The complications of tracheostomy were comparable between the groups, whereas the duration of ECMO and ICU length of stay increased significantly as the quartiles of tracheostomy timing increased. Patients in quartile 1 had the lowest hospital mortality rate (19.2%), whereas those in quartile 4 had the highest mortality rate (50.0%). Multivariate logistic regression analysis showed a significant association between the increment of the quartiles of tracheostomy timing and hospital mortality (adjusted odds ratio for quartile increment:1.55, 95% confidence interval 1.03-2.35, p for trend = 0.037). Conclusion(s): The timing of tracheostomy in patients requiring ECMO was significantly associated with patient outcomes in a time-dependent manner. Further investigation is warranted to determine the optimal timing of tracheostomy in terms of mortality. Copyright © 2022, The Author(s).

5.
Thrombosis Journal ; 21(1) (no pagination), 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2196325

RESUMO

Background: (p-BthTX-I)2 K, a dimeric analog peptide derived from the C-terminal region of phospholipase A2-like bothropstoxin-I (p-BthTX-I), is resistant to plasma proteolysis and inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains with weak cytotoxic effects. Complications of SARS-CoV-2 infection include vascular problems and increased risk of thrombosis;therefore, studies to identify new drugs for treating SARS-CoV-2 infections that also inhibit thrombosis and minimize the risk of bleeding are required. Objective(s): To determine whether (p-BthTX-I)2 K affects the hemostatic system. Method(s): Platelet aggregation was induced by collagen, arachidonic acid, and adenosine diphosphate (ADP) in the Chronolog Lumi-aggregometer. The coagulation activity was evaluated by determining activated partial thromboplastin clotting time (aPTT) and prothrombin time (PT) with (p-BthTX-I)2 K (5.0-434.5 microg) or 0.9% NaCl. Arterial thrombosis was induced with a 540 nm laser and 3.5-20 mg kg- 1 Rose Bengal in the carotid artery of male C57BL/6J mice using (p-BthTX-I)2 K. Bleeding time was determined in mouse tails immersed in saline at 37 degreeC after (p-BthTX-I)2 K (4.0 mg/kg and 8.0 mg/kg) or saline administration. Result(s): (p-BthTX-I)2 K prolonged the aPTT and PT by blocking kallikrein and FXa-like activities. Moreover, (p-BthTX-I)2 K inhibited ADP-, collagen-, and arachidonic acid-induced platelet aggregation in a dose-dependent manner. Further, low concentrations of (p-BthTX-I)2 K extended the time to artery occlusion by the formed thrombus. However, (p-BthTX-I)2 K did not prolong the bleeding time in the mouse model of arterial thrombosis. Conclusion(s): These results demonstrate the antithrombotic activity of the peptide (p-BthTX-I)2 K possibly by kallikrein inhibition, suggesting its strong biotechnological potential. Copyright © 2023, The Author(s).

6.
Interventional Neuroradiology ; 28(1 Supplement):227, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2195331

RESUMO

Purpose: Aneurysmal subarachnoid hemorrhage (SAH) is one of the most severe neurosurgical diseases in which systemic management is important from the acute phase to the chronic phase. We experienced the patient with intra-abdominal hemorrhage due to segmental arterial mediolysis (SAM) accompanied by SAH. Material(s) and Method(s): A 60-year-old woman suddenly collapsed at home and was brought to our institution by ambulance. On arrival, she was comatous state and her head CT showed SAH and intracerebral hematoma in the right frontal lobe, suggesting the presence of an anterior communicating artery aneurysm. Subsequently, whole body CT was performed to screen for COVID-19. However, immediately after these scans, her blood pressure suddenly decreased, and her breathing deteriorated. Whole body CT showed unexpected intra-abdominal hemorrhage. Additional contrast-enhanced CT suggested bleeding from the ovarian artery. Emergent embolization of the right ovarian artery aneurysm was conducted, but the vital sign worsened again. Unfortunately, she deceased three days later. Result(s): To the best of our knowledge, a total of 14 similar cases have been reported, including the present patient. The clinical manifestations at the time of onset included hypovolemic shock in 6 patients (40%), abdominal pain in 3 patients (20%), and impaired consciousness in 2 patients (13%). There has been no previous report describing the bleeding from ovarian artery aneurysm due to SAM. Four of 14 patients (28.6%) died even after the treatment for SAM. Conclusion(s): It is necessary to keep in mind that the patients with SAH rarely have intra-abdominal hemorrhage. When the blood pressure suddenly decreases during the clinical course, this peculiar disorder should be suspected.

7.
Interventional Neuroradiology ; 28(1 Supplement):286-287, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2195328

RESUMO

Purpose: Intravenous (IV) heparin remains the standard of care for cerebral venous thrombosis (CVT), however, permanent disability or death still ensues in ~20% of patients. Endovascular treatment (EVT) is increasingly used to treat CVT, however, trials have not shown improved outcomes using catheter thrombolytic infusion, balloon angioplasty, or mechanical thrombectomy with stent-retrievers. We report successful EVT and outcomes of two CVT patients treated using an 0.088 inch large bore aspiration catheter. Methods HiPoint 088 aspiration catheter was delivered over a Tenzing 8 delivery catheter through a BaseCamp guide catheter (Route 92 Medical, San Mateo, CA, USA). Result(s): Case 1: young female 3 months post-partum, schizophrenia, COVID positive, presented with a three-day history of headache/nausea/vomiting/clumsiness/gait instability. In ED, her Glasgow Coma Scale declined to 3 and she was intubated. CT showed a small right posterior temporal venous infarct with some small hemorrhage, diffuse sulcal edema, and extensive hyperdense thrombus throughout her superficial and deep venous sinuses. IV Heparin was initiated. Due to the clot burden and rapid neurologic decline, EVT was performed. 6 F left femoral artery and 9 F right femoral vein access was obtained. After confirmation of CTA findings, and diffuse poor filling of the cerebral venous phase, 16 thrombectomy passes were performed, debulking thrombus from the right sigmoid sinus, then dominant right transverse sinuses, followed by the superior sagittal sinus (SSS). Copious, pink-colored thrombus was removed piecemeal. At the end of thrombectomy, a small residual non-occlusive thrombus remained in the parietal SSS, with persistent thrombosis of the deep cerebral veins and straight sinus. IV heparin was continued post-procedure. Post-op day two, she was extubated and neurologically intact. Her discharge mRS was 0. Case 2- a young obese female on oral contraceptives presented with headache worsening over three days. In the ED, the patient became acutely unresponsive and was intubated. CT/CTA revealed diffuse sulcal edema, and extensive hyperdense thrombus throughout her superficial and deep veins. IV Heparin was initiated. 6 F left femoral artery and 9 F right femoral vein access was obtained. After confirmation of CTA findings, 7 passes of venous thrombectomy were performed with the Basecamp guide catheter in the Left internal jugular vein, and one pass of the HiPoint 088 in the left transverse sinus. Copious dark red thrombus was removed piecemeal. Final venography demonstrated restoration of venous outflow with residual partially occlusive thrombus in the SSS and right transverse sinus. IV heparin was continued postprocedure. On POD 1, she was extubated and neurologically intact. Her discharge mRS was 0. Conclusion- Further investigation of EVT using HiPoint 088 large bore aspiration catheter system for CVT in warranted.

8.
BMJ Nutrition, Prevention and Health ; (no pagination), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2193749

RESUMO

The clinical objectives of this prospective, random, convenience series were: 1. Compare a novel fibre-optic pH test device (NGPOD) to gastric aspirate and pH testing for nasogastric tube (NGT) confirmation. 2. Determine if the new device reduces the need for chest radiography (chest X-ray, CXR). Method(s): Recruitment of patients over the age of 18, requiring NGT feeding. Exclusion criteria: oesophageal gastrointestinal surgery within 3 months;all those with partial or total gastrectomy;bleeding gastric and duodenal ulcers;gastric cancer;those with oesophageal varices;those considered to be inappropriate. The index test, NGPOD, comprises a fine, flexible fibre-optic sensor passed down the NGT, then connected to an electronic device. A green light indicates pH <=5.5, and a red light if pH is >5.5. The reference test is withdrawal of gastric aspirate and testing with universal pH indicator strips then comparison to a colour chart. Second-line testing is establishing NGT position by CXR or subjective clinical assessment (SCA) in intensive care unit (ICU). Result(s): The analysed data set contained 174 subjects who had undergone 496 tests, 96 initial and 400 repeat NGT checks. For all patients, NGPOD can reduce the need for CXR or SCA by 21.2%. In ICU, NGPOD can reduce the need for CXR or SCA by 24.5%. When performing initial tests, immediately after tube placement, NGPOD can reduce the need for CXR or SCA in 61% of patients. With repeat testing, NGPOD can reduce the need to progress to CXR or SCA in 16% of tests. Conclusion(s): The objective, yes - no result delivered by NGPOD, eliminates the subjective reading of a pH strip colour change, reducing the subjective element. The index test has the opportunity to reduce risk, improve safety and decrease the numbers of patients requiring X-ray. It, therefore, has the potential to reduce never events associated with NGT misplacement. Copyright © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

10.
Critical Care Medicine ; 51(1 Supplement):610, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190688

RESUMO

INTRODUCTION: Prompt recognition of sepsis is imperative for timely treatment and has led to the creation of the CERNER St. Johns Sepsis (SJS) Surveillance Agent Algorithm. Patient specific values are analyzed to determine if criteria for a Systemic Inflammatory Response Syndrome (SIRS) or Septic Shock Alert is met. The SJS Surveillance Agent Algorithm has a positive predictive value of 64%. The study site modified the alert criteria in the acute care areas and the emergency department to reduce alert fatigue. The purpose of this evaluation was to assess whether the modified alert criteria accurately identifies patients with possible sepsis. METHOD(S): This is a single center, retrospective, cohort evaluation. A Cerner Sepsis Audit report of all SIRS and Septic Shock Alert patients admitted between July 1 and July 14, 2021 was used for analysis. Patients were screened at random and included once per admission, first occurrence only. Patients were excluded if they had a presumed or confirmed COVID-19 diagnosis during admission. The proportion of SIRS and Septic Shock Alerts that correlate to a sepsis diagnosis and the proportion of patients with a discharge diagnosis code of sepsis where no alert was generated were analyzed using descriptive statistics. RESULT(S): A total of 147 patients were screened for inclusion with 121 patients included in the final analysis. There were 105 patients who triggered a SIRS or Septic Shock Alert and 16 patients coded for sepsis with no alert generated. The modified SJS criteria resulted in a positive predictive value of 60% (63 sepsis diagnosis vs. 42 noninfectious diagnosis). A majority of alerts were generated by SIRS criteria versus Septic Shock criteria. The most common non-infectious diagnoses in patients who alerted without sepsis were hemorrhage, hypovolemia, and trauma. CONCLUSION(S): Modification of the SJS algorithm occurred in an effort to decrease alert fatigue and was found to be comparable in positive predictive value to the unmodified algorithm.

11.
Critical Care Medicine ; 51(1 Supplement):555, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190672

RESUMO

INTRODUCTION: Patients supported on extracorporeal membrane oxygenation (ECMO) due to COVID-19 are at an increased risk of both thromboembolic complications and thrombocytopenia. Bivalirudin, a direct thrombin inhibitor, is increasingly being utilized for anticoagulation in the ECMO patient though there is largely a lack of literature within the COVID-19 population. The objective of our study was to evaluate the safety and efficacy of alternative anticoagulation with bivalirudin in patients on ECMO with COVID-19 respiratory failure. METHOD(S): This was a non-interventional retrospective chart review conducted at a single center large community hospital between January 2020 - November 2021. We included both venovenous (VV) and venoarterial (VA) adult ECMO patients anticoagulated with bivalirudin that tested positive for COVID-19. Patients were excluded if their duration of ECMO cannulation was less than 48 hours. Descriptive statistical analyses were performed utilizing median with interquartile range and frequency with percent as appropriate. RESULT(S): Overall, 180 ECMO patients were included in the study. The duration of ECMO cannulation was 29 (9-54) days and our cohort experienced a 42% mortality rate. The rate of thrombotic events including in-circuit thrombosis, arterial and venous thrombotic events was 22%. The median initial platelet count on ECMO was 206 (157-274) and the median nadir was 85 (48-121). ELSO defined major bleeding occurred at a rate of 53% within this cohort. CONCLUSION(S): To our knowledge, this study describes the largest number of patients anticoagulated with bivalirudin for ECMO secondary to COVID-19. Our results suggest similar rates of thrombotic events compared to ELSO registry data. While the half-life of bivalirudin is short, clinicians should still be cautious of bleeding due to lack of a specific reversal agent. Retrospective studies with a comparator cohort, as well as randomized trials are warranted to further evaluate the selection of intravenous anticoagulants in the ECMO population with and without COVID-19.

12.
Critical Care Medicine ; 51(1 Supplement):381, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190601

RESUMO

INTRODUCTION: Anticoagulation is critical in preventing thrombosis in extracorporeal membrane oxygenation (ECMO). Unfractionated heparin (UFH) has historically been the anticoagulant of choice;however, is limited by a co-factor to assert its action that leads to fluctuations in dose responsiveness and complications like heparin-induced thrombocytopenia and heparin resistance. For these reasons, use of direct thrombin inhibitors is increasing in ECMO. The purpose of this study is to compare the efficacy and safety of UFH vs. bivalirudin for anticoagulation in ECMO with a subset of COVID-19 patients. METHOD(S): This was a retrospective, single-centered, cohort study of patients receiving UFH (n=106) vs. bivalirudin (n=27) for ECMO. The primary outcome was the percentage of thrombotic events (in-circuit, non-circuit related thrombosis) during ECMO between patients receiving UFH and bivalirudin. RESULT(S): There were significant differences between bivalirudin and UFH patients with the following baseline characteristics: BMI (29.9 vs. 26.5;p=0.02), Caucasian race (29.6% vs. 65.1%;p< 0.01), positive COVID-19 status (66.7% vs. 0.9%;p< 0.01), and indication for ECMO (respiratory failure 100% vs. 67.9%;p< 0.01). The time to goal anticoagulation was longer in bivalirudin patients (7.1 vs. 25.0 hr;p< 0.01). COVID-19 patients had greater thrombotic events (47.4% vs. 25.4%;p=0.05), number of bleeding events per patient (2 vs.1;p< 0.01), as well as longer ECMO duration (42.2 vs. 6.6 days;p< 0.01), length of ICU (46.4 vs. 6.6 days;p< 0.01) and hospital stay (52.1 vs. 33.2 days;p=0.03) compared to non-COVID-19 patients. A sub-group analysis of venovenous (VV) ECMO, non-COVID-19 patients was propensity score matched by age, sex, Caucasian race, BMI, and ECMO duration. This analysis demonstrated no significant differences between UFH and bivalirudin in thrombotic or bleeding events, however, there was greater mortality in the UFH arm (100% vs. 28.6%;p=0.02). CONCLUSION(S): Patients with COVID-19 experienced greater thrombotic and bleeding events, with longer ECMO duration and lengths of stay. In the propensity matched analysis comparing UFH vs. bivalirudin in VV-ECMO, non- COVID-19 patients, there were no significant differences between thrombotic or bleeding events, but significantly greater mortality in the UFH arm.

13.
Critical Care Medicine ; 51(1 Supplement):380, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190600

RESUMO

INTRODUCTION: Data is lacking regarding the safety and efficacy of factor Xa inhibitors in patients with acute kidney injury (AKI). The goal of this study is to compare bleeding and thromboembolic events in patients receiving therapeutic doses of apixaban or rivaroxaban versus unfractionated heparin (UFH) in patients with AKI. METHOD(S): This retrospective, observational study evaluated hospitalized adult patients who received therapeutic doses of either apixaban, rivaroxaban, or UFH for at least 24 hours in the setting of AKI as defined by AKIN criteria. Patients were excluded if they met any of the following criteria: non-FDA approved factor-Xa inhibitor indication;COVID admission;major bleeding or clinically relevant non-major bleeding (CRNMB) on admission, embolic event within 30 days of admission;coagulopathy;receipt of a contraindicated medication, or ESRD. Bleeding events were evaluated in accordance with International Society on Thrombosis and Hemostasis criteria. The primary outcome was defined as composite major and clinically relevant non-major bleeding events. Secondary outcomes included comparison of the individual components of the composite bleeding endpoint and thromboembolic events. RESULT(S): A total of 500 patients met inclusion criteria, with 250 patients included in the UFH group and factor Xa inhibitor group. AKIN Stage I was most prevalent in the overall study population;patients with AKIN stage III were more likely to be transitioned to UFH (p< 0.01). Surgical patients were more likely to be transitioned to UFH (p< 0.01). Patients transitioned to IV heparin were more likely to undergo a procedure (p< 0.01). After adjusting for confounding factors, patients who received a factor Xa inhibitor experienced a lower risk of composite major bleeding and CRNMB events as compared to UFH (OR: 0.57, 95% CI: 0.34-0.94;p = 0.03). This was driven by a decreased risk of CRNMB in the factor Xa inhibitor group (OR: 0.55, 95% CI: 0.33-0.91, p = 0.02). No significant differences in major bleeding or VTE were noted. CONCLUSION(S): Continuation of factor Xa inhibitor therapy in the setting of AKI was associated with a reduced incidence of bleeding events compared to patients transitioned to UFH in accordance with package insert recommendations.

14.
Critical Care Medicine ; 51(1 Supplement):216, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190550

RESUMO

INTRODUCTION: COVID pathogenesis involves a dysregulated inflammatory state and coagulopathy. Affected patients are at risk for thrombosis and bleeding as well as cytokine storming. Antithrombin 3 (AT3) has antiinflammatory and anti-coagulant properties but its role in COVID is unknown. The incidence of AT3 deficiency (< 80% activity) in COVID is unknown. We hypothesize that AT3 supplementation is safe in patients with COVID and AT3 deficiency. METHOD(S): Prospective randomized control trial of COVID, IRB approved at 2 centers from July 2021 to March 2022. Those with plasma AT3< 100% were randomized to either standard of care (SOC) or SOC+AT3 q48hr weight-based for a goal of 120% for up to 5 doses. An additional group with AT3>100% received SOC. Data are compared using ANOVA and Fisher's exact test. Enrollment was concluded early due to reduced COVID cases and reduced length of stay. RESULT(S): In 531 subjects assessed for eligibility, 324 did not meet inclusion criteria, 151 did not consent, 4 withdrew consent, and 52 subjects completed the study. Enrollment AT3 (M+/-SD) was 96+/-12%. AT3 levels were < 100% in 40 (77%) and < 80% in 11(21%). SOC+AT3, SOC only, and AT3>100% had a Disseminated Intravascular Coagulation (DIC) score change (M+/-SD) of 0.4+/-1.5, -0.13+/-1.85 and 0+/-1.2, respectively, (p=0.63). Hospital length of stay was 13.9+/-14.9, 9.1+/-8.4, and 13+/-0.5 days respectively, (p=0.39). Mortality occurred in 2 (10%), 3 (15%), and 3 (25%), respectively, (p=0.56). There was 1 bleeding event in a subject with AT3>100% and no bleeding events were observed with exogenous AT3. There were no observed drug-related adverse events. Of the 18 subjects assigned to receive AT3, 15 received a median of 2 doses (IQR 2) for a total of 38 doses with a median dose of 1825.5 IU (IQR 794). CONCLUSION(S): COVID is associated with a relative AT3 deficiency and was observed in 21% of this cohort with reports of .02% to .2% in the general population. Exogenous AT3 supplementation was safe with no bleeding complications or drug-related adverse events. There was no significant change in outcomes, likely due to under-dosing and sample size. Further studies should evaluate higher doses of exogenous AT3 and focus on higher risk groups.

15.
European Heart Journal, Supplement ; 24(Supplement K):K239, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188692

RESUMO

Background: Anakinra, an interleukin 1beta recombinant receptor antagonist, could be used to reduce corticosteroid-dosage in colchicine-resistant pericarditis. Recently anakinra has been approved to treat patients presenting covid-19 related pneumonia requiring supplementary oxygen at risk of developing ARDS (identified by the finding of sieric suPAR at least 6 ng/mL.) Clinical case: A 86-years-old woman with history of hypertensive heart disease, diabetes mellitus and hyperthyroidism. Echocardiography showed pericardial effusion with signs of early-stage cardiac tamponade requiring pericardiocentesis. Post-procedural AF occurred. Considering the potential high bleeding risk caused by an high dose of NSAIDs, has been set up medical treatment with colchicine and corticosteroid. During hospitalization patient tested positive for SARS-CoV-2. At the same time pericardial fluid cultures were negative to infectious and non-infectious etiologies. Despite the persisting chest pain (sharp and pleuritic, improved by sitting up and leaning forward), elevated serum CRP and a pericardiocentesis residual right ventricle pericardial effusion, there has been a fast improvement of the clinical picture and of the laboratory findings after the treatment with Anakinra. Conclusion(s): treatment with IL-1 inhibitors (Anakinra) has been exploited to reduce COVID-19-associated mortality and to treat patients with symptoms refractory to first lines of conventional pericarditis therapy.

16.
British Journal of Surgery ; 109(Supplement 9):ix56, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188335

RESUMO

Background: Surgical consent forms can be difficult for patients to read and understand. Important points including procedure details, relevant complications and alterative treatment options are often lost in the communication process. Furthermore, surveys have found that patients struggle to grasp basic surgical concepts. Procedure specific consent forms (PSCFs) have been shown to improve the process of surgical consent. This is partly because they provide a standardised list of complications and their incidence, presented in a uniform, legible format without any abbreviations. However, despite their benefits, PSCFs are nationally underused. Cholecystectomy is one of the most common operations performed in the United Kingdom. Due to the pandemic disrupting elective surgical lists, the backlog of patients with biliary pathology has increased. More patients are therefore presenting to the on-call surgical team with biliary disease. Many trusts employ an Emergency Surgery Ambulatory Care (ESAC) list to offload the stretched emergency service. Our aim was to assess the variability of cholecystectomy consent forms amongst this cohort of patients, subsequently review patient understanding and evaluate whether the introduction of a procedure specific consent form improved this understanding. Method(s): We performed a prospective audit of laparoscopic cholecystectomy consent forms using the ESAC service. These consent forms were all obtained from patient's paper notes and assessed individually for variables. The first loop of the audit assessed the consent form used for the first 20 patients allocated to the ESAC list. Subsequently, each patient was telephoned post-operatively and asked a series of standardised questions which were adapted from a published questionnaire. Following this, we introduced a Procedure Specific Consent Form (PCSF) for laparoscopic cholecystectomies, with the agreement of all consultant surgeons who perform this operation in the trust. The second loop of the audit assessed another 20 patients from the emergency list, after the introduction of the PCSF. Similarly, patients were later telephoned to assess understanding. Over both loops, each consent form was assessed for the scope of their included complications and measured against the NHS-recognised list of potential adverse outcomes. Secondly, the legibility of the consenter's writing and the use of any abbreviations was noted. Legibility was evaluated by two doctors independently to reduce subjectivity. Result(s): The first loop revealed that all forms contained infection and bleeding;90% included injury to bile duct;80% included injury to viscera and risks from general anaesthetic;75% included blood clots and bile leak;and only 55% included post-cholecystectomy syndrome. The additional complications included were pain, herniae, covid risk, retained stone, collection, pancreatitis, failure and death;with an even higher degree of variability. The 20 forms were 95% legible, with 50% of them containing one or more acronyms. Relating to the post-op questionnaire, >80% of patients remembered details surrounding their operation, however only 60% could recall basic potential complications. After PCSF introduction, itwas used in 10 of the second loop cases,with the remaining 10 using traditional Consent Form 1 (non-PSCF). The non-PSCF group demonstrated similar variability in the complications included, with identical legibility rates and acronym usage. Again, only 60% of patients were able to accurately define the associated complications. Of the PSCFs, 100% were legible and 0% used acronyms, and the list of complications was standardised with 100% compliance with NICE and RCS England guidance. Notably, 90% of patients accurately recalled potential complications and nearly all were satisfied with their level of understanding prior to signing the consent form. Conclusion(s): This Quality Improvement Project demonstrated that hand written Consent Forms are highly variable, especially regarding the list of complications. We also found that while the were largely legible, half of the consent forms contained acronyms. Lastly, patients were satisfied with the information provided to them and could recall knowledge on the nature of the surgery, but many were not able to recollect important potential complications. The use of a PSCF allowed for a standardised, easily accessible, legible consent form devoid of misinterpretable acronyms. This was reflected in the patient questionnaire, where patients were able to recall details of the surgery and were satisfied with their level of understanding. This was reaffirmed by their grasp of the complications, where 90% of patients could recall potential adverse risks, compared to 60% in the Form 1 groups. This audit demonstrates the benefit of PSCFs from a legislative and litigative standpoint, but more importantly from the standpoint of patient understanding and holistic care. We recommend the use of PSCFs in the process of all surgical consent, to help ensure patient understanding and subsequent satisfaction.

17.
British Journal of Surgery ; 109(Supplement 9):ix35-ix36, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188331

RESUMO

Background: Good quality of operation notes are essential for good post-operative care, patient safety and medico-legal issues. RCSEng have guidelines on items that should be included in all operation notes. RCSEng Guidelines state: Ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. We re-audited the quality of operation notes in general surgery. Method(s): We re-audited and compared the results with the first cycle. Four months (1st August to 30th November 2021) period of consecutive operation notes were reviewed. Operation notes for endoscopy were excluded. Operations notes were analysed for documentation of the items as per RCSEng guidelines. There were less operations post COVID-19, hence longer study period. After first cycle, departmental presentation given for education and posters displayed in theatres as reminder. Initial plan for 2nd cycle in 2020 but it was not possible due to COVID-19. Problems/complications, extra procedures and prosthesis used were not included. Additional criteria reviewed was: Type of anaesthetic, patient position, indication for procedure and ASA grade. Result(s): A total of 239 operation notes were identified. 169 emergency and 70 elective cases. 193 were handwritten and 46 were typed.The results were compared to the first cycle: Conclusion(s): Higher proportion was ofemergency procedures during the 2nd cycle. Also, higher proportion of handwritten notes during 2nd cycle. There was improvement in documenting elective/emergency, time, type of anaesthesia, indication, position, operative findings/diagnosis, details of tissue removed/added/altered, blood loss, antibiotics, DVT prophylaxis. However, there was poorer documentation of date, name of assistant, incision, closure, signature remains. Ongoing education of the surgeons is vital to improve the quality of the operation notes. We suggest addition of further headings on the current op-note as aid-memoire and introduction of digital operation notes.

18.
Indian Journal of Radiology and Imaging ; 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2186431

RESUMO

An aberrant right subclavian artery (ARSA), also called as arteria lusoria, is one of the most common aortic arch anomalies. ARSA-esophageal fistula is a rare, life-threatening complication, with only 37 cases reported in literature. We describe a case of a young girl who developed acute episode of massive hematemesis after the recovery from novel coronavirus disease 2019 (COVID-19) pneumonia. Computed tomography (CT) angiography showed ARSA with retroesophageal course and active contrast leak in esophagus. Digital subtraction angiography confirmed the site of active contrast extravasation from the ARSA. However, the patient succumbed to hypovolemic shock even before the endovascular or surgical interventions could be done. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

19.
American journal of perinatology ; 06, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2186362

RESUMO

OBJECTIVES: The use of extracorporeal membrane oxygenation (ECMO) therapy has increased in the adult population. Studies from the H1N1 influenza pandemic suggest that ECMO deployment in pregnancy is associated with favorable outcomes. With increasing numbers of pregnant women affected by COVID-19 and potentially requiring this life-saving therapy, we sought to compare comorbidities, costs, and outcomes between pregnancy and non-pregnancy associated ECMO therapy among reproductive-aged female patients. STUDY DESIGN: We used the 2013-2019 National Readmissions Database. Diagnosis and procedural coding were used to identify ECMO deployment, potential indications, comorbid conditions, and pregnancy outcomes. The primary outcome was in-hospital mortality during the patient's initial ECMO stay. Secondary outcomes included length of stay and hospital charges/costs, occurrence of thromboembolic or bleeding complications during ECMO hospitalization, and mortality and readmissions up to 330 days following ECMO stay. Univariate and multivariate regression models were used to model the associations between pregnancy status and outcomes. RESULT(S): The sample included 324 pregnancy-associated hospitalizations and 3,805 non- pregnancy associated hospitalizations, corresponding to national estimates of 665 and 7,653 over the study period, respectively. Pregnancy-associated ECMO had lower incidence of in-hospital death (adjusted odds ratio (AOR): 0.56, 95% confidence interval (CI): 0.41-0.75) and bleeding complications (AOR: 0.67, 95% CI: 0.49-0.93). Length of stay was significantly shorter (adjusted rate ratio (ARR): 0.86, 95% CI: 0.77-0.96) and total hospital costs were less (ARR: 0.83, 95% CI: 0.75-0.93). Differences in the incidence of thromboembolic events (AOR: 1.04, 95% CI: 0.78-1.38) were not statistically significant. CONCLUSION(S): Pregnancy-associated ECMO therapy had lower incidence of in-hospital death, bleeding complications, total inpatient cost, and length of stay when compared to non-pregnancy associated ECMO therapy without increased thromboembolic complications. Pregnancy-associated ECMO therapy should be offered to eligible patients. Copyright Thieme. All rights reserved.

20.
Placenta ; 128:134, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2182350

RESUMO

Objective: Chronic Abruption Oligohydramnios Sequence (CAOS) is known as a disease with a poor perinatal prognosis characterized by placental marginal hematoma and genital bleeding, associated with fetal growth restriction, hemorrhagic amniotic fluid, oligohydramnios and chronic lung disease in the newborn. We reviewed the placental pathology of five cases diagnosed as CAOS without genital bleeding. Method(s): Pregnant women with CAOS without genital bleeding between April 2020 and July 2022 were identified. Five of these cases were clinically suspected as CAOS. Therefore, we evaluate the presence of hemorrhagic amniotic fluid and/or posterior placental hematoma by MRI;one case could not perform MRI because of COVID-19 infection. Placentas were examined histopathological and reviewed for the four Amsterdam classification groups, presence of diffuse chorioamniotic hemosiderosis (DCH), and other special findings. Result(s): The median age of the patients was 31 years and the median number of weeks of delivery was 24 weeks, including 2 cases of artificial abortion, 1 case of vaginal delivery, and 2 cases of cesarean section. The main complaints were FGR in 2 cases, amniotic fluid depletion in 2 cases, and suspected fetal congenital anomaly in 1 case. In histopathologic examination, 4 cases show DCH, 3 cases show maternal vascular marperfusion, and all cases had Acute chorioamnionitis. Conclusion(s): Four of the five patients had DCH, which suggest that the chorion and amnion are exposed to hematoma over a long period of time. This finding provides the basis for a final diagnosis in cases of clinically suspected CAOS. Our cases suggested that CAOS may be established before the appearance of genital hemorrhage. MRI or other tests should be performed aggressively in cases of clinically suspected CAOS without genital hemorrhage, and the patient should be strictly managed. Copyright © 2022

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