Characteristics of visits from otolaryngological patients before and during three waves of the COVID-19 pandemic: A retrospective study.

INTRODUCTION: COVID-19 pandemic has had a significant impact on healthcare systems around the world. The rapid spread of the virus caused several restrictions, including limited access to outpatient clinics. The purpose of the study was to compare the characteristics and reasons of the visits of otolaryngological patients conducted during the first three waves of the COVID-19 pandemic with those of the prepandemic period. MATERIALS AND METHODS: Volume, demographic data, type of visits, additional tests, referral types, and reasons for consultation were analyzed. RESULTS: There were 1578 visits performed before the pandemic and, respectively, 434, 1198 and 1299 during the first, second and third waves. The patients in the first and second waves were older than the patients before the pandemic (mean age 59, 56, and 52 years, respectively, for both comparisons p<0.0001). Regarding the type of visit, the vast majority were in-person visits in all groups. The highest percentage of teleconsultations was in the first wave and was equal to 3.46%. Before the pandemic, patients were admitted mainly due to upper respiratory system diseases (52.15%), while during the first wave the main reasons were tumors (39.86%, malignant and benign tumors comprised 29.26% and 10.6%, respectively). CONCLUSIONS: The COVID-19 pandemic, especially the first wave, changed the profile of ambulatory patients. In the first wave, a higher prevalence of tumor patients and a lower prevalence of patients with diseases of the upper respiratory system were observed. The COVID-19 pandemic caused an increase in number of teleconsultations, but its role was limited.

Prothrombotic fibrin clot properties associated with increased endogenous thrombin potential and soluble P-selectin predict occult cancer after unprovoked venous thromboembolism.

BACKGROUND: Compact fibrin clots relatively resistant to lysis are observed in patients at increased risk of venous thromboembolism (VTE) including malignancy. The citrullinated histone H3 (H3Cit) predicts VTE in cancer patients. OBJECTIVES: We performed a cohort study to investigate whether abnormal clot properties predict cancer diagnosis following unprovoked VTE. METHODS: In 369 consecutive patients aged <70 years without malignancy detected during routine screening, we determined plasma clot permeability (Ks ) and clot lysis time (CLT), along with several prothrombotic markers and H3Cit after 2 to 8 months since VTE. RESULTS: During follow-up (median, 37; interquartile range, 33-39 months), malignancy was diagnosed in 22 patients (6%), who were older. This group had denser fibrin networks (-13% Ks ), impaired fibrinolysis (+25.5% CLT), increased endogenous thrombin potential (ETP,+7%), soluble P-selectin (+40.3%), and H3Cit (+169.2%) measured off anticoagulation after median 4 months since VTE. The Ks and CLT correlated with H3Cit (r = -.58 and r = .31, P < .05, respectively). The Kaplan-Meier survival analysis showed that reduced Ks (the first quartile, ≤6.2 × 10-9  cm2 ), prolonged CLT (the top quartile, >106 min), and higher ETP (the top quartile, >1657 nM × min) were predictors of cancer diagnosed during follow-up. The multivariable Cox proportional hazards model showed that patients with the prothrombotic clot phenotype (low Ks and long CLT) had the highest risk of cancer diagnosis [hazard ratio(HR), 23.4; 95% confidence interval (CI), 6.67-82.15]. CONCLUSIONS: Prothrombotic clot properties following unprovoked VTE might help identify patients at risk of a diagnosis of cancer within the first 3 years of follow-up.

Unfavorably altered plasma clot properties in women with a HERDOO2 score equal to or greater than 2 and prediction of recurrent venous thromboembolism.

Introduction The HERDOO2 rule can help identify patients in whom anticoagulation can be safely discontinued. Unfavorably altered fibrin clot properties predict recurrent venous thromboembolism (VTE). Objectives We aimed to assess a possible association between fibrin clot properties and the HERDOO2 score in women after unprovoked VTE. Patients and methods Eighty women younger than 70 years after a first unprovoked VTE separately and combined with 32 women after hormone­related VTE were followed for a median of 48.5 months (interquartile range, 37.5-67 years). Plasma fibrin clot permeability (Ks), lysability, turbidity measurements, and thrombin generation were assessed 3 months after the index event in relation to the HERDOO2 score. Results Nineteen women (23.8%) with a HERDOO2 score equal to or higher than 2 were characterized by lower Ks (-6.8%), indicating formation of more compact clots, impaired fibrinolysis as evidenced by a reduced maximum rate of D­dimer release from clots (D­D rate, by 6.8%), and prolonged clot lysis time (CLT, by 23.8%). No increased thrombin generation or differences in the remaining fibrin clot properties were observed. When combined with estrogen­related VTE, the same trends were observed. D­D rate and CLT correlated with the HERDOO2 score (r = -0.28, P = 0.01 and r = 0.35, P = 0.002, respectively) in 80 women with unprovoked VTE. Unfavorable clot phenotype, defined as Ks ≤6.55×10-9 cm2 and CLT >99.5 minutes, was associated with high risk of recurrence in the HERDOO2 rule (P = 0.02). Conclusions We showed that middle­aged women after unprovoked VTE with high risk of recurrence based on the HERDOO2 rule are characterized by formation of denser fibrin clots and impaired fibrinolysis.

Elevated leptin and decreased adiponectin independently predict the post-thrombotic syndrome in obese and non-obese patients.

Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT). Little is known about the involvement of adipokines in the pathogenesis of DVT. We evaluated whether adipokines can predict PTS. In a prospective cohort study, 320 DVT patients aged 70 years or less were enrolled. Serum adiponectin, leptin and resistin levels were measured three months since the index first-ever DVT. After 2 years' follow-up PTS was diagnosed in 83 of 309 available patients (26.9%) who had 13.9% lower adiponectin and 16% higher leptin levels compared with the remainder (both p < 0.0001). No PTS-associated differences in C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 and resistin were observed. The multivariable logistic regression adjusted for age, sex, obesity and tissue plasminogen activator (tPa) showed that lower adiponectin (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.31-0.56) and higher leptin levels (OR, 1.49; 95% CI, 1.31-1.69) are independent predictors for PTS. Obesity-stratified logistic regression analysis confirmed that lower adiponectin (OR, 0.49; 95% CI, 0.38-0.64) and higher leptin (OR, 1.41; 95% Cl, 1.25-1.58) levels predicted PTS. Our findings showed that lower adiponectin and higher leptin measured 3 months after DVT, regardless of obesity, can independently predict PTS, which suggests novel links between adipokines and thrombosis.

Altered plasma clot properties increase the risk of recurrent deep vein thrombosis: a cohort study.

It has been demonstrated that fibrin clots generated from plasma samples obtained from patients with prior thromboembolic events are denser and less susceptible to lysis. Such a prothrombotic fibrin clot phenotype has been suggested as a new risk factor for venous thromboembolism, but its prognostic value is unclear. To assess whether abnormal clot properties can predict recurrent deep vein thrombosis (DVT), we studied 320 consecutive patients aged 18 to 70 years following the first-ever DVT. Plasma clot properties were evaluated after 3 months of anticoagulant treatment since the index event. A mean duration of anticoagulation was 10 months (range, 4-20). Recurrent DVT was observed in 77 patients (25%; 6.6%/year) during a median follow-up of 44 months. Recurrences of DVT were associated with faster formation (-9% lag phase) of denser fibrin networks (-12% fibrin clot permeability [Ks]) and 4% higher maximum absorbance of plasma clots that displayed impaired fibrinolytic degradation (+25% prolonged clot lysis time [CLT]) and a 5% slower rate of increase in D-dimer levels during clot degradation (D-Drate; all P < .05). Proximal DVT alone, higher C-reactive protein, D-dimer, peak thrombin, lower Ks, shorter lag phase, decreased D-Drate, and prolonged CLT were independent predictors of recurrences (all P < .05). Individuals characterized by low Ks (≤7.3 × 10-9 cm2) and prolonged CLT (>96 min) were at the highest risk of recurrent DVT (odds ratio, 15.8; 95% confidence interval, 7.5-33.5). Kaplan-Meier curves showed that reduced Ks and prolonged CLT predicted recurrent DVT. We demonstrate that unfavorably altered clot properties may predict recurrent DVT after anticoagulation withdrawal.