RESUMO
There have recently been safety concerns regarding an increased risk of vaccine-induced immune thrombotic thrombocytopenia (VITT) following administration of SARS-CoV-2 adenoviral vector vaccines. The Southern African Society of Thrombosis and Haemostasis reviewed the emerging literature on this idiosyncratic complication. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by independent international experts to avoid local bias. We present concise, practical guidelines for the clinical management of VITT.
Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Trombocitopenia/terapia , Trombose/terapia , Vacinas contra COVID-19/administração & dosagem , Humanos , SARS-CoV-2/imunologia , África do Sul , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Trombose/diagnóstico , Trombose/etiologiaRESUMO
Medium income country such as South Africa face a dilemma on the need to offer high quality vascular surgical care in a resource constrained environment, where the vast majority of population has inadequate access to even the most basic health care provision. At the same time with rapid development in technology there is also the need to provide high technological treatment to a small population that can afford high cost therapy. This apparent dichotomy in health care provides a challenge and the solution is for all role players in the health care provision to find a solution which will suite the population at large.
Assuntos
Países em Desenvolvimento/economia , Educação de Pós-Graduação em Medicina/economia , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/educação , Escolha da Profissão , Competência Clínica , Currículo , Recursos em Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Fatores Socioeconômicos , África do SulRESUMO
OBJECTIVES: The aim of this study was to determine whether the collar graft (standard dacron graft with a customized flexible collar attached to the proximal rim) decreased anastomotic bleeding and the overall clamp time. DESIGN: Prospective randomised single center study. METHODS: Between November 2003 and January 2006, 21 patients were treated with a collar graft and 19 with a standard dacron graft. Routine endoaneurysmorraphy was used. Only infra-renal aneurysms between 5.5cm and 6.5cm were included. Aneurysms were diagnosed by CT scans. The total number of bleeding points, the total clamp time, and the number of teflon felt pledgets, was determined. RESULTS: The total number of bleeding points; the number of aortic re-clamps and total clamp time (minutes) per patient were all significantly lower in the collar graft group (1.2 versus 2, p<0.04; 0.5 versus 2.0, p<0.001; 13.6 versus 20.1, p<0.003 respectively). The number of teflon felt pledgets and new sutures used was significantly lower in the collar graft group (p<0.001 and p<0.003 respectively). CONCLUSION: The collar graft resulted in fewer anastomotic bleeding points and a shorter clamp time.
