Prevalence of Pulmonary Embolism in COVID-19 at Quaternary Hospital Running Head: Pulmonary Embolism in COVID-19.

Background: Patients with COVID-19 are at greater risk of pulmonary embolism. Objective: The aim of the present study was to evaluate the monthly prevalence of pulmonary embolism diagnosed by angiotomography and mortality between March 2020 and May 2021 in more than 6000 patients hospitalized with COVID-19 at a single institution. Methods: A clinical trial was conducted with evaluated medical records the patients hospitalized at the institution who developed pulmonary embolism determined by angiotomography. Monthly and overall mortality rates between March 2020 and May 2021 in this population were evaluated. Results: A total of 6040 patients were hospitalized in this period, 203 of whom (3.36%) had an angiotomographic diagnosis of pulmonary embolism and 119 of these patients (58.62%) died. The largest number of patients with pulmonary embolism occurred in the periods from July to September 2020 and March to May 2021. No significant difference was found between mortality and the two peaks of the pandemic (p = 0.9, Fisher's exact test). Conclusion: Pulmonary embolism is associated a higher mortality rate among patients with COVID-19. Therefore, one of the strategies is an emphasis on the prevention of thrombotic and embolic events.

Aortic Thrombosis Associated with Three Types of COVID-19 Vaccine.

Aortic thrombosis has been studied little in patients with COVID-19 and an association has recently been reported with the vaccine for this disease. The aim of the present study is to report five cases of aortic thrombosis at our institution within a three-month period associated with the COVID-19 vaccine. Five cases of aortic thrombosis were evaluated-three women and two men aged 29, 49, 51, 60, and 79 years. Four thrombi involved the thoracic aortic and one involved the abdominal aorta, with embolisms found in the kidneys, spleen, liver, upper limbs, and lower limbs. Embolectomy was performed on the limbs, and anticoagulant therapy was performed for the abdominal arteries. The patients recovered well and anticoagulant therapy was maintained. Aortic thrombosis is uncommon but was associated with the AstraZeneca vaccine in this case series.

Prevalence of COVID-19 Among 8000 Patients at a Hospitalized and Mortality in Old Age.

BACKGROUND: COVID-19 created a general challenge to healthcare systems throughout the world and was an important cause of mortality. AIM: The aim of the present study was to report the general evolution of patients with COVID-19 at a teaching hospital and analyze differences by age group and sex considering mortality rates in the years 2020 and 2021 among patients older than 60 years of age. METHOD: A cross-sectional study was conducted with patients hospitalized with a diagnosis of COVID-19 confirmed by RT-PCR at the São Jose do Rio Preto university hospital between March 2020 and March 2022. The patients were male and female patients, of varying ages belonging to the region of Sao Jose do Rio Preto, were accommodated in the wards or intensive care units (ICUs). Overall mortality was analyzed for the hospital as well as in the ICUs and wards. This analysis was performed separately in two years considering age group, sex, and main comorbidities in patients older than 60 years of age. RESULTS: A total of 8032 patients with COVID-19 were hospitalized between March 2020 and March 2022: 2866 patients with 658 deaths (22.92%) in 2020; 4324 patients with 1168 deaths (27.01%) in 2021; and 842 patients with 205 deaths (24.35 %) in 2022 up to the month of March. More than half (53.60%) of the patients were hospitalized in the ICUs and 46.39% were hospitalized in the wards. Differences in the mortality rate were found for the different age groups in the comparison of the years, with more deaths occurring among individuals up to 90 years of age in the second year (p <0.05). Men were affected more and had a higher mortality rate (p <0.0001). The main comorbidities were cardiovascular disease (70.93%), diabetes (37.76%), and obesity (23.68%). CONCLUSIONS: The mortality rate of older people hospitalized with COVID-19 was higher than the average, it was higher in 2021 compared to 2020 and increased with age. Cardiovascular disease, diabetes, and obesity were the main comorbidities.

SARS-CoV-2 gamma variant and chronic arterial insufficiency due to late arterial thrombosis.

The current evidence suggests a state of hypercoagulability as one of the sequelae of hyperinflammation. Thus, it is an important pathogenic mechanism that contributes to increase the mortality caused by COVID-19. The aim of the present study is to report chronic arterial insufficiency after post-thrombosis in the same arteries 32 days later, as a sequel after severe acute respiratory syndrome coronavirus 2 P.1. After the 2nd day of discharge, she had a lot of pain in her left and limiting leg and was referred to the vascular service. The patient was evaluated by vascular surgery who underwent a clinical diagnosis of Rutherford II.A arterial thrombosis and underwent arteriography of the limb that revealed thrombosis of the anterior, posterior, and fibular arteries in the middle third and the plantar arch was not contrasted. She underwent emergency embolectomy with selective isolation of the tibial arteries, but with success after the procedure only for the posterior tibial artery. Anticoagulation was maintained and 100 mg aspirin was associated.

Monotherapy for the Treatment of Lymphedema in Children: A Review.

The Godoy Method of cervical lymphatic therapy is the first treatment option as monotherapy for children which facilitates achieving normalization or near normalization of the affected limb as well as the maintenance of the results, which could assist millions of children throughout the world.

Diabetes as an Isolated Cause of Minor Lower Limb Amputations.

Objectives: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease. The aim of the present study was to investigate whether diabetes mellitus is an important isolated cause of toe amputation. Methods: A cross-sectional study was conducted involving the records of 108 patients with minor lower limb amputations and 80 with major lower limb amputations. Association between diabetes/chronic arterial insufficiency and level of amputation was tested. Statistical analysis was performed using Fisher's exact test. Results: The prevalence of diabetes was 87.5% among patients submitted to minor amputations and 52.5% among those submitted to major amputations with or without chronic arterial disease. This difference was statistically significant (p<0.0001, Fisher's exact test). A total of 44.44% of the patients submitted to minor amputations had diabetes alone (no chronic arterial insufficiency), whereas only 14.81% of the patients submitted to major amputations did not have chronic arterial insufficiency. Thus, diabetes was significantly associated with minor lower limb amputations (p<0.0004, Fisher's exact test). Conclusion: Based on the present findings, patients with diabetes are at greater risk of toe amputation compared to those with chronic arterial disease.

Epidemiological data on lower limb lymphedema

Objective: The aim of the present study was to evaluate epidemiological data of patients seen at a clinic specialized in the treatment of lymphedema. Methods: A retrospective, cross-sectional study was conducted involving data from 150 consecutive patients with lower limb lymphedema in clinical stages II and III treated at the Godoy Clinic in São Jose do Rio Preto. The follow data were collected: sex, age, type of lymphedema (primary or secondary), cause of secondary lymphedema (cancer, trauma, venous disease) and limb dominance. The diagnosis of lymphedema was based on the clinical history and physical examination; in cases of doubt, lymphoscintigraphy of the lower limbs was requested. Descriptive statistics were performed and results were expressed as percentages. Results: Twenty-five (16.66%) of the patients were male and 125 (83.33%) were female. Mean age was 42.52 years (41.8 years among the men and 42.67 years among the women). One hundred nine cases (72.66%) were primary lymphedema and 41 (27.33%) were secondary. Among the secondary cases, 27 (18%) were related to cancer treatment, 10 (6.6%) were linked to trauma and four (2.6%) were cases of phlebolymphedema. Mean age was 51.4 years among the patients with cancer treatment-related lymphedema, 41 years among those with trauma-related lymphedema and 64.25 years among those with phlebolymphedema. The left leg was affected in 61 cases (40.66%), the right leg was affected in 37 cases (24.66%) and lymphedema was bilateral in 52 cases (34.66%). Conclusion: Primary lymphedema was predominant and affected women more than men. Primary lymphedema occurred at an earlier age compared to cancer treatment-related lymphedema and phlebolymphedema. The left leg was affected more often, followed by bilateral lymphedema and, finally, the right leg alone

Thrombosis of the right iliac, femoral, popliteal, and tibial arteries in a post-COVID-19 in adolescent.

BACKGROUND: Viral infection into lung, muscular, and endothelial cells results in inflammatory response, including edema, degeneration, and necrotic alterations. The involvement of the major arteries in adolescent with COVID-19 has been infrequently reported in the literature. The aim of the present study is to report thrombosis of the right iliac, femoral and tibial arteries and stenosis of left iliac artery in an adolescent with COVID-19 and to discuss the pathophysiological hypotheses. CASE PRESENTATION: We report the case of a 17-year-old female patient with COVID-19 infection. She was seen at the physician specialized general medicine in her hometown, was diagnosed with COVID-19 but did not require hospitalization. After 15 days, she had sudden pain in the left leg that has limited her ability to walk more than 10 met, associated with extremity cyanosis and coldness. Angiotomography revealed thrombosis of a portion of the iliac and popliteal arteries. Na emergency embolectomy was successfully performed, followed by full-dose heparinization with unfractionated heparin. CONCLUSION: Arterial thrombosis of large arteries may be associated with chronic inflammatory syndrome secondary to COVID-19 infection and the treatment with a late embolectomy was successful, even in a thrombotic event.

Exercícios passivos na reabilitação de pacientes com dor, edema e limitação articular: estudo piloto / Passive exercises in the rehabilitation of patients with pain, edema and joint limitation: pilot study

A Imobilização parcial ou completa leva a diferentes processos de ajuste como perda de força muscular, diminuição do desempenho geral e edema. Objetivo: Avaliar a melhora da dor utilizando de um dispositivo eletromecânico que realiza movimentos passivo nos pacientes com dor, limitação da mobilidade e uso de dispositivos auxiliadores da marcha. Método: Foram avaliados em ensaio clinico prospectivo 20 pacientes, a melhora da dor, fazendo uso de dispositivos auxiliares de locomoção, em pacientes que faziam tratamento convencional por quatro a 12 meses, mas que passaram a fazer diariamente por uma hora e, comparando com exercício passivo realizado com o dispositivo, por duas horas/dia, por cinco dias, e avaliados pela escala analógica de dor antes e depois no Hospital de Base da Fundação Faculdade de Medicina de São Jose do Rio Preto - FUNFARME de março de 2019 a janeiro de 2020. Resultados: Quando compara a diferença de redução do grupo realizou dispositivo eletromecânico passivo com o grupo convencional houve uma redução de 6,6 na escala analógica de dor e em relação ao grupo convencional de 2, sendo diferente estatisticamente teste t pareado valor p= 0,0001. Conclusão: Exercícios passivos mecânicos, que realizam a drenagem linfática é uma nova opção de tratamento aos pacientes que tem dor e limitação crônica da marcha.

Partial or complete immobilization leads to different adjustment processes such as loss of muscle strength, decreased overall performance and edema. Objective: Was to assess pain improvement using an electromechanical passive device in patients with pain, limited mobility and use of gait assistive devices. Method: 20 patients were evaluated in a prospective clinical trial, pain improvement, using auxiliary locomotion devices, in patients who underwent conventional treatment for four to 12 months, but who started doing it daily for an hour and, compared with exercise passive performed with electromechanical passive device, for two hours/day, for five days, and evaluated by the pain scale before and after in Hospital de Base - Fundação Faculdade de Medicina de Sao Jose do Rio Preto - FUNFARME from march 2019 to january 2020. Results: When comparing the difference in reduction of the electromechanical passive device group with the conventional group, there was a reduction of 6.6 in the analogue pain scale and in relation to the conventional group of 2, with a statistically different paired t-test p= 0.0001. Conclusion: Passive mechanical exercises that perform lymphatic drainage are a new treatment option for patients who have pain and chronic gait limitation.

Treatment for chest pain intercurrence after breast cancer surgery using Godoy's intermittent skin therapy.

OBJECTIVE: Chest pain and swelling are routinely reported in women after breast cancer treatment and are often not valued by health professionals. In general, these patients suffer and without many effective solutions. The aim of the present study was to report the results of a novel technique for the treatment of chest pain related to breast cancer treatment. METHODS: A clinical trial was conducted involving 25 women with chest pain resulting from the treatment of breast cancer and submitted to treatment for lymphedema at the Godoy School in 2018. Godoy's intermittent dermal therapy was performed on the participants 2-4 h/day for 2 days until the occurrence of a significant improvement or complete resolution of pain (measured using the visual analog pain scale). RESULTS: All patients reported a significant reduction in pain in the first ½ h of treatment (P < 0.0001, Wilcoxon signed-rank test). Six of the 25 patients (24%) reported the absence of pain after treatment on the 1st day and all (100%) reported the absence of pain at the end of treatment on the 2nd day. CONCLUSION: Chronic chest pain in patients having been submitted to treatment for breast cancer can be significantly reduced with Godoy's intermittent skin therapy, achieving standards of normality or near normality within only a few sessions.

Clinical aspects of congenital primary lymphedema.

PURPOSE: Lymphedema is a specific type of edema with a chronic, progressive nature. The aim of the present study is to report clinical findings related to edema and its location in children with primary lymphedema. METHODS: Sixty-eight children with congenital primary lymphedema were evaluated at the Godoy Clinic in São Jose do Rio Preto, Brazil, between 2014 and 2017. A retrospective, cross-sectional study was conducted involving the analysis of clinical data on the location of edema in 68 children with congenital primary lymphedema. We evaluated the charts of all children with this condition in the period analyzed, recording the affected limbs and conditions associated with lymphedema. RESULTS: Sixty-eight children, 37 girls (54.41%) and 31 boys (45.58%), were evaluated. CONCLUSION: We found that congenital primary lymphedema predominantly affects the lower limbs and is more prevalent in girls than boys.

Automedicação entre acadêmicos de medicina de Fernandópolis ­ São Paulo / Self medication among medical students: analysis of variable related

Objetivo: buscou-se investigar a automedicação por acadêmicos de curso de graduação em Medicina de instituição privada e analisar possíveis variáveis relacionadas. Métodos: trata-se de um estudo transversal realizado com 320 discentes dos quatro primeiros anos do curso de Medicina da Universidade Brasil, campus Fernandópolis-SP. Foi aplicado questionário validado com variáveis sociais e de consumo de medicamentos, seguido de análise estatística por regressão linear simples. Resultado: como resultado, a automedicação foi considerada uma opção em 309 dos participantes, a maioria deles do sexo feminino, idade entre 21 a 23 anos, solteiros, sem curso superior prévio, com convênio médico e conscientes de eventuais riscos à Saúde, mesmo após acesso a bulas ou a pesquisas on-line. O quadro clínico precedente à automedicação incluiu, principalmente, cefaleia e mialgia. Houve preferência por fármacos anteriormente utilizados com consumo médio (por 1 a 2 dias), principalmente de analgésicos e anti-inflamatórios. Estar mais próximo ao término do curso (p = 0,006) e possuir convênio médico (p = 0,046) se relacionaram com automedicação. Conclusão: o hábito da automedicação aumenta, gradativamente, ao decorrer

Objective: we sought to investigate self-medication by Medicine undergraduated students in a private institution of Medicine and to examine possible related variables. Methods: it is a cross-sectional study conducted with 320 students of the first four years of medical school at Universidade Brasil, Fernandópolis-SP campus. Validated questionnaire was applied taking into account social variables and medicine consumption, being followed by statistical analysis with simple linear regression. Results: as a result, self-medication was considered an option to 309 of the participants, the majority of women, aged 21-23 years old, single, without higher education, with health insurance and aware of possible risks to health even after access to bulls or online research. Clinical symptoms prior to self-medication included headache and myalgia. There was a preference for drugs previously used with an average consumption (from 1 to 2 days), especially analgesics and anti-inflammatories. It was verified that being related to self-medication was more likely to happen among those students closer to the end of the course (p = 0.006) and to those who have health insurance (p = 0.046). Conclusion: the habit of self-medication gradually increases over the undergradution, therefore, it is suggested to implement an educational pedagogical proposal on this subject in medical school curriculum.

Systemic subclinical lymphedema due to obesity as the cause of clinical lymphedema: A new concept.

On evaluating patients with lymphedema, the authors found that obesity is associated with generalized edema of all extremities and the trunk with increased intracellular and extracellular fluids, thus suggesting a new concept of lymphedema that the authors have termed systemic subclinical lymphedema. Animal studies show that obesity and its progression lead to changes in the lymphatic system and microcirculation with alterations in lymphatic motility, inflammatory processes, capillary permeability and immune response. Systemic subclinical lymphedema is diagnosed when above normal fluid levels are detected in all the extremities and the trunk with the progression of obesity; this can lead to the appearance of clinical lymphedema of the extremities.

Does right-sided varicocele indicate a right-sided kidney tumor?

Varicocele is a dilation of the pampiniform venous plexus, mainly affecting the left side of the scrotum. In rare cases, however, the right side is affected. When this occurs, a retroperitoneal disease should be suspected, such as right-sided renal neoplasm. The present case report highlights the importance of right-sided varicocele in the diagnostic investigation of neoplasm of the right kidney.

Elephantiasis and Directed Occupational Rehabilitation.

The aim of the present study was to demonstrate the cure of elephantiasis over a ten-year follow-up period and novel discoveries with directed occupational rehabilitation. A 66-year-old female patient with a history of bilateral lower limb lymphedema reported the aggravation of the condition over the years, reaching stage III (elephantiasis). The physical examination confirmed elephantiasis. The circumference of the left lower limb was 106 cm. Her body weight was 106 kilograms, height was 160 cm, and the body mass index (BMI) was 41.6 kg/m2. The patient was submitted to intensive treatment for three weeks, which led to a 21-kg reduction in weight and 66 cm reduction in leg circumference. Ten years after treatment, the patient has maintained the results with the compression stockings. Elephantiasis can be cured, although lymphedema cannot. The cure of elephantiasis depends on maintaining the treatment of lymphedema after normalization or near normalization. Directed occupational therapy stimulates the search for new activities and a life closer to normality.

Compression therapy: Unna boot applied to venous injuries: an integrative review of the literature. / Terapia compressiva: bota de Unna aplicada a lesões venosas: uma revisão integrativa da literatura.

OBJECTIVE: To analyze the literature related to the types of therapies for venous injuries with emphasis on use of the Unna boot, and to investigate and discuss the main aspects related to its use compared to other techniques. METHOD: Integrative review of the literature of the last five years through searches in the following databases: VHL, LILACS, BDENF, SciELO, MEDLINE/PubMed. RESULTS: Twenty-two publications were identified, with 15,931 cases among adult or elderly individuals, whose mean age was 60 (35-78) years or greater with no sex differences. The Unna boot presented a shorter healing time than the single and two-layer elastic bandage. CONCLUSION: Although other compression techniques may prove to be more efficient than the Unna boot by adding more technology, the boot stands out as a traditional low-cost dressing. Multilayer bandage is a gold standard technique. This review demonstrated the best option may not be the Unna boot, because it requires a higher healing time compared to the multilayer bandage, but it meets the expectation with a high rate of treatment efficiency, also when compared to simple dressing, single or two-layer bandage.

Evidências do efeito da terapia fotodinâmica sobre a Propionibacterium acnes / Evidence of the effect of photodynamic therapy on Propionibacterium acnes

Introdução: A Propionibacterium acnes é uma bactéria causadora da acne. Devido aos efeitos colaterais ou à falta de resposta ao tratamento da acne, foi proposta a terapia fotodinâmica como um tratamento alternativo para a acne. Objetivo: O objetivo foi evidenciar a ação fotodinâmica do LED vermelho 660 nm e do fotossensibilizador azul de metileno sobre Propionibacterium acnes in vitro. Métodos: Os ensaios foram constituídos por quatro grupos: 1. controle (sem aplicação de luz e sem fotossensibilizador); 2. com aplicação de luz; 3. com fotossensibilizador e sem aplicação de luz; 4. com fotossensibilizador e com aplicação de luz. Os ensaios foram submetidos a aplicação de luz por 4 ciclos de 5 minutos com intervalos de 3 minutos. Resultados: Houve redução estatisticamente significante (p<0,05) nas médias dos grupos 1, 2 e 4, ainda que o grupo 3 não tenha apresentado significância estatística, mas houve redução detectada nas médias. Conclusão: A ação fotodinâmica é eficiente para a destruição do material biológico por irradiação a 660nm atribuída ao processo de fotossensibilização pela presença do fotossensibilizador.(AU)

Introduction: Propionibacterium acnes is a bacterium that causes acne. Due to the side effects or the lack of response to acne treatment, photodynamic therapy was proposed as an alternative treatment for acne. Objective: To demonstrate the photodynamic action of the 660 nm red LED and the methylene blue photosensitizer on Propionibacterium acnes in vitro. Methods: Four groups were studied: 1. control (without light application and without photosensitizer); 2. with light application; 3. with photosensitizer and without light application; 4. with photosensitizer and light application. The assays were subjected to light application for 4 cycles of 5 minutes at 3 minute intervals. Results: There was a statistically significant reduction (p <0.05) in the means of groups 1, 2 and 4, although group 3 did not present statistical significance, but there was a reduction detected in the means. Conclusion: The photodynamic action is efficient for the destruction of the biological material by irradiation at 660nm attributed to the process of photosensitization by the presence of the photosensitizer.(AU)

Mobilization of Fluids in the Intensive Treatment of Primary and Secondary Lymphedemas.

BACKGROUND: Lymphedema is a clinical condition resulting from the accumulation of macromolecules in the interstitial space with a consequent buildup of fluids. AIM: The objective of this study was to compare the therapeutic response to treatment that mobilizes fluids between primary and secondary lymphedemas. METHOD: Thirty-three patients with severe leg lymphedema who underwent intensive treatment for five consecutive days in 2013 and 2014 at the Clínica Godoy were evaluated in a prospective clinical trial. Diagnosis was based on the patient's history and physical examination. Treatment consisted of eight hours/day of Mechanical Lymphatic Therapy using an electromechanical device (RAGodoy®) that performs plantar flexion and extension associated with 15 minutes of Cervical Lymphatic Therapy, a technique developed by Godoy and Godoy that involves stimulation in the cervical region and a grosgrain compression stocking alternated with elastic bandages. The unpaired t-test and Fisher's exact test were used for statistical analysis with an alpha error of 5% (p value < 0.05) being considering acceptable. Secondary lymphedema was more prevalent in women (Fisher exact test p value < 0.01). RESULTS: The age of patients with secondary lymphedema was greater than those with primary lymphedema (unpaired t-test: p value < 0.03). The mean volume losses were 64.62% and 48.35% for the patients with secondary and primary lymphedema, respectively (p value < 0.03). CONCLUSION: Women are more prevalent and older in the secondary lymphedema group. Volumetric reductions below the knee are faster with intensive treatment for secondary rather than for primary lymphedema.