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.

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.

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.

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.

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.

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.

Evolution of Skin during Rehabilitation for Elephantiasis Using Intensive Treatment.

The objective of this study is to describe the evolution of the skin during rehabilitation for elephantiasis using intensive treatment. We report on the case of a 55-year-old patient with a seven-year history of leg edema. The patient reported that it began with repeated outbreaks of erysipelas over several years. One leg evolved with significant edema leading to an inability to ambulate and for about one month the patient said that he could not get out of bed. Moreover the patient was obese weighing 130 kilos and with a BMI of 39. Intensive treatment was performed over three weeks resulting in a significant reduction in limb volume. The treatment consisted of Mechanical Lymphatic Therapy (RAGodoy), Cervical Lymphatic Stimulation (Godoy & Godoy technique), and a custom-made inelastic stocking of a grosgrain textile. What caught the attention during therapy were the open wounds resulting from fragmentation of the plaque as the edema reduced; the plaque was about 0.5 cm thick. As the treatment evolved the plaque disappeared and the wounds healed. The limb size decreased by more than 80% in three weeks after which the patient began to be treated in an outpatient setting with ambulation using a grosgrain stocking.

Bioimpedance to screen for abdominal fat in patients with breast cancer treatment-related lymphedema.

BACKGROUND: One of the dreaded complications after the treatment of breast cancer is lymphedema. Therapies used in the treatment of breast cancer such as surgery, radiotherapy, hormone therapy and chemotherapy may be adversely affected by obesity. AIM: The objective of this study was to use bioimpedance to assess abdominal fat in women with breast cancer treatment-related lymphedema and suggest this as a screening method. METHODS: Forty-five female patients with clinical diagnosis of breast cancer treatment-related lymphedema were evaluated in this quantitative cross-sectional study. A control group, composed of 38 patients with varicose veins and women attending a social support group, was matched for age and body mass index (BMI). All participants were submitted to a bioimpedance evaluation (In Body S 10), with particular attention being paid to abdominal fat and their BMI. The unpaired t -test, Fisher Exact test and Mann-Whitney test were used for statistical analysis and an alpha error of 5%. RESULTS: There was no significant difference (p -value = 0.23) in the mean BMI between the study group (27.79 kg∕m2) and the control group (28.80 kg∕m2). The mean abdominal circumference, a measure of abdominal fat, of the women in the study group was 130.54 cm2 and for the control group it was 102.24 cm2 (p -value = 0.0037). Thus the study group had more abdominal fat (p -value = 0.0003). Moreover, on comparing obese patients in the two groups, the study group had more abdominal fat (p -value = 0.02). However, no significant difference was observed comparing non-obese patients (p -value = 0.6). The comparison of obese patients with non-obese patients in the control group identifies an association between obesity and abdominal fat (p -value < 0.04). CONCLUSION: Overweight and obese women with breast cancer treatment-related lymphedema are more likely to have increased abdominal fat than the general population with bioimpedance.

Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome.

Association of Hypertension With Erectile Function in Chronic Peripheral Arterial Insufficiency Patients.

BACKGROUND: Risk factors may influence the improvement or worsening of erectile dysfunction (ED). The aim of the current study was to evaluate the effect of systemic hypertension on ED in patients with peripheral arterial disease. METHODS: The effect of hypertension on ED was assessed in 125 consecutive patients in a cross-sectional quantitative study. The ages of the patients ranged from 19 to 88 years old (mean: 59.82 ± 10.48 years). The only exclusion criterion was the amputation of one or both legs. The ankle-arm index was assessed and the international index of ED questionnaire was applied to all participants in the study. RESULTS: Of the 125 patients, 22 (17.6%) had mild (grade 1), 50 (40.0%) had moderate (grade 2) and 53 (42.4%) had severe (grade 3) ED. Hypertensive patients have more ED, with ED in hypertensive patients being associated to chronic arterial disease. However, in comparison with normotensive patients, hypertension exerts an immediate protective effect on erectile function. CONCLUSIONS: In conclusion, although erectile function is initially protected by systemic arterial hypertension in patients with chronic arterial disease, both chronic arterial disease and ED deteriorate over the long term in hypertensive patients.