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1.
World J Surg Oncol ; 20(1): 8, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996471

RESUMO

BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma mainly treated via surgical resection. Herein, we report a case of MPNST wherein a massive tumor thrombus extended to the major veins and heart. CASE PRESENTATION: A 39-year-old female with a history of neurofibromatosis type 1 developed MPNST from the right radial nerve. In addition to adjuvant chemotherapy, she underwent wide tumor resection and concomitant radial nerve resection, followed by postoperative radiotherapy. Histological evaluation revealed marked venous invasion. The 2-year follow-up CT revealed an asymptomatic recurrent tumor thrombus extending from the right subclavian vein to the heart. An urgent life-saving operation was performed to ligate the base of the right subclavian vein and remove the entire intravenous thrombus that extended to the right ventricle. The remaining tumor in the right subclavian vein increased in size 3 months after thrombectomy. After confirming the absence of any metastatic lesions, the patient underwent extended forequarter amputation to achieve surgical remission. One year later, a new metastasis to the right diaphragm was safely resected. The patient remains alive without any evidence of disease 2 years after the extended forequarter amputation. CONCLUSIONS: In cases of a previous history of microscopic venous invasion, recurrence can occur as a massive tumor thrombus that extends to the great vessels.


Assuntos
Neurofibromatose 1 , Neurofibrossarcoma , Neoplasias de Tecidos Moles , Trombose , Adulto , Feminino , Humanos , Recidiva Local de Neoplasia/cirurgia , Trombose/etiologia , Trombose/cirurgia
2.
Mymensingh Med J ; 31(1): 194-199, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34999702

RESUMO

Presently Coronavirus disease 2019 is a huge human misery that is almost unstoppable with little remedy on board. The disease is predominantly associated with inflammation and thrombosis. Although aspirin exhibits excellent anti-thrombotic and anti-inflammatory properties, it is yet to be explored in treating Covid-19 patients. In this article we want to bring forth its beneficial effect in Covid-19 case management. It is a retrospective observational study. Adult Covid-19 patients either diagnosed with RT-PCR (reverse transcriptase polymerized chain reaction), or categorized as probable cases (as per World Health Organization case definition protocol) by medical doctors were enrolled as participants. Data were collected from doctors' office records for the period ranging from May 2020 to September 2020 in six districts of Bangladesh. Out of 44 participants 42 were eligible (2 children excluded) for the study. Among them 11 participants took low dose aspirin (75mg daily) during the disease process. All participants in aspirin group became cured without complication or death (RR 2.2, 95% CI 1.5-3.2, p<0.001). On the other hand, no aspirin group suffered complications and deaths. The study findings revealed that complications were significantly low among aspirin users. It documented that low dose aspirin is beneficial for Covid-19 patients. Further study is warranted with larger sample size.


Assuntos
COVID-19 , Trombose , Adulto , Aspirina , Bangladesh/epidemiologia , Criança , Humanos , SARS-CoV-2
3.
PLoS One ; 17(1): e0262352, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34986205

RESUMO

INTRODUCTION: COVID-19 infection has been hypothesized to precipitate venous and arterial clotting events more frequently than other illnesses. MATERIALS AND METHODS: We demonstrate this increased risk of blood clots by comparing rates of venous and arterial clotting events in 4400 hospitalized COVID-19 patients in a large multisite clinical network in the United States examined from April through June of 2020, to patients hospitalized for non-COVID illness and influenza during the same time period and in 2019. RESULTS: We demonstrate that COVID-19 increases the risk of venous thrombosis by two-fold compared to the general inpatient population and compared to people with influenza infection. Arterial and venous thrombosis were both common occurrences among patients with COVID-19 infection. Risk factors for thrombosis included male gender, older age, and diabetes. Patients with venous or arterial thrombosis had high rates of admission to the ICU, re-admission to the hospital, and death. CONCLUSION: Given the ongoing scientific discussion about the impact of clotting on COVID-19 disease progression, these results highlight the need to further elucidate the role of anticoagulation in COVID-19 patients, particularly outside the intensive care unit setting. Additionally, concerns regarding clotting and COVID-19 vaccines highlight the importance of addressing the alarmingly high rate of clotting events during actual COVID-19 infection when weighing the risks and benefits of vaccination.


Assuntos
COVID-19/patologia , Trombose/patologia , Idoso , COVID-19/mortalidade , Estudos de Coortes , Comorbidade , Feminino , Hospitalização , Humanos , Masculino , New Jersey , Estudos Retrospectivos , Trombose/mortalidade , Estados Unidos
4.
Am J Case Rep ; 23: e934272, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34980875

RESUMO

BACKGROUND ST-elevation myocardial infarction (STEMI), when associated with acute left ventricular (LV) free-wall rupture, is often a lethal complication, and if not followed by sudden death, the rupture may be contained by the parietal pericardium and a local thrombus, leading to the formation of a left ventricular (LV) pseudoaneurysm. The incidence of LV pseudoaneurysm after STEMI is ~ 0.3%. CASE REPORT A 73-year-old man who presented with an acute syncopal episode and intermittent chest pain for 7 days was found to have an anterolateral myocardial infarction (MI) with lateral wall rupture and pseudoaneurysm formation. He had an LV thrombosis in the LV aneurysm. While this increased his risk of thromboembolic events, it likely stopped the evolution of the rupture and stabilized the pericardial effusion size. The patient underwent coronary artery bypass grafting (CABG), thrombectomy, and lateral wall repair. CONCLUSIONS Left ventricular pseudoaneurysm and left ventricular thrombus in a patient presenting with an acute ST-elevation myocardial infarction is a rare complication of myocardial infraction, with an incidence of <1%. It is often a lethal complication and requires stabilization and repair if not followed by sudden death.


Assuntos
Falso Aneurisma , Infarto Miocárdico de Parede Anterior , Aneurisma Cardíaco , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose , Idoso , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Trombose/complicações , Trombose/diagnóstico por imagem
5.
Orv Hetil ; 163(1): 3-11, 2022 01 02.
Artigo em Húngaro | MEDLINE | ID: mdl-34974427

RESUMO

Összefoglaló. A malignus daganat és a stroke egy-egy betegnél gyakran kombinálódik, sokszor egyidejuleg diagnosztizálják, vagy rövid ido telik el a két kórkép felismerése között. Az együttes megjelenés hátterében elsosorban a hasonló tradicionális rizikófaktorok állhatnak: az idosebb életkor, a magas vérnyomás, a hyperlipidaemia, a cukorbetegség, az elhízás és a dohányzás. Az átfedo kockázati tényezokön túl a daganat által okozott hiperkoaguláció artériás és vénás thrombosis kialakulásához vezethet. A hiperkoaguláció hátterének kutatása foként a thrombocyták és a szöveti faktor aktiválására és a heparanáz fokozott expressziójára fókuszált, és felvetodött a neutrophil extracelluláris csapdák szerepe is. A daganat által okozott hiperkoagulációhoz társuló cryptogen (tradicionális rizikófaktor nélküli) stroke-ban sokszor található magasabb D-dimer-szint, és a CT/MRI-képeken gyakrabban látszanak multifokális, több ér ellátási területében megjeleno ischaemiás laesiók, melyek ritkábban fordulnak elo a tradicionális rizikófaktorokkal magyarázható stroke-okban. Az elozokön kívül a daganatok kezelésére alkalmazott kemoterápia és sugárterápia is emeli a stroke kockázatát. A malignus daganatokhoz társuló stroke-ok megelozése érdekében további vizsgálatok szükségesek a daganat által okozott hiperkoaguláció és vascularis változások pontosabb megértéséhez. Orv Hetil. 2022; 163(1): 3-11. Summary. Cancer and stroke have long been studied individually, but their detrimental forces together have also been a strong point of focus. The occurrence of both cancer and stroke in a patient is often a reflection of their similar risk factors (hypertension, hyperlipidemia, diabetes, obesity, and smoking), however, a subgroup of the cancer stroke population is believed to occur due to cancer-associated hypercoagulability. A deeper look into the cancer-associated hypercoagulable environment has indicated that thrombosis may be explained by cancer's role in several factors, including activation of platelets and tissue factor, elevated expression of heparanase and influence on neutrophilic extracellular traps. When a cryptogenic stroke (stroke lacking the aforementioned risk factors) occurs due to the cancer-induced hypercoagulation state, patient serum D-dimer levels have been found elevated, and CT/MRI images of the brain have shown multivascular infarctions compared to stroke patients with traditional risk factors. Additionally, cancer treatment - chemotherapy and radiation - have also been found to increase the occurrence of cerebral vascular thrombosis. Further investigations are required to better understand cancer-associated vascular pathophysiologic changes and how to discern their unique strokes compared to strokes from other etiologies. With these insights, the prevalence of strokes in the cancer population could be decreased. Orv Hetil. 2022; 163(1): 3-11.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Neoplasias , Acidente Vascular Cerebral , Trombose , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Humanos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Trombose/etiologia
7.
Clin Imaging ; 82: 244-250, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34920388

RESUMO

Although yttrium-90 (90Y) transarterial radioembolization (TARE) is an effective treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT), inability to cannulate tumor-feeding vessels can preclude its use. In this case we demonstrate the feasibility of employing balloon occlusion within the proper hepatic artery to treat a left lobar HCC and PVTT with an inaccessible left hepatic artery. Vessel angulation prevented subselection of the left hepatic artery, and subsequent mapping studies indicated significant non-target radiotracer activity. Through occlusion of the proper hepatic artery by a balloon microcatheter, flow alterations were created that led to uptake of the 90Y microspheres by the tumor while sparing the non-diseased liver parenchyma. Thus, this innovative approach may permit the use of TARE in patients when proximal tumor vessels are inaccessible.


Assuntos
Carcinoma Hepatocelular , Embolização Terapêutica , Neoplasias Hepáticas , Trombose , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Artéria Hepática/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Radioisótopos de Ítrio/uso terapêutico
8.
Paediatr Drugs ; 24(1): 13-27, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34904182

RESUMO

Pediatric antiphospholipid syndrome (APS) is a rare acquired multisystem autoimmune thromboinflammatory condition characterized by thrombotic and non-thrombotic clinical manifestations. APS in children and adolescents typically presents with large-vessel thrombosis, thrombotic microangiopathy, and, rarely, obstetric morbidity. Non-thrombotic clinical manifestations are frequently seen in pediatric APS and may be present even before the vascular thrombotic events occur. We review insights into the pathogenesis of APS and discuss potential targets for therapy. The identification of multiple immunologic abnormalities in patients with APS reveals molecular targets for current or future treatment. Management strategies, especially for APS in adolescents, require screening for additional prothrombotic risk factors and consideration of counseling regarding contraceptive strategies, lifestyle recommendations, treatment adherence, and mental health issues associated with this autoimmune thrombophilia. The main goal of therapy in pediatric APS is the prevention of thrombosis. The management of acute thrombosis events in children and adolescents is the same as for primary APS, which involves isolated occurrences, and secondary APS, which is seen in association with another autoimmune disease, e.g., systemic lupus erythematosus. A pediatric hematologist should be consulted so other differential thrombophilic conditions can be eliminated. Therapy includes unfractionated heparin or low-molecular-weight heparin followed by vitamin K antagonists. Treatment of catastrophic APS involves triple therapy (anticoagulation, intravenous corticosteroid pulse therapy, and plasma exchange) and may include intravenous immunoglobulin for children and adolescents with this condition. New drugs such as eculizumab and sirolimus seem to be promising drugs for APS.


Assuntos
Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Trombose , Adolescente , Anticoagulantes , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Criança , Feminino , Heparina , Humanos , Gravidez
9.
Methods Mol Biol ; 2373: 201-212, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34520014

RESUMO

Mechanical circulatory support devices (MCSDs), although proved to be a pillar in the clinical setting of advanced heart failure, are afflicted by thromboembolic complications. Shear-mediated platelet activation has been recognized to drive thromboembolic events in patients implanted with MCSDs. Despite this, to date, a clinically reliable diagnostic test for assessing platelet response to stress stimuli is still missing. Here, we describe and apply the previously developed device thrombogenicity emulation methodology to the design of a microfluidic platform able to replicate shear stress profiles representative of MCSDs. The device-specific shear-mediated platelet activation is finally assessed by the platelet activity state assay, which measures real-time thrombin production, as a marker of platelet activation level. This technique can be employed to emulate the shear stress patterns of different MCSDs, such as mechanical heart valves, ventricular assist devices, and stents.


Assuntos
Coração Auxiliar , Microfluídica , Plaquetas , Coração Auxiliar/efeitos adversos , Humanos , Ativação Plaquetária , Tromboembolia , Trombose/etiologia
10.
Methods Mol Biol ; 2375: 13-19, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34591295

RESUMO

A major limitation in engineering vascular grafts is the lack of proper endothelium to prevent thrombosis and subsequent graft failure. Obtaining endothelial cells from patients' vasculature is intrusive and requires extensive culture time. Here we present an alternative strategy wherein abundant and easily accessible monocytes from peripheral blood are cultured and differentiated towards an endothelial-like state capable of preventing thrombosis through production of nitric oxide and formation of endothelial adherens junctions. Considering the plethora of monocytes present within peripheral blood, this method provides a robust alternative to generating endothelial cells required for vascular graft production.


Assuntos
Monócitos , Células Cultivadas , Células Endoteliais , Humanos , Óxido Nítrico , Trombose
11.
Vasc Endovascular Surg ; 56(1): 5-10, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34372714

RESUMO

BackgroundRenal cell carcinoma (RCC) with tumor thrombus (TT) may extend into and, in rare cases, actually invade the inferior vena cava (IVC). Techniques of IVC reconstruction after removal of the RCC, TT, and infiltrated portion of the IVC have not been well documented. Methods A ringed polytetrafluoroethylene (PTFE) interposition graft along with an IVC filter placed within the graft (to prevent the development of pulmonary emboli) was used for patients who underwent surgical resection of RCC with TT extending into and directly invading the wall of the IVC. Demographic information about these patients along with their pathology reports, surgical procedures, and patency of the PTFE graft was obtained and described. Results Four male patients were identified as having RCC and TT with histologic invasion of the IVC requiring IVC dissection and replacement with a PTFE graft (as described above); their TT levels were II, IIIa, IIIc, and IV, respectively. Patient ages were 58, 65, 58, and 51 years and tumor sizes were 7.5, 7.5, 15.0, and 6.5 cm, respectively. These patients were followed for 36, 24, 32, and 48 months, respectively. At last follow-up, each patient had a patent IVC graft, and none of them developed any pulmonary emboli post-operatively. Conclusions Ringed PTFE interposition graft along with an IVC filter deployed inside the graft appears to be a safe vascular conduit for IVC reconstruction after surgical resection of RCC with TT directly invading the IVC.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Trombose , Filtros de Veia Cava , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Politetrafluoretileno , Estudos Retrospectivos , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
12.
Clin Imaging ; 81: 33-36, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34598001

RESUMO

In the U.S., pulmonary embolism (PE) is a common cause of cardiovascular death. Right heart thrombus (RHT) occurs in approximately 4% of patients with PE, and when concurrent is associated with increased 30-day PE-related and all-cause mortality. The consensus on optimal management of acute massive or high-risk PE is unclear, and even less so for concurrent RHT. In this report, we review a successful multidisciplinary coordination of vacuum-assisted thrombectomy (VAT) of a complex pacemaker lead-associated RHT in a patient with concurrent acute PE and significant comorbidities, using the AngioVac system (Vortex Medical, Norwell, MA). VAT is a reasonable treatment option that should be considered particularly for patients who are poor surgical or thrombolytic candidates. Procedural success and patient outcomes can be further optimized through multidisciplinary collaboration such as with the Pulmonary Embolism Response Team (PERT) model.


Assuntos
Marca-Passo Artificial , Embolia Pulmonar , Trombose , Ecocardiografia Transesofagiana , Humanos , Marca-Passo Artificial/efeitos adversos , Trombectomia , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento
13.
J Colloid Interface Sci ; 608(Pt 1): 1015-1024, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-34785450

RESUMO

Addressing thrombosis and biofouling of indwelling medical devices within healthcare institutions is an ongoing problem. In this work, two types of ultra-low fouling surfaces (i.e., superhydrophobic and lubricant-infused slippery surfaces) were fabricated to enhance the biocompatibility of commercial medical grade silicone rubber (SR) tubes that are widely used in clinical care. The superhydrophobic (SH) coatings on the tubing substrates were successfully created by dip-coating in superhydrophobic paints consisting of polydimethylsiloxane (PDMS), perfluorosilane-coated hydrophobic zinc oxide (ZnO) and copper (Cu) nanoparticles (NPs) in tetrahydrofuran (THF). The SH surfaces were converted to lubricant-infused slippery (LIS) surfaces through the infusion of silicone oil. The anti-biofouling properties of the coatings were investigated by adsorption of platelets, whole blood coagulation, and biofilm formation in vitro. The results revealed that the LIS tubes possess superior resistance to clot formation and platelet adhesion than uncoated and SH tubes. In addition, bacterial adhesion was investigated over 7 days in a drip-flow bioreactor, where the SH-ZnO-Cu tube and its slippery counterpart significantly reduced bacterial adhesion and biofilm formation of Escherichia coli relative to control tubes (>5 log10 and >3 log10 reduction, respectively). The coatings also demonstrated good compatibility with fibroblast cells. Therefore, the proposed coatings may find potential applications in high-efficiency on-demand prevention of biofilm and thrombosis formation on medical devices to improve their biocompatibility and reduce the risk of complications from medical devices.


Assuntos
Incrustação Biológica , Trombose , Aderência Bacteriana , Biofilmes , Incrustação Biológica/prevenção & controle , Humanos , Interações Hidrofóbicas e Hidrofílicas , Propriedades de Superfície , Trombose/prevenção & controle
14.
Curr Opin Nephrol Hypertens ; 31(1): 36-46, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34846312

RESUMO

PURPOSE OF REVIEW: Severe COVID-19 disease is often complicated by acute kidney injury (AKI), which may transition to chronic kidney disease (CKD). Better understanding of underlying mechanisms is important in advancing therapeutic approaches. RECENT FINDINGS: SARS-CoV-2-induced endothelial injury initiates platelet activation, platelet-neutrophil partnership and release of neutrophil extracellular traps. The resulting thromboinflammation causes ischemia-reperfusion (I/R) injury to end organs. Severe COVID-19 induces a lipid-mediator storm with massive increases in thromboxane A2 (TxA2) and PGD2, which promote thromboinflammation and apoptosis of renal tubular cells, respectively, and thereby enhance renal fibrosis. COVID-19-associated AKI improves rapidly in the majority. However, 15-30% have protracted renal injury, raising the specter of transition from AKI to CKD. SUMMARY: In COVID-19, the lipid-mediator storm promotes thromboinflammation, ischemia-reperfusion injury and cytotoxicity. The thromboxane A2 and PGD2 signaling presents a therapeutic target with potential to mitigate AKI and transition to CKD. Ramatroban, the only dual antagonist of the thromboxane A2/TPr and PGD2/DPr2 signaling could potentially mitigate renal injury in acute and long-haul COVID. Urgent studies targeting the lipid-mediator storm are needed to potentially reduce the heavy burden of kidney disease emerging in the wake of the current pandemic.


Assuntos
Injúria Renal Aguda , COVID-19 , Insuficiência Renal Crônica , Trombose , Injúria Renal Aguda/etiologia , COVID-19/complicações , Fibrose , Humanos , Inflamação , Rim/patologia , Lipídeos , Insuficiência Renal Crônica/patologia , SARS-CoV-2 , Trombose/patologia
15.
J Colloid Interface Sci ; 611: 61-70, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34929439

RESUMO

Vein thrombosis is one of the most serious types of cardiovascular disease. During the traditional treatment, due to the excessive blood flow rate, the drug utilization rate at the thrombus site is low and the thrombolysis efficiency is poor. In this study, bowl-shaped silica nanomotors driven by nitric oxide (NO) are designed to target the thrombus surface by modifying arginine-glycine-aspartic acid (RGD) polypeptide, and simultaneously loading l-arginine (LA) and thrombolytic drug urokinase (UK) in its mesopore structure. LA can react with excessive reactive oxygen species (ROS) in the thrombus microenvironment to produce NO, thus promoting the movement of nanomotors to improve the retention efficiency and utilization rate of drugs in the thrombus site, and at the same time achieve the effect of eliminating ROS and reducing the oxidative stress of inflammatory endothelial cells. The loaded UK can dissolve thrombus quickly. It is worth mentioning that NO can not only be used as a power source of nanomotors, but also can be used as a therapeutic agent to stimulate the growth of endothelial cells and reduce vascular injury. This therapeutic agent based on nanomotor technology is expected to provide support for future research on thrombus treatment.


Assuntos
Dióxido de Silício , Trombose , Células Endoteliais , Humanos , Óxido Nítrico , Dióxido de Silício/uso terapêutico , Terapia Trombolítica , Trombose/tratamento farmacológico
16.
Methods Mol Biol ; 2303: 789-805, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34626423

RESUMO

Evaluating prospective anticoagulant therapies in animal thrombosis and bleeding models are standard pre-clinical approaches. Mice are frequently used for initial evaluations because a variety of models have been developed in this well-characterized species, and mice are relatively inexpensive to maintain. Because mice seem to be resistant to forming "spontaneous" thrombosis, vessel injury is used to induce intravascular clot formation. For the purpose of testing heparin-based drugs, we adapted a well-established model in which thrombus formation in the carotid artery is induced by exposing the vessel to ferric chloride. For studying anticoagulant effects on venous thrombosis, we use a model in which the inferior vena cava is ligated and the size of the resulting clots are measured. The most common adverse effect of anticoagulation therapy is bleeding. We describe a simple tail bleeding time that has been used for many years to study the effects of anticoagulants on hemostasis. We also describe a more reproducible, but more technically challenging, saphenous vein bleeding model that is also used for this purpose.


Assuntos
Anticoagulantes/química , Trombose , Animais , Anticoagulantes/farmacologia , Modelos Animais de Doenças , Hemorragia , Heparitina Sulfato , Camundongos , Estudos Prospectivos , Trombose/tratamento farmacológico
17.
Am J Surg Pathol ; 46(1): 89-96, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081038

RESUMO

Approximately 20% of patients with symptomatic syndrome-associated coronavirus-2 (SARS-CoV-2) infection have gastrointestinal bleeding and/or diarrhea. Most are managed without endoscopic evaluation because the risk of practitioner infection outweighs the value of biopsy analysis unless symptoms are life-threatening. As a result, much of what is known about the gastrointestinal manifestations of coronavirus disease-2019 (COVID-19) has been gleaned from surgical and autopsy cases that suffer from extensive ischemic injury and/or poor preservation. There are no detailed reports describing any other gastrointestinal effects of SARS-CoV-2 even though >3,000,000 people have died from COVID-19 worldwide. The purpose of this study is to report the intestinal findings related to SARS-CoV-2 infection by way of a small case series including one with evidence of direct viral cytopathic effect and 2 with secondary injury attributed to viral infection. Infection can be confirmed by immunohistochemical stains directed against SARS-CoV-2 spike protein, in situ hybridization for spike protein-encoding RNA, and ultrastructural visualization of viruses within the epithelium. It induces cytoplasmic blebs and tufted epithelial cells without inflammation and may not cause symptoms. In contrast, SARS-CoV-2 infection can cause gastrointestinal symptoms after the virus is no longer detected, reflecting systemic activation of cytokine and complement cascades rather than direct viral injury. Reversible mucosal ischemia features microvascular injury with hemorrhage, small vessel thrombosis, and platelet-rich thrombi. Systemic cytokine elaboration and dysbiosis likely explain epithelial cell injury that accompanies diarrheal symptoms. These observations are consistent with clinical and in vitro data and contribute to our understanding of the protean manifestations of COVID-19.


Assuntos
COVID-19/patologia , Enteropatias/patologia , Enteropatias/virologia , Intestinos/patologia , Intestinos/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Biópsia , COVID-19/diagnóstico , COVID-19/imunologia , Citocinas/metabolismo , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/imunologia , Hemorragia Gastrointestinal/patologia , Hemorragia Gastrointestinal/virologia , Humanos , Enteropatias/diagnóstico , Enteropatias/imunologia , Intestinos/imunologia , Isquemia/diagnóstico , Isquemia/imunologia , Isquemia/patologia , Isquemia/virologia , Masculino , Trombose/diagnóstico , Trombose/imunologia , Trombose/patologia , Trombose/virologia
18.
J Infect Chemother ; 28(1): 108-111, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34711507

RESUMO

Portal vein thrombosis (PVT) is considered a relatively rare thrombotic complication in coronavirus disease 2019 (COVID-19). Most reported cases of PVT develop within 2 weeks from COVID-19 onset. We report a fatal case of extensive gastrointestinal necrosis due to portal and mesenteric vein thrombosis approximately 6 weeks after the onset of critical COVID-19. Excessive elevation of his plasma D-dimer level had continued for weeks during the hospitalization contrary with improvement of respiratory failure. Thrombotic complication should be cautiously paid attention even in the post-acute phase of COVID-19, especially in patients with persistent elevation of plasma D-dimer level.


Assuntos
COVID-19 , Trombose , Humanos , Veias Mesentéricas , Necrose , Veia Porta/diagnóstico por imagem , SARS-CoV-2
20.
Clin Chem Lab Med ; 60(1): 7-17, 2022 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-34714985

RESUMO

Coronavirus disease 2019 (COVID-19) is a life-threatening infectious disease caused by Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2). In response to the still ongoing pandemic outbreak, a number of COVID-19 vaccines have been quickly developed and deployed. Although minor adverse events, either local (e.g., soreness, itch, redness) or systematic (fever, malaise, headache, etc.), are not uncommon following any COVID-19 vaccination, one rare vaccine-associated event can cause fatal consequences due to development of antibodies against platelet factor 4 (PF4), which trigger platelet activation, aggregation, and possible resultant thrombosis, often at unusual vascular sites. Termed thrombosis with thrombocytopenia syndrome (TTS) by reporting government agencies, the term vaccine-induced (immune) thrombotic thrombocytopenia (VITT) is more widely adopted by workers in the field. In response to increasing reports of VITT, several expert groups have formulated guidelines for diagnosis and/or management of VITT. Herein, we review some key guidelines related to diagnosis of VITT, and also provide some commentary on their development and evolution.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Trombocitopenia , Trombose , COVID-19/prevenção & controle , Humanos , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico , Trombose/induzido quimicamente , Trombose/diagnóstico
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