Trombosis vascular en pacientes pediátricos afectados por COVID-19

Introducción: La enfermedad por el nuevo coronavirus provocó una pandemia con impacto en la salud infantil que hizo patente la relación entre un estado de inflamación, hipercoagulabilidad y trombosis vascular como génesis de la insuficiencia respiratoria aguda. Objetivo: Describir la epidemiología de la trombosis vascular en pediatría y resumir las principales evidencias disponibles relacionadas con la interacción entre la hiperinflamación, disregulación inmunológica, hipercoagulabilidad y trombosis. Métodos: Entre diciembre 2019 y junio de 2021, se realizó una revisión ordenada de las bases de datos médicas PubMed, y Google Scholar, en las que se emplearon los términos de los títulos (MeSH): "SARS-CoV-2 and Covid-19"; "coronavirus" and "infección"; "sepsis" and "Covid-19" and "Síndrome inflamatorio multisistémico en niños" and "MIS-C and "PIMS-TS". Análisis y síntesis de la información: La trombosis vascular en pediatría se presenta entre 1,2 y 26 %, generado por procesos inflamatorios que conducen a una endotelítis con alteraciones de las estructuras microvasculares y la formación de trombos. Existen factores de riesgos como edad≥ 12 años, ventilación mecánica, abordaje venoso profundo, presencia de síndrome inflamatorio multisistémico, obesidad y cáncer. El diagnóstico se sustenta con análisis específicos en especial el dímero D, ultrasonidos con dopplers y tomografías. El tratamiento con anticoagulante no se ha unificado y dependerá de los protocolos indicados en cada país. Conclusiones: La trombosis vascular en pediatría, aunque infrecuente, debe tenerse presente para detectar su presencia en pacientes graves con factores de riesgo y actuar en consecuencia de acuerdo con los protocolos establecidos.

Introduction: The disease by the new coronavirus caused a pandemic with an impact on children's health, which made clear the relationship between a state of inflammation, hypercoagulability and vascular thrombosis as the genesis of acute respiratory failure. Objective: To describe the epidemiology of vascular thrombosis in pediatrics and to summarize the main available evidence related to the interaction between hyperinflammation, immune dysregulation, hypercoagulability and thrombosis. Methods: Between December 2019 and June 2021, an orderly review of the medical databases PubMed and Google Scholar was carried out, in which the terms of the titles (MeSH) were used: "SARS-CoV-2 and Covid-19"; "coronavirus" and "infection"; "sepsis" and "Covid-19" and "Multisystem inflammatory syndrome in children" and "MIS-C and "PIMS-TS". Analysis and synthesis of information: Vascular thrombosis in pediatrics occurs between 1.2 and 26%, generated by inflammatory processes that lead to endothelitis with alterations of microvascular structures and thrombus formation. There are risk factors such as age≥ 12 years, mechanical ventilation, deep venous approach, presence of multisystem inflammatory syndrome, obesity and cancer. The diagnosis is supported by specific analyzes, especially the D-dimer, ultrasound with Dopplers and tomography. Anticoagulant treatment has not been unified and will depend on the protocols indicated in each country. Conclusions: Vascular thrombosis in pediatrics, although infrequent, should be kept in mind to detect its presence in severe patients with risk factors and act accordingly with established protocols.

Research on emergency department clinicians′Vascular thrombosis knowledge insome Three-Grade Hospital in Suzhou / 中国实用护理杂志

Objective We conduct this survey one mergency department clinicians′ vascular thrombosis knowledge in Suzhou city to find if the reare questions related to this to picand provide effective strategies. Method 200self- made questionnaires were sent to Emergency Department clinicians in two THREE-GRADE hospitals. A cluster sampling method was adopted to carry out the secret test. The literature on vascular embolism diseases was reviewed, and the results were statistically analyzed. Result The age distribution of the medical and nursing staff in the emergency department decreased in turn, and the medical and nursing staff in the emergency department were not familiar with the common thrombus risk assessment scale; 51.37%(94/183)of the medical and nursing staff were trained, 25.14%(46/183)of the doctors and nurses participated in the thrombus conference, and 33.88% (62/183)of the medical staff passed self-study, and 18.03%(33/183)of the doctors and nurses passed the newspapers and newspapers. There are also 19.67%(36/183) health care workers through other means, and 98.36%(180/183)of medical staff know about thrombotic diseases. Conclusions The level of Three-A hospital clinicians′knowledge was higher than Three-B hospital clinicians’.It is essential for clinicians to strengthen vascular thrombosis prevention awareness. It is urgent to build the mechanism of vascular thrombosis prevention-management.

Pulmonary embolism in an immunocompetent patient with acute cytomegalovirus colitis

Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir.

Pulmonary vascular disease in children / 中华实用儿科临床杂志

Pulmonary vascular disease is a group of diseases,defined as the dysfunction of pulmonary artery,pulmonary vein and pulmonary capillary.Pulmonary vascular disease includes pulmonary hypertension,pulmonary vascular malformation,pulmonary vasculitis and pulmonary vascular thrombosis,et al.The manifestations of pulmonary vascular disease vary from recurrent wheezing,respiratory tract infection,short of breath and hemoptysis,et al.With the development of radiography investigations,the diagnosis of pulmonary vascular disease is improved.Pulmonary vascular disease in children is not uncommon therefore we should focus on it.

A Rare Cause of Peripheral Vascular Thrombosis: Hypereosinophilia Caused by Toxocara canis Infection / 대한내과학회지

Hypereosinophilia is often associated with eosinphilic infiltration of tissue, which can lead to severe and irreversible organ damage. One of the most characteristic and critical complications is development of thrombosis in cardiac ventricles, and occasionally in deep veins. We report a rare case of hypereosinophilia, with peripheral vascular thrombosis, caused by Toxocara canis infection.

The correlation between MMP-2, MMP-13 and the axillary lymph node metastasis in breast cancer / 中华内分泌外科杂志

Objective To study the function of the important members of MMPs in breast cancer and their correlation with lymph nodes metastasis through making groups according to vascular thrombosis status showed by pathological diagnosis and detecting the expression of MMP-2,-9,-13,-14 in order.Methods Fluorescent quantitative RT-PCR was used to detect mRNA expression of MMP-2,-9,-13,-14 in 30 cases of breast cancer patients in both groups (negative and positive vascular thrombosis groups).Streptavidin-peroxidase methods (S-P) immunohistochemical method was employed to detect the expression of ER,PR,HER2,P53 and Ki-67 in breast cancer tissues.The data were analyzed by t test etc.Results Lymph nodes metastasis was significantly more in vascular thrombosis positive group than in negative group(P ＜ 0.05 ).MMP-2 and -13 were overexpressed in vascular thrombosis negative group (P ＜ 0.05).Conclusions Breast cancer patients with positive vascular thrombosis have a more apparent trend of lymph nodes metastasis.MMP-2 and MMP-13 mRNA play a negative regulatory role in intravasation of tumor cells by producing substances that may inhibit tumor angiogenesis and intravasation.

Usefulness of Silica Clotting Time for Detection of Lupus Anticoagulants / 대한진단검사의학회지

BACKGROUND: The presence of lupus anticoagulants (LA) is a strong risk factor for thrombosis in antiphospholipid syndrome. We investigated the usefulness of addition of silica clotting time (SCT) to the pre-existing dilute Russell's viper venom test (dRVVT) for detection of LA. Also, we analyzed differences in the thrombotic features and the characteristics of antiphospholipid antibodies between dRVVT and SCT. METHODS: A total of 167 patients positive for LA or anti-cardiolipin (anti-CL) antibody and 76 healthy controls were enrolled. The dRVVT and SCT were used for detection of LA. Anti-CL, anti-beta2-glycoprotein I (anti-beta2 GPI) and anti-prothrombin (anti-PT) antibodies were measured using commercial ELISA kits. RESULTS: In detection of thrombosis, the sensitivity of the combined test of SCT and dRVVT was 56.4%, which was higher than that of dRVVT alone (46.2%) or SCT alone (23.1%). The specificity of the combined test (80.9%) was comparable to that of dRVVT (81.9%). Also, odds ratio for predicting thrombosis was higher in the combined test than in dRVVT or SCT alone. When normalized LA ratio of the two tests was compared, the group of patients with higher ratio of SCT showed significantly higher prevalence of recurrent abortion and higher positivity of IgG types of anti-CL, anti-beta2 GPI and anti-PT than the group with higher ratio of dRVVT. CONCLUSIONS: Addition of SCT to dRVVT can improve the detection sensitivity of thrombosis in LA test. And the high normalized LA ratio of SCT may be a useful parameter for detection of recurrent abortion.