ABSTRACT
Arterial thrombosis occurs when a blood clot forms within an artery, frequently associated with ruptures of atherosclerotic plaques. This event is a major contributor to mortality and morbidity worldwide.1 In this text we will present the clinical case of a 57-year-old female patient treated at the Herminda Martin Clinical Hospital, who entered the facility in cardiorespiratory arrest triggered by extensive aortic arterial thrombosis along much of its course, associated with mesenteric ischemia with significant hemodynamic compromise, after the description of the corresponding emergency management, the radiological images that allowed guiding the diagnosis of the case are presented.
La trombosis arterial ocurre cuando se produce la formación de un coágulo de sangre dentro de una arteria, frecuentemente asociado a rupturas de placas ateroscleróticas. Este evento contribuye de manera importante a la mortalidad y la morbilidad en todo el mundo.1 En el presente texto presentaremos el caso clínico de una paciente femenina de 57 años atendida en el Hospital Clínico Herminda Martin, quien ingresa al establecimiento en paro cardiorrespiratorio desencadenado por una trombosis arterial aórtica extensa en gran parte de su trayecto, asociado a isquemia mesentérica con significativo compromiso hemodinámico, posterior a la descripción del manejo correspondiente de urgencias, se presentan las imágenes radiológicas que permitieron guiar el diagnóstico del caso.
Subject(s)
Humans , Female , Middle Aged , Thrombosis/diagnosis , Thrombosis/etiology , Thrombosis/surgery , Tomography, X-Ray Computed , Coronary Vessels , Sagittal Sinus Thrombosis , Heart ArrestABSTRACT
Esta revisión narrativa explora el papel potencial del estetrol (E4), un esteroide estrogénico natural, en la anticoncepción, analizando sus propiedades farmacológicas, su efectividad y su seguridad. Se revisaron estudios preclínicos, ensayos clínicos y evaluaciones de seguridad del E4 como anticonceptivo oral combinado (AOC). Se investigó el impacto en parámetros endocrinos, metabólicos y hemostáticos, así como su tolerabilidad. En los resultados, el E4 tiene menor afinidad por el receptor de estrógeno-α de membrana, pero mantiene la actividad agonista en los receptores nucleares. E4/DRSP (drospirenona) demostró ser un AOC eficaz, con ciclos de sangrado regulares y predecibles en la mayoría de las mujeres. La tolerabilidad fue favorable, con eventos adversos leves o moderados y bajas tasas de interrupción. El sangrado fue el evento adverso más común, y se reportaron casos raros de migrañas con aura, trombosis venosa profunda, hiperpotasemia y depresión. E4/DRSP tuvo mínimo impacto en los parámetros lipídicos, hepáticos, de globulina fijadora de hormonas sexuales y de metabolismo de hidratos de carbono, y efecto neutral o mínimo en los parámetros hemostáticos. Se concluye que E4/DRSP parece ser una opción anticonceptiva eficaz y segura, con reducido riesgo trombótico y mínimo impacto en los parámetros endocrinos y metabólicos. Se requiere más investigación para confirmar su seguridad y eficacia a largo plazo.
This narrative review explores the potential role of estetrol (E4), a natural estrogenic steroid, in contraception, analyzing its pharmacological properties, effectiveness, and safety. Preclinical studies, clinical trials, and safety assessments of E4/DRSP (drospirenone) as a combined oral contraceptive (COC) were reviewed. The impact on endocrine, metabolic, and hemostatic parameters, as well as tolerability, was investigated. In results, E4 exhibits lower affinity for estrogen transmembrane receptor-α but maintains agonistic activity on nuclear receptors. E4/DRSP proved to be an effective COC with regular and predictable bleeding cycles in most women. Tolerability was favorable with mild or moderate adverse events and low discontinuation rates. Bleeding was the most common adverse event, and rare cases of aura migraines, deep vein thrombosis, hyperkalemia, and depression were reported. E4/DRSP had minimal impact on lipid, hepatic, sex hormone-binding globulin, and carbohydrate metabolism parameters, with a neutral or minimal effect on hemostatic parameters. The conclusion is that E4/DRSP seems to be an effective and safe contraceptive option, with reduced thrombotic risk and minimal impact on endocrine and metabolic parameters. Further research is needed to confirm long-term safety and efficacy.
Subject(s)
Humans , Female , Contraceptives, Oral, Combined/administration & dosage , Estetrol/administration & dosage , Thrombosis/chemically induced , Contraceptives, Oral, Combined/adverse effects , Estetrol/adverse effectsABSTRACT
Introduction Pulmonary thromboembolism (PTE) is the obstruction that occurs in the pulmonary artery or one of its branches due to an embolus or thrombus that predominantly originates in the lower extremities. It continues to be a frequent reason for admission to the emergency department. However, the specific clinical characteristics in the emergency department are not well described and are sometimes underdiagnosed, resulting in high mortality rates. Objective: This study aimed to describe the most common clinical characteristics of patients who present spontaneously to the emergency department of a high-complexity institution in the city of Santiago de Cali, Colombia, and are diagnosed with PTE using chest angiotomography. Materials and Methods Signs, symptoms, and risk factors were described in a descriptive case series of patients over 18 years of age who consulted the emergency department with imaging evidence of PTE. Pregnant patients and patients from services other than emergency were excluded. Bivariate analysis was performed using proportions, frequencies, means, medians, and standard deviation. This study has received ethical approval from the research ethics committee. Results and Discussion Tachycardia and tachypnea continue to be the most frequent signs for suspecting PTE, and dyspnea remains the most common symptom, along with chest pain, in the emergency department. Regarding risk factors, obesity is the most prevalent risk factor for PTE in our study, unlike deep vein thrombosis, which is the most common risk factor.
Subject(s)
Humans , Thrombosis , Computed Tomography Angiography , Pulmonary Embolism , Thorax , Risk FactorsABSTRACT
ANTECEDENTES Y OBJETIVOS: El Tromboembolismo Venenoso, incluye la Trombosis venosa profunda y el Tromboembolismo Pulmonar. Existen múltiples factores de riesgo para su desarrollo, entre los cuales están los traumas o cirugías. En este contexto, el Departamento de Seguridad y Calidad de Atención, de la División de Gestión de la Red Asistenciales de la subsecretaría de Redes Asistenciales, solicita esta síntesis con el objetivo de actualizar la norma vigente sobre esta temática METODOLOGÍA: Se formuló una estrategia de búsqueda en las bases de datos MEDLINE y EMBASE, utilizando conceptos "practice guideline", "venous thromboembolism", "surgical procedures", con fecha del 1 al 3 de Abril del 2024 dos revisores independientes seleccionaron los estudios que respondieron a la pregunta basándose en criterios de inclusión y exclusión acordados. La extracción de cada artículo la realizó una persona. Los hallazgos fueron resumidos narrativamente RESULTADOS: Se encontraron 20 GPC sobre profilaxis en pacientes quirúrgicos. De estas 14 fueron procedimientos quirúrgicos específicos, y 16 para procedimientos quirúrgicos variados En total se contabilizaron más de 400 recomendaciones, las cuales se distinguen por tipo de profilaxis; farmacológicas, mecanismos/no farmacológicas o profilaxis conjuntas, y referentes al momento de aplicación y duración de la intervención Se encontraron recomendaciones para 10 tipos de cirugías; cirugía general y mayor, ortopédica; neurológica; urológica; cardiaca y vascular; de trauma; ginecología u obstetricia; bariátrica o gástrica; ambulatoria; de cabeza y cuello
Subject(s)
Venous Thromboembolism , Patients , Pulmonary Embolism , Thrombosis , Venous Thrombosis , Disease PreventionABSTRACT
El síndrome del martillo hipotenar es la trombosis de la arteria cubital en el canal de Guyon causada por traumatismos repetitivos. Se trata de un cuadro infrecuente que se diagnostica mediante la detallada valoración de los antecedentes y el examen físico, y se confirma con estudios vasculares. El manejo incluye desde tratamiento médico hasta cirugía reconstructiva. El objetivo de este artículo es brindar una breve reseña de esta enfermedad y presentar el caso de un paciente de 45 años, con parestesias y signos de hipoperfusión de los dedos 4.° y 5.° luego de múltiples traumatismos en la eminencia hipotenar. En la prueba de Allen, se detectó ausencia de vascularización de la arteria cubital, y la trombosis se confirmó mediante ecografía Doppler y angiotomografía. Se resecó el fragmento trombosado y se liberó el canal de Guyon. La evolución fue satisfactoria, no se observaron signos de isquemia y las parestesias mejoraron. Se realizó un seguimiento por 1 año. Nivel de Evidencia: IV
Hypothenar hammer syndrome is a thrombosis of the ulnar artery in Guyon's canal induced by repeated trauma. It is a rare disorder that can be diagnosed with an extensive medical history and physical examination, and confirmed by vascular studies. Management options include medical treatment and reconstructive surgery. The aim of this article is to provide a brief overview of this disorder and to discuss the case of a 45-year-old patient who developed paresthesias and signs of hypoperfusion of the fourth and fifth fingers following multiple injuries to the hypothenar eminence. The Allen test revealed the absence of vascularization in the ulnar artery, and thrombosis was verified by Doppler ultrasound and angiotomography. The thrombosed portion was excised, and Guyon's canal was cleared. The evolution was satisfactory; no signs of ischemia were found, and paresthesias improved. Follow-up was performed for 1 year. Level of Evidence: IV
Subject(s)
Middle Aged , Thrombosis , Cumulative Trauma Disorders , Ulnar Artery , Hand InjuriesABSTRACT
Abstract Objective: to analyze the association between coronavirus disease infection and thromboembolic events in people with cancer in the first year of the pandemic. Method: case-control study carried out by collecting medical records. The selected cases were adults with cancer, diagnosed with a thromboembolic event, treated in the selected service units during the first year of the pandemic. The control group included adults with cancer without a diagnosis of a thromboembolic event. Pearson's chi-square test was applied to verify the association between risk factors and the outcome and logistic regression techniques were applied to identify the odds ratio for the occurrence of a thromboembolic event. Results: there were 388 cases and 440 control cases included in the study (ratio 1/1). Females predominated, who were white, with mean age of 58.2 (±14.8) years. Antineoplastic chemotherapy was the most used treatment and coronavirus disease was identified in 11.59% of participants. In the case group, deep vein thrombosis was more prevalent. Conclusion: the study confirmed the hypothesis that coronavirus disease infection did not increase the chance of thromboembolic events in people with cancer. For the population studied, the factors that were associated with these events were those related to cancer and its treatment.
Resumo Objetivo: analisar a associação entre a infecção por coronavírus e os eventos tromboembólicos em pessoas com câncer, durante o primeiro ano da pandemia. Método: estudo caso-controle realizado mediante coleta em prontuários. Os casos estudados foram de adultos com câncer, com diagnóstico de evento tromboembólico, atendidos nas unidades do serviço selecionado durante o primeiro ano da pandemia. O grupo controle contou com adultos com câncer sem diagnóstico de evento tromboembólico. Teste qui-quadrado de Pearson foi aplicado para verificar associação entre fatores de risco e o desfecho de técnicas de regressão logística foram aplicadas para identificar a razão de chance de ocorrência de evento tromboembólico. Resultados: 388 casos e 440 controles foram incluídos no estudo (proporção 1/1). Prevaleceu o sexo feminino, raça branca, média de idade de 58,2 (±14,8) anos. A quimioterapia antineoplásica foi o tratamento mais utilizado e a doença por coronavírus foi identificada em 11,59% dos participantes. No grupo caso, trombose venosa profunda foi mais prevalente. Conclusão: o estudo confirmou a hipótese de que a infecção por doença por coronavírus não aumentou a chance de eventos tromboembólicos em pessoas com câncer. Para a população estudada, os fatores que tiveram associação com os eventos foram os relacionados ao câncer e seu tratamento.
Resumen Objetivo: analizar la asociación entre la infección por enfermedad por coronavirus y eventos tromboembólicos en personas con cáncer durante el primer año de la pandemia. Método: estudio caso-control realizado mediante la recolección de datos en historiales médicos. Los casos fueron adultos con cáncer, diagnosticados con evento tromboembólico, atendidos en las unidades del servicio seleccionado durante el primer año de la pandemia. El grupo control estuvo compuesto por adultos con cáncer sin diagnóstico de evento tromboembólico. Se aplicó la prueba de chi-cuadrado de Pearson para verificar la asociación entre factores de riesgo y el resultado, y se utilizaron técnicas de regresión logística para identificar la razón de posibilidades de ocurrencia de evento tromboembólico. Resultados: se incluyeron en el estudio 388 casos y 440 controles (proporción 1/1). Prevaleció el género femenino, raza blanca, con una edad media de 58,2 (±14,8) años. La quimioterapia antineoplásica fue el tratamiento más utilizado y la enfermedad por coronavirus fue identificada en el 11,59% de los participantes. En el grupo de casos, la trombosis venosa profunda fue más prevalente. Conclusión: el estudio confirmó la hipótesis de que la infección por enfermedad por coronavirus no aumentó la probabilidad de eventos tromboembólicos en personas con cáncer. Para la población estudiada, los factores que tuvieron asociación con estos eventos fueron los relacionados con el cáncer y su tratamiento.
Subject(s)
Humans , Male , Female , Oncology Nursing , Thrombosis , Case-Control Studies , COVID-19 , Medical OncologyABSTRACT
Background: Oncohematologic patients have a high incidence of thrombosis, due to either their the underlying disease or treatment. The standard management involves low molecular weight anticoagulants; however, these agents may increase bleeding risk. Case report: A rare case of acute hemorrhagic lesion in pediatric patient is described, emphasizing the diagnostic challenges encountered. An eight-year-old male with severe anemia, fever, and thrombosis of the superior and inferior vena cava was admitted for diagnostic evaluation. Enoxaparin was prescribed, and the diagnosis of anaplastic large cell lymphoma (ALCL) was confirmed. After 20 days of anticoagulant therapy, the patient developed epistaxis followed by the formation of oral hemorrhagic edema in the upper and lower lips. A specific protocol of oral care with multiprofessional team was implemented.The lesion showed resolution, along with physical and emotional recovery. Conclusion: The personalized care protocol successfully restored essential oral functions, including chewing, swallowing, digestion, taste, and speech, thereby redefining the true significance of a smile; crucial in oncohematological patients (AU)
Contexto: Pacientes oncohematológicos tem elevada taxa de trombose devido ao tratamento ou à doença. O tratamento preconizado para esses casos é o anticoagulante de baixo peso molecular, entretanto pode aumentar o risco de sangramentos. Relato de caso: Descreve-se um caso raro de lesão hemorrágica aguda na infância discutindo o desafio do diagnóstico. Paciente do sexo masculino, 8 anos, internado para investigação diagnóstica. Apresentava anemia grave associada a febre e trombose das veias cavas superior e inferior, por isso prescreveu-se enoxaparina. O diagnóstico foi de linfoma anaplásico de grandes células. Após 20 dias da administração do anticoagulante, o paciente desenvolveu epistaxe seguida de formação de trombo hemorrágico oral em lábio superior e inferior. Um protocolo específico de cuidados bucais envolveu a avaliação da equipe multiprofissional. Houve remissão da ferida com o restabelecimento físico e emocional. Conclusão: conforme protocolo individual de atendimento houve restabelecimento das funções vitais da cavidade oral: mastigação, deglutição, digestão, paladar, fala, resignificando o real significado do sorriso; crucial em pacientes oncohematológicos.(AU)
Subject(s)
Humans , Male , Child , Pediatrics , Thrombosis , Dentistry , Medical Oncology , MouthABSTRACT
A prevalência de doença valvar cardíaca permanece significativa globalmente, assim como a consequente interposição de dispositivos de substituição valvar. Atualmente, contamos com próteses valvares mecânicas (PVM), próteses valvares biológicas (PVB) e próteses valvares de implante transcateter (THV). A tomografia apresenta excelente resolução espacial e destacada participação no fluxo de diagnóstico complementar nas disfunções das próteses valvares. A tomografia computadorizada (TC) permite a adequada visualização de calcificação/espessamento dos folhetos (biológicas) ou movimentação e angulação discos (mecânicas), desempenhando papel fundamental no diagnóstico de pannus e/ou trombo, assim como na caracterização das complicações paravalvares (deiscência, fistula, "leak", abscesso, pseudoaneurisma). Por fim, a TC tem papel bem estabelecido como ferramenta necessária para o planejamento de intervenções percutâneas (valve-in-valve [VIV]) ou cirúrgicas na substituição de próteses biológicas disfuncionais (Figura Central).(AU)
The prevalence of valvular heart disease remains significant worldwide, as does the resulting use of valve replacement devices. Currently, mechanical valve prostheses (MVP), biological valve prostheses (BVP), and transcatheter valve prostheses are available. Computer tomography (CT) provides excellent spatial resolution and plays a critical role in the diagnostic process for prosthetic valve dysfunction (PVD). CT allows proper visualization of leaflet calcification/thickening (biological) or leaflet motion and angulation (mechanical). CT plays a fundamental role in the diagnosis of pannus and/or thrombus and in the characterization of paravalvular complications (e.g., dehiscence, fistula, leak, abscess, and pseudoaneurysm). Finally, CT has an established role as a necessary tool for planning percutaneous (valve-in-valve [VIV]) or surgical interventions to replace dysfunctional biological prostheses (Central Figure). (AU)
Subject(s)
Humans , Thrombosis/diagnostic imaging , Heart Valve Diseases/surgery , Heart Valve Diseases/complications , Heart Valve Diseases/diagnostic imaging , Magnetic Resonance Spectroscopy/methods , Tomography, X-Ray Computed/methods , Echocardiography, Transesophageal/methods , Heart Valve Prosthesis Implantation/methodsABSTRACT
As lesões pseudotumorais cardíacas são condições não neoplásicas que muitas vezes são negligenciadas no diagnóstico diferencial das massas cardíacas. Apresentam quadro clínico variável, podendo ser assintomáticas ou causar complicações como restrição ao enchimento ventricular e obstrução da via de saída. O ecocardiograma é o método de imagem de primeira linha, mas possui limitações como dependência da janela acústica e variabilidade interoperadoras. No entanto, uma abordagem multimodalidade, incluindo TC e RM, é essencial para a busca de um diagnóstico preciso. A TC, com excelente resolução espacial, permite detalhamento anatômico, avaliação de calcificações e gordura intralesionais, além de contribuir para o planejamento terapêutico. A RM é preferida para a caracterização tecidual e diferenciação entre lesões benignas e malignas. Estruturas anatômicas normais, como a valva de Eustáquio e a rede de Chiari, podem ser confundidas com trombos ou tumores, exigindo sua correta identificação. Trombos são comuns em pacientes com fibrilação atrial ou doença valvar mitral, sendo a RM importante para diferenciá-los de neoplasias. Outras condições pseudotumorais incluem vegetação, gossipibomas, calcificação caseosa do anel valvar mitral, hipertrofia lipomatosa do septo interatrial. A integração de modalidades avançadas de imagem cardiovascular é fundamental para o diagnóstico e manejo dessas lesões, otimizando o cuidado dos pacientes. (AU)
Cardiac pseudotumoral lesions are non-neoplastic conditions that are often overlooked in the differential diagnosis of cardiac masses. They present a variable clinical picture, ranging from asymptomatic to causing complications such as ventricular filling restriction and outflow tract obstruction. Echocardiography is the first-line imaging method but has limitations, such as dependence on the acoustic window and operator variability. However, a multimodality approach, including CT and MRI, is essential for seeking an accurate diagnosis. CT, with its excellent spatial resolution, allows for anatomical detailing, assessment of intralesional calcifications and fat, and contributes to therapeutic planning. MRI is preferred for tissue characterization and differentiation between benign and malignant lesions. Normal anatomical structures, such as the Eustachian valve and Chiari network, can be confused with thrombi or tumors, requiring correct identification. Thrombi are common in patients with atrial fibrillation or mitral valve disease, with MRI being important for differentiating them from neoplasms. Other pseudotumoral conditions include vegetation, gossypibomas, caseous calcification of the mitral valve annulus, and lipomatous hypertrophy of the interatrial septum. The integration of advanced cardiovascular imaging modalities is fundamental for the diagnosis and management of these lesions, optimizing patient care. (AU)
Subject(s)
Humans , Male , Female , Child , Adult , Middle Aged , Aged , Aged, 80 and over , Histiocytosis, Sinus/diagnostic imaging , Erdheim-Chester Disease/diagnostic imaging , Heart Neoplasms/etiology , Heart Neoplasms/diagnostic imaging , Thrombosis/diagnosis , Cardiomyopathy, Hypertrophic/diagnostic imaging , Magnetic Resonance Spectroscopy/methods , Tomography, Emission-Computed/methodsABSTRACT
Introducción: El presente estudio de caso muestra el impacto de la infección por SARS-CoV-2, en particular, sus manifestaciones neurológicas, que incluyen la anosmia, ageusia, adinamia, confusión, alteración en el estado de conciencia y alteración en la circulación cerebral, y que pueden generar secuelas como el evento vascular cerebral (EVC) isquémico. Objetivo: aplicación de intervenciones y acciones especializadas a un paciente con EVC isquémico secundario a infección por SARS-CoV-2, con base en la teoría del autocuidado. Material y métodos: se realizó una valoración neurológica del paciente mediante un instrumento de valoración elaborado por estudiantes del posgrado de Enfermería Neurológica con base en los requisitos de autocuidado universal planteados por Dorothea Orem. Se mantuvo un seguimiento holístico, y se proporcionaron cuidados según planes de intervención específicos para las alteraciones presentadas. Descripción del caso clínico: paciente con diagnóstico médico de EVC isquémico de la arteria cerebral media izquierda. Debido al estado de salud que presentaba durante la aplicación del instrumento de valoración, para la adquisición de datos se contó con el apoyo de la persona responsable, mediante consentimiento informado. Relevancia: La COVID-19, ocasionada por la infección de SARS-CoV-2, se caracteriza por la afinidad del virus a los receptores ECA2 presentes en todo el organismo humano. El cerebro, debido a los múltiples receptores de este tipo que presenta, genera una sintomatología específica. Esto deriva en cuadros neurológicos que, dependiendo de la gravedad de la enfermedad, podrían ocasionar secuelas en la persona infectada. Conclusiones: El personal de enfermería tiene un papel importante en el cuidado de las personas infectadas por SARS-CoV-2, ya que mediante los cuidados especializados que brindan posibilitan su estabilización y recuperación.
Introduction: The present case study shows the impact of SARS-CoV-2 infection, in particular, its neurological manifestations, which include anosmia, ageusia, adynamia, confusion, altered state of consciousness, and altered cerebral circulation, and which can generate sequelae such as ischemic cerebral vascular event (CVE). Objective: application of interventions and specialized actions to a patient with ischemic CVE secondary to SARS-CoV-2 infection, based on the self-care theory. Material and methods: a neurological assessment of the patient was carried out using an assessment instrument developed by students of the postgraduate course in Neurological Nursing based on the universal self-care requirements proposed by Dorothea Orem. Holistic follow-up was maintained, and care was provided according to specific intervention plans for the alterations presented. Description of the clinical case: patient with a medical diagnosis of ischemic CVE of the left middle cerebral artery. Due to the state of health presented during the application of the assessment instrument, the data acquisition was supported by the responsible person, through informed consent. Relevance: COVID-19, caused by SARS-CoV-2 infection, is characterized by the affinity of the virus for ECA2 receptors present throughout the human body. Due to its multiple receptors of this type, the brain generates a specific symptomatology. This results in neurological symptoms which, depending on the severity of the disease, may cause sequelae in the infected person. Conclusions: Healthcare personnel play an important role in caring for people infected with SARSCoV- 2 since their specialized nursing services enable stabilization and recovery.
Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Stroke , Thrombosis , Risk Factors , Cytokine Release Syndrome , SARS-CoV-2 , COVID-19 , Post-Acute COVID-19 SyndromeABSTRACT
Introducción. En los estadios avanzados de la cirrosis se pueden presentar coagulopatías, las cuales se definen como los trastornos en el sistema de coagulación y se identifican por la prolongación del tiempo de protrombina, INR elevado, tiempo de tromboplastina parcial activado prolongado y trombocitopenia. El objetivo del estudio fue determinar la prevalencia de alteraciones de coagulación en los pacientes con cirrosis hepática. Materiales y métodos. Se realizó un estudio observacional, descriptivo, retrospectivo de corte transversal, en mayores de 18 años de edad atendidos en el Hospital Universitario San Rafael de Tunja entre el 01 de enero del 2016 al 31 de diciembre del 2021 con diagnóstico de cirrosis hepática, identificados a partir del sistema de información de la institución, mediante el código internacional de enfermedades (CIE-10). Resultados. De 289 pacientes, 74.4% presentaba coagulopatías, predominando el género masculino. La etiología más relacionada al desarrollo de coagulopatías fue el enolismo (62.98%). Los antecedentes comúnmente relacionados fueron: hipertensión arterial 19.38%, diabetes 11.43% y litiasis biliar 11.76%. El 38.75% de pacientes categorizados en clase C (Child Pugh) presentó predisposición al desarrollo de coagulopatías. Conclusiones. La prevalencia de coagulopatías en los pacientes con cirrosis hepática es alta, presentándose con mayor frecuencia en los pacientes de sexo masculino, alcohólicos. En valores pronósticos, la escala de Child Pugh ayuda a categorizar al paciente con mayor riesgo de coagulopatías.
Subject(s)
Blood Coagulation Disorders , Alcoholism , Liver Cirrhosis , Thrombosis , HemostasisABSTRACT
Introduction: In hospitalized patients, atrial fibrillation is the most common arrhythmia, and leading cause of cardio-embolic stroke. Objective: To evaluate the association between N-terminal b-type natriuretic peptide pro (NT-proBNP) and left atrial appendage thrombus in persistent atrial fibrillation patients. Methods: A cross-sectional study, enrolled 139 patients with persistent non-valvular atrial fibrillation. Transthoracic and trans-esophageal echocardiographs were performed in all patients. Results: Mean age was 70.5 ( 10.6 years, 80.6% male. In patients with LAAT, NT-proBNP was positively correlated with left ventricular end diastolic diameter (LVEDD) (r=0.345), left ventricular end-systolic diameter (LVEDS) (r= 0.449), E/e' (r=0.445), and left atrial spontaneous echo contrast (LA SEC) (r=0.478), and negatively correlated with left ventricular ejection fraction (LVEF) (r=-0.473), left atrial strain (r= -0.301), strain rate (r= -0.283), and e'(r= -0.458). In patients without LAAT, NT-proBNP was positively correlated with LVEDD (r= 0.333), LVESD (r= 0.358), E (r= 0.318), E/e' (r= 0.411), left atrial volume index (LAVI) (r= 0.421), and negatively correlated with LVEF (r= -0.307). Plasma NT-proBNP (> 1279 pg/mL) could be used to predict LAAT (AUC= 0.639; Se= 67.7 percent, Sp= 60.2 percent). In patients with ejection fraction > 50 percent, the cutoff value of NT-proBNP to predict LAAT was 1325 pg/mL (AUC= 0.572; Se= 57.9 percent , Sp= 78.3 percent). Multiple logistic regression analysis showed that prior stroke, E/e' index, and NT-proBNP correlated with LAAT (r= 0.887; p< 0.001; r= -0.092, p= 0.035 and 0.022; p= 0.004, respectively). Conclusion: Plasma NT-proBNP levels and E/e' index are associated with LAAT in patients with persistent atrial fibrillation(AU)
Introducción: En pacientes hospitalizados, la fibrilación auricular es la arritmia más común y causa principal de ictus cardioembólico. Objetivo: Evaluar la asociación entre el péptido natriurético NT proBNP y el trombo en la orejuela auricular izquierda en pacientes con fibrilación auricular persistente. Métodos: Se reclutaron prospectivamente 139 pacientes con fibrilación auricular no valvular persistente. Se realizaron ecocardiografías transtorácicas y transesofágicas en todos los pacientes. Resultados: Edad media, 70,5±10,6 años; 80,6 por ciento hombres. En pacientes con LAAT, NT-proBNP correlacionó positivamente con el diámetro telediastólico del ventrículo izquierdo (DDVI) (r=0,345), diámetro sistólico final del ventrículo izquierdo (DSVI) (r=0,449), E/e' (r=0,445) y contraste de eco espontáneo auricular izquierdo (LA SEC) (r=0,478), y negativamente con la fracción de eyección del ventrículo izquierdo (FEVI) (r=-0,473), tensión auricular izquierda (r=-0,301), tasa de tensión (r=0,283) y e' (r=-0,458). En pacientes sin LAAT, NT-proBNP correlacionó positivamente con LVEDD (r= 0,333), LVESD (r=0,358), E (r=0,318), E/e' (r=0,411), índice de volumen auricular izquierdo (LAVI) (r=0,421), y negativamente con FEVI (r=-0,307). NT-proBNP plasmático (>1279 pg/mL) podría usarse para predecir LAAT (AUC=0,639; Se=67,7 por ciento, Sp=60,2 por ciento). En pacientes con fracción de eyección >50 por ciento; valor de corte de NT-proBNP para predecir LAAT fue 1325 pg/mL (AUC=0,572; Se=57,9 por ciento, Sp=78,3 por ciento). Según regresión logística múltiple, el accidente cerebrovascular previo, el índice E/e' y NT-proBNP se correlacionaron con LAAT (r=0,887; p<0,001; r=0,092, p=0,035 y 0,022; p=0,004, respectivamente). Conclusiones: Los niveles plasmáticos de NT-proBNP y el índice E/e' se asocian con el OAI en pacientes con FA persistente(AU)
Subject(s)
Humans , Male , Aged , Atrial Fibrillation , Thrombosis , Cross-Sectional Studies , Atrial Appendage , Embolic Stroke/etiologyABSTRACT
Introducción. El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), el tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades. Métodos. Describir los principales cambios hematológicos y complicaciones asociadas al procedimiento de esplenectomía. Discusión. Los cambios posteriores a la esplenectomía pueden ser inmediatos, como la aparición de cuerpos de Howell-Jolly, la trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones tempranas incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo secundarios (edad, sedentarismo, manejo hospitalario, obesidad) o un estado hipercoagulable (diabetes, cáncer, trombofilia primaria), siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición. Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas, en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo. Debido al riesgo de infecciones, principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción. Conclusión. Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones posoperatorias son fundamentales para reducir la mortalidad asociada a la esplenectomía
Introduction. The spleen is a lymphoid organ involved in antigen recognition, pathogen clearance, and removal of aged erythrocytes or those with cytoplasmic inclusions. Splenectomy is a technique used for diagnosis (lymphomas), treatment (immune thrombocytopenia, acquired hemolytic anemia), and cure (hereditary microspherocytosis) of various diseases. Methods. To describe the main hematological changes and complications associated with the splenectomy procedure. Discussion. Changes after splenectomy can be considered immediate: the appearance of Howell-Jolly bodies, thrombocytosis, and leukocytosis during the first two weeks. Other complications include the presence of thrombosis, especially in patients with risk factors (age, sedentary lifestyle, long hospital stay, obesity) or a hypercoagulable state (diabetes, cancer, primary thrombophilia), with both portal vein flow and splenic volume being the main risk factors for its appearance. Late complications include altered immune response, increased risk of infections by encapsulated bacteria, and a reduction in IgM levels secondary to the absence of B lymphocytes in the spleen; due to the risk of diseases mainly by Streptococcus pneumoniae, partial splenectomy has been considered an option. Conclusion. An adequate assessment of the indication for splenectomy and the early identification of complications are essential to reduce the mortality associated with splenectomy
Subject(s)
Humans , Splenectomy , Splenic Diseases , Postoperative Complications , Thrombosis , Erythrocyte Inclusions , LeukocytosisABSTRACT
Abstract Carpal tunnel syndrome is the most common compressive neuropathy of the upper limb, affecting ~ 4% of the general population. The clinical picture is characterized by pain and, mainly, paresthesia in the median nerve territory, of insidious onset and, in the most severe cases, loss of strength and atrophy of the thenar musculature is observed. It is an extremely common pathology in the daily practice of hand surgery, and in most cases, it can be treated with conservative methods. We present here an atypical case of carpal tunnel syndrome, of acute onset, triggered by persistent median artery (PMA) thrombosis, condition associated with distal embolization and hypoper-fusion of the limb.
Resumo A síndrome do túnel do carpo é a neuropatia compressiva mais comum do membro superior, afetando ~ 4% da população geral. O quadro clínico caracteriza-se por dor e, principalmente, parestesia no território do nervo mediano, de início insidioso e, nos casos mais graves, observa-se perda de força e atrofia da musculatura tenar. Trata-se de patologia extremamente comum na prática diária de cirurgia da mão, e na maior parte dos casos pode ser tratada com métodos conservadores. Apresentamos aqui um caso atípico de síndrome do túnel do carpo, de surgimento agudo, desencadeado pela trombose da artéria mediana persistente, quadro associado com embolização distal e hipoperfusão do membro.
Subject(s)
Humans , Male , Middle Aged , Arteries , Thrombosis , Carpal Tunnel Syndrome , Compressive StrengthABSTRACT
A hipoplasia da veia cava inferior é uma patologia rara que integra o conjunto de anomalias do desenvolvimento da veia cava inferior. A sua incidência situa-se entre 0,3%-0,5% na população saudável e 5% nos adultos jovens sem fatores de risco para trombose venosa profunda, sendo considerada um importante fator de risco para o desenvolvimento de trombose dos membros inferiores. O principal objetivo deste trabalho é reportar a conduta obstétrica de um caso clínico de uma grávida diagnosticada com hipoplasia da veia cava inferior, prévia à gravidez. Trata-se de um caso clínico, de uma grávida, primigesta, com 37 anos, com hipoplasia da veia cava inferior e heterozigotia para o gene MTHFR677 diagnosticadas, na sequência de uma trombose venosa bilateral dos membros inferiores e do segmento infrarrenal da veia cava inferior. A gravidez foi seguida em consulta hospitalar na nossa instituição, tendo a grávida sido medicada com enoxaparina em dose profilática e ácido acetilsalicílico, com um período pré natal que decorreu sem intercorrências. Às 37 semanas e 6 dias de gestação, deu entrada no Serviço de Urgência de Obstetrícia por rotura prematura de membranas. Intraparto foram utilizadas meias de compressão pneumática intermitente, tendo o parto ocorrido às 38 semanas de gestação por via vaginal (parto eutócico), do qual nasceu um recém-nascido do sexo feminino, com 2620g e índice de Apgar 9/10/10. O presente caso clínico demonstra que em situações de hipoplasia da veia cava inferior com um seguimento obstétrico adequado é possível a realização de um parto vaginal, possibilitando um desfecho obstétrico favorável (AU).
Hypoplasia of the inferior vena cava is a rare condition that belongs to the group of developmental anomalies of the inferior vena cava. It has an incidence between 0.3% and 0.5% in the healthy population and 5% in young adults without risk factors for deep venous thrombosis, being considered an important risk factor for the development of lower limb thrombosis. This study aims to report the obstetric conduct of a clinical case of a pregnant woman diagnosed with hypoplasia of the inferior vena cava prior to pregnancy. This is a clinical case of a pregnant woman, primigravid 37 years old, with hypoplasia of the inferior vena cava and heterozygosity for MTHFR677, diagnosed following a bilateral venous thrombosis of the lower limbs and the infrarenal segment of the inferior vena cava. The pregnancy was followed up in our institution. The pregnant woman was medicated with a prophylatic dose of low molecular weight heparin and acetylsalicylic acid with an uneventful prenatal period. At 37 weeks and 6 days of gestation, she was admitted to the Obstetrics Emergency Service due to premature rupture of membranes. Intermittent pneumatic compression sockings were used intrapartum, and at 38 weeks of gestation, a female newborn was vaginally delivered (eutocic delivery) with 2620g and an Apgar score of 9/10/10. The present clinical case demonstrates that in situations of hypoplasia of the inferior vena cava with an adequate obstetric follow-up, it is possible to perform a vaginal delivery, enabling a favourable obstetric outcome (AU).
Subject(s)
Humans , Female , Pregnancy , Adult , Thrombosis/therapy , Vena Cava, Inferior/abnormalities , Health Knowledge, Attitudes, Practice , ParturitionABSTRACT
RESUMEN INTRODUCCIÓN: La COVID-19 se acompaña de eventos tromboembólicos venosos y arteriales en pacientes con historia de hipertensión y aterosclerosis. Se reporta el caso de una paciente joven y sin factores de riesgo cardiovascular que adquirió la infección por el SARS-COV2 y luego presentó un accidente cerebrovascular isquémico. CASO: Paciente de 44 años hospitalizada por la covid-19 en tratamiento protocolario con anticoagulación, esteroide y oxígeno suplementario. Al día 7 del inicio de los síntomas respiratorios presentó infarto cerebral por trombosis de arteria carótida derecha, arteria cerebral media derecha e izquierda y edema cerebral hemisférico derecho, tras lo cual fue diagnosticada con muerte encefálica. El estudio vascular no documentó una etiología diferente a la covid-19. DISCUSIÓN: Se plantea que la infección condiciona un estado inflamatorio sistémico, endotelialitis, ulceración de placas ateroscleróticas preexistentes e hipercoagulabilidad. Lo anterior facilita la aparición de trombosis vascular. Es frecuente encontrar elevación de reactantes de fase aguda y de los productos del metabolismo de la fibrina. El accidente cerebrovascular (ACV) isquémico se ha descrito en el 1 al 5 % de los pacientes con la covid-19. En pacientes con factores de riesgo cardiovascular, durante las primeras 2 semanas desde el inicio de los síntomas respiratorios, el compromiso isquémico suele afectar a múltiples territorios vasculares. CONCLUSIÓN: La covid-19 por sí sola es un factor de riesgo para trombosis arterial secundaria a la inflamación sistémica y estados de hipercoagulabilidad, por lo que debe ser tenida en cuenta en el estudio de ACV isquémico en pacientes jóvenes.
ABSTRACT INTRODUCTION: It is known that COVID-19 is associated with venous and arterial thromboembolic events in patients with history of hypertension and atherosclerosis. Herein, it is presented a case of a young woman without known cardiovascular risk, who was infected by SARS-COV 2 and then an ischemic stroke. CASE: 44 years-old woman with moderate COVID-19 in protocolary treatment with anticoagulants, steroid and oxygen. In the seventh day since symptoms onset, she presented acute ischemic stroke due to acute thrombosis of right carotid artery, and right and left medial cerebral arteries, then rapidly developed malignant cerebral edema and brain death. Vascular study failed to report and etiology other than COVID-19. DISCUSSION: It is suggested that the infection produces a systemic inflammatory state, endothelialitis, ulceration of preexisting atherosclerotic plaques, and hypercoagulability that facilitate thrombosis. Ischemic stroke is described in 1 to 5% of COVID-19, it is common to find an elevation of acute phase reactants and products of fibrin metabolism. Multiple vascular territories are usually compromised in patients with known cardiovascular risk factors and 12 days after the onset of symptoms. CONCLUSION: COVID-19 by itself is a risk factor for arterial thrombosis secondary to systemic infection and hypercoagulability states and it should be taken into account in the study of ischemic stroke in young patients.
Subject(s)
COVID-19 , Thrombosis , Brain Death , Brain IschemiaABSTRACT
The trigeminal nerve is the fifth cranial nerve, which transmits facial sensations, and is divided into the ophthalmic, maxillary, and mandibular branches. Damage to this nerve can cause trigeminal neuralgia, a clinical condition that can also present in patients with coronavirus disease 2019 (COVID-19). This meta-analysis reviews the clinical cases of trigeminal neuralgia reported in patients with COVID-19 from 2019 to 2022, describes the anatomical mechanism of pain and its radiation and identifies other associated symptoms. We performed a literature search to identify reports of patients with COVID-19 who developed trigeminal neuralgia and examined these cases for prevalence and any identified source of associated ocular pain. Of the relevant studies identified, 638 patients with COVID-19 developed trigeminal neuralgia out of 7561 total COVID-19 cases (8.4 %). Of the 638 cases, 590 (7.8 %) had known causes of ocular pain, while the cause of ocular pain was unknown in 48 cases (0.6 %). Trigeminal neuralgia developed infrequently in patients with COVID-19, and cases with known causes of ocular pain were more common than cases with unknown causes. Understanding the link between COVID-19 and trigeminal neuralgia may lead to preventing further complications and mortality in these patients, as well as improving care for patients with these conditions in the future. Additionally, understanding these new clinical issues can prepare many types of physicians to protect themselves better in the event of a COVID-19 outbreak among medical staff in different departments of hospitals, such as clinics, wards, emergency rooms, and operating theatres.
El nervio trigémino es el quinto par craneal, que transmite las sensaciones faciales, y se divide en las ramas oftálmica, maxilar y mandibular. El daño a este nervio puede causar neuralgia del trigémino, una condición clínica que también puede presentarse en pacientes con enfermedad por coronavirus 2019 (COVID-19). Este metaanálisis revisa los casos clínicos de neuralgia del trigémino informados en pacientes con COVID-19 desde 2019 hasta 2022, describe el mecanismo anatómico del dolor y su radiación e identifica otros síntomas asociados. Realizamos una búsqueda bibliográfica para identificar informes de pacientes con COVID-19 que desarrollaron neuralgia del trigémino y examinamos estos casos en busca de prevalencia y cualquier fuente identificada de dolor ocular asociado. De los estudios relevantes identificados, 638 pacientes con COVID-19 desarrollaron neuralgia del trigémino de un total de 7561 casos de COVID-19 (8,4 %). De los 638 casos, 590 (7,8 %) tenían causas conocidas de dolor ocular, mientras que la causa del dolor ocular era desconocida en 48 casos (0,6 %). La neuralgia del trigémino se desarrolló con poca frecuencia en pacientes con COVID-19, y los casos con causas conocidas de dolor ocular fueron más comunes que los casos con causas desconocidas. Comprender el vínculo entre COVID-19 y la neuralgia del trigémino puede ayudar a prevenir más complicaciones y mortalidad en estos pacientes, así como a mejorar la atención de los pacientes con estas afecciones en el futuro. Además, comprender estos nuevos problemas clínicos puede preparar a muchos tipos de médicos para protegerse mejor en caso de un brote de COVID-19 entre el personal médico en diferentes departamentos de hospitales, como clínicas, salas de emergencia y quirófanos.