Quais são os mecanismos celulares relacionados aos eventos tromboembólicos em pacientes com COVID-19? / What cellular mechanisms are related to thromboembolic events in patients with COVID-19?

Resumo O SARS-CoV-2 é o vírus responsável pela pandemia da COVID-19. Essa doença começou a ser melhor entendida devido a outras manifestações clínicas além das respiratórias. Ao longo dos meses de atendimento aos pacientes infectados pelo vírus, foram identificadas alterações clínicas e laboratoriais que incitaram os pesquisadores a discutir sobre o potencial do SARS-CoV-2 no desencadeamento de uma resposta imunológica exacerbada capaz de alterar a homeostase endotelial, através de mecanismos diretos e indiretos. Com esse intuito, foram revisados os possíveis mecanismos que desencadeiam este fenômeno em pacientes portadores de COVID-19. Dessa forma, torna-se importante o entendimento fisiopatológico dos mecanismos imunológicos relacionados à doença para a compreensão do potencial de dano endotelial que a COVID-19 pode promover.

Abstract SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. This disease is beginning to be better understood in terms of its other, non-respiratory, clinical manifestations. Over the course of months caring for patients infected by the virus, clinical and laboratory changes have been identified that have prompted researchers to debate the potential that SARS-CoV-2 has to trigger an exacerbated immune response that is capable of changing endothelial homeostasis through both direct and indirect mechanisms. With the intention of contributing to this debate, a review was conducted of the possible mechanisms that could trigger these phenomena in patients with COVID-19. It is important to understand the pathophysiology of the immunological mechanisms related to this disease in order to understand the potential endothelial damage that COVID-19 can provoke.

Anticoncepción hormonal y COVID-19 / Hormonal contraception and COVID-19

La enfermedad producida por el nuevo coronavirus SARS-CoV-2 se identificó por primera vez en diciembre de 2019 en la ciudad de Wuhan, en la República Popular China, y en pocos meses se convirtió en una pandemia. Desde el comienzo ha sido un desafío mundial, que amenazó la salud pública y obligó a tomar medidas estrictas de aislamiento social. Como consecuencia de la emergencia sanitaria se ha producido una reducción importante de la actividad asistencial, que puso en riesgo el acceso y la continuidad de los métodos anticonceptivos, exponiendo a mujeres a embarazos no intencionales. Los derechos sexuales y reproductivos resultan esenciales y deben garantizarse siempre. (AU)

The disease caused by the new coronavirus SARS-CoV-2 was identified for the first time in December 2019 in the city of Wuhan, in the People's Republic of China, and within a few months it became a pandemic. From the beginning, it has been a global challenge, threatening public health, having to take strict measures of social isolation. As a consequence of the health emergency, there has been a significant reduction in healthcare activity, putting access and continuity of contraceptive methods at risk, exposing women to unintended pregnancies. Sexual and reproductive rights are essential and must always be guaranteed. (AU)

Lonomia obliqua Walker (Lepidoptera: Saturniidae): hemostasis implications / Lonomia obliqua Walker (Lepidoptera: Saturniidae): implicações em hemostasia.

Summary In southern Brazil, since 1989, several cases of accidents produced by unwilling contact with the body of poisonous caterpillars of the moth species Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae), were described. L. obliqua caterpillars have gregarious behavior and feed on leaves of host trees during the night, staying grouped in the trunk during the day, which favors the occurrence of accidents with the species. This caterpillar has the body covered with bristles that on contact with the skin of individuals, breaks and release their contents, inoculating the venom into the victim. The basic constitution of the venom is protein and its components produce physiological changes in the victim, which include disturbances in hemostasis. Hemorrhagic syndrome associated with consumption coagulopathy, intravascular hemolysis and acute renal failure are some of the possible clinical manifestations related to poisoning by L. obliqua. Specific laboratory tests for diagnosis of poisoning have not been described previously. The diagnosis of poisoning is made based on the patient's medical history, clinical manifestations, erythrocyte levels, and, primarily, parameters that evaluate blood coagulation. Treatment is performed with the use of supportive care and the administration of specific hyperimmune antivenom. Poisoning can be serious and even fatal.

Na região Sul do Brasil, a partir de 1989, foram descritos inúmeros casos de contato acidental com o corpo de lagartas venenosas da mariposa da espécie Lonomia obliqua Walker, 1855 (Lepidoptera: Saturniidae). As lagartas de L. obliqua possuem comportamento gregário e alimentam- -se de folhas das árvores hospedeiras durante a noite, permanecendo agrupadas no tronco durante o dia, o que favorece a ocorrência de acidentes. Essa lagarta possui o corpo recoberto por cerdas urticantes, que, ao contato com a pele dos indivíduos, se rompem e liberam seu conteúdo, inoculando o veneno na vítima. A constituição básica do veneno é proteica e seus componentes produzem modificações fisiológicas no acidentado, que incluem distúrbios na hemostasia. Síndrome hemorrágica associada a coagulopatia de consumo, hemólise intravascular e insuficiência renal aguda são algumas das manifestações clínicas possíveis relacionadas ao envenenamento por L. obliqua. Ainda não foram descritas avaliações laboratoriais específicas para diagnóstico do envenenamento, que é feito com base na anamnese do paciente, nas manifestações clínicas, nos índices hematimétricos e, principalmente, nos parâmetros que avaliam a coagulação sanguínea. A terapêutica é feita com a utilização de medidas de suporte e com a administração de um soro heterólogo hiperimune específico. Os envenenamentos podem ser graves e até mesmo fatais.

Coagulación intravascular retiniana: como signo clínico de embolización de líquido amniónico / Intravascular coagulation in the retina as clinical sign of embolization of amniotic fluid

La embolización de líquido amniótico es una de las condiciones más infrecuentes pero desvastadora que puede presentarse en embarazadas. La prevalencia se ha reportado de 1 en 80.000, con un alto índice de mortalidad (86%). El diagnóstico esta basado en uno o más de los 4 signos clínicos: colapso cardiovascular, dificultad respiratoria, coma y/o convulsiones y coagulopatía. Coagulación intravascular diseminada puede ocasionar pérdida visual bilateral en el grupo de sobrevivientes, por oclusión del sistema arterial retiniano u coroideo. Los sintomas visuales se presentan usualmente después del desarrollo de síntomas sistémicos; sin embargo, en el caso clínico que se expone a continuación la manifestación visual ocurrió simultaneamente con el desarrollo de las sistémicas. Por tanto, la pérdida visual bilateral en el contexto de los signos clínicos sistémicos expuestos, debe alertar al obstetra sobre la posibilidad de embolización de liquido amniótico.

Amniotic fluid embolism is one of the most devastating and infrequent condition known in pregnant women. The prevalence has been reportd as a 1 in 80.000 deliveries with high mortality rate, almost 86%. The diagnosis is based on one or more of the four symptoms and signs: cardiovascular collapse, respiratory distress, coma/seizures and/or coagulopathy. Disseminated intravascular coagulopathy can cause bilateral visual loss in the group of survivors by occlusion of the retinal artery and/or the choroid system. The visual manifestations appear usually after the development of systemic symptoms, but in the clinical case described below the visual symptoms occurred simultaneously to the development of systemic manifestations. Therefore, bilateral visual loss in the context of the systemic clinical signs exposed, should alert the obstetrician about the possibility of embolization of amniotic fluid.

Disseminated intravascular coagulation in obstetric patients at combine Military Hospital Quetta

To describe the frequency of disseminated intravascular coagulation [DIG] as a complication in obstetric patients. Descriptive study. This study was carried out between April 2006 to August 2007 at the department of obstetrics and gynecology, Combined Military Hospital Quetta. All pregnant subjects who presented at the out-patient department, CMH Quetta for delivery or related complaints were considered for inclusion into the study. After various exclusions, a total of 1939 patients were included in our study. They were consented, and evaluated with detailed history and clinical examination for the presence of DIC. In suspected patients DIC screening was ones's, including fibrinogen levels, prothrombin time, partial thromboplastin time, platelet and fibrin degradation products. These patients were regularly followed up during the course of the disease till their discharge or otherwise. Out of 1939 subjects 15 [0.77%] subjects developed disseminated intravascular coagulation. Out of these 15 subjects, 10 [66.7%] subjects were having no booking record. 10 [66.7%] subjects developing DIC were multi-gravida, while 5 [33.3%] were primary gravida. The major complications leading to DIC in our subjects were abruption 4 [26.7%], intrauterine death 4 [26.7%] and sepsis 4 [26.7%].13 [86.7%] ladies were finally discharged without complications, while 1 [6.7%] subject developed acute renal failure and 1 [6.7%] subjects died. Disseminated intravascular coagulation is a grave complication of obstetrical population, which increases the maternal mortality and morbidity

[Chronic dissiminated intravascular coagulation caused by aortic dissection]

Disseminated intravascular coagulation [DIC] is a severe disease. It's can be caused by lost of pathology. We report the case of chronic aortic dissection discovered during the evaluation of disseminated intravascular coagulation [DIC]. This case is characterised by the severity of clinical presentation, challenging diagnosis and difficulty of therapeutic approach. Low dose of heparine may reduce the severity of this situation; but vital prognosis remains obscure. Aortic dissection is a rare but a severe cause of disseminated intravascular coagulation

Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

OBJECTIVE: To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. MATERIALS AND METHODS:From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. RESULTS: The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 +/- 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. CONCLUSION: Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

How to Increase the Probability of Visualizing Angiographic Extravasation in Patients with Acute Hemorrhage from the Gastrointestinal Tract?

No abstract available.

Splenic metastasis and bleeding manifestations--an unusual association with gastric malignancy.

Splenic metastasis is a rare clinical entity--incidence being 0.6% at autopsy and 1.1% at splenectomy. We report the case of a 30 year old female who presented with purpura and melena and who was later diagnosed to have a mucinous adenocarcinoma of stomach with disseminated intravascular coagulation and splenic metastasis.

Cryptococcal neoformans profiles in peripheral blood neutrophils: an unusual presentation.

We report an unusual observation of Cryptococcal neoformans profiles engulfed by neutrophils on a routine peripheral blood smear examination in an HIV-negative young female patient who presented with perforation of large bowel following a pregnancy termination procedure by an untrained midwife.

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol

Background: Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness; low cost; stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect; uterine rupture and post partum haemorrhage (PPH) have been documented. Method: This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use.Result: This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100?g of isoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously; then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Conclusion: Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC

Idiopathic purpura fulminans in dengue hemorrhagic fever.

Purpura fulminans is a rapidly progressive thrombotic disease that has been described during both severe bacterial and viral infections. Disseminated intravascular coagulation (DIC), antiphospholipid antibodies and acquired or congenital C and S protein deficiency are thought to play a role in its pathogenesis. Here we report the case of a 4-year-old girl who developed gangrene of all her fingers and toes following dengue shock syndrome complicated by DIC and also discuss its management.

Trastornos de coagulación en el cirrótico / Coagulation disorders in cirrhosis

The liver plays a central role in the clotting process. In this organ are sintetizated the major part of the coagulation factors. Historically, was considered that alteration in liver function causes important bleeding disorders. However, actual evidence is not in agreement with this asseveration. Decreased synthesis of clotting and inhibitor factors, decrease clearance of activated factors, quantitative and qualitative platelet defects, hyperfibrinolysis and intravascular coagulation are some of the defects observed in liver diseases. Thrombotic events, even if rare in cirrhotic patients, occur manly in the portal and mesenteric veins. The aim of the present work is to review the present evidence in coagulation disorders and liver disease.

El hígado participa de manera importante en el proceso de la coagulación. En él se sintetizan la mayor parte de los factores pro- y anticoagulantes. De manera histórica se ha considerado que las alteraciones en la función de este órgano provoca trastornos predisponentes para eventos de sangrado. La evidencia actual pone en tela de juicio esta aseveración. En los casos de hepatopatía se hacen evidentes alteraciones en el número y funcionamiento de las plaquetas, disminución de la síntesis de factores de la coagulación, disfibrinogenemia, alteraciones en la fibrinólisis, deficiencia de vitamina K y cambios similares a los ocurridos en la coagulación intravascular diseminada (CID). El presente trabajo está dirigido a revisar los conocimientos actuales respecto a las alteraciones de la coagulación presentes en los pacientes con hepatopatías.

Triada mortal en pacientes politraumatizados / Mortal triad in polytraumatized patients

La exanguinación es uno de los motivos fundamentales de fallecimiento en las primeras horas después de un trauma. Los mecanismos fisiopatológicos que contribuyen a la pérdida sanguínea traumática son complejos. Estos pacientes se presentan con severas anormalidades metabólicas, entre las cuales la más notable es el desencadenamiento de la llamada tríada mortal, constituida por: a) hipotermia, b) coagulopatía y c) acidosis. Si estas no pueden ser controladas adecuadamente, pueden llevar rápidamente al paciente a la muerte. Este enfoque ha permitido el surgimiento de la ®cirugía de control de daños¼, una técnica en tres etapas, que tiene como objetivo esencial la restauración de la fisiología normal por encima de la anatomía, en un intento de romper el círculo vicioso de la tríada. En este trabajo nos propusimos realizar una revisión de las causas, consecuencias y tratamiento de los componentes de la tríada mortal, para una mejor atención del paciente traumatizado grave exanguinado(AU)

The exanguinación is one of the fundamental reasons of death in the first hours after a trauma. The mechanisms fisiopatológicos that contribute to the traumatic sanguine loss are complex. These patients are presented with severe metabolic abnormalities, among which the most remarkable is the desencadenamiento of the call mortal triad, constituted for: to) hypothermia, b) coagulopatía and c) acidosis. If these they cannot be controlled appropriately, they can take to the patient quickly to the death. This focus has allowed the emergence of the ®cirugía of control of damages¼, a technique in three stages that he/she has as essential objective the restoration of the normal physiology above the anatomy, in an intent of breaking the vicious circle of the triad. In this work we intended to be carried out a revision of the causes, consequences and treatment of the components of the mortal triad, for the patient's traumatized serious exanguinado better attention(AU)