Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 39
Filter
Add filters

Document Type
Year range
1.
Int J Gynaecol Obstet ; 155(3): 450-454, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1400847

ABSTRACT

OBJECTIVE: To evaluate fetal lung development using pulmonary artery Doppler in pregnant women who had recovered from COVID-19. METHODS: The prospective case-control study included 41 pregnant women who had recovered from COVID-19 and 43 healthy pregnant women (control group). All the women in the study group had been diagnosed with COVID-19 and had completed a quarantine period. RESULTS: The demographic data of patients were similar in the groups (P > 0.05). Main pulmonary artery peak systolic velocity was higher and pulsatility indices were lower in pregnant women who recovered from COVID-19 compared to the controls (P < 0.001, P = 0.001). Acceleration time, ejection time, and acceleration/ejection time ratio (PATET) of the fetal MPA Doppler were significantly decreased in pregnant women who recovered from COVID-19 (P < 0.001, P = 0.036, and P = 0.002, respectively). The patients who had recovered from COVID-19 were divided into two groups: those treated with expectant management and those treated in hospital. The pulmonary artery acceleration time and PATET ratio were significantly lower in the group treated in the hospital (P = 0.023 and P = 0.045, respectively). CONCLUSION: Detailed Doppler evaluations of the pulmonary artery may help in evaluating the fetal adverse effects of COVID-19 disease.


Subject(s)
COVID-19 , Pulmonary Artery , Blood Flow Velocity , Case-Control Studies , Female , Humans , Pregnancy , Pregnant Women , Prospective Studies , Pulmonary Artery/diagnostic imaging , SARS-CoV-2 , Ultrasonography, Doppler , Ultrasonography, Prenatal
2.
Am J Physiol Heart Circ Physiol ; 320(1): H404-H410, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1388544

ABSTRACT

While SARS-CoV-2 primarily affects the lungs, the virus may be inflicting detriments to the cardiovascular system, both directly through angiotensin-converting enzyme 2 receptor and initiating systemic inflammation. Persistent systemic inflammation may be provoking vascular dysfunction, an early indication of cardiovascular disease risk. To establish the potential effects of SARS-CoV-2 on the systemic vasculature in the arms and legs, we performed a cross-sectional analysis of young healthy adults (control: 5 M/15 F, 23.0 ± 1.3 y, 167 ± 9 cm, 63.0 ± 7.4 kg) and young adults who, 3-4 wk prior to testing, had tested positive for SARS-CoV-2 (SARS-CoV-2: 4 M/7 F, 20.2 ± 1.1 y, 172 ± 12 cm, 69.5 ± 12.4 kg) (means ± SD). Using Doppler ultrasound, brachial artery flow-mediated dilation (FMD) in the arm and single passive limb movement (sPLM) in the leg were assessed as markers of vascular function. Carotid-femoral pulse wave velocity (PWVcf) was asvsessed as a marker of arterial stiffness. FMD was lower in the SARS-CoV-2 group (2.71 ± 1.21%) compared with the control group (8.81 ± 2.96%) (P < 0.01) and when made relative to the shear stimulus (SARS-CoV-2: 0.04 ± 0.02 AU, control: 0.13 ± 0.06 AU, P < 0.01). The femoral artery blood flow response, as evidenced by the area under the curve, from the sPLM was lower in the SARS-CoV-2 group (-3 ± 91 mL) compared with the control group (118 ± 114 mL) (P < 0.01). PWVcf was higher in the SARS-CoV-2 group (5.83 ± 0.62 m/s) compared with the control group (5.17 ± 0.66 m/s) (P < 0.01). Significantly lower systemic vascular function and higher arterial stiffness are evident weeks after testing positive for SARS-CoV-2 among young adults compared with controls.NEW & NOTEWORTHY This study was the first to investigate the vascular implications of contracting SARS-CoV-2 among young, otherwise healthy adults. Using a cross-sectional design, this study assessed vascular function 3-4 wk after young adults tested positive for SARS-CoV-2. The main findings from this study were a strikingly lower vascular function and a higher arterial stiffness compared with healthy controls. Together, these results suggest rampant vascular effects seen weeks after contracting SARS-CoV-2 in young adults.


Subject(s)
Blood Vessels/physiopathology , Brachial Artery/physiopathology , COVID-19/physiopathology , Carotid-Femoral Pulse Wave Velocity , Femoral Artery/physiopathology , Hyperemia/physiopathology , Vascular Stiffness/physiology , Vasodilation/physiology , Adolescent , Angiotensin-Converting Enzyme 2/metabolism , Area Under Curve , Blood Vessels/metabolism , Brachial Artery/diagnostic imaging , COVID-19/diagnostic imaging , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Hyperemia/diagnostic imaging , Male , SARS-CoV-2 , Severity of Illness Index , Ultrasonography, Doppler , Young Adult
4.
Br J Hosp Med (Lond) ; 82(7): 1-6, 2021 Jul 02.
Article in English | MEDLINE | ID: covidwho-1337825

ABSTRACT

Pulmonary embolism remains a common and potentially deadly disease, despite advances in diagnostic imaging, treatment and prevention. Managing pulmonary embolism requires a multifactorial approach involving risk stratification, determining appropriate diagnostics and selecting individualised therapy. The first part of this article reviewed the pathophysiology, risk factors, clinical presentation, diagnostic evaluation and therapeutic management and early outpatient management of pulmonary embolism. This second part summarises pulmonary embolism in the setting of pregnancy, COVID-19, recurrent disease and chronic thromboembolic pulmonary hypertension.


Subject(s)
COVID-19/epidemiology , Pulmonary Embolism/epidemiology , Pulmonary Embolism/pathology , COVID-19/pathology , Chronic Disease , Female , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/pathology , Male , Pregnancy , Pulmonary Embolism/diagnostic imaging , Radiography, Thoracic , Recurrence , Risk Factors , SARS-CoV-2 , Ultrasonography, Doppler , Venous Thromboembolism/epidemiology , Venous Thromboembolism/pathology
5.
Crit Care Med ; 49(7): e663-e672, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1189487

ABSTRACT

OBJECTIVES: Extracorporeal membrane oxygenation is a lifesaving therapy for patients with severe acute respiratory distress syndrome refractory to conventional mechanical ventilation. It is frequently complicated by both thrombosis and hemorrhage. A markedly prothrombotic state associated with high rates of venous thromboembolism has been described in patients with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) infection. These rates have currently not been described during extracorporeal membrane oxygenation in comparison to other viral pneumonias. DESIGN: Retrospective observational study. SETTING: Single high-volume tertiary critical care department at a university hospital. PATIENTS: Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between March 1, 2020, and May 31, 2020, with coronavirus disease 2019 were compared with a cohort of patients with influenza pneumonia between June 1, 2012, and May 31, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The rates of venous thromboembolism and hemorrhage were compared in patients with coronavirus disease 2019 against a historic population of patients with influenza pneumonia who required extracorporeal membrane oxygenation. There were 51 patients who received extracorporeal membrane oxygenation due to coronavirus disease 2019 and 80 patients with influenza. At cannulation for extracorporeal membrane oxygenation, 37% of patients with coronavirus disease 2019 compared with 8% of patients with influenza had filling defects on CT pulmonary angiography (p = 0.0001). Catheter-associated deep vein thrombosis shown on ultrasound Doppler after decannulation was present in 53% with coronavirus disease 2019 versus 25% with influenza (p = 0.01). The rates of intracranial hemorrhage at the time of cannulation were 16% with coronavirus disease 2019 and 14% with influenza (p = 0.8). Elevated d-dimer levels were seen in both conditions and were significantly higher in those with pulmonary thromboembolism than those without in coronavirus disease 2019 (p = 0.02). Fibrinogen and C-reactive protein levels were significantly higher in those with coronavirus disease 2019 than influenza (p < 0.01). CONCLUSIONS: Significant rates of pulmonary thromboembolism and of catheter-associated deep vein thrombosis were seen in both viral infections but were greater in those requiring the use of extracorporeal membrane oxygenation in coronavirus disease 2019 than for influenza.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation , Influenza, Human/therapy , Intracranial Hemorrhages/complications , Pulmonary Embolism/complications , Venous Thromboembolism/complications , Venous Thrombosis/complications , Adult , C-Reactive Protein/metabolism , Computed Tomography Angiography , Female , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Humans , Influenza A Virus, H1N1 Subtype , Influenza A virus , Influenza B virus , London/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , State Medicine , Tertiary Care Centers , Ultrasonography, Doppler
7.
BMJ Case Rep ; 14(3)2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1138311

ABSTRACT

We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.


Subject(s)
Back Pain/etiology , Diagnostic Imaging/methods , Ovarian Cysts/complications , Ovarian Cysts/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Adult , Diagnosis, Differential , Enoxaparin/therapeutic use , Female , Fibrinolytic Agents/therapeutic use , Humans , Leg , Magnetic Resonance Imaging , Ovarian Cysts/surgery , Ovary/diagnostic imaging , Ovary/surgery , Tomography, X-Ray Computed , Ultrasonography, Doppler , Venous Thrombosis/drug therapy , Young Adult
8.
J Perinat Med ; 49(6): 697-701, 2021 Jul 27.
Article in English | MEDLINE | ID: covidwho-1117164

ABSTRACT

OBJECTIVES: To investigate the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on fetal Doppler parameters. METHODS: This was a prospective case-control study conducted in Ankara City Hospital with confirmed SARS-CoV-2 infected pregnants between August 1, 2020 and October 1, 2020. There were 54 COVID-19 confirmed pregnant women and 97 age-matched pregnant women as a control group between 28 and 39 weeks. Infection was confirmed based on positive real-time polymerase-chain reaction results. Demographic features, uterine artery (right, left), umblical artery, middle cerebral artery, ductus venosus, cerebro-placental ratio, and cerebral-placental-uterine ratio Doppler parameters were investigated in both groups. RESULTS: Two groups were similar in terms of demographic features and no difference was found for fetal Doppler parameters. CONCLUSIONS: COVID-19 seems to have no adverse effect on fetoplacental circulation in mild and moderate patients during the acute phase of the infection.


Subject(s)
COVID-19/diagnostic imaging , Pregnancy Complications, Infectious/diagnostic imaging , Adult , Case-Control Studies , Female , Humans , Pregnancy , Prospective Studies , Ultrasonography, Doppler , Ultrasonography, Prenatal , Young Adult
9.
J Obstet Gynaecol Res ; 47(5): 1757-1762, 2021 May.
Article in English | MEDLINE | ID: covidwho-1109588

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the maternal-fetal Doppler patterns in pregnant women recovered from COVID-19. METHODS: This prospective case-control study was conducted in Ankara City Hospital between July 1, 2020 and August 30, 2020. Thirty pregnant women who were diagnosed with COVID-19 and completed the quarantine process were compared with 40 healthy pregnant women in terms of the fetal Doppler parameters. All pregnant women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were followed up in our clinic and their diagnoses have been confirmed in nasopharyngeal and oropharyngeal samples by quantitative real time reverse transcriptase polymerase chain reaction (RT-PCR) method. Doppler ultrasonographic assessment of the uterine arteries (UtA) and middle cerebral artery (MCA) were used in addition to umbilical artery (UA) Doppler between 23 and 40 weeks of gestation. Also, cerebroplacental ratio (CPR) was calculated according to gestational age. RESULTS: The pulsatility and resistance indices of umbilical and UtA showed a significant increase in pregnant women in the study group compared to the control group (p < 0.05). Multivariable logistic regression analysis revealed that pulsatility and resistance indices of the mean UtA were independently associated with disease (OR > 1000, 95%CI 9.77 to >1000, p = 0.009; OR 0,000 95%CI 0,000-0,944, p = 0,049), respectively. Medical treatment was given to 16/30 (53%) of pregnant women diagnosed with COVID-19. CONCLUSION: In conclusion, uterine artery Doppler indices in the third trimester may have clinical value in pregnant women recovered from COVID-19.


Subject(s)
COVID-19 , Pregnant Women , Case-Control Studies , Female , Fetus/diagnostic imaging , Gestational Age , Humans , Middle Cerebral Artery/diagnostic imaging , Pregnancy , Prospective Studies , Pulsatile Flow , SARS-CoV-2 , Ultrasonography, Doppler , Ultrasonography, Prenatal , Umbilical Arteries/diagnostic imaging
10.
J Med Case Rep ; 15(1): 87, 2021 Feb 18.
Article in English | MEDLINE | ID: covidwho-1090620

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), the global pandemic that has spread throughout the world, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the limited scientific evidence on the manifestations and potential impact of this virus on pregnancy, we decided to report this case. CASE PRESENTATION: The patient was a 38 year-old Iranian woman with a triplet pregnancy and a history of primary infertility, as well as hypothyroidism and gestational diabetes. She was hospitalized at 29 weeks and 2 days gestational age due to elevated liver enzymes, and finally, based on a probable diagnosis of gestational cholestasis, she was treated with ursodeoxycholic acid. On the first day of hospitalization, sonography was performed, which showed that biophysical scores and amniotic fluid were normal in all three fetuses, with normal Doppler findings in two fetuses and increased umbilical artery resistance (pulsatility index [PI] > 95%) in one fetus. On day 4 of hospitalization, she developed fever, cough and myalgia, and her COVID-19 test was positive. Despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses leading to the rapid development of absent umbilical artery end-diastolic flow. Finally, 6 days later, the patient underwent cesarean section due to rapid exacerbation of placental insufficiency and declining biophysical score in two of the fetuses. Nasopharyngeal swab COVID-19 tests were negative for the first and third babies and positive for the second baby. The first and third babies died 3 and 13 days after birth, respectively, due to collapsed white lung and sepsis. The second baby was discharged in good general condition. The mother was discharged 3 days after cesarean section. She had no fever at the time of discharge and was also in good general condition. CONCLUSIONS: This was a complicated triplet pregnancy, in which, after maternal infection with COVID-19, despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses, and the third fetus had a positive COVID-19 test after birth. Therefore, in cases of pregnancy with COVID-19 infection, in addition to managing the mother, it seems that physicians would be wise to also give special attention to the possibility of acute placental insufficiency and subsequent fetal hypoxia, and also the probability of vertical transmission.


Subject(s)
COVID-19/physiopathology , Fetal Hypoxia/physiopathology , Placental Insufficiency/physiopathology , Pregnancy Complications, Infectious/physiopathology , Pregnancy, Triplet , Adult , COVID-19/complications , Cesarean Section , Cholestasis, Intrahepatic , Diabetes, Gestational , Female , Fetal Hypoxia/etiology , Hemorrhage , Hospitalization , Humans , Hypothyroidism/complications , Infant, Newborn , Infant, Premature , Infectious Disease Transmission, Vertical , Iran , Lung Diseases , Male , Middle Cerebral Artery/diagnostic imaging , Neonatal Sepsis , Placental Insufficiency/diagnostic imaging , Placental Insufficiency/etiology , Pregnancy , Pregnancy Complications , Pregnancy Trimester, Third , Pulsatile Flow , SARS-CoV-2 , Severity of Illness Index , Ultrasonography, Doppler , Ultrasonography, Prenatal , Umbilical Arteries/diagnostic imaging , Vascular Resistance
11.
Acta Obstet Gynecol Scand ; 100(6): 1034-1039, 2021 06.
Article in English | MEDLINE | ID: covidwho-1087948

ABSTRACT

INTRODUCTION: Our objective was to compare the fetal growth velocity and fetal hemodynamics in pregnancies complicated and in those not complicated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. MATERIAL AND METHODS: Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. The z scores of head circumference, abdominal circumference, femur length, and estimated fetal weight were compared between the two groups. Fetal growth was assessed by analyzing the growth velocity of head circumference, abdominal circumference, femur length, and estimated fetal weight between the second- and third-trimester scans. Similarly, changes in the pulsatility index of uterine, umbilical, and middle cerebral arteries, and their ratios were compared between the two study groups. RESULTS: Forty-nine consecutive pregnancies complicated, and 98 not complicated, by SARS-CoV-2 infection were included. General baseline and pregnancy characteristics were similar between pregnant women with and those without SARS-CoV-2 infection. There was no difference in head circumference, abdominal circumference, femur length, and estimated fetal weight z scores between pregnancies complicated and those not complicated by SARS-CoV-2 infection at both the second- and third-trimester scans. Likewise, there was no difference in the growth velocity of all these body parameters between the two study groups. Finally, there was no difference in the pulsatility index of both maternal and fetal Doppler scans throughout gestation between the two groups. CONCLUSIONS: Pregnancies complicated by SARS-CoV-2 infection are not at higher risk of developing fetal growth restriction through impaired placental function. The findings from this study do not support a policy of increased fetal surveillance in these women.


Subject(s)
COVID-19/complications , Fetal Development , Hemodynamics , Pregnancy Complications, Infectious/virology , Pulsatile Flow , Adult , Biometry , Case-Control Studies , Female , Gestational Age , Humans , Pregnancy , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Prospective Studies , SARS-CoV-2 , Ultrasonography, Doppler
12.
Int J Infect Dis ; 104: 77-82, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1065180

ABSTRACT

BACKGROUND AND PURPOSE: An increasing number of reports have observed thrombosis in severe cases of COVID-19. The aim of this study was to evaluate the incidence of thromboembolism in mild/moderate cases of COVID-19. All of the patients had normal coagulation tests and none had any overt thrombotic complications. Our findings indicate that it is important to screen the thrombotic status of cases with mild/moderate COVID-19. METHODS: Between 11 June and 8 July 2020, 23 patients with mild/moderate COVID-19 pneumonia consented to having computed tomography pulmonary angiography (CPTA) and computed tomography venography (CTV) scans of the lungs and extremity veins. Doppler ultrasound (DUS) was also performed in all patients for screening. The incidence, clinical manifestations, laboratory examinations, imaging features, and prognosis, of patients with venous thromboembolism (VTE) were analyzed and compared with those of patients with COVID-19 pneumonia without VTE. RESULTS: Nineteen patients (82.6%) had VTE, mainly distal limb thrombosis. Only one of the VTE patients was positive when screened by DUS; the other VTE patients were negative by DUS. All of the mild/moderate patients with VTE were screened by CTPA + CTV. Blood tests for inflammatory, coagulation, and biochemical, parameters were all within the normal range, except for WBC and LDH. CONCLUSIONS: When using CTV screening for DVT, we found that the incidence of thrombosis in patients with mild/moderate COVID-19 markedly increased to 82.6% (19/23). Screening for thrombosis is therefore important in patients with COVID-19. CTV is more sensitive than DUS for the detection of thrombosis. More research is now needed to evaluate the significance of thrombosis in COVID-19 pneumonia.


Subject(s)
COVID-19/complications , SARS-CoV-2 , Venous Thromboembolism/epidemiology , Adult , Female , Humans , Male , Middle Aged , Prevalence , Tomography, X-Ray Computed/methods , Ultrasonography, Doppler , Venous Thromboembolism/diagnostic imaging
14.
Medicine (Baltimore) ; 100(1): e24002, 2021 Jan 08.
Article in English | MEDLINE | ID: covidwho-1024159

ABSTRACT

ABSTRACT: We aimed to investigate the prevalence of pulmonary thromboembolism (PTE) and its association with clinical variables in a cohort of hospitalized coronavirus disease 2019 (COVID-19) patients receiving low-molecular-weight heparin (LMWH) at prophylactic dosage.In this retrospective observational study we included COVID-19 patients receiving prophylactic LMWH from admission but still referred for lower-limbs venous Doppler ultrasound (LL-US) and computed tomography pulmonary angiography (CTPA) for clinical PTE suspicion. A dedicated radiologist reviewed CTPA images to assess PTE presence/extension.From March 1 to April 30, 2020, 45 patients were included (34 men, median age 67 years, interquartile range [IQR] 60-76). Twenty-seven (60%) had PTE signs at CTPA, 17/27 (63%) with bilateral involvement, none with main branch PTE. In 33/45 patients (73%) patients LL-US was performed before CTPA, with 3 patients having superficial vein thrombosis (9%, none with CTPA-confirmed PTE) and 1 patient having deep vein thrombosis (3%, with CTPA-confirmed PTE). Thirty-three patients (73%) had at least one comorbidity, mainly hypertension (23/45, 51%) and cardiovascular disease (15/45, 33%). Before CTPA, 5 patients had high D-dimer (11.21 µg/mL, IQR 9.10-13.02), 19 high fibrinogen (550 mg/dL, IQR 476-590), 26 high interleukin-6 (79 pg/mL, IQR 31-282), and 11 high C-reactive protein (9.60 mg/dL, IQR 6.75-10.65), C-reactive protein being the only laboratory parameter significantly differing between patients with and without PTE (P = .002)High PTE incidence (60%) in COVID-19 hospitalized patients under prophylactic LMWH could substantiate further tailoring of anticoagulation therapy.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/complications , Heparin, Low-Molecular-Weight/therapeutic use , Pulmonary Embolism/epidemiology , Thrombolytic Therapy , Aged , Computed Tomography Angiography , Female , Hospitalization , Humans , Incidence , Male , Prevalence , Pulmonary Embolism/prevention & control , Retrospective Studies , Risk Factors , Ultrasonography, Doppler , Venous Thromboembolism/diagnostic imaging , Venous Thromboembolism/prevention & control
15.
BMJ Case Rep ; 13(12)2020 Dec 28.
Article in English | MEDLINE | ID: covidwho-1020894

ABSTRACT

We present a previously healthy man in his 30s who presented with typical viral prodrome symptoms and worsening abdominal pain. He was found to have portal vein thrombosis, with extensive hypercoagulability workup performed. It was determined that the aetiology of thrombus was secondary to acute cytomegalovirus infection. The patient was started on anticoagulation therapy, with later clot resolution demonstrated on abdominal Doppler ultrasound and abdominal CT scan. Given the atypical presentation of this common virus, we performed a literature review of cytomegalovirus-associated portal vein thrombosis in healthy individuals; we found that most patients present with non-specific symptoms of fever and abdominal pain in the setting of a viral prodrome. This case and literature review suggest physicians must consider cytomegalovirus-associated portal vein thrombosis as a potential diagnosis when patients present with abdominal pain and viral symptoms. The literature highlights the need for a consensus on anticoagulation and antiviral therapy.


Subject(s)
Cytomegalovirus Infections/complications , Portal Vein , Venous Thrombosis/virology , Abdominal Pain/etiology , Adult , Anticoagulants/therapeutic use , Blood Coagulation Disorders/drug therapy , Blood Coagulation Disorders/virology , Computed Tomography Angiography , Cytomegalovirus Infections/immunology , Humans , Immunocompetence , Male , Portal Vein/diagnostic imaging , Ultrasonography, Doppler , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy
17.
Sci Rep ; 10(1): 17485, 2020 10 15.
Article in English | MEDLINE | ID: covidwho-872729

ABSTRACT

Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.


Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Animals , Aortic Valve/diagnostic imaging , Aortic Valve/physiology , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/pathology , Coronavirus Infections/virology , Disease Models, Animal , Echocardiography , Female , Heart Failure/complications , Imaging, Three-Dimensional , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Prostheses and Implants , SARS-CoV-2 , Sheep , Ultrasonography, Doppler
20.
Emerg Med J ; 37(10): 644-649, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-751490

ABSTRACT

The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool. LUS shows characteristic changes in viral pneumonitis, and while these changes are not specific for COVID-19, it may be a useful adjunct during the diagnostic process. It is quick to perform and repeat and may be done at the bedside. The authors believe that LUS can help to mitigate uncertainty in undifferentiated patients with respiratory symptoms. This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.


Subject(s)
Coronavirus Infections/diagnostic imaging , Emergency Service, Hospital/statistics & numerical data , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Point-of-Care Systems/organization & administration , Severe Acute Respiratory Syndrome/diagnostic imaging , Ultrasonography, Doppler/methods , COVID-19 , Coronavirus Infections/diagnosis , Female , Humans , Lung/physiopathology , Male , Pandemics/prevention & control , Pandemics/statistics & numerical data , Pneumonia, Viral/diagnosis , Severe Acute Respiratory Syndrome/epidemiology , Severity of Illness Index , Ultrasonography, Doppler/statistics & numerical data , United Kingdom
SELECTION OF CITATIONS
SEARCH DETAIL
...