Venous Thromboembolism Risk and Adherence to Pharmacological Thromboprophylaxis in Hospitalized Patients in Uruguay: First Nationwide Study.

INTRODUCTION: Venous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels. AIM: To determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay. METHODS: An observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients. RESULTS: 1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were "protected" against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk. CONCLUSIONS: Despite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay.

Adhesión insuficiente a la prevención de la enfermedad tromboembólica venosa en Hospitales Uruguayos. Un grave problema en salud / Insufficient adherence to the prevention of venous thromboembolic disease in Uruguayan Hospitals. A serious health problem / Insuficiente adesão à prevenção da doença tromboembólica venosa em hospitais uruguaios. Um sério problema de saúde

Resumen: Introducción: La Enfermedad Tromboembólica Venosa (ETV) es una complicación médica grave, frecuente y prevenible en el paciente hospitalizado. Si bien se ha demostrado la eficacia de su prevención (farmacológica y/o mecánica), su adhesión es insuficiente a nivel internacional y nacional. Objetivos: Contribuir al conocimiento de la realidad nacional sobre tromboprofilaxis en el paciente hospitalizado en vistas a optimizar su adherencia. Conocer la prevalencia del riesgo de ETV en la población analizada y evaluar la adherencia a la indicación de tromboprofilaxis. Metodología. Estudio observacional, descriptivo, transversal y multicéntrico de todos los pacientes médico-quirúrgicos internados en salas de cuidado moderado del Hospital de Clínicas, Hospital Maciel y Sanatorio Americano, durante el 26 y 27 de Abril 2017. Se estudiaron variables sociodemográficas y el porcentaje de pacientes en riesgo de ETV. En los pacientes de riesgo se valoró el porcentaje que reciben tromboprofilaxis farmacológica. Resultados. Se incluyeron 427 pacientes. 63% (269) presentaban patología médica y 37% (158) patología quirúrgica. 294 (68,9%) se encontraban en riesgo de ETV, de los cuales 55,8% (164) recibían profilaxis farmacológica. No la recibían por omisión 19,4% (57), por contraindicación 18,4% (54) y por estar anticoagulados 6,4% (19). Ninguno de los pacientes con contraindicación para tromboprofilaxis farmacológica recibía medidas mecánicas. La población de pacientes en riesgo que recibían tromboprofilaxis era estadísticamente mayor en los pacientes médicos (66,7%, 110/165) que en los quirúrgicos (41,9%, 54/129) p < 0,001. De los 130 pacientes que no tenían indicación de tromboprofilaxis farmacológica 9,3% (12) la recibían. Todos estos pacientes presentaban patología médica. Conclusiones: En nuestro estudio encontramos un 68,9 % de pacientes en riesgo, lo que confirma que es un problema grave y frecuente. Con respecto a la tromboprofilaxis, si bien objetivamos una franca mejoría con respecto a estudios nacionales previos, creemos que es aún insuficiente y debemos seguir trabajando esta línea.

Abstract: Introduction: Venous Thromboembolic Disease (VTE) is a serious, frequent and preventable medical complication in hospitalized patients. Although the efficacy of its prevention (pharmacological and / or mechanical) has been demonstrated, its adherence is insufficient at the international and national level. Objectives: Contribute to the knowledge of the national reality on thromboprophylaxis in hospitalized patients in order to optimize their adherence. To know the prevalence of the risk of VTE in the analyzed population and evaluate adherence to the indication of thromboprophylaxis. Methodology: Observational, descriptive, cross-sectional and multicenter study of all medical-surgical patients admitted to moderate care wards of Hospital de Clínicas, Hospital Maciel and Sanatorio Americano, during April 26 and 27, 2017. Sociodemographic variables and the percentage of patients were studied at risk of VTE. In patients at risk, the percentage who received pharmacological thromboprophylaxis was assessed. Results: 427 patients were included. 63% (269) presented medical pathology and 37% (158) surgical pathology. 294 (68.9%) were at risk of VTE, of which 55.8% (164) were receiving pharmacological prophylaxis. They did not receive it by omission 19.4% (57), due to contraindication 18.4% (54) and because they were anticoagulated 6.4% (19). None of the patients with a contraindication for pharmacological thromboprophylaxis received mechanical measures. The population of patients at risk who received thromboprophylaxis was statistically higher in medical patients (66.7%, 110/165) than in surgical patients (41.9%, 54/129) p <0.001. Of the 130 patients who did not have an indication for drug thromboprophylaxis, 9.3% (12) received it. All these patients presented medical pathology. Conclusions: In our study we found 68.9% of patients at risk, which confirms that it is a serious and frequent problem. With regard to thromboprophylaxis, although we observed a clear improvement compared to previous national studies, we believe that it is still insufficient and we must continue working on this line.

Resumo: Introdução: A Doença Tromboembólica Venosa (TEV) é uma complicação médica grave, frequente e evitável em pacientes hospitalizados. Embora a eficácia da sua prevenção (farmacológica e / ou mecânica) tenha sido demonstrada, a sua adesão é insuficiente a nível internacional e nacional. Objetivos: Contribuir para o conhecimento da realidade nacional sobre tromboprofilaxia em pacientes hospitalizados de forma a otimizar a sua adesão. Conhecer a prevalência de risco de TEV na população analisada e avaliar a adesão à indicação de tromboprofilaxia. Metodologia: Estudo observacional, descritivo, transversal e multicêntrico de todos os pacientes médico-cirúrgicos internados em unidades de cuidados moderados do Hospital de Clínicas, Hospital Maciel e Sanatorio Americano, durante os dias 26 e 27 de abril de 2017. Foram estudadas variáveis sociodemográficas e o percentual de pacientes em risco de TEV. Em pacientes de risco, foi avaliada a porcentagem que recebeu tromboprofilaxia farmacológica. Resultados: 427 pacientes foram incluídos. 63% (269) apresentavam patologia médica e 37% (158) patologia cirúrgica. 294 (68,9%) estavam em risco de TEV, dos quais 55,8% (164) recebiam profilaxia farmacológica. Não o receberam por omissão 19,4% (57), por contra-indicação 18,4% (54) e por estarem anticoagulados 6,4% (19). Nenhum dos pacientes com contra-indicação para tromboprofilaxia farmacológica recebeu medidas mecânicas. A população de pacientes em risco que recebeu tromboprofilaxia foi estatisticamente maior em pacientes médicos (66,7%, 110/165) do que em pacientes cirúrgicos (41,9%, 54/129) p <0,001. Dos 130 pacientes que não tinham indicação de tromboprofilaxia medicamentosa, 9,3% (12) a receberam. Todos esses pacientes apresentavam patologia médica. Conclusões: Em nosso estudo encontramos 68,9% de pacientes em risco, o que confirma que se trata de um problema grave e frequente. No que se refere à tromboprofilaxia, embora tenhamos observado uma clara melhora em relação aos estudos nacionais anteriores, acreditamos que ainda é insuficiente e devemos continuar trabalhando nessa linha.

[Etiology of renal infarction. A systematic review]. / Etiología del infarto renal. Revisión sistemática de 1.582 casos de la literatura.

BACKGROUND: Renal infarction is a rare and usually underdiagnosed entity. AIM: To study the etiology of renal infarction in published series. MATERIAL AND METHODS: A systematic review was carried out selecting 28 series that included 1582 patients. RESULTS: The proposed cause was cardiac or aortic embolism in 718 cases (45%), an arterial injury in 253 (16%), prothrombotic factors in 146 (9%) and other causes in 79 (5%). 291 cases were classified as idiopathic (18.4%). Atrial fibrillation was present in 542 of the 718 patients with cardiac or aortic embolism. CONCLUSIONS: The main cause of renal infarction is cardiac or aortic embolism and among this group, most cases are due to atrial fibrillation. One out of five cases is labeled as idiopathic.

Toxicology of Avermectins and Milbemycins (Macrocyclic Lactones) and the Role of P-Glycoprotein in Dogs and Cats.

Overdoses of macrocyclic lactones in dogs and cats can result in such signs as tremors, ataxia, seizures, coma, and blindness. Dogs with the ABCB1-1Δ gene defect are predisposed to macrocyclic lactone toxicosis at lower dosages than dogs without the defect. Intravenous lipid emulsion therapy has been suggested for treatment of macrocyclic lactone toxicosis but evidence of efficacy is limited. Initial decontamination and supportive care remain the mainstays of therapy for macrocyclic lactone toxicosis.

Clinical signs associated with ingestion of black walnut tree (Juglans nigra) wood, nuts, and hulls in dogs: 93 cases (2001-2012).

OBJECTIVE: To identify clinical signs associated with oral exposure to black walnut tree (Juglans nigra) wood, nuts, or nut hulls in dogs and to compare clinical syndromes between dogs that ingested wood and dogs that ingested the walnuts or nut hulls. DESIGN: Retrospective case series. ANIMALS: 93 dogs. PROCEDURES: Records of dogs with oral exposure to black walnut wood, nuts, or nut hulls between November 2001 and December 2012 were retrieved from the Animal Poison Control Center database. Records were reviewed, and data regarding signalment; exposure; time of onset, type, and duration of clinical signs; serum biochemical abnormalities; treatment; and response to treatment were collected. Results were compared statistically between dogs that ingested wood and those that ingested nut components. RESULTS: 28 cases involved exposure to wood, and 65 involved exposure to nuts or hulls. Spontaneous vomiting was commonly observed (13/28 [46%] and 31/65 [48%] dogs that ingested wood and nut components, respectively). Neurologic or musculoskeletal signs were significantly more common in dogs that ingested wood (26/28 [93%]) than in those that ingested nuts or hulls (15/65 [23%]). Relative risk of developing neurologic signs after ingestion of wood was approximately 4 times that after ingestion of nuts or hulls. CONCLUSIONS AND CLINICAL RELEVANCE: Ingestion of black walnut wood by dogs resulted in a clinical syndrome in which neurologic or musculoskeletal signs were most frequently reported, whereas ingestion of black walnuts or their hulls was most commonly associated with vomiting. To our knowledge, this is the first report describing 2 different clinical syndromes associated with exposure to black walnut tree components in dogs.

Empiema epidural espinal: clínica, diagnóstico y tratamiento a propósito de tres casos / Spinal epidural empyema: clinical, diagnosis and treatment with regard to three cases

El empiema epidural espinal (EEE) es una infección supurada del sistema nervioso central, predomina en el sexo masculino y en la edad media de la vida. El microorganismo mayormente implicado es Staphylococcus aureus. Alcanza el espacio epidural por contigüidad, inoculación directa o diseminación a distancia. Se manifiesta con fiebre, dolor espinal y déficit neurológico. Se presentan tres casos de EEE y se realizan consideraciones clínicas, microbiológicas y terapéuticas.

Abstract Spinal epidural empyema is a suppurating infection of the central nervous system, more frequent in male patients and during the midlife stage. Staphylococcus aureus is the most commonly found microorganism. It reaches the epidural space extending contiguously, by direct inoculation or distant spread. It manifests with fever, spinal pain and neurological deficit. Three cases of spinal epidural empyema are presented and clinical, microbiological and therapeutic considerations are made.

Resumo O empiema epidural espinal (EEE) é uma infecção supurada do sistema nervoso central, predominante no sexo masculino e na meia idade. O micro-organismo implicado na maioria dos casos é o Staphylococcus aureus. Atinge o espaço epidural por contiguidade, inoculação direta ou disseminação a distancia. Manifesta-se com febre, dor espinal e déficit neurológico. Apresentam-se três casos de EEE e fazem-se considerações clínicas, microbiológicas e terapêuticas.

Hiperpotasemia severa en emergencia: Manifestaciones clínicas y manejo terapéutico a propósito de tres casos / Severe hyperkalemia in the emergency: Clinical manifestations and therapeutic management on three cases

La hiperpotasemia se define como la elevación del potasio plasmático por encima de 5,5 mEq/L. Es una alteración electrolítica que puede determinar complicaciones clínicas fatales, siendo las más graves las cardiovasculares y musculares. Es consecuencia de una disminución en la eliminación renal del potasio, distribución corporal desde el espacio intracelular al extracelular, o aumento del aporte del ion. Entre los factores que se vinculan a la presencia de repercusiones clínicas está el nivel de hiperpotasemia, la velocidad de su instalación y la coexistencia con otras disionías. Se presentan tres casos de hiperpotasemia severa asistidos en el departamento de emergencia. Presentan como elementos comunes la presencia de alteraciones electrocardiográficas y la necesidad de hemodiálisis para su corrección. La estrategia terapéutica consiste en antagonizar los efectos a nivel de la membrana celular, facilitar el ingreso del potasio al espacio intracelular y remover el exceso corporal del ion. Se destaca la importancia del reconocimiento y diagnóstico precoz de las repercusiones clínicas de la hiperpotasemia en los pacientes con riesgo de presentarla.

ABSTRACT:: Arch Med Interna 2012 - 34(3):91-94 Hyperkalemia is defined as the elevation of serum potassium levels over 5.5 mEq/L. It is an electrolytic disorder that may lead to lethal clinical complications, with cardiovascular and muscular events being the worst. It results from a reduction of potassium excretion by the kidney, body distribution from the intracellular to the extracellular space, or an increased intake or administration of the ion. The clinical impact depends on a number of factors, including the severity of the hyperkalemia, its rate of onset and the co-existence with other ionic imbalances. The paper discusses two patients that sought care at the emergency department with severe hyperkalemia. They both presented with electrocardiographic disorders, and they both required hemodialysis. The therapeutic strategy consists of antagonizing the effects at the level of the cell membrane, facilitating the transfer of potassium into the cell and removing the excessive ion from the body. The authors emphasize the importance of an early detection and diagnosis of the clinical impact of hyperkalemia in the patients at risk of developing the disorder.

Venous thromboembolic disease in systemic autoimmune diseases: an association to keep in mind.

Systemic autoimmune diseases are conditions of unknown etiology, characterized by the simultaneous or successive involvement of most organs and systems, as well as the presence of autoantibodies as biological markers. Venous thromboembolic disease has a higher incidence in this population when compared to healthy individuals. This responds to the increase in congenital and acquired risk factors in this group. One of the main risk factors is linked to the presence of antiphospholipid antibodies, whose prevalence is increased among patients with such conditions.

Toxicology of avermectins and milbemycins (macrocylic lactones) and the role of P-glycoprotein in dogs and cats.

The macrocyclic lactones (MLs) are parasiticides able to kill a wide variety of arthropods and nematodes. They have a high margin of safety for labeled indications, and ivermectin has become the best-selling antiparasitic in the world. Dogs of certain breeds and mixtures of those breeds have a defect in the ABCB1 gene (formerly MDR1 gene) that results in a lack of functional P-glycoprotein, which leads to accumulation of the MLs in the central nervous system and a higher risk of adverse effects when exposed. There is no specific antidote for ML toxicosis so the most important part of treatment is good supportive care.

[Stewart-Treves syndrome: report of one case]. / Síndrome de Stewart-Treves: Caso clínico.

Angiosarcomas are malignant tumors derived from the endothelium of blood vessel (hemangiosarcomas) or lymph vessels (lymphangiosarcomas). Lymph edema of the limbs is considered secondary when extrinsic injuries are observed and primary when these injuries are not present. Stewart-Treves syndrome or a Lymphangiosarcoma, developed over a chronic lymph edema, is a rare complication described in mastectomized patients but it can be observed in lymph edemas located elsewhere. It appears as nodular skin lesions that grow, multiply quickly and frequently metastasize. We report a 40-year-old mole with an angiosarcoma associated with primary chronic lower limb lymph edema. The patient consulted for a history of weight loss and malaise and appearance of violaceous lesions over the zone of lymph edema and inguinal lymph node involvement. A CT scan showed bilateral lung lesions and enlargement of inguinal and iliac lymph nodes. A biopsy of one of the skin lesions disclosed an angiosarcoma, diagnosis that was confirmed with immuno-histochemistry Chemotherapy was started but the patient died five months after the diagnosis.

Síndrome de Stewart-Treves: Caso clínico / Stewart-Treves syndrome: Report of one case

Angiosarcomas are malignant tumors derived from the endothelium of blood vessel (hemangiosarcomas) or lymph vessels (lymphangiosarcomas). Lymph edema of the limbs is considered secondary when extrinsic injuries are observed and primary when these injuries are not present. Stewart-Treves syndrome or a Lymphangiosarcoma, developed over a chronic lymph edema, is a rare complication described in mastectomized patients but it can be observed in lymph edemas located elsewhere. It appears as nodular skin lesions that grow, multiply quickly and frequently metastasize. We report a 40-year-old mole with an angiosarcoma associated with primary chronic lower limb lymph edema. The patient consulted for a history of weight loss and malaise and appearance of violaceous lesions over the zone of lymph edema and inguinal lymph node involvement. A CT scan showed bilateral lung lesions and enlargement of inguinal and iliac lymph nodes. A biopsy of one of the skin lesions disclosed an angiosarcoma, diagnosis that was confirmed with immuno-histochemistry Chemotherapy was started but the patient died five months after the diagnosis.

Ivermectin toxicosis in dogs: a retrospective study.

Ivermectin is a commonly used veterinary drug that may cause serious problems in overdose situations. A retrospective study was completed, which evaluated canine exposures to ivermectin from 1998 to 2005. The cases were evaluated based on ivermectin dosage, clinical signs seen, signalment of the animal involved, and the potential that the animal could have a p-glycoprotein defect. Results showed that clinical signs may be seen in some animals at doses lower than previously reported. Some dogs may have p-glycoprotein defects or other reasons for increased susceptibility to ivermectin toxicosis. The clinician should be aware that clinical signs may develop even at dosages previously thought to be of little risk (e.g., 0.2 to 2.5 mg/kg in breeds historically considered to have normal p-glycoprotein function).

Thallium toxicosis in a Pit Bull Terrier.

Thallotoxicosis is described in an adult Pit Bull Terrier. The dog exhibited anorexia, emesis, weakness, conscious proprioceptive deficits, and a hemorrhagic diarrhea before death. A severe, acute necrotizing enterocolitis was evident upon histological examination, as was a multifocal to coalescing pulmonary edema. Liver and kidney thallium concentrations were 18 and 26 ppm, respectively. The source of the thallium was determined to be thallium sulfate obtained by a person with the intent to harm family members. Although thallium has not been produced in the United States for 20 years, this report demonstrates the need to consider thallium toxicosis as a differential diagnosis for animals presenting with vague and mixed gastrointestinal and neurological signs.