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1.
J Clin Med ; 13(8)2024 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-38673677

RESUMO

The therapeutic management and short-term consequences of the coronavirus disease 2019 (COVID-19) are well known. However, COVID-19 post-acute sequelae are less known and represent a public health problem worldwide. Patients with COVID-19 who present post-acute sequelae may display immune dysregulation, a procoagulant state, and persistent microvascular endotheliopathy that could trigger microvascular thrombosis. These elements have also been implicated in the physiopathology of postural orthostatic tachycardia syndrome, a frequent sequela in post-COVID-19 patients. These mechanisms, directly associated with post-acute sequelae, might determine the thrombotic consequences of COVID-19 and the need for early anticoagulation therapy. In this context, heparin has several potential benefits, including immunomodulatory, anticoagulant, antiviral, pro-endothelial, and vascular effects, that could be helpful in the treatment of COVID-19 post-acute sequelae. In this article, we review the evidence surrounding the post-acute sequelae of COVID-19 and the potential benefits of the use of heparin, with a special focus on the treatment of postural orthostatic tachycardia syndrome.

2.
Front Neurol ; 14: 1221518, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37654428

RESUMO

The COVID-19 pandemic has caused a challenge for our society due to the post-acute sequelae of the disease. Persistent symptoms and long-term multiorgan complications, known as post-acute COVID-19 syndrome, can occur beyond 4 weeks from the onset of the COVID-19 infection. Postural orthostatic tachycardia syndrome (POTS) is considered a variety of dysautonomia, which is characterized by chronic symptoms that occur with standing and a sustained increase in heart rate, without orthostatic hypotension. POTS can lead to debilitating symptoms, significant disability, and impaired quality of life. In this narrative review, the etiopathogenic basis, epidemiology, clinical manifestations, diagnosis, treatment, prognosis, and socioeconomic impact of POTS, as well as other related dysautonomic disorders, after COVID-19 infection and SARS-CoV-2 postvaccination, were discussed. After a search conducted in March 2023, a total of 89 relevant articles were selected from the PubMed, Google Scholar, and Web of Science databases. The review highlights the importance of recognizing and managing POTS after COVID-19 infection and vaccination, and the approach to autonomic disorders should be known by all specialists in different medical areas. The diagnosis of POTS requires a comprehensive clinical assessment, including a detailed medical history, physical examination, orthostatic vital signs, and autonomic function tests. The treatment of POTS after COVID-19 infection or vaccination is mainly focused on lifestyle modifications, such as increased fluid and salt intake, exercise, and graduated compression stockings. Pharmacotherapy, such as beta-blockers, fludrocortisone, midodrine, and ivabradine, may also be used in selected cases. Further research is needed to understand the underlying mechanisms, risk factors, and optimal treatment strategies for this complication.

3.
Med. clín (Ed. impr.) ; 139(11): 467-472, nov. 2012. tab
Artigo em Espanhol | IBECS | ID: ibc-105454

RESUMO

Fundamento y objetivo: El objetivo de este estudio es evaluar el grado de adecuación de tromboprofilaxis en pacientes médicos hospitalizados aplicando 2 guías de práctica clínica y analizar el grado de acuerdo entre ambas. Pacientes y método: Estudio de corte transversal en servicios médicos de un hospital de tercer nivel. Calculamos el riesgo tromboembólico y la adecuación de tromboprofilaxis aplicando las recomendaciones de la viii conferencia de la American College of Chest Physicians (ACCP) y la Guía de Profilaxis de Patología Tromboembólica en Patología Médica (PRETEMED), así como su concordancia. Resultados: Se analizaron 128 pacientes. Según la guía PRETEMED, el 34,4% de los pacientes tenían riesgo bajo, un 6,3% moderado y un 59,4% alto; la tromboprofilaxis fue adecuada en el 72,7% (intervalo de confianza del 95% [IC 95%] 64,4-79,9), fueron infratratados el 18,8% (IC 95% 12,7-26,2) y sobretratados el 8,6% (IC 95% 4,6-14,4). Según las recomendaciones de la ACCP, un 50% tenían bajo riesgo y un 50% alto; la tromboprofilaxis fue adecuada en el 74,2% (IC 95% 66,1-81,2), fueron infratratados el 10,9% (IC 95% 6,4-17,3) y sobretratados el 14,8% (IC 95% 9,4-21,8). Agrupando el riesgo PRETEMED en bajo o moderado-alto frente a riesgo ACCP bajo o alto, el índice de concordancia entre guías fue de 0,68 (IC 95% 0,56-0,81). Agrupando el riesgo PRETEMED en bajo-moderado o alto frente a riesgo ACCP bajo o alto el índice de concordancia fue de 0,81 (IC 95% 0,71-0,91). Conclusiones: Alrededor de un cuarto de los pacientes médicos hospitalizados no recibieron tromboprofilaxis adecuada, demostrándose un importante margen de mejora. La guía PRETEMED y los criterios de la ACCP presentan diferencias en la valoración del riesgo debido principalmente a que PRETEMED sobrestima el riesgo de enfermedad tromboembólica venosa al contemplar más factores de riesgo (AU)


Background and objective: The aim of this study is to evaluate the use of venous thromboembolism prophylaxis in hospitalized medical patients using 2 clinical practice guidelines and to analyze the agreement between them. Patients and methods: Cross-sectional study of medical services in a third level hospital. We calculated the thromboembolic risk and the thromboprophylaxis adequacy by implementing the recommendations of viii conference of the American College of Chest Physicians (ACCP) and PRETEMED guide as well as their agreement. Results: One hundred and twenty eight patients were included in the study. According to the PRETEMED guide, 34.4% of patients were low risk, 6.3% moderate and 59.4% high, with appropriate prophylaxis in 72.7% of patients (CI95%: 64.4-79.9), 18.8% (CI95%: 12.7-26.2) were undertreated and 8.6% (CI95%: 4.6-14.4) overtreated. According to ACCP recommendations, 50% of patients were low risk and 50% high, with appropriate prophylaxis in 74.2% of patients (CI95%: 66.1-81.2), 10.9% (CI95%: 6.4-17.3) were undertreated and 14.8% (CI95%: 9.4-21.8) overtreated. When PRETEMED risk was classified into low or moderate-high group versus ACCP risk low or high, the grade of concordance between both guides was 0.68 (CI95%: 0.56-0.81). When PRETEMED risk was classified into low-moderate or high group versus ACCP risk low or high, the grade of concordance between both guides was 0.81 (CI95%: 0.71-0.91). Conclusions: About a quarter of hospitalized medical patients did not receive adequate prophylaxis, showing an important room for improvement. PRETEMED guide and ACCP recommendations differ in risk assessment mainly because PRETEMED guide overestimates the risk of venous thromboembolism since it includes more risk factors (AU)


Assuntos
Humanos , Tromboembolia/epidemiologia , Hospitalização/estatística & dados numéricos , Fatores de Risco , Embolia Pulmonar/prevenção & controle , Trombose Venosa/prevenção & controle , Padrões de Prática Médica
4.
Med. clín (Ed. impr.) ; 139(supl.2): 13-18, oct. 2012. tab
Artigo em Espanhol | IBECS | ID: ibc-141304

RESUMO

Los pacientes sometidos a un recambio articular de cadera o rodilla presentan un riesgo elevado de tromboembolia en el período postoperatorio, riesgo que se mantiene tras el alta del hospital, por lo que se recomienda que reciban tromboprofilaxis durante 10-35 días. Sin embargo, a pesar de que las mejoras en las técnicas quirúrgicas y la utilización de anticoagulantes de forma generalizada han disminuido su incidencia, la enfermedad tromboembólica venosa continúa siendo una complicación temible y la embolia de pulmón es todavía la principal causa de muerte en estos pacientes. Hasta ahora, las heparinas de bajo peso molecular han sido el tratamiento de elección, aunque su administración parenteral supone un inconveniente y crea problemas de adherencia al tratamiento en algunos pacientes. En los últimos años se ha desarrollado un nuevo grupo de anticoagulantes con diferentes mecanismos de acción, administración oral, dosis fija, escasas interacciones y un efecto predecible. En la actualidad, 1 inhibidor de la trombina (dabigatran) y 2 fármacos inhibidores del factor Xa (rivaroxaban y apixaban) están ya disponibles para la prevención de la enfermedad tromboembólica venosa tras una artroplastia de cadera o rodilla, habiendo demostrado en diversos estudios en fase III una eficacia igual o superior a la enoxaparina, con un nivel de seguridad equiparable. Estos nuevos anticoagulantes pueden suponer una importante mejora en la prevención a largo plazo, particularmente en el ámbito extrahospitalario (AU)


Patients undergoing a total hip or total knee arthroplasty are at high risk of thromboembolism in the postoperative period and after hospital discharge; consequently, clinical guidelines recommended thromboprophylaxis for 10-35 days. Although improved surgical techniques and widespread use of anticoagulants have substantially reduced the incidence of thromboembolic events, venous thromboembolic disease is still a dangerous complication and, in these patients, pulmonary embolism remains the main cause of death. Low molecular weight heparins have long been the mainstay of prevention. However, parenteral administration is inconvenient for many patients, which can sometimes cause poor treatment adherence. In recent years, a new class of oral, fixed-dose anticoagulants, with different mechanisms of action, few interactions and a predictable effect, has been developed. At present, a thrombin inhibitor (dabigatran) and two FXa inhibitors (rivaroxaban and apixaban) are available for prophylaxis in patients after total knee or total hip arthroplasty. In several phase III clinical trials, these drugs have been shown to have equal or superior efficacy and a similar degree of safety to conventional therapy with enoxaparin. These new drugs can significantly improve long-term prevention, particularly in the community setting (AU)


Assuntos
Humanos , Anticoagulantes/uso terapêutico , Artroplastia de Quadril , Artroplastia do Joelho , Complicações Pós-Operatórias/prevenção & controle , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Benzimidazóis/uso terapêutico , Morfolinas/uso terapêutico , Embolia Pulmonar/etiologia , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Tiofenos/uso terapêutico , Tromboembolia Venosa/etiologia , beta-Alanina/análogos & derivados , beta-Alanina/uso terapêutico
6.
Med Clin (Barc) ; 139 Suppl 2: 13-8, 2012 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-23498067

RESUMO

Patients undergoing a total hip or total knee arthroplasty are at high risk of thromboembolism in the postoperative period and after hospital discharge; consequently, clinical guidelines recommended thromboprophylaxis for 10-35 days. Although improved surgical techniques and widespread use of anticoagulants have substantially reduced the incidence of thromboembolic events, venous thromboembolic disease is still a dangerous complication and, in these patients, pulmonary embolism remains the main cause of death. Low molecular weight heparins have long been the mainstay of prevention. However, parenteral administration is inconvenient for many patients, which can sometimes cause poor treatment adherence. In recent years, a new class of oral, fixed-dose anticoagulants, with different mechanisms of action, few interactions and a predictable effect, has been developed. At present, a thrombin inhibitor (dabigatran) and two FXa inhibitors (rivaroxaban and apixaban) are available for prophylaxis in patients after total knee or total hip arthroplasty. In several phase III clinical trials, these drugs have been shown to have equal or superior efficacy and a similar degree of safety to conventional therapy with enoxaparin. These new drugs can significantly improve long-term prevention, particularly in the community setting.


Assuntos
Anticoagulantes/uso terapêutico , Artroplastia de Quadril , Artroplastia do Joelho , Complicações Pós-Operatórias/prevenção & controle , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Benzimidazóis/uso terapêutico , Dabigatrana , Humanos , Morfolinas/uso terapêutico , Embolia Pulmonar/etiologia , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana , Tiofenos/uso terapêutico , Tromboembolia Venosa/etiologia , beta-Alanina/análogos & derivados , beta-Alanina/uso terapêutico
7.
Med Clin (Barc) ; 139(11): 467-72, 2012 Nov 03.
Artigo em Espanhol | MEDLINE | ID: mdl-22032816

RESUMO

BACKGROUND AND OBJECTIVE: The aim of this study is to evaluate the use of venous thromboembolism prophylaxis in hospitalized medical patients using 2 clinical practice guidelines and to analyze the agreement between them. PATIENTS AND METHODS: Cross-sectional study of medical services in a third level hospital. We calculated the thromboembolic risk and the thromboprophylaxis adequacy by implementing the recommendations of viii conference of the American College of Chest Physicians (ACCP) and PRETEMED guide as well as their agreement. RESULTS: One hundred and twenty eight patients were included in the study. According to the PRETEMED guide, 34.4% of patients were low risk, 6.3% moderate and 59.4% high, with appropriate prophylaxis in 72.7% of patients (CI95%: 64.4-79.9), 18.8% (CI95%: 12.7-26.2) were undertreated and 8.6% (CI95%: 4.6-14.4) overtreated. According to ACCP recommendations, 50% of patients were low risk and 50% high, with appropriate prophylaxis in 74.2% of patients (CI95%: 66.1-81.2), 10.9% (CI95%: 6.4-17.3) were undertreated and 14.8% (CI95%: 9.4-21.8) overtreated. When PRETEMED risk was classified into low or moderate-high group versus ACCP risk low or high, the grade of concordance between both guides was 0.68 (CI95%: 0.56-0.81). When PRETEMED risk was classified into low-moderate or high group versus ACCP risk low or high, the grade of concordance between both guides was 0.81 (CI95%: 0.71-0.91). CONCLUSIONS: About a quarter of hospitalized medical patients did not receive adequate prophylaxis, showing an important room for improvement. PRETEMED guide and ACCP recommendations differ in risk assessment mainly because PRETEMED guide overestimates the risk of venous thromboembolism since it includes more risk factors.


Assuntos
Enoxaparina/uso terapêutico , Fibrinolíticos/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Heparina de Baixo Peso Molecular/uso terapêutico , Embolia Pulmonar/prevenção & controle , Trombose Venosa/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Técnicas de Apoio para a Decisão , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Medição de Risco , Fatores de Risco , Espanha , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia
9.
J Craniomaxillofac Surg ; 34(8): 489-93, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17157517

RESUMO

INTRODUCTION: Madelung's disease is characterized by benign, non-encapsulated accumulations of fat in a symmetrical manner. Although rare, symmetrical lipomatosis involving the tongue exclusively has been previously reported. Here another case is presented of Madelung's disease involving the tongue. CASE REPORT: A 57-year-old woman was referred with the diagnosis of Madelung's disease, with slight difficulty in swallowing, dysarthria and dyspnoea while sleeping due to tongue swelling. Clinical examination revealed multiple, large disfiguring soft masses involving neck, upper arms and hips. There was enlargement of the tongue with bilateral protrusions and buccal displacement of the teeth. The masses were soft and non-tender. Bilateral partial glossectomy was performed under general anaesthesia. Histology revealed adipose tissue, interspersed within the lingual musculature. DISCUSSION: Lipomas in Madelung's disease are characterized by multiplicity, non-encapsulation and invasiveness. Over the years, the fat deposits enlarge significantly, become cosmetically deforming, and cause dyspnoea and dysphagia in advanced cases. The aetiology of benign symmetrical lipomatosis is still unknown. It is often accompanied by liver dysfunction probably due to alcoholism. Treatment is limited to surgical removal of the fatty tissue, in patients with a severe cosmetic deformity causing psychological stress, and in patients with dyspnoea or dysphagia if there is restriction of the aerodigestive tract.


Assuntos
Lipomatose Simétrica Múltipla/patologia , Lipomatose Simétrica Múltipla/cirurgia , Macroglossia/patologia , Macroglossia/cirurgia , Transtornos de Deglutição/etiologia , Disartria/etiologia , Dispneia/etiologia , Feminino , Glossectomia , Humanos , Lipomatose Simétrica Múltipla/complicações , Macroglossia/complicações , Macroglossia/etiologia , Pessoa de Meia-Idade
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