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Immuno-Pathologic Basis of COVID-19 and the Management of Mild and Moderate Cases
Published in Srijan Goswami, Chiranjeeb Dey, COVID-19 and SARS-CoV-2, 2022
Debdeep Dasgupta, Srijan Goswami, Chiranjeeb Dey
Thrombosis refers to the formation of blood clots inside a blood vessel; the clot formed is termed a thrombus. Thrombus prevents the normal circulation of blood to concerned organs. The formation of blood clot or coagulation is the body's first line of defense against bleeding. Embolism, also known as thromboembolism, represents blockage in one of the arteries of the body due to a blood clot that has broken off from another location in the body (embolus) and traveled through the bloodstream to lodge in a small blood vessel (Cecil et al., 2012; Kumar et al., 2014; Hall, 2015; McPhee et al., 2021).
Methodology and Clinical Implementation of Ventilation/Perfusion Tomography for Diagnosis and Follow-up of Pulmonary Embolism and Other Pulmonary Diseases
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
An important step in the diagnostic procedure is to quantify the extent of embolism. V/P SPECT is particularly suitable for this because it has a greater sensitivity and lower radiation dose than CTPA. The number of segments and sub-segments indicating typical mismatch in PE are counted and expressed in per cent of the total lung parenchyma [20]. Furthermore, areas with ventilation abnormalities are recognized. This procedure allows estimation of the degree of lung malfunction. Quantification of V/P SPECT helps clinicians to evaluate home treatment of PE. Patients with a PE compromising up to 40 per cent of the lung perfusion can be safely treated at home if ventilation abnormalities engage not more than 20 per cent of the lung [21].
Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The diagnosis of pelvic thrombophlebitis, in either form, may not be confirmed by radiographic study. Clinical response to heparin may secure the diagnosis in both the acute and the enigmatic syndromes. Full anticoagulation should be instituted along with broad-spectrum antibiotics (Table 2) as microorganisms have been isolated from resected venous specimens and require treatment to promote resolution of the thrombus (73,85). Resolution of the fever does not imply resolution of the clot, so a full course of anticoagulation is necessary. Substitution of low molecular weight for unfractionated heparin seems reasonable, but has not been systematically studied. Primary surgical ligation of ovarian veins and vena cava, employed 50 years ago, decreased mortality from 50% to 10% (86), but is fraught with risks of significant hemorrhage, embolization, and death (74). Today, a surgical approach should be reserved for patients who do not respond to anticoagulation plus antibiotics, who experience pulmonary embolism while on therapeutic anticoagulation, or in whom the diagnosis is uncertain. If pelvic vein thrombosis is found unexpectedly at postpartum laparotomy, closure of the abdomen without vein ligation and institution of medical therapy is probably the treatment of choice. Need for anticoagulation during or after subsequent pregnancy is probably not required.
Association between CHARGE-AF risk score and LA mechanics: LA reservoir strain can be a single parameter for predicting AF risk
Published in Acta Cardiologica, 2023
Turkan Seda Tan, Kubra Korkmaz, Irem Muge Akbulut, Kaan Akin, Yakup Yunus Yamanturk, Haci Ali Kurklu, Volkan Kozluca, Kerim Esenboga, Irem Dincer
Stroke is one of the main causes of death and disability worldwide. The global burden of stroke is rising due to the ageing population [1]. Ischaemic stroke, which is a prevalent type of stroke, can result from a variety of causes, such as atherosclerosis of the cerebral circulation, occlusion of small cerebral vessels, and cardiac embolism [2]. Given increases in life expectancy, the incidence of ischaemic stroke is expected to increase in the future [3]. Approximately one-third of ischaemic strokes remain cryptogenic after the standard evaluations of ischaemic strokes [4]. Due to the embolic nature of cryptogenic strokes, these strokes are classified as embolic stroke of undetermined source (ESUS) [5]. Causes of embolism may be due to artery-to-artery embolism, or emboli may originate directly from the heart. Long-term follow-up of cryptogenic stroke (CS) patients with continuous heart rhythm monitoring often reveals paroxysmal AF that was not apparent at the time of stroke [6]. With the hope that oral anticoagulant therapy can prevent most stroke in AF, the detection of patients who are at high risk for developing atrial fibrillation is essential for the primary prevention of stroke.
Bispecific antibodies for the treatment of hemophilia A
Published in Expert Opinion on Biological Therapy, 2022
In the post-marketing setting up to 31 December 2019, TMA was identified in one additional patient from over 6100 cases treated with emicizumab [57]. This adverse event was associated with the previously reported risk of concomitant aPCC. A total of 16 thromboembolic events (TE) were recorded. Two patients had been treated with aPCC and three appeared to be CV catheter device-related events. Ten events were non-device related TE and eight of these were in patients with congenital hemophilia A. Six incidents of myocardial infarction were described in individuals with cardiovascular risk factors. Pulmonary embolism was noted in one other cases. These wider population post-marketing studies indicated that concomitant use of aPCC would be a significant risk of TMA/TE. Careful attention and monitoring of patients is recommended especially in those known with increased cardiovascular risk.
Detachment and embolization of totally implantable central venous access devices: diagnosis and management
Published in Acta Chirurgica Belgica, 2022
Halil Kara, Akif Enes Arikan, Onur Dulgeroglu, Cihan Uras, Gul Esen Icten, Burcin Tutar, Ulku Tuba Parlakkilic, Ozlem Sonmez
Many publications reported that most patients were asymptomatic and diagnosis was reached via routine chest X-ray [2,4]. Catheter malfunction was the most common finding in reviews by Surov et al. [10] and Cheng et al. [9]. Mirza et al. [8] reported the most common presentation as pain and/or swelling upon injection (60%). In addition to these findings, inability to withdraw blood from the catheter, extravasation, edema, and pain around the catheter and reservoir during infusion should also be considered. In the case of embolization to the right heart, ventricular arrhythmias may be expected [19]. Endocarditis and cardiac tamponade should be considered carefully. Cough, dyspnea, and chest pain may be more commonly seen in cases of pulmonary embolism. In our study, seven (58%) patients were asymptomatic, four (33.3%) patients had TIVAD malfunction, and one (8.3%) patient had pain and swelling at the port site after injection.