scholarly journals Complete splenic infarction in association with COVID-19

2021 ◽  
Vol 14 (12) ◽  
pp. e246274
Author(s):  
Graham Prentice ◽  
Stephen Wilson ◽  
Alexander Coupland ◽  
Stephen Bicknell
Keyword(s):  
Respiratory System ◽  
Splenic Infarction ◽  
Thromboembolic Complications ◽  
Secondary Complications ◽  
High Incidence ◽  
Disease Understanding

COVID-19 predominantly affects the respiratory system. As a novel disease, understanding of its management and complications continues to grow. Herein, we present a case of almost complete splenic infarction in a patient with COVID-19 pneumonia. This case highlights the need to maintain diagnostic vigilance whilst investigating secondary complications of COVID-19. It is also important to stress the high incidence of thromboembolic complications in patients with COVID-19, which may occur anywhere in the vasculature.

Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

1999 ◽  
Vol 12 (2) ◽  
pp. 224-242 ◽  
Author(s):  
Shamez Ladhani ◽  
Christopher L. Joannou ◽  
Denise P. Lochrie ◽  
Robert W. Evans ◽  
Susan M. Poston
Keyword(s):  
Clinical Features ◽  
Treatment Options ◽  
Entire Body ◽  
Secondary Complications ◽  
Staphylococcal Scalded Skin Syndrome ◽  
Treatment And Prevention ◽  
Causative Agents ◽  
Underlying Diseases ◽  
Disease Understanding ◽  
Significant Mortality

SUMMARY The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.

Pulmonary disease and anaesthesia

2017 ◽  
Author(s):  
Gary H. Mills
Keyword(s):  
Critical Care ◽  
Respiratory Disease ◽  
Respiratory System ◽  
Respiratory Muscles ◽  
Postoperative Recovery ◽  
Respiratory Support ◽  
Normal Lung ◽  
High Incidence ◽  
Risk Patients ◽  
The Right

Respiratory adverse events are the commonest complications after anaesthesia and have profound implications for the recovery of the patient and their subsequent health. Outcome prediction related to respiratory disease and complications is vital when determining the risk:benefit balance of surgery and providing informed consent. Surgery produces an inflammatory response and pain, which affects the respiratory system. Anaesthesia produces atelectasis, decreases the drive to breathe, and causes muscle weakness. As the respiratory system ages, closing capacity increases and airway closure becomes an increasing issue, resulting in atelectasis. Increasing comorbidity and polypharmacy reduces the patient’s ability to eliminate drugs. The proportion of major operations on older frailer patients is rising and postoperative recovery becomes more complicated and the demand for critical care rises. At the same time, the population is becoming more obese, producing rapid decreases in end-expiratory lung volume on induction, together with a high incidence of sleep-disordered breathing. Despite this, many high-risk patients are not accurately identified preoperatively, and of those that are admitted to critical care, some are discharged and then readmitted to the intensive care unit with complications. Respiratory diseases may lead to increases in pulmonary vascular resistance and increased load on the right heart. Some lung diseases are primarily fibrotic or obstructive. Some are inflammatory, autoimmune, or vasculitic. Other diseases relate to the drive to breathe, the nerve supply to, or the respiratory muscles themselves. The range of types of respiratory disease is wide and the physiological consequences of respiratory support are complex. Research continues into the best modes of respiratory support in theatre and in the postoperative period and how best to protect the normal lung. It is therefore essential to understand the effects of surgery and anaesthesia and how this impacts existing respiratory disease, and the way this affects the balance between load on the respiratory system and its capacity to cope.

scholarly journals Post-COVID-19 vaccination occurrence of splenic infarction due to arterial thrombosis

2021 ◽  
Vol 14 (12) ◽  
pp. e243846
Author(s):  
Alexander Anderson ◽  
Mary Seddon ◽  
Khalid Shahzad ◽  
Raimundas Lunevicius
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Arterial Thrombosis ◽  
Splenic Artery ◽  
Thromboembolic Complication ◽  
Splenic Infarction ◽  
Thromboembolic Complications ◽  
Emergency General Surgery ◽  
Rare Form ◽  
Time Of Administration

We present the case of an 82-year-old woman admitted to a regional emergency general surgery centre with severe left upper quadrant abdominal pain and tenderness within 21 days of receiving the first dose of the ChAdOx1 nCov-19 vaccine (Vaxzevria, AstraZeneca). Following further investigation through CT imaging, a thrombus was discovered in the patient’s splenic artery resulting in a large splenic infarct. Splenic infarcts are rare and it is important to note the association between time of administration of the first dose of vaccine and the occurrence of thromboembolic complications in the noted absence of other risk factors for this condition. We hypothesise a link between Vaxzevria vaccine injection and a rare form of thromboembolic complication: thrombosis of the splenic artery.

scholarly journals Surgical perspective in pseudoaneurysm of peripheral arteries: a better limb salvage option

2021 ◽  
Vol 8 (5) ◽  
pp. 1566
Author(s):  
Lakshmi Sinha ◽  
Sanjeev Kumar ◽  
Nishit Ranjan ◽  
Rituraj .
Keyword(s):  
Femoral Artery ◽  
Popliteal Artery ◽  
Vessel Wall ◽  
False Aneurysm ◽  
Common Femoral Artery ◽  
Limb Loss ◽  
Thromboembolic Complications ◽  
High Incidence ◽  
Peripheral Aneurysms ◽  
The Common

Aneurysm involve all three layers of vessel wall. Psudoaneurysm also known as false aneurysm is a collection of blood that forms between the two outer layers of an artery. Femoral and popliteal artery aneurysms account for more than 90% of peripheral aneurysms, with popliteal artery aneurysms being the most common (70%). The estimated incidence of femoral and popliteal aneurysms is approximately 7/100,000 men and 1/100,000 women. Femoral aneurysms usually involve the common femoral artery but may occasionally extend or be limited to the superficial femoral artery (SFA) in the midthigh. Femoral and popliteal aneurysms are commonly associated with other aneurysms, with approximately 80% of patients having multiple aneurysms. Femoral and popliteal aneurysms show a high incidence of thromboembolic complications, which can result in limb loss. Pseudoaneurysm, if left untreated can result in deadly limb loss.

scholarly journals THE SURFACTANT SYSTEM OF THE LUNGS. A REVIEW ARTICLE

2021 ◽  
Vol 20 (4) ◽  
pp. 7-17
Author(s):  
O.V. Ishutsina ◽  
Keyword(s):  
Respiratory System ◽  
Biological Role ◽  
Surfactant System ◽  
Premature Babies ◽  
High Incidence ◽  
Pulmonary Pathology ◽  
High Level ◽  
Structure And Functions

This article contains the information about the structure, functioning, and regeneration of type 2 pneumocytes. The composition of the surfactant, the processes of its synthesis, formation, secretion, distribution and redistribution of its components, as well as the biological role of the surfactant in the functioning of the lungs are described in detail. The information about the development of the surfactant system of the lungs during embryogenesis is also included. Objectives. To review modern literature on the structure and functions of the surfactant system of the lungs, the organization and structure of the surfactant, the mechanism of surfactant formation, the embryogenesis of the respiratory section, to characterize the structure and processes of the functioning of type 2 pneumocytes, as well as the processes of synthesis and secretion of the surfactant, its biological role in the functioning of the lungs. The relevance of the chosen topic is connected with a high level of the respiratory system pathology including a high incidence of respiratory system organs diseases in early childhood, associated with an insufficient level of the surfactant maturity. The problem of pulmonary pathology in newborns, including premature babies, largely determines the level of infant morbidity and mortality.

scholarly journals Case Report: Heparin-induced thrombocytopenia in a patient with COVID-19

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 704
Author(s):  
Ragia Aly ◽  
Sachin Gupta ◽  
Sorab Gupta ◽  
Balraj Singh ◽  
Abhinav Goyal ◽  
...  
Keyword(s):  
Healthcare Systems ◽  
Dialysis Catheter ◽  
The Novel ◽  
Thromboembolic Complications ◽  
Health Crisis ◽  
Heparin Induced Thrombocytopenia ◽  
High Incidence ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication

With the spread of the novel coronavirus disease of 2019 (COVID-19) worldwide and associated high incidence of thromboembolic complications, the use of heparin is on the rise. It therefore is crucial to identify patients with contraindications for heparin. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. We report a 66-year-old woman, who was admitted to the hospital with COVID-19 infection. Her course was complicated by pulmonary embolism and dialysis catheter thrombosis. Our patient had a known history of HIT. Treatment of this patient with heparin would have been catastrophic. The COVID-19 pandemic has overwhelmed healthcare systems and is causing a global health crisis. Nevertheless, this case serves as a reminder of the importance of making every effort to obtain thorough history and review of records of every patient.

High Incidence of Thromboembolic Complications and PF4 Positivity in Patients with Ventricular Assist Devices.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4083-4083
Author(s):  
Brandon J. McMahon ◽  
Jainulabdeen J. Ifthikharuddin ◽  
Elie Dib ◽  
Leway Chen ◽  
Charles W. Francis ◽  
...  
Keyword(s):  
Anticoagulation Therapy ◽  
High Rate ◽  
Thrombin Inhibitors ◽  
Ventricular Assist Devices ◽  
Direct Thrombin Inhibitors ◽  
Thromboembolic Complications ◽  
Ventricular Assist ◽  
Full Dose ◽  
Assist Devices ◽  
High Incidence

Abstract Patients with ventricular assist devices (VAD) are at high risk for thromboembolic complications (TEC) probably due to platelet activation and excessive thrombin generation once the device is implanted. This warrants prophylactic use of full dose anticoagulation, usually with unfractionated heparin (UFH), which increases the risk for development of heparin-induced thrombocytopenia (HIT). We retrospectively evaluated the incidence of TEC and PF4 positivity in 50 sequential patients who underwent VAD placement for severe ventricular dysfunction between November 2002 and April 2005. Median age at VAD placement was 52 years (range 18–72), 68% were men, and all patients were on full dose UFH post-VAD insertion. TEC were observed in 22/50 patients (44%), with 8 patients experiencing >1 event. CNS embolic phenomena occurred in 11/22 (50% of TEC), with watershed/non-embolic CNS infarcts being identified in 2 additional patients. Splenic infarcts were identified in 6/22 (27%). Two patients had lower extremity deep vein thromboses (DVT), and two patients had pulmonary emboli. One patient died from complications of multiple infarcts involving his spleen and gut that were attributed to HIT. All patients became thrombocytopenic (<150K) at some point during VAD/UFH use. 44 patients (88%) dropped the platelet count below 100K with an average nadir of 56K. Antibodies to the PF4/heparin complex were checked using a standard enzyme immunoassay (EIA) in 38 (76%) patients, and found to be positive in 17 (44.7%). PF4 antibodies were detected using the EIA in 50% of patients with TEC and in 25% of patients with no documented TEC. A functional antibody assay was checked in a total of 17 patients, the serotonin release assay (SRA) in 13 and heparin-induced agglutination (HIA) in 4 cases. The SRA was only positive in 2/13 cases, and concordant with the PF4 result both times. The HIA was positive once, and concordant with the PF4 result. These results highlight the high incidence of TEC in patients with a VAD, despite anticoagulation therapy. There is a particularly high rate of embolic stroke in this patient population, and better ways of preventing this complication need to be explored. Thrombocytopenia is also extremely common post-VAD placement, prompting evaluation of HIT in over ¾ of the patients, often necessitating use of direct thrombin inhibitors. The frequent detection of PF4 antibodies in this patient group and lack of correlation with functional assays illustrates the need for more specific laboratory means to quickly confirm those patients with HIT.

scholarly journals Multiple arterial thrombosis in a COVID-19 patient

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Diana Calaras ◽  
◽  
Evghenii Arseni ◽  
Natalia Porcereanu ◽  
Andrei Grib ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Cardiovascular Risk ◽  
Critically Ill ◽  
Respiratory System ◽  
Critically Ill Patients ◽  
Arterial Thrombosis ◽  
Thromboembolic Complications ◽  
Vein Thrombosis ◽  
Deep Vein

SARS-COV-2 infection primarily affects the respiratory system with emerging complications, but can also involve other systems and organs, as well as cause coagulopathy. Cases of deep vein thrombosis with pulmonary thromboembolic complications are commonly reported in critically ill patients with COVID-19, much less frequently encountered is thrombosis in the arterial bed. Particularly rare are cases of concomitant thrombosis in multiple sites. We present a case with multiple arterial thrombosis in a patient with COVID-19 and increased cardiovascular risk.

scholarly journals A Study on Complication and Monitoring of Warfarin in Post-Valve Surgery

2009 ◽  
Vol 48 (174) ◽  
pp. 111-5 ◽  
Author(s):  
Poonam Shrestha ◽  
B Koirala ◽  
N Shrestha ◽  
P Thapa
Keyword(s):  
Bleeding Complication ◽  
Prospective Observational Study ◽  
Mechanical Valve ◽  
Valve Surgery ◽  
Target Range ◽  
Minor Bleeding ◽  
Thromboembolic Complications ◽  
Frequent Monitoring ◽  
High Incidence ◽  
Potential Risk Factors

Introduction:This study was carried out to determine the incidence of complication related to warfarin in patients with valve surgery and identify potential risk factors for complication and study its monitoring aspects.Methods:A combined retrospective and prospective observational study including a total of 185 patients who underwent mechanical valve replacement in Shahid Gangalal National Heart Centre. The study was conducted from 4 November 2006 till 1 February 2007. Results:There were a total of 141 episodes of bleeding. Among them signifi cant bleeding occurred in 15.7% patients, major bleeding was 3.2 per 100 patient-years (3.8%) and minor bleeding was 11.8 per 100 patient-years (11.9%). Epistaxis (16.8%) was the most common bleeding complication. Menorrhagia was the most common bleeding complication in females with 20.5 per 100 patient-years (27.4%). Thromboembolic complications occurred at the rate of 2.3 per 100 patient-years. Patients on warfarin were outside the INR target range 67.8% of the time, with 21% INR values above range and 46.8% INR values below range. However, dose adjustment was done only 31.8% of times when INR was outside range.Conclusions:There is high incidence of bleeding complication in patients on warfarin and hypertension is signifi cantly associated with bleeding. Diffi culty in tightly controlling INR probably is related to high incidence of bleeding. Better patient education, stricter adjustment of INR, frequent monitoring of INR at peripheral hospitals and standardization of the test at different hospitals are suggested to reduce the warfarin related complications.Key Words: bleeding complication, heart valve surgery, warfarin

Massive Preoperative Pulmonary Embolism and Suprasellar Brain Tumor: Case Report and Review of the Literature

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 566-571 ◽  
Author(s):  
Raymond Sawaya ◽  
Gabriella Decourteen-Meyers ◽  
Bradley Copeland
Keyword(s):  
Pulmonary Embolism ◽  
Brain Tumor ◽  
Case Report ◽  
Brain Tumors ◽  
Massive Pulmonary Embolism ◽  
Frequent Occurrence ◽  
Thromboembolic Complications ◽  
Review Of The Literature ◽  
High Incidence ◽  
Intimate Relation

Abstract A 57-year-old man presented to our facility with the diagnosis of a suprasellar mass and died on the 2nd post-admission day from a massive pulmonary embolism. At autopsy, the mass was diagnosed as craniophyarngioma. This case report and review of the literature suggest an intimate relation between brain tumors and thromboembolic complications as evidenced by the high incidence of this association, the frequent occurrence of coagulopathies in patients with brain tumors, and the prevalence of tumors in the suprasellar location. The specific mechanisms that may be at play are reviewed.

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