scholarly journals Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 584
Author(s):  
Decsa Medika Hertanto ◽  
Henry Sutanto ◽  
Soebagijo Adi
Keyword(s):  
Diabetic Nephropathy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
The Novel ◽  
Functional Impairments ◽  
Left Posterior ◽  
Novel Coronavirus ◽  
Peripheral Artery Diseases ◽  
Leg Amputation

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.

scholarly journals Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 584
Author(s):  
Decsa Medika Hertanto ◽  
Henry Sutanto ◽  
Soebagijo Adi
Keyword(s):  
Diabetic Nephropathy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
The Novel ◽  
Functional Impairments ◽  
Left Posterior ◽  
Novel Coronavirus ◽  
Peripheral Artery Diseases ◽  
Leg Amputation

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.

scholarly journals Acute arterial ischemia in COVID-19

2021 ◽  
Vol 20 ◽  
Author(s):  
Silvia Maqueda Ara ◽  
Marta Ballesteros Pomar ◽  
Nuria Sanz Pastor ◽  
Cristina Nogal Arias ◽  
Marcos Del Barrio Fernández
Keyword(s):  
Arterial Thrombosis ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
The Novel ◽  
Surgical Revascularization ◽  
Prognosis Factor ◽  
Coronavirus Infection ◽  
Poor Outcomes ◽  
Novel Coronavirus ◽  
D Dimer

Abstract Since the coronavirus pandemic set in in Spain in March 2020, a noteworthy increase in the incidence of acute limb ischemia (ALI) has been observed. It has been recently discovered that SARS-CoV 2 may lead to ALI secondary to arterial thrombosis. Elevation of D-dimer (DD) in patients with coronavirus infection (COVID-19) indicates that a hypercoagulable state causes acute arterial thrombosis. A remarkably high DD elevation has been reported to be a poor prognosis factor in COVID-19. The ways in which SARS-CoV 2 results in arterial thrombosis may be multiple. On the other hand, surgical revascularization for ALI is associated with poor outcomes in COVID-19 patients, probably in relation to hypercoagulability. Here, we describe two ALI cases in patients who required urgent surgical treatment for limb salvage and were positive for the novel coronavirus infection (COVID 19).

scholarly journals Residual Respiratory Impairment After COVID-19 Pneumonia

2021 ◽  
Author(s):  
Francesco Lombardi ◽  
Angelo Calabrese ◽  
Bruno Iovene ◽  
Chiara Pierandrei ◽  
Marialessia Lerede ◽  
...  
Keyword(s):  
Pulmonary Function Tests ◽  
Functional Condition ◽  
The Novel ◽  
Functional Impairments ◽  
Respiratory Impairment ◽  
Arterial Blood Gas ◽  
Lung Capacity ◽  
Arterial Blood ◽  
Novel Coronavirus

Abstract Introduction: the Novel Coronavirus Disease (Covid-19) can infect the respiratory tract, causing mild to deadly respiratory impairment. It is still unknown whether patients recovering from Covid-19 will develop respiratory sequelae. This study aims to evaluate the respiratory and functional condition of Covid-19 recovered patients, stratified according to their worst p/F during hospitalization for Covid-19. Method: 86 Covid-19 recovered subjects performed, after 39 days on average, physical examination and arterial blood gas (ABG) examination, pulmonary function tests (PFTs) with diffusing capacity of the lung for carbon monoxide (DLco), and six-minute walk test (6MWT). Subjects also quantified their dyspnoea and cough using a visual analogic scale (VAS) at three-time points: previously than COVID infection, during COVID hospitalization, and currently. The 76 subjects with reliable ABG during the hospitalization were stratified in three groups according to their worst PaO2/FiO2 ratio (p/F): “mild”: p/F>300 (n = 38); “moderate”: 200<p/F<300 (n = 30), “severe” p/F < 200 (n = 20). Results: In this cohort, Covid-19 recovered subjects still reported significant residual dyspnoea at the visit time. The severe subjects group showed a lower Total Lung Capacity (TLC), a lower DLco, and a worse 6MWT performance. Conclusion: After Covid-19, respiratory and functional impairments may persist. These impairments seem to be more severe as much as minor was the patient worst p/F during hospitalization. These patients should receive a strict follow-up.

scholarly journals SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heidi Luise Schulte ◽  
José Diego Brito-Sousa ◽  
Marcus Vinicius Guimarães Lacerda ◽  
Luciana Ansaneli Naves ◽  
Eliana Teles de Gois ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Federal District ◽  
Therapeutic Interventions ◽  
Diagnostic Process ◽  
The Novel ◽  
Prevention Measures ◽  
Laboratory Findings ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

scholarly journals Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB

Open Medicine ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. 749-753
Author(s):  
Wenyuan Li ◽  
Beibei Huang ◽  
Qiang Shen ◽  
Shouwei Jiang ◽  
Kun Jin ◽  
...  
Keyword(s):  
The Novel ◽  
Chain Reaction ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Oxygen Inhalation ◽  
New Strategy ◽  
Polymerase Chain ◽  
Novel Coronavirus ◽  
Specific Symptoms

Abstract In recent months, the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health crisis with takeover more than 1 million lives worldwide. The long-lasting existence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not yet been reported. Herein, we report a case of SARS-CoV-2 infection with intermittent viral polymerase chain reaction (PCR)-positive for >4 months after clinical rehabilitation. A 35-year-old male was diagnosed with COVID-19 pneumonia with fever but without other specific symptoms. The treatment with lopinavir-ritonavir, oxygen inhalation, and other symptomatic supportive treatment facilitated recovery, and the patient was discharged. However, his viral PCR test was continually positive in oropharyngeal swabs for >4 months after that. At the end of June 2020, he was still under quarantine and observation. The contribution of current antivirus therapy might be limited. The prognosis of COVID-19 patients might be irrelevant to the virus status. Thus, further investigation to evaluate the contagiousness of convalescent patients and the mechanism underlying the persistent existence of SARS-CoV-2 after recovery is essential. A new strategy of disease control, especially extending the follow-up period for recovered COVID-19 patients, is necessary to adapt to the current situation of pandemic.

scholarly journals Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care

Heart ◽  
2020 ◽  
Vol 106 (20) ◽  
pp. 1549-1554 ◽  
Author(s):  
Benoy Nalin Shah ◽  
Dominik Schlosshan ◽  
Hannah Zelie Ruth McConkey ◽  
Mamta Heena Buch ◽  
Andrew John Marshall ◽  
...  
Keyword(s):  
Heart Valve ◽  
Waiting Times ◽  
Severe Disease ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
The Novel ◽  
Future Care ◽  
Novel Coronavirus

The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict ‘normal’ practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic—such as increased use of virtual clinics—should be further developed and evaluated.

scholarly journals Case Report: Disposition of Symptomatic Probable COVID-19

2020 ◽  
Vol 4 (3) ◽  
pp. 336-339
Author(s):  
Aleq Jaffery ◽  
John Slakey ◽  
David Zodda ◽  
Douglas Finefrock
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Distress Syndrome ◽  
Healthcare Providers ◽  
The Novel ◽  
Moderate Risk ◽  
Risk Of Progression ◽  
Novel Coronavirus ◽  
Tools And Techniques

Introduction: The novel coronavirus disease 2019 (COVID-19) presents a challenge for healthcare providers in terms of diagnosis, management, and triage of cases requiring admission. Case Report: A 47-year-old male with symptoms suspicious for COVID-19, pulse oximetry of 93% on room air, and multifocal pneumonia was risk stratified and safely discharged from the emergency department (ED) despite having moderate risk of progression to acute respiratory distress syndrome. He had resolution of his symptoms verified by telephone follow-up. Conclusion: Various risk-stratifying tools and techniques can aid clinicians in identifying COVID-19 patients who can be safely discharged from the ED.

Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series

2021 ◽  
Author(s):  
Javad Salimi ◽  
Ehsan Rahimpour ◽  
Hossein Zabihi Mahmoudabadi ◽  
Pezhman Farshidmehr
Keyword(s):  
Success Rate ◽  
Treatment Success ◽  
Case Series ◽  
Pulmonary Hemorrhage ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Technical Success Rate ◽  
Catheter Directed Thrombolysis ◽  
One Year

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the oneyear study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.

Acute limb ischemia in cancer patients: Aggressive treatment is justified

Vascular ◽  
2014 ◽  
Vol 23 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Daniel Silverberg ◽  
Tal Yalon ◽  
Emanuel R Reinitz ◽  
Dmitry Yakubovitch ◽  
Tal Segev ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Survival Rates ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Acute Limb Ischemia ◽  
Aggressive Treatment ◽  
Perioperative Mortality ◽  
Term Survival

Background The outcome of cancer patients with acute limb ischemia (ALI) is not well defined. The purpose of this study is to report our experience treating patients with active malignancy who developed ALI and compare their outcome with non-cancer patients. Methods A retrospective review of patients treated for ALI between 2009 and 2012 with ALI. We identified those patients who suffered from ALI and compared the outcome of those with active malignancy to those without malignancy. Results Of 147 patients treated for ALI (122 lower extremity, 25 upper extremity), 24 (16%) were cancer patients. Mean follow-up was 9.8 months for the malignancy group and 13.4 months for the control. Perioperative mortality rates were similar among cancer and non-cancer patients (20% vs. 16%, respectively, NS). Freedom from major amputation at 30 months was similar (95% vs. 89%, NS). Long-term survival rates of cancer patients were significantly lower compared to non-cancer patients (45% vs. 77% respectively, P < 0.05). Conclusions Treatment of ALI among cancer patients can be achieved with perioperative mortality and limb salvage rates comparable to non-cancer patients. Aggressive treatment is justified when treating cancer patients with ALI.

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