26 research outputs found
UEMS Training Requirements for Angiology and Vascular Medicine: European Standards of Postgraduate Medical Specialist Training (ETR Document)
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Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials.
Coronavirus disease 2019 (COVID-19) has been shown to be strongly associated with increased risk for venous thromboembolism events (VTE) mainly in the inpatient but also in the outpatient setting. Pharmacologic thromboprophylaxis has been shown to offer significant benefits in terms of reducing not only VTE events but also mortality, especially in acutely ill patients with COVID-19. Although the main source of evidence is derived from observational studies with several limitations, thromboprophylaxis is currently recommended for all hospitalized patients with acceptable bleeding risk by all national and international guidelines. Recently, high quality data from randomized controlled trials (RCTs) further support the role of thromboprophylaxis and provide insights into the optimal thromboprophylaxis strategy. The aim of this statement is to systematically review all the available evidence derived from RCTs regarding thromboprophylaxis strategies in patients with COVID-19 in different settings (either inpatient or outpatient) and provide evidence-based guidance to practical questions in everyday clinical practice. Clinical questions accompanied by practical recommendations are provided based on data derived from 20 RCTs that were identified and included in the present study. Overall, the main conclusions are: (i) thromboprophylaxis should be administered in all hospitalized patients with COVID-19, (ii) an optimal dose of inpatient thromboprophylaxis is dependent upon the severity of COVID-19, (iii) thromboprophylaxis should be administered on an individualized basis in post-discharge patients with COVID-19 with high thrombotic risk, and (iv) thromboprophylaxis should not be routinely administered in outpatients. Changes regarding the dominant SARS-CoV-2 variants, the wide immunization status (increasing rates of vaccination and reinfections), and the availability of antiviral therapies and monoclonal antibodies might affect the characteristics of patients with COVID-19; thus, future studies will inform us about the thrombotic risk and the optimal therapeutic strategies for these patients
Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations–State-of-the-Art.
Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currentlyindicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARS-CoV2 remains unclear In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist
Energy for the future - nuclear fusion
Ocenjeno je naraščanje prebivalstva na Zemlji v naslednjih desetletjih, sočasno naraščanje potreb po primarni energiji in napisani so možni nosilci primarne energije. Razložen je princip jedrske fuzije, navedeni so robni pogoji, pri katerih je zlitje jeder sploh mogoče, in opisana je razlika med jedrsko fisijo in fuzijo. V obeh primerih se skupna masa po končani jedrski reakciji zmanjša, del mase se namreč spremeni v energijo. Prikazani so doslej vloženi napori znanstvenikov, skupaj z najnovejšim projektom ITER. Projekt naj bi končno realiziral težko pričakovano samodejno reakcijo zlitja jeder vodika v jedro helija in s tem rešil problem preskrbe človeštva s primarno energijo.Evaluation of the growth of word population for the next decades, the parallel growth of consumption of primary energy and the sources of primary energy are listed. Description the principle of nuclear fusion, of the boundary conditions for this fusion and of the difference between nuclear fusion and fission are explained. In both cases the mas is decreased in the reaction, since part of the mass is transformed to energy. The achievents of scientists in this field, the newest ITER project included, are presented. In the project the expected self supporting reaction of fusion of hydrogen nuclea to a helium nucleus will be achieved and the problem of supply of primary energy for the humanity solved
Recommendations for diagnosis and treatment of vasospastic disorders (Raynaud‘s phenomenon)
In the article diagnostic and therapeutic recommendations for the treatment of patients with suspected vasospastic disorders (Raynaud‘s phenomenon) are presented. All recommendations are evaluated according to evidence and general agreement
Recommendations for the diagnosis and treatment of chronic venous disease
Clinical manifestations of chronic superficial venous insufficiency are described, followed by recommendations for diagnostic evaluation and various treatment possibilities.</p