Evaluation of the Predictive Role of Standard Laboratory Tests for Disease Severity in Patients with Deep Venous Thrombosis

Introduction: Deep venous thrombosis (DVT) can result in fatal outcomes if it is not timely diagnosed and sufficiently treated. Some laboratory markers were identified in previous reports for predicting the disease with low sensitivity or specificity. We aimed to evaluate the predictive value of serum albumin levels and compare them with conventional laboratory parameters. Material and Methods: Fifty patients with acute lower-extremity DVT who has no previous history of malignancy or hematologic disorder were included in the study. The demographical variables and standard biomarkers of the DVT group were compared with the normal population (n:50). Thereafter patients were divided into two groups as extensive DVT (thrombosis involves popliteal, femoral, and iliac veins together) and localized DVT (thrombosis involves popliteal vein and below) and biomarkers were compared in patient groups. Results: The demographical variables and white blood cell count (WBC) found as similar between healthy groups and DVT groups. However, mean platelet volume (MPV), D-Dimer, neutrophil to lymphocyte ratio (NLR), and fibrinogen to albumin ratio (FAR) were found markedly higher in DVT patients. Moreover, statistically incremental FAR and NLR levels were detected (p < 0.05) in patients with extensive DVT (involved iliac and femoral veins). Conclusion: Serum NLR and FAR levels seem to be significant predictors for the extensive thrombotic event in patients with DVT

Efeito do levosimendan em pacientes com insuficiência cardíaca sistólica severa e agravamento da função renal

FUNDAMENTO: O levosimendan, um sensibilizador de cálcio, aumenta a sensibilidade do coração para o cálcio, aumentando assim a contratilidade miocárdica, sem aumento do cálcio intracelular. Recentemente foi demonstrado que o levosimendan era benéfico na melhoria da função renal. No entanto, fica por determinar que o efeito benéfico esteja relacionado em forma diferencial ao status renal durante o evento-índice. OBJETIVO: O objetivo do presente estudo foi determinar se o levosimendan pode melhorar o resultado renal em pacientes com insuficiência cardíaca aguda descompensada com e sem agravamento da função renal. MÉTODOS: Quarenta e cinco pacientes consecutivos que tiveram uma taxa de filtração glomerular reduzida e pelo menos dois dados consecutivos quanto à função renal, antes da administração de levosimendan, foram incluídos no estudo. Os pacientes foram classificados em dois grupos, com e sem agravamento da função renal com base no aumento da creatinina sérica > 0,3 mg/dL. RESULTADOS: Uma melhoria significativa foi observada na função renal em pacientes com agravamento da função renal (creatinina sérica de 1,4 ± 0,16 a 1,21 ± 0,23 mg/dL, p = 0,001 e taxa de filtração glomerular de 48,9 ± 15 a 59,3 ± 21,8 mL/min/m², p = 0,011), apesar de que não houve melhoria significativa em aqueles sem agravamento da função renal (creatinina sérica de 1,29 ± 0,33 a 1,37 ± 0,66 mg/dL, p = 0,240 e taxa de filtração glomerular de 53,7 ± 17,6 a 52,9 ± 21,4 mL/min/m², p = 0,850). CONCLUSÃO: O levosimendan parece proporcionar um efeito de realce renal em pacientes com severa insuficiência cardíaca sistólica descompensada aguda e agravamento da função renal. Considerar esse efeito diferencial poderia contribuir a obter resultados renais benéficos. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0

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

Limb Necrosis in a Lung Cancer Case Presenting with Widespread Thrombosis

The malignancies are commonly associated with enhanced thrombotic vascular events. The thrombotic events are also increased in lung cancer subtypes. Even, the systemic mortal thrombotic disorders were reported in the literature. We report a case of a nonsmall-cell carcinoma patient who progressed with widespread thrombosis

The Views of Pre-Service Elementary Teachers About Online and Traditional Peer Assessment

The goal of this study is to compare traditional peer evaluation and online peer evaluation in order to identify which method is more effective in evaluating peers. Qualitative research method was used in this study to understand pre-service teachers' opinions on different peer evaluation techniques. The study was carried out in a state university in Turkey. The sample consisted of 58 second year pre-service teachers majoring in primary school teacher program who enrolled in Instructional Technologies and Material Development course. Pre-service teachers were divided into 11 groups, with five or six students in each group. Participation was voluntary and the students in each group actively participated in the traditional and online peer assessment activities. The analyses of the data were done via content analysis, by creating categories and then themes. The themes that emerged as a result of the analysis of the data collected within the study were (1) objectivity, (2) evaluation criteria, (3) interaction, and (4) attributes of the online evaluation platform. The study concluded that a combination of peer and instructor evaluation and even selfassessment can give a better validity and objectivity of assessment.WOS:00066357330001

Exploring Online Payment System Adoption Factors in the Age of COVID-19—Evidence from the Turkish Banking Industry

Turkey’s e-commerce market is rapidly expanding, and the country is ranked first in the world in monthly mobile purchases. The purpose of this study is to determine the factors that influence the adoption of online payments systems among the customers of a Turkish bank during the COVID-19 pandemic. The research model extends the technology acceptance model (TAM) by further examining the impact of 11 factors on attitude, behavioral intention and actual usage. The results suggest a strong influence of these factors on attitude and behavioral intention. Relative advantage, perceived trust, perceived usefulness, personal innovativeness, perceived integrity, perceived ease of use, health and epidemic effects, income, private sector employment and self-employment all have a positive effect on actual online payment system usage. However, perceived risk and age have a negative impact on the actual online payment system usage

Pregnancy Complicated with Severe Recurrent Aortic Coarctation: A Case Report

A 23-year-old primigravida was referred to our clinic for evaluation of high blood pressure (BP) in her 16th week of gestation. She had an operation to repair congenital aortic coarctation and patent ductus arteriosus 8 years ago. On physical examination the blood pressure in upper extremity was 155/95 and in lower extremity was 90/55 mmHg, and heart rate was 93 beats/min. Transthoracic echocardiography showed narrowing of the descending aorta, the diameter of the aortic arch was 10.60 mm and an echocardiographic gradient was 96 mmHg. During the pregnancy (from 16 weeks to 38 weeks) BP was regulated with metoprolol. Cesarean section delivery was applied at 38 weeks of gestation. There was no complication in postpartum period. Spinal anesthesia application was used for caesarean section intervention and healthy female baby was delivered with the APGAR scores of 10/10. Herein the diagnosis of aortic coarctation is reviewed and the management when found during pregnancy is discussed