Can we manage prophylactic therapy in COVID-19 patients to prevent severe illness complications?

Many patients with COVID-19 have thromboembolic complications that worsen their prognosis. Herein, the authors propose a modified version of the CHA2DS2-VASc score, including 1 point for COVID-19, so that prophylaxis to protect against thromboembolic events would be indicated before the condition becomes severe. The advantages of this modification would be prevention of the patient’s condition worsening due to thromboembolic problems and reduction of the likelihood of a need for intensive care and mechanical ventilation, reducing mortality.Many patients with COVID-19 have thromboembolic complications that worsen their prognosis. Herein, the authors propose a modified version of the CHA2DS2-VASc score, including 1 point for COVID-19, so that prophylaxis to protect against thromboembolic events would be indicated before the condition becomes severe. The advantages of this modification would be prevention of the patient’s condition worsening due to thromboembolic problems and reduction of the likelihood of a need for intensive care and mechanical ventilation, reducing mortality

Podemos atuar preventivamente para evitar que os pacientes portadores de COVID-19 evoluam de forma mais grave?

Muitos pacientes com COVID-19 apresentam complicações tromboembólicas que acabam piorando seu prognóstico. Os autores propõem uma modificação no escore CHA2DS2-VASc, incluindo 1 ponto para COVID-19, para, desse modo, indicar profilaxia de eventos tromboembólicos antes do agravamento do quadro. As vantagens dessa modificação seriam evitar a piora do paciente por problemas tromboembólicos, bem como a necessidade de internação em unidade de tratamento intensivo e de ventilação mecânica, e diminuir a mortalidade

Can we manage prophylactic therapy in COVID-19 patients to prevent severe illness complications?

Muitos pacientes com COVID-19 apresentam complicações tromboembólicas que acabam piorando seu prognóstico. Os autores propõem uma modificação no escore CHA2DS2-VASc, incluindo 1 ponto para COVID-19, para, desse modo, indicar profilaxia de eventos tromboembólicos antes do agravamento do quadro. As vantagens dessa modificação seriam evitar a piora do paciente por problemas tromboembólicos, bem como a necessidade de internação em unidade de tratamento intensivo e de ventilação mecânica, e diminuir a mortalidade.SimMany patients with COVID-19 have thromboembolic complications that worsen their prognosis. Herein, the authors propose a modified version of the CHA2DS2-VASc score, including 1 point for COVID-19, so that prophylaxis to protect against thromboembolic events would be indicated before the condition becomes severe. The advantages of this modification would be prevention of the patient’s condition worsening due to thromboembolic problems and reduction of the likelihood of a need for intensive care and mechanical ventilation, reducing mortality

Carotid artery plaque structure in the context of symptomatic/asymptomatic nature of carotid artery stenosis

Objective: In this paper, we examined the relationship between atherosclerotic plaque characteristics and symptomatic carotid artery disease. Material and methods: Twenty-two patients who underwent carotid endarterectomy were enrolled into the study. Thirteen patients were male and remaining 9 patients were female. The mean age was 60.2 +/- 9.6 years. The carotid artery stenosis ranged between 75% and 99%. Eight patients were asymptomatic and remaining 14 patients were symptomatic. Ten patients suffered stroke. One of them had recurrent transient ischemic attacks, 4 patients had dizziness, and one of them had amaurosis fugax. The extracted plaques were evaluated by scanning acoustic microscopy (SAM) and micro-computerized tomography (micro-CT). Results: Smaller acoustic impedance values that reveal collagen-rich plaque formation were detected in patients who had stroke, while higher acoustic impedance values that reveal calcium-rich plaque formation were detected in the asymptomatic patients' plaques. Conclusions: Determination of plaque characteristics with modern radiographic techniques, rather than relying on the degree of stenosis in patients with carotid artery disease, may be helpful to discriminate patients requiring intervention.Cíl: V této studii jsme zkoumali vztah mezi charakteristikami aterosklerotického plátu a symptomatickým postižením karotických tepen. Materiál a metody: Do studie bylo zařazeno 22 pacientů (13 mužů a 9 žen průměrného věku 60,2 ± 9,6 roku) po endarterektomii karotických tepen. Závažnost stenózy karotické tepny se pohybovala v rozmezí 75 % až 99 %. Osm pacientů bylo asymptomatických a zbývajících 14 symptomatických. Deset pacientů prodělalo cévní mozkovou příhodu. V anamnéze měl jeden pacient recidivující tranzitorní ischemické příhody, čtyři pacienti uváděli presynkopální stav a u jednoho byla stanovena diagnóza amaurosis fugax. Odstraněné pláty byly vyšetřeny skenující akustickou mikroskopií (scanning acoustic microscopy, SAM) a mikrovýpočetní tomografi í (micro-computerized tomography, micro-CT). Výsledky: U pacientů po cévní mozkové příhodě byly nalezeny nižší hodnoty akustické impedance ukazující na tvorbu plátů s vysokým obsahem kolagenu, zatímco u asymptomatických pacientů byly vyšší hodnoty akustické impedance spojeny s tvorbou plátů bohatých na vápník. Závěry: Spíše než spoléhání se na závažnost stenózy u pacientů s postižením karotických tepen může při vyhledávání pacientů vyžadujících intervenci napomáhat určení charakteristik plátů moderními radiografi ckými metodami.Türkiye Cumhuriyeti Kalkınma Bakanlığ