Deep vein thrombosis in noncritically ill patients with coronavirus disease 2019 pneumonia: deep vein thrombosis in nonintensive care unit patients

Background: Venous thromboembolic events have been one of the main causes of mortality among hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia. The aim of our study was to describe the prevalence of deep vein thrombosis (DVT) in noncritically ill patients with COVID-19 pneumonia and correlate such observations with the thromboprophylaxis received. Methods: We performed a prospective cohort study of 67 patients admitted to the hospital for COVID-19 pneumonia. The diagnosis was confirmed using polymerase chain reaction testing of nasopharyngeal specimens. The deep veins were examined using compression duplex ultrasonography with the transducer on B-mode. The patients were separated into two groups for statistical analysis: those receiving low-molecular-weight heparin prophylaxis and those receiving intermediate or complete anticoagulation treatment. Risk analysis and logistic regression were performed. Results: Of the 67 patients, 57 were included in the present study after applying the inclusion and exclusion criteria; 49.1% were women, and the patient mean age was 71.3 years. All 57 patients had undergone compression duplex ultrasonography. Of these 57 patients, 6 were diagnosed with DVT, for an in-hospital rate of DVT in patients with COVID-19 pneumonia of 10.5%. All the patients who had presented with DVT had been receiving low-molecular-weight heparin prophylaxis. The patients receiving prophylactic anticoagulation treatment had a greater risk of DVT (16.21%; 95% confidence interval, 0.04-0.28; P = .056) compared with those receiving intermediate or complete anticoagulation treatment. We also found a protective factor for DVT in the intermediate or complete anticoagulation treatment group (odds ratio, 0.19; 95% confidence interval, 0.08-0.46; P < .05). Conclusions: Noncritically ill, hospitalized patients with COVID-19 pneumonia have a high risk of DVT despite receipt of correct, standard thromboprophylaxis

Comparison between primary minor amputations and minor amputations with previous revascularization in diabetic foot pathology

[spa] Introducción: la realización de amputaciones menores primarias en pacientes diabéticos es una práctica aún frecuente en servicios de cirugía vascular. El objetivo de este estudio es comparar la evolución de las amputacio- nes menores primarias respecto a las realizadas con revascularización previa, considerando la presencia o no de angiosoma directo que revascularice la zona del muñón que vamos a crear. Material y métodos: se realizó un estudio observacional y comparativo sobre la población de pacientes dia- béticos que requerían amputaciones menores de miembros inferiores ingresados en nuestro servicio durante el periodo comprendido entre enero y diciembre de 2018. La revascularización previa (o no) a la amputación menor se decidía con base en estudios hemodinámicos y posibilidades según pruebas de imagen. La muestra se dividió en cuatro grupos tomando en cuenta la necesidad-posibilidad de revascularización previa a la amputación menor y la presencia de vascularización basada en angiosoma directo o indirecto a la zona del muñón que íbamos a crear. Se valoró en cada grupo la tasa de amputaciones mayores, la tasa de curación de las amputaciones menores y la mortalidad. Consideramos significativa p < 0,05. Resultados: se reclutaron 106 pacientes de enero a diciembre de 2018. Las tasas de curación de los muñones de amputación en los cuatro grupos no presentaron diferencias estadísticamente significativas (p = 0,085). Los pacientes no revascularizados mostraron una tasa de pérdida de extremidad más alta que el grupo previamente revascularizado, con una diferencia estadísticamente significativa entre los grupos (p = 0,002). Conclusiones: la tasa de pérdida de extremidad es mayor en los pacientes que no son sometidos a cirugía de revascularización previa a la amputación menor, así como en los pacientes cuya vascularización depende de angio- somas indirectos al muñón creado. [eng] Introduction: the performance of primary minor amputations in diabetic patients is a frequent practice in vascular surgery services. The aim of this study is to compare the evolution of minor primary amputations, with those performed with previous revascularization, considering the presence or not of a direct angiosome that revascularizes the stump area that we are going to create. Material and methods: on observational and comparative study was performed on diabetic patients who required minor lower limb amputations admitted to our department during the period from January to December 2018.The revascularization prior, or not, to minor amputation, was decided based on hemodynamic studies and possibilities according to imaging tests. Patients were divided into 4 groups considering the need-possibility of revascularization prior to minor amputation, and vascularization based on direct or indirect a ngiosome to the area of the stump that we were going to create. The rate of major amputations, the healing rate of minor amputations, and mortality were assessed in each group. We consider significant p < 0.05. Results: 106 patients were recruited, from January to December 2018. The healing rate of the amputation stumps in the four groups did not show statistically significant differences (p - 0.085). Non-revascularized patients showed a higher rate of limb loss respect the previously revascularized group, with a statistically significant difference between the groups (p= 0.002). Conclusions: the rate of limb loss is higher in patients who do not undergo revascularization surgery prior to minor amputation, as well as in patients whose vascularization depends on indirect angiosomes to the created stump

Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies

[Background]: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet. [Objective]: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts.[Design]: We assessed 18,566 participants in the “Seguimiento Universidad de Navarra” (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the “PREvencion con DIeta MEDiterránea” (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality.[Results]: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%–32%, for the highest vs lowest category of DII).[Conclusion]: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively.Supported by the official funding agency for biomedical research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140, to R.E.; RTIC RD 06/0045, to Miguel A. Martínez-González) and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (Proyecto de Investigación (PI) 04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462, PI13/00615, PI13/01090, PI14/01668, PI14/01798, PI14/01764), Ministerio de Ciencia e Innovación (Recursos y teconologia agroalimentarias(AGL)-2009-13906-C02 and AGL2010-22319-C03 and AGL2013-49083-C3-1- R), Fundación Mapfre 2010, the Consejería de Salud de la Junta de Andalucía (PI0105/2007), the Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (Generalitat Valenciana Ayuda Complementaria (GVACOMP) 06109, GVACOMP2010-181, GVACOMP2011-151), Conselleria de Sanitat y, PI14/01764 AP; Atención Primaria (CS) 2010-AP-111, and CS2011-AP-042), and Regional Government of Navarra (P27/2011).). Drs. Shivappa and Hébert were supported by grant number R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases