Introduction: The proliferation of literature regarding the COVID-19 pandemic has served to highlight a wide spectrum of disease manifestations and complications, such as thrombotic microangiopathies. Our review with a brief case presentation highlights the increasing recognition of TTP in COVID-19 and describes its salient characteristics. Methods: We screened the available literature in PubMed, EMBASE, and Cochrane databases from inception until April 2022 of articles mentioning COVID-19-associated TTP in English language. Results: From 404 records, we included 8 articles mentioning data of 11 patients in our review. TTP was predominantly reported in females (72%) with a mean age of 48.2 years (SD 15.1). Dyspnea was the most common symptom in one third of patients (36.6%). Neurological symptoms were reported in 27.3% of cases. The time to diagnosis of TTP was 10 days (SD 5.8) from onset of COVID-19. All 11 cases underwent plasma exchange (PLEX), with a mean of 12 sessions per patient, whereas 6 cases received Rituximab (54.5%), and 3 received Caplacizumab (27.3%). One patient died from the illness. Conclusion: This review of available literature highlights the atypical and refractory nature of COVID-19-associated TTP. It required longer sessions of PLEX, with half of the patients receiving at least one immunosuppressant.

Background: Lower extremity edema occurs in many conditions including congestive heart failure, lymphedema, diabetes-related, kidney and liver disease, chronic venous insufficiency with venous hypertension. Clinical edema assessment methods are often subjective and variable. Our goals were to introduce a simple noninvasive measurement procedure potentially useful to characterize lower extremity edema by providing normative values from which edema thresholds might emerge. Methods: Tissue dielectric constant (TDC) values, as indices of skin-to-fat tissue water, were measured on foot dorsum, lower medial leg and anterior forearm of 88 adults (44 female) with ages ranging from 19-77 years with BMI ranging from 18.3-40.6 kg/m 2. From these direct measurements lower-to-upper extremity TDC ratios (foot/ arm and leg/arm) were determined for each gender. Possible edema threshold ratios were calculated as the mean lower-to-upper ratio to which was added two standard deviations of the overall ratio thereby providing initial thresholds for future testing. Results: Results showed that at each anatomical site absolute TDC values for males significantly exceed those of females (P<0.001). Male vs. female TDC values were 33.0±5.4 vs. 27.7±4.0 for the forearm, 34.8±6.5 vs. 27.5±4.6 for the leg, and 32.5±6.5 vs. 28.7±5.1 for the foot. In contrast, the foot/arm and leg/arm ratios were similar between genders ranging 0.990±0.144 to 1.063±0.170. Corresponding lower extremity to upper extremity threshold ratios ranged from 1.278 for foot/arm to 1.403 for leg/arm. The composite ratios considering both gender ration (N.=88) yielded a composite threshold foot/arm ratio of 1.387 and a leg/arm threshold ratio of 1.324. Conclusions: This assessment method together with the normative ratios and calculated thresholds may aid in rapid detection of lower extremity edema in patients and possibly as a way to quantitatively track changes in edema status with time or treatment. However, the suitability of these thresholds is subject to future validation in persons with clearly defined lower extremity edema for which this report's findings serve as an initial quantitative starting point.

Introduction: The proliferation of literature regarding COVID-19 pandemic has served to highlight a wide spectrum of disease manifestations and complications like thrombotic microangiopathies. Our review with a brief case presentation highlights the increasing recognition of TTP in COVID-19 and describes its salient characteristics. Methods: We screened the available literature in Pubmed, EMBASE and Cochrane database from inception till April 2022 of articles mentioning COVID-19 associated TTP in English Language. Results: From 404 records, we included 8 articles mentioning data of 11 patients in our review. TTP was predominantly reported in females (72%) with a mean age of 48.2 years (SD 15.1). Dyspnea was the most common symptom in 1/3rd of patients (36.6%). Neurological symptoms were reported in 27.3% of cases. The time to diagnosis of TTP was 10 days (SD: 5.8) from onset of Covid-19. All 11 cases underwent plasma exchange (PLEX), with a mean of 12 sessions per patient, whereas six cases received Rituximab (54.5%), and three received Caplacizumab (27.3%). One patient died from the illness. Conclusion: This review of available literature highlights the atypical and refractory nature of COVID-19 associated TTP. It required longer sessions of PLEX with half of the patients receiving at least one immunosuppressant.

Suppurative thrombophlebitis of the portal vein, or pylephlebitis, is a rare infectious manifestation. Only few cases resulting from Fusobacterium species have been reported, demonstrating the disease that is in some ways analogous to Lemierre's syndrome, or suppurative thrombophlebitis of the internal jugular vein. Of these, Fusobacterium nucleatum represents an important subtype with unique colon cancer risk. With high mortality rates up to 32% being described in the past, prompt identification and treatment of pylephlebitis is necessary to avoid poor outcomes with this condition, including complications such as intestinal ischemia and portal hypertension. This condition typically presents alongside bacteremia, for which antibiotic therapy typically targets anaerobic organisms of oral and intestinal mucosa, as well as Streptococcus species. The use of anticoagulation therapy for pylephlebitis is supported by limited data, which shows potential benefit for preventing worsening thrombosis and liver atrophy. Here we present a case of F. nucleatum pylophlebitis who presented with related bacteremia and liver abscess after a dental infection, and treated with anaerobic coverage antibiotics including amoxicillin clavulanate until resolution of his hepatic abscess and with anticoagulation with apixaban for a total of 6 months.