Background Patients hospitalised with COVID-19 are at risk for thrombotic events after discharge; the role of extended thromboprophylaxis in this population is unknown. Methods In this open-label, multicentre, randomised trial conducted at 14 centres in Brazil, patients hospitalised with COVID-19 at increased risk for venous thromboembolism (International Medical Prevention Registry on Venous Thromboembolism [IMPROVE] venous thromboembolism [VTE] score of ≥4 or 2–3 with a D-dimer >500 ng/mL) were randomly assigned (1:1) to receive, at hospital discharge, rivaroxaban 10 mg/day or no anticoagulation for 35 days. The primary efficacy outcome in an intention-to-treat analysis was a composite of symptomatic or fatal venous thromboembolism, asymptomatic venous thromboembolism on bilateral lower-limb venous ultrasound and CT pulmonary angiogram, symptomatic arterial thromboembolism, and cardiovascular death at day 35. Adjudication was blinded. The primary safety outcome was major bleeding. The primary and safety analyses were carried out in the intention-to-treat population. This trial is registered at ClinicalTrials.gov , NCT04662684 . Findings From Oct 8, 2020, to June 29, 2021, 997 patients were screened. Of these patients, 677 did not meet eligibility criteria; the remaining 320 patients were enrolled and randomly assigned to receive rivaroxaban (n=160 [50%]) or no anticoagulation (n=160 [50%]). All patients received thromboprophylaxis with standard doses of heparin during hospitalisation. 165 (52%) patients were in the intensive care unit while hospitalised. 197 (62%) patients had an IMPROVE score of 2–3 and elevated D-dimer levels and 121 (38%) had a score of 4 or more. Two patients (one in each group) were lost to follow-up due to withdrawal of consent and not included in the intention-to-treat primary analysis. The primary efficacy outcome occurred in five (3%) of 159 patients assigned to rivaroxaban and 15 (9%) of 159 patients assigned to no anticoagulation (relative risk 0·33, 95% CI 0·12–0·90; p=0·0293). No major bleeding occurred in either study group. Allergic reactions occurred in two (1%) patients in the rivaroxaban group. Interpretation In patients at high risk discharged after hospitalisation due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. Funding Bayer.
ObjectiveTo determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting.MethodsA retrospective study with analysis of 230 medical records between January 2011 and October 2013 was conducted.ResultsFifty-six (24.3%) out of the 230 patients were female. The average age of patients undergoing on-pump coronary artery bypass grafting was 59.91±8.62 years old, and off-pump was 57.16±9.01 years old (P=0.0213). The average EuroSCORE for the on-pump group was 3.37%±3.08% and for the off-pump group was 3.13%±3% (P=0.5468). Eighteen (13.43%) patients who underwent off-pump coronary artery bypass grafting developed postoperative atrial fibrillation, whereas for the onpump group, 19 (19.79%) developed this arrhythmia, with no significant difference between the groups (P=0.1955).ConclusionOff-pump coronary artery bypass grafting did not reduce the incidence of atrial fibrillation in the postoperative period. Important predictors of risk for the development of this arrhythmia were identified as: patients older than 70 years old and presence of atrial fibrillation in perioperative period in both groups, and non-use of beta-blockers drugs postoperatively in the on-pump group.
Com a finalidade de colaborar para a geração de fitoterápicos, o presente trabalho teve como objetivo realizar um screening da atividade antimicrobiana in vitro dos extratos das plantas Piper solmsianum e Equisetum arvensis. Os rendimentos dos extratos brutos etanólicos foram de 18,6% para folhas de P. solmsianum e de 6,7 % para as partes aéreas de E. arvensis. A atividade antimicrobiana foi testada frente ao Staphylococcus aureus ATCC 25923 e Escherichia coli ATCC 25922, utilizando o método de difusão em ágar cilindro em placas. Os extratos foram testados nas concentrações de 2000µg (1:1), 1000 µg (1:2), 500 µg (1:4), 250 µg (1:8) e 125 µg (1:16) dissolvidos em DMSO. O extrato de E. arvensis apresentou atividade antimicrobiana até a concentração de 125 µg (1:16) para ambas as cepas testadas, com halo médio de inibição de 11,5 mm para S. aureus e 11mm para E. coli. O extrato bruto etanólico de P. solmsianum também apresentou atividade antimicrobiana até a concentração de 125 µg (1:16) para ambas as cepas, com halo médio de inibição de 15 mm para S. aureus e 11mm para E. coli. A atividade antimicrobiana dos extratos testados foi considerada moderada tanto para microrganismos Gram positivo como Gram negativo.
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ResumoAneurismas da artéria temporal superficial são incomuns segundo a literatura. A grande maioria é secundária a traumatismos ou cirurgia na região temporal, sendo que 95% dos casos evoluem para pseudoaneurismas. Entretanto, os aneurismas verdadeiros ou espontâneos são extremamente raros e representam 8% dos casos de aneurismas da artéria temporal superficial, sendo estes, geralmente, de origem aterosclerótica. Aneurismas temporais espontâneos podem coexistir com outras lesões vasculares, incluindo aneurismas intracranianos. Nosso relato trata de um paciente com aneurisma de artéria temporal superficial esquerda, de origem aterosclerótica, no qual foi realizada a excisão cirúrgica, sob anestesia geral.
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