Objective: To evaluate the clinical course of and risk factors for arterial thrombotic events in adult inpatients with coronavirus disease 2019 . Methods: All consecutive adult patients admitted for COVID-19 infection in a referral center in France and discharged from the hospital between April 1 and April 30, 2020, were included. All arterial thrombotic events that occurred through discharge were considered for analysis. Epidemiologic, demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records with use of a standardized data collection form. Results: Overall, 531 COVID-19þ patients were analyzed. Among them, 30 (5.6%) experienced arterial thrombotic events. Arterial thrombotic events in the setting of COVID-19 infection happened at a median of 11 (5-20) days after the first symptoms of infection; occurred in high-risk patients according to traditional cardiovascular risk factors; had an atypical pattern, such as thrombosis of the aorta, upper limb, or renal arteries or cerebral microvasculopathy in 7 (23.3%) cases; and were associated with an in-hospital mortality rate of 40%. Arterial thrombotic events increased the risk of death by 3-fold in COVID-19þ patients (hazard ratio, 2.96; 95% CI, 1.4 to 4.7; P¼.002). A subdistribution survival hazard model showed that a concentration of D-dimer above 1250 ng/mL increased the risk of arterial thrombotic events in COVID-19þ patients by more than 7 (subdistribution hazard ratio, 7.68; 95% CI, 2.9 to 20.6; P<.001). Conclusion:A dramatically high rate of in-hospital death was observed in patients who suffered arterial thrombotic events in the setting of COVID-19 infection. A D-dimer level above 1250 ng/mL at entry may identify COVID-19þ patients at risk for arterial thrombotic events.
This study confirms the important prevalence of ADH among elderly institutionalized patients. Consequences on the level of dependence were significant. It seems relevant to elaborate hierarchical therapeutic strategies in order to counter these disorders and the fatalism that ensues.
Exudate control is important in the management of both acute and chronic wounds. A new category of absorbent dressings that contain superabsorbent particles promises high absorbency. The aim of this multicentre, prospective, non-comparative observational study was to evaluate the clinical efficacy and absorbent capacity of a superabsorbent dressing. Fifteen inpatients and outpatients with highly exuding wounds were included. Most patients (n=8) (53%) had chronic wounds; 20% (n=3) had ulcerating tumours. The superabsorbent dressing was used as a primary or a secondary dressing. Assessment was on day 0 (start), day 3 and day 7 (end of study). The study looked at wound bed and periwound skin condition, exudate production, pain upon dressing removal, reason for dressing removal, and frequency of dressing changes. A clinical visual scoring tool was used, together with digital photographs, which were assessed by the same experienced clinician. All 15 patients completed the study, during which no adverse events were noted. At day 7, maceration had reduced from 46.7% (n=7) at day 0 to 6.7% (n=1). After only 3 days, dressing change frequency was reduced from once daily to twice weekly in 80% (n=12) of patients. The superabsorbent dressing seems to reduce complications associated with exudate production, stimulate wound healing and increase patient comfort; it may also save time and costs for caregivers.
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