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Central venous catheters including dialysis catheters are a potential source of venous thrombosis and pose a risk for paradoxical embolic events including ischemic stroke and systemic embolism in patients with a patent foramen ovale (PFO). The adult population with a PFO and patients with a central venous dialysis catheter (CVDC) are at increased risk of a paradoxical embolic event. Since bubble study is not routinely done during echocardiogram in a patient with CVDC, it is difficult to identify at-risk patients for paradoxical embolic events during catheter manipulation, especially for clogged CVDC.We report a rare case of a 79-year-old lady with end-stage renal disease on hemodialysis (HD) using a CVDC who developed a paradoxical embolic ischemic stroke following the use of tissue plasminogen activator (tPA) for unclogging a dialysis catheter. We aimed to highlight the existing risks of thromboembolism associated with the long-term use of central CVDC, especially the potential risk of paradoxical embolism and ischemic stroke with the use of tPA for management of clogged dialysis catheters. We emphasize the questionable need for a bubble study echocardiogram in all patients requiring long-term dialysis catheters.

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Background: COVID-19 disease has disproportionately affected ethnic minorities in the US. Objective: To describe the characteristics and predictors of mortality and length of hospital stay (LOS) in patients of Hispanic ethnicity hospitalized for COVID-19 disease. Design: Retrospective cohort study of 162 patients. Setting: Tertiary care teaching hospital in Brooklyn, NY. Patients: Hispanic patients hospitalized with principal diagnosis of COVID-19 disease between March 8, and April 25, 2020. Methods: Patients were classified into mild/moderate, severe/very severe, and critical disease (intubated) based on oxygen requirements. The primary endpoint was overall mortality rate and the secondary endpoint was LOS. Results: Mean age was 55.6 years and 40.1% had critical disease. The overall mortality was 35.8%. Increasing age (OR:1.09, 95% CI:1.04, 1.13, p<0.001) and vasopressor use (OR:198.55, 95% CI:15.89, 2480.66, p<0.001) were each independently associated with increased odds for mortality. Steroid use was significantly associated with decreased odds for mortality (OR:0.05, 95% CI:0.004, 0.61, p<0.05). Mean LOS was 14 days. Severe/very severe disease was significantly associated with increased LOS while critical disease was significantly associated with decreased LOS. The use of hydroxychloroquine, steroids, antibiotics, vasopressor, blood transfusion, and diagnosis of bacteremia/fungemia were each significantly associated with increased LOS.  Spanish-speaking patients were older than English-speaking ones, however, there was no difference in mortality or LOS between the groups. Conclusion: Age and vasopressor use was associated with increased mortality in Hispanics. Steroid use was associated with decreased mortality but increased LOS. No difference in outcomes was observed between English- and Spanish-speaking Hispanics.

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