35 research outputs found
An update on the efficacy and safety of novel anticoagulants for cancer associated thrombosis
No full textIntroduction: Cancer-associated thrombosis (CAT) refers to the most common thromboembolic complication of cancer which is venous thromboembolism (VTE). CAT primary prophylaxis, treatment, and secondary prevention are challenging for the complexity of cancer patients, who exhibit hypercoagulability with concomitant-heightened bleeding risk. Areas covered: In this review, the author examines the role of low molecular weight heparins (LMWH), which have been the standard of care for CAT treatment for many years. Direct oral anticoagulants (DOACS) have practical advantages over subcutaneous LMWH, especially for long-term therapy. The author then discusses the results of two RCTs which separately compared the direct oral factor Xa inhibitors, apixaban or rivaroxaban, with placebo for CAT prophylaxis in ambulatory high-risk cancer patients and found that DOACS reduced VTE but increased bleeding. Finally, the author discusses four RCTS separately comparing an oral direct factor Xa inhibitor (edoxaban, rivaroxaban, or apixaban) with LMWH for CAT treatment. DOACS showed non-inferior efficacy, although rivaroxaban and edoxaban showed higher bleeding rates, especially in gastrointestinal cancers. Expert opinion: DOACS have a convenient route of administration and do not require laboratory monitoring, although choice of anticoagulants for CAT depends on factors such as tumor type, bleeding risk, concomitant drugs, and comorbidities
Heparin-induced thrombocy-topenia and COVID-19
Get PDFHeparin-induced thrombocytopenia (HIT) has not been included as a possible cause of thrombocytopenia in Coronavirus Disease 2019 (COVID-19) patients. We report a case of HIT in a patient with COVID-19 treated with heparin. A 78-year-old man was admitted to our hospital for acute respiratory failure and acute renal failure due to SARS-CoV-2 infection; in intensive care unit, one 5000IU heparin dose (day 0, platelet count 305000/μL). On day 2, haemoglobin started to decrease and heparin was stopped. On day 10, platelet count was 153000/μL and 5000IU calcium heparin subcutaneously twice daily was started. The platelet further decreased, reaching 49000/μL on day 17, and the patient was investigated for suspected HIT: an IgG specific chemiluminescence test for heparin-PF4 antibodies was positive and a femoral DVT was found at ultrasound. Argatroban was started, platelet count increased without any bleeding and thrombosis complication. Our experience shows that HIT may develop in heparin treated COVID-19 patients and should be included among the possible cause of thrombocytopenia in such patients. © the Author(s), 2021
Relevance of immobility as a risk factor for symptomatic proximal and isolated distal deep vein thrombosis in acutely ill medical inpatients
No full textImmobility is a well-recognized risk factor for deep vein thrombosis (DVT) in surgical patients, whereas the level of DVT risk conferred by immobility is less defined in patients on medical wards. The aim of this study was to establish whether immobility and its duration are associated with the risk of DVT in acutely ill medical inpatients. We conducted a cohort study in acutely ill medical inpatients. Patients underwent whole leg ultrasound for suspected lower extremity DVT and were divided into two groups according to presence or absence of immobility, defined as total bed rest or sedentary without bathroom privileges. The endpoint was the detection of proximal DVT or isolated distal DVT (IDDVT). Among the 252 acutely ill medical inpatients with immobility (age 82.6 ± 10.3 years, female 63.9%), ultrasound showed 36 (14.3%) proximal DVTs and 39 (15.5%) IDDVTs, while there were 11 (4.4%) proximal DVTs and 26 (10.5%) IDDVTs among the 248 inpatients without immobility (age 73.6 ± 14.2 years, female 54.8%). The risk of proximal DVT was higher in immobile than in mobile patients (OR 3.59, 95% CI: 1.78–7.23, p = 0.0001), whereas the risk of IDDVT was similar between the two groups (OR 1.56, 95% CI: 0.92–2.66, p = 0.111). During the first 3 days of hospitalization, the frequency of all DVTs was similar in patients with and without immobility, but it was 0.26 ± 0.03 vs 0.18 ± 0.03, respectively, after 4 days. In conclusion, immobility for more than 3 days is a risk factor for proximal DVT in acutely ill medical inpatients. © The Author(s) 2021
Della realtà & perfettione delle impresse / con l'essamine di tutte le openioni infino a quì scritte sopra tal' arte.
No full textIncludes errata, p. [7] of preliminaries.Includes index.Printer's device on t.p. (Fortuna). Head- and tail-pieces. Initials.Mode of access: Internet.Inscription on front pastedown lined out. Signature at foot of t.p.: Cosmi Maiochij ?Gismerij.Binding: old limp vellum. Author & title written twice on spine, with shelf mark G 38 at foot
Curiosas páginas negras
No full textEste ensayo aborda dos posibles antecedentes de las páginas negras incluidas en Tristram Shandy del autor inglés Lawrence Sterne (1713-1768). Una de las fuentes serían las páginas de duelo del siglo anterior, algunas de ellas con textos blancos sobre fondo negro, o completamente negras. Otra de las fuentes sería el libro Utris Cosmi, Maioris scilicet et Minoris Metaphysica, Physica atque Technica Historia, un tratado sobre el macro y microcosmos de Robert Fludd.This essay addresses two possible antecedents of the black pages included in Tristram Shandy, by English author Lawrence Sterne (1713-1768). One source would be the mourning pages from the 17th century, some of them with white text written over black background, or completely black. Another source would be the book Utris Cosmi, scilicet et Minoris Maioris Metaphysica, Physica atque Technica history, a treatise on the macro and microcosm by Robert Fludd
Do women with venous thromboembolism bleed more than men during anticoagulation? Data from the real-life, prospective START-Register
Get PDFBackground: Venous thromboembolism (VTE) is a frequent and serious disease that requires immediate and long-term anticoagulant treatment, which is inevitably associated with a risk of bleeding complications. Some studies, though not all, reported a higher risk of bleeding in female patients treated with either old anticoagulants [vitamin k antagonists (VKAs)] or recent anticoagulants [direct oral anticoagulants (DOACs)]. Furthermore, analyses of clinical trials reported an abnormal vaginal bleeding in women of reproductive age treated with DOACs. This study aimed at comparing the risk of bleeding in an inception cohort of VTE women and men included in a prospective observational registry. Methods: Baseline characteristics and bleeding events occurring during anticoagulation in patients of both sexes, included in the START-Register after a first VTE, were analyzed. Results: In all, 1298 women were compared with 1290 men. Women were older and more often had renal diseases; their index events were often provoked (often by hormonal contraception and pregnancy), and more frequently presented as isolated pulmonary embolism (PE). The rate of bleeding was similar in women (2.9% patient-years) and men (2.1% patient-years), though it was higher when uterine bleeds were included (3.5% patient-years, p = 0.0141). More bleeds occurred in VKA- than DOAC-treated patients (6.4% versus 2.6%, respectively; p = 0.0013). At multivariate analysis, age ⩾ 75 years was associated with higher prevalence of bleeds. Conclusion: The occurrence of bleeding was not different between women and men during anticoagulation after VTE. Only after inclusion of vaginal/uterine bleeds, the rate of bleeding was higher in women. The incidence of bleeding was higher in women treated with VKAs. Background: The occurrence of a venous thromboembolic event (VTE, including deep vein thrombosis and pulmonary embolism) necessarily requires a period of at least 3–6 months of treatment with anticoagulant drugs [either vitamin k antagonists (VKA) or, more recently, direct oral anticoagulants (DOACs)]. Anticoagulation therapy, however, is associated with a risk of bleeding that is influenced by several factors. Sex is one of these factors as some authors have hypothesized that women are at higher risk than men. Furthermore, some studies have recently found more vaginal bleeding in VTE women treated with a DOAC compared with those who received VKAs. Methods: The present study aimed to compare the frequency of bleeds occurring in women and in men who were treated with DOACs or VKAs for a first VTE event and followed in real-life conditions. Since the beginning of their anticoagulant treatment, the patients were included in a prospective, multicenter, observational registry (the START-Register), and bleeding events were recorded. Results: A total of 1298 women were compared with 1290 men. Women were older and more often were affected by renal diseases; their VTE events were often associated with risk factors (especially hormonal contraception and pregnancy) and presented as isolated pulmonary embolism. The rate of all bleeding events (including major, non-major but clinically relevant, and minor bleeds) was higher in women (3.5% patient-years) than in men (2.1% patient-years, p = 0.0141); however, the difference was no longer statistically significant after exclusion of uterine bleeds (2.9% patient years). More bleeding occurred in women receiving VKA as anticoagulant drug compared with those treated with a DOAC (6.4% versus 2.6%, respectively; p = 0.0013). At multivariate analysis, age ⩾ 75 years was associated with higher prevalence of bleeds. Conclusion: In conclusion, we found that in real-life conditions, the rate of bleeding events occurring during anticoagulation after a VTE episode is not higher in women than in men. Only after inclusion of vaginal bleeds, the rate of bleeding was higher in women. More bleeds (including vaginal bleeding) occurred in women treated with VKA than DOACs. © The Author(s), 2021.BACKGROUND: Venous thromboembolism (VTE) is a frequent and serious disease that requires immediate and long-term anticoagulant treatment, which is inevitably associated with a risk of bleeding complications. Some studies, though not all, reported a higher risk of bleeding in female patients treated with either old anticoagulants [vitamin k antagonists (VKAs)] or recent anticoagulants [direct
oral anticoagulants (DOACs)]. Furthermore, analyses of clinical trials reported an abnormal vaginal bleeding in women of reproductive age treated with DOACs.
This study aimed at comparing the risk of bleeding in an inception cohort of VTE women and men included in a prospective observational registry.
METHODS: Baseline characteristics and bleeding events occurring during
anticoagulation in patients of both sexes, included in the START-Register after a first VTE, were analyzed.
RESULTS: In all, 1298 women were compared with 1290 men. Women were older and more often had renal diseases; their index events were often provoked (often by hormonal contraception and pregnancy), and more frequently presented as isolated pulmonary embolism (PE). The rate of bleeding was similar in women (2.9% patient-years) and men (2.1% patient-years), though it was higher when uterine bleeds were included (3.5% patient-years, p = 0.0141). More bleeds occurred in
VKA- than DOAC-treated patients (6.4% versus 2.6%, respectively; p = 0.0013). At multivariate analysis, age ⩾ 75 years was associated with higher prevalence of bleeds.
CONCLUSION: The occurrence of bleeding was not different between women and men during anticoagulation after VTE. Only after inclusion of vaginal/uterine bleeds, the rate of bleeding was higher in women. The incidence of bleeding was higher in women treated with VKAs.
PLAIN LANGUAGE SUMMARY: The risk of bleeding in women anticoagulated for deep
vein thrombosis or pulmonary embolism is not higher than that in men, except for
vaginal bleeding: Background:: The occurrence of a venous thromboembolic event
(VTE, including deep vein thrombosis and pulmonary embolism) necessarily
requires a period of at least 3-6 months of treatment with anticoagulant drugs
[either vitamin k antagonists (VKA) or, more recently, direct oral
anticoagulants (DOACs)]. Anticoagulation therapy, however, is associated with a
risk of bleeding that is influenced by several factors. Sex is one of these
factors as some authors have hypothesized that women are at higher risk than
men. Furthermore, some studies have recently found more vaginal bleeding in VTE
women treated with a DOAC compared with those who received VKAs.Methods:: The
present study aimed to compare the frequency of bleeds occurring in women and in
men who were treated with DOACs or VKAs for a first VTE event and followed in
real-life conditions. Since the beginning of their anticoagulant treatment, the
patients were included in a prospective, multicenter, observational registry
(the START-Register), and bleeding events were recorded.Results:: A total of
1298 women were compared with 1290 men. Women were older and more often were
affected by renal diseases; their VTE events were often associated with risk
factors (especially hormonal contraception and pregnancy) and presented as
isolated pulmonary embolism. The rate of all bleeding events (including major,
non-major but clinically relevant, and minor bleeds) was higher in women (3.5%
patient-years) than in men (2.1% patient-years, p = 0.0141); however, the
difference was no longer statistically significant after exclusion of uterine
bleeds (2.9% patient years). More bleeding occurred in women receiving VKA as
anticoagulant drug compared with those treated with a DOAC (6.4% versus 2.6%,
respectively; p = 0.0013). At multivariate analysis, age ⩾ 75 years was
associated with higher prevalence of bleeds.Conclusion:: In conclusion, we found
that in real-life conditions, the rate of bleeding events occurring during
anticoagulation after a VTE episode is not higher in women than in men. Only
after inclusion of vaginal bleeds, the rate of bleeding was higher in women.
More bleeds (including vaginal bleeding) occurred in women treated with VKA than DOACs
Spatial palindromes/palindromic spaces: spatial devices in Vitruvius, Mallarmé, Polieri, Perec and Libeskind
No full textThis thesis explores non-linear geometric texts and narratives in literature and architecture and the experience of space that is facilitated by them. The research focuses on the palindrome because it is a non-linear mathematical/geometrical device that is found both in literature and architecture. In language, the palindrome is expressed in the geometrical arrangement of words, letters or concepts in the text or the narrative; and, in architecture, as mirrored symmetries or palindromic proportions, measurements and distributions of elements in drawings and buildings. The primary aim of the thesis is to explore the spatial qualities of palindromes, and the experience of those qualities not only in text but also in architecture. This dissertation thus consists of two parts: the first examines Spatial Palindromes in terms of the spatial structures of selected texts and considers their relation to architecture; and the second examines Palindromic Spaces in terms of the spatial experiences created by and through palindromes in text and architecture. The first part, Spatial Palindromes, constructs an original history of the spatial qualities of palindromes by looking at the theory guiding the use of non-linear devices in texts and architecture. This history moves from the use of palindromes in the work of classical figures and scholars (Orpheus, Pythagoras and Vitruvius), to the Medieval and Renaissance practice of mnemonics (Frances Yates, Mary Carruthers), to early twentieth-century structural linguistics (Ferdinand de Saussure) and the group OuLiPo (Raymond Queneau, Franyois Le Lionnais) and, finally, to late twentieth-century post-structural linguistics (Jean Baudrillard.) The thesis argues that palindromes create spatial experiences both in texts and architecture. For this reason the second part, Palindromic Spaces, studies the nature of spatial experience in the fictions and designs of Stephane Mallarme, Jacques Polieri, Georges Perec, and Daniel Libeskind. According to Baudrillard the poetic space, hidden or revealed by the anagram and palindrome, is where the solid structure of language is "exterminated." This act of extermination, or the poetic space that palindrome reveals in language, opens up perception, memory and recollection to a spatial experience "that incorporates the recession of outcomes ad infinitum;" a self-generated, self-consumed or self-reflective conception of history and space that this thesis aims to explore in architecture
A possible new approach in the prediction of late gestational hypertension: The role of the fetal aortic intima-media thickness
Get PDFThe aim was to determine the predictive role of combined screening for late-onset gestational hypertension by fetal ultrasound measurements, third trimester uterine arteries (UtAs) Doppler imaging, and maternal history. This prospective study on singleton pregnancies was conducted at the tertiary center of Maternal and Fetal Medicine of the University of Padua during the period between January 2012 and December 2014. Ultrasound examination (fetal biometry, fetal wellbeing, maternal Doppler study, fetal abdominal aorta intima-media thickness [aIMT], and fetal kidney volumes), clinical data (mother age, prepregnancy body mass index [BMI], and parity), and pregnancy outcomes were collected. The P value <0.05 was defined significant considering a 2-sided alternative hypothesis. The distribution normality of variables were assessed using Kolmogorov-Smirnoff test. Data were presented by mean (±standard deviation), median and interquartile range, or percentage and absolute values. We considered data from 1381 ultrasound examinations at 29 to 32 weeks’ gestation, and in 73 cases late gestational hypertension developed after 34 weeks’ gestation. The final multivariate model found that fetal aIMT as well as fetal umbilical artery pulsatility index (PI), maternal age, maternal prepregnacy BMI, parity, and mean PI of maternal UtAs, assessed at ultrasound examination of 29 to 32 weeks’ gestation, were significant and independent predictors for the development of gestational hypertension after 34 weeks’ gestation. The area under the curve of the model was 81.07% (95% confidence interval, 75.83%-86.32%). A nomogram was developed starting from multivariate logistic regression coefficients. Late-gestational hypertension could be independently predicted by fetal aIMT assessment at 29 to 32 weeks’ gestation, ultrasound Doppler waveforms, and maternal clinical parameters. Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc
Adverse intrapartum outcome in pregnancies complicated by small for gestational age and late fetal growth restriction undergoing induction of labor with Dinoprostone, Misoprostol or mechanical methods: A systematic review and meta-analysis
No full textObjective: To investigate the outcome of pregnancies with small baby, including both small for gestational
age (SGA) and late fetal growth restriction (FGR) fetuses, undergoing induction of labor (IOL) with
Dinoprostone, Misoprostol or mechanical methods.
Study design: Medline, Embase and Cochrane databases were searched. Inclusion criteria were nonanomalous
singleton pregnancies complicated by the presence of a small fetus, defined as a fetus with
estimated fetal weight (EFW) or abdominal circumference (AC) <10th centile undergoing IOL from 34
weeks of gestation with vaginal Dinoprostone, vaginal misoprostol, or mechanical methods (including
either Foley or Cook balloon catheters). The primary outcome was a composite measure of adverse
intrapartum outcome. Secondary outcomes were the individual components of the primary outcome,
perinatal mortality and morbidity. All the explored outcomes were reported in three different sub-groups
of pregnancies complicated by a small fetus including: all small fetuses (defined as those with an EFW
and/or AC <10th centile irrespective of fetal Doppler status), late FGR fetuses (defined as those with EFW
and/or AC <3rd centile or AC/EFW <10th centile associated with abnormal cerebroplacental Dopplers)
and SGA fetuses (defined as those with EFW and/or AC <10th but >3rd centile with normal
cerebroplacental Dopplers). Quality assessment of each included study was performed using the Risk of
Bias in Non-randomized Studies-of Interventions tool (ROBINS-I), while the GRADE methodology was
used to assess the quality of the body of retrieved evidence. Meta-analyses of proportions and individual
data random-effect logistic regression were used to analyze the data.
Results: 12 studies (1711 pregnancies) were included. In the overall population of small fetuses, composite
adverse intra-partum outcome occurred in 21.2 % (95 % CI 10.034.9) of pregnancies induced with
Dinoprostone, 18.0 % (95 % CI 6.932.5) of those with Misoprostol and 11.6 % (95 % CI 5.519.3) of those
undergoing IOL with mechanical methods. Cesarean section (CS) for non-reassuring fetal status (NRFS)
was required in 18.1 % (95 % CI 9.928.3) of pregnancies induced with Dinoprostone, 9.4 % (95 % CI
1.422.0) of those with Misoprostol and 8.1 % (95 % CI 5.011.6) of those undergoing mechanical
induction. Likewise, uterine tachysystole, was recorded on CTG in 13.8 % (95 % CI 6.922.3) of cases
induced with Dinoprostone, 7.5 % (95 % CI 2.115.4) of those with Misoprostol and 3.8 % (95 % CI 0–4.4) of
those induced with mechanical methods. Composite adverse perinatal outcome following delivery
complicated 2.9 % (95 % CI 0.56.7) newborns after IOL with Dinoprostone, 0.6 % (95 % CI 0–2.5) with
Misoprostol and 0.7 % (95 % CI 0–7.1) with mechanical methods. In pregnancies complicated by late FGR,
adverse intrapartum outcome occurred in 25.3 % (95 % CI 18.832.5) of women undergoing IOL with
Dinoprostone, compared to 7.4 % (95 % CI 3.911.7) of those with mechanical methods, while CS for NRFS
was performed in 23.8 % (95 % CI 17.330.9) and 6.2 % (95 % CI 2.810.5) of the cases, respectively. Finally,
in SGA fetuses, composite adverse intrapartum outcome complicated 8.4 % (95 % CI 4.613.0) of
pregnancies induced with Dinoprostone, 18.6 % (95 % CI 13.125.2) of those with Misoprostol and 8.7 (95
% CI 2.517.5) of those undergoing mechanical IOL, while CS for NRF was performed in 8.4 % (95 % CI
4.613.0) of women induced with Dinoprostone, 18.6 % (95 % CI 13.125.2) of those with Misoprostol and
8.7 % (95 % CI 2.517.5) of those undergoing mechanical induction. Overall, the quality of the included
studies was low and was downgraded due to considerable clinical and statistical heterogeneity.
Conclusions: There is limited evidence on the optimal type of IOL in pregnancies with small fetuses.
Mechanical methods seem to be associated with a lower occurrence of adverse intrapartum outcomes,
but a direct comparison between different techniques could not be performed
