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2. Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center

Author

Parth Rali, Oisin O'Corragain, Lawrence Oresanya, Daohai Yu, Omar Sheriff, Robert Weiss, Catherine Myers, Parag Desai, Nadia Ali, Anthony Stack, Michael Bromberg, Andrea L. Lubitz, Joseph Panaro, Riyaz Bashir, Vladimir Lakhter, Roberto Caricchio, Rohit Gupta, Chandra Dass, Kumaran Maruti, Xiaoning Lu, A. Koneti Rao, Gary Cohen, Gerard J. Criner, Eric T. Choi, Aaron Mishkin, Abbas Abba, Abhijit S. Pathak, Abhinav Rastogi, Adam Diamond, Aditi Satti, Adria Simon, Ahmed Soliman, Alan Braveman, Albert J. Mamary, Aloknath Pandya, Amy Goldberg, Amy Kambo, Andrew Gangemi, Anjali Vaidya, Ann Davison, Anuj Basil, Beata Kosmider, Charles T. Bakhos, Bill Cornwell, Brianna Sanguily, Brittany Corso, Carla Grabianowski, Carly Sedlock, Charles Bakhos, Chenna Kesava Reddy Mandapati, Cherie Erkmen, Chethan Gangireddy, Chih-ru Lin, Christopher T. Burks, Claire Raab, Deborah Crabbe, Crystal Chen, Daniel Edmundowicz, Daniel Sacher, Daniel Salerno, Daniele Simon, David Ambrose, David Ciccolella, Debra Gillman, Dolores Fehrle, Dominic Morano, Donnalynn Bassler, Edmund Cronin, Eduardo Dominguez, Ekam Randhawa, Ekamjeet Randhawa, Eman Hamad, Eneida Male, Erin Narewski, Francis Cordova, Frederic Jaffe, Frederich Kueppers, Fusun Dikengil, Jonathan Galli, Jamie Garfield, Gayle Jones, Gennaro Calendo, Gerard Criner, Gilbert D'Alonzo, Ginny Marmolejos, Matthew Gordon, Gregory Millio, Fernandez Gustavo, Hannah Simborio, Harwood Scott, Heidi Shore-Brown, Hernan Alvarado, Ho-Man Yeung, Ibraheem Yousef, Ifeoma Oriaku, Iris Jung-won Lee, Isaac Whitman, James Brown, Jamie L. Garfield, Janpreet Mokha, Jason Gallagher, Jeffrey Stewart, Jenna Murray, Jessica Tang, Jeyssa Gonzalez, Jichuan Wu, Jiji Thomas, Jim Murrett, Joanna Beros, John M. Travaline, Jolly Varghese, Jordan Senchak, Joseph Lambert, Joseph Ramzy, Joshua Cooper, Jun Song, Junad Chowdhury, Kaitlin Kennedy, Karim Bahmed, Karim Loukmane, Karthik Shenoy, Kathleen Brennan, Keith Johnson, Kevin Carney, Kraftin Schreyer, Kristin Criner, Maruti Kumaran, Lauren Miller, Laurie Jameson, Laurie Johnson, Laurie Kilpatrick, Lii-Yoong Criner, Lily Zhang, Lindsay K. McGann, Llera A. Samuels, Marc Diamon, Margaret Kerper, Maria Vega Sanchez, Mariola Marcinkienwicz, Maritza Pedlar, Mark Aksoy, Mark Weir, Marla R. Wolfson, Marla Wolfson, Robert Marron, Martin Keane, Massa Zantah, Mathew Zheng, Matthew Delfiner, Maulin Patel, Megan Healy, Melinda Darnell, Melissa Navaro, Meredith A. Brisco-Bacik, Michael Gannon, Michael Jacobs, Mira Mandal, Nanzhou Gou, Nathaniel Marchetti, Nathaniel Xander, Navjot Kaur, Neil Nadpara, Nicole Desai, Nicole Mills, Norihisa Shigemura, Ohoud Rehbini, Oneida Arosarena, Osheen Abramian, Paige Stanley, Patrick Mulhall, Pravin Patil, Priju Varghe, Puja Dubal, Puja Patel, Rachael Blair, Rajagopalan Rengan, Rami Alashram, Randol Hooper, Rebecca A. Armbruster, Regina Sheriden, Rogers Thomas, Rohit Soans, Roman Petrov, Roman Prosniak, Romulo Fajardo, Ruchi Bhutani, Ryan Townsend, Sabrina Islam, Samantha Pettigrew, Samantha Wallace, Sameep Sehgal, Samuel Krachman, Santosh Dhungana, Sarah Hoang, Sean Duffy, Seema Rani, Shapiro William, Sheila Weaver, Shelu Benny, Sheril George, Shuang Sun, Shubhra Srivastava-Malhotra, Stephanie Brictson, Stephanie Spivack, Stephanie Tittaferrante, Stephanie Yerkes, Stephen Priest, Steve Codella, Steven G. Kelsen, Steven Houser, Steven Verga, Sudhir Bolla, Sudhir Kotnala, Sunil Karhadkar, Sylvia Johnson, Tahseen Shariff, Tammy Jacobs, Thomas Hooper, Tom Rogers, Tony S. Reed, Tse-Shuen Ku, Uma Sajjan, Victor Kim, Whitney Cabey, Wissam Chatila, Wuyan Li, Zach Dorey-Stein, Zachariah Dorey-Stein, and Zachary D. Repanshek

Subjects
Male, medicine.medical_specialty, Computed Tomography Angiography, Deep vein, Hypercoagulable state in COVID-19, 030204 cardiovascular system & hematology, COVID-19 VTE, Article, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, COVID-19 coagulopathy, medicine, Humans, Thrombophilia, 030212 general & internal medicine, cardiovascular diseases, Prospective cohort study, Retrospective Studies, Philadelphia, Venous Thrombosis, Ultrasonography, Doppler, Duplex, business.industry, SARS-CoV-2, Incidence (epidemiology), Incidence, COVID-19, Retrospective cohort study, Odds ratio, Middle Aged, medicine.disease, Prognosis, equipment and supplies, Respiration, Artificial, Confidence interval, Pulmonary embolism, medicine.anatomical_structure, Cohort, Surgery, Female, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism
Abstract

Background Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors of VTE at our high-volume tertiary care center. Methods We performed a retrospective cohort study of 147 patients who had been admitted to Temple University Hospital with coronavirus disease 2019 (COVID-19) from April 1, 2020 to April 27, 2020. We first identified the VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]) incidence in our cohort. The VTE and no-VTE groups were compared by univariable analysis for demographics, comorbidities, laboratory data, and treatment outcomes. Subsequently, multivariable logistic regression analysis was performed to identify the early predictors of VTE. Results The 147 patients (20.9% of all admissions) admitted to a designated COVID-19 unit at Temple University Hospital with a high clinical suspicion of acute VTE had undergone testing for VTE using computed tomography pulmonary angiography and/or extremity venous duplex ultrasonography. The overall incidence of VTE was 17% (25 of 147). Of the 25 patients, 16 had had acute PE, 14 had had acute DVT, and 5 had had both PE and DVT. The need for invasive mechanical ventilation (adjusted odds ratio, 3.19; 95% confidence interval, 1.07-9.55) and the admission D-dimer level ≥1500 ng/mL (adjusted odds ratio, 3.55; 95% confidence interval, 1.29-9.78) were independent markers associated with VTE. The all-cause mortality in the VTE group was greater than that in the non-VTE group (48% vs 22%; P = .007). Conclusions Our study represents one of the earliest reported from the United States on the incidence rate of VTE in patients with COVID-19. Patients with a high clinical suspicion and the identified risk factors (invasive mechanical ventilation, admission D-dimer level ≥1500 ng/mL) should be considered for early VTE testing. We did not screen all patients admitted for VTE; therefore, the true incidence of VTE could have been underestimated. Our findings require confirmation in future prospective studies.

Published
2020

4. Prehospital intubation does not decrease complications in the penetrating trauma patient

Author

Sharven, Taghavi, Halley P, Vora, Senthil N, Jayarajan, John P, Gaughan, Abhijit S, Pathak, Thomas A, Santora, and Amy J, Goldberg

Subjects
Adult, Aged, 80 and over, Male, Emergency Medical Services, Wounds, Stab, Length of Stay, Middle Aged, Injury Severity Score, Logistic Models, Treatment Outcome, Intubation, Intratracheal, Humans, Female, Wounds, Gunshot, Registries, Propensity Score, Emergency Treatment, Aged, Retrospective Studies
Abstract

Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to determine if PHI in patients with penetrating trauma results in reduced mortality and in-hospital complications. Patient records for all Category 1 trauma activations as a result of penetrating injury admitted to our institution from 2006 to 2010 were reviewed. There were 1615 Category 1 trauma activations with 152 (9.8%) intubated in the field. A total of 1311 survived initial resuscitative efforts to permit hospital admission with 55 (4.2%) being intubated in the field. For patients surviving to admission, prehospital intubation was associated with increased mortality (hazard ratio, 8.266; 95% confidence interval [CI, 4.336 to 15.758; P0.001). After correcting for Injury Severity Score, PHI was not protective against pulmonary complications (odds ratio [OR], 0.724; 95% CI, 0.229 to 2.289; P = 0.582), deep vein thrombosis/pulmonary embolus (OR, 0.838; 95% CI, 0.281 to 2.494; P = 0.750), sepsis (OR, 0.572; 95% CI, 0.201 to 1.633; P = 0.297), wound infections (OR, 1.739; 95% CI, 0.630 to 4.782; P = 0.286), or complications of any kind (OR, 1.020; 95% CI, 0.480 to 2.166; P = 0.959). For victims of penetrating trauma, immediate transportation by emergency medical personnel may result in improved outcomes.

Published
2014

6. Contributors

Author

Daria Arcaro, Francisco Badosa, Julia K. Barbarisi, Darric E. Baty, Steve B. Behrens, Michael Belden, Sharon Ben-Or, Robert L. Benz, James G. Bittner, Linda L. Blank, Robert E. Booth, Charles Bosk, Kevin M. Bradley, Christopher P. Brandt, Karen J. Brasel, Ari D. Brooks, Julia Bulatova, Umber Burhan, Ned Z. Carp, Andres E. Castellanos, Robin M. Ciocca, Jeffrey A. Claridge, John R. Clarke, Donald R. Cooney, Andrew J. Curtin, Sharon Del Bono, Gabriel Del Corral, Adeline M. Deladisma, Jennifer L. Denne, Rita El-Hajj, Rebecca S. Evangelista, Francis D. Ferdinand, Nicole D. Figueredo, Sandra Fine, Julia E. Gabis Esquire, Jonathan Gefen, Brett C. Gilbert, Rashna F. Ginwalla, Amy J. Goldberg, Matthew I. Goldblatt, Scott M. Goldman, Joseph F. Golob, Leo A. Gordon, Stephen E. Gordon, Gregg Guilfoyle, Dipin Gupta, Linnea S. Hauge, Jonathan R. Hiatt, Ryan S. Hoffman, Celeste M. Hollands, Mary Ann Hopkins, Justin B. Hurie, Donald M. Jacobs, Jason M. Johanning, Larry Jonas, Susan Kaiser, Lewis J. Kaplan, Jeffry L. Kashuk, Douglas Katz, Stephen K. Klasko, Jaromir Kohout, Omar Yusef Kudsi, Catherine L. Kuntz, Peter F. Lalor, Leah Lande, Stephanie R. Landmesser, Nicholas P. Lang, James Lim, D. Scott Lind, David M. Lingle, G. Matthew Longo, Thomas G. Lynch, Aditi Madabhushi, Anton Mahne, Barry D. Mann, John H. Marks, Ruth D. Mayforth, Thomas G. McCarter, Carlos R. Medina, Andreas H. Meier, John D. Mellinger, Giancarlo Mercogliano, Thomas J. Meyer, Lino F. Miele, Mira Milas, John Mullarkey, Robert B. Noone, Meredith N. Osterman, James R. Ouellette, Rohit A. Patel, Abhijit S. Pathak, Douglas E. Paull, Gregory Peck, Clifford H. Pemberton, Marjie L. Persons, Barbara J. Pettit, Roy Phitayakorn, Iraklis I. Pipinos, Dan Poenaru, Walter E. Pofahl, Saqib Rehman, David A. Rogers, Benjamin J. Rogoway, Christina M. Rose, Joel C. Rosenfeld, Pamela A. Rowland, Jane Ruddell Esquire, W. Randall Russell, Jennifer L. Sabol, Louis Samuels, Hilary A. Sanfey, Thomas A. Santora, Kimberly D. Schenarts, Paul J. Schenarts, Catherine M. Schermer, John F. Schilling, Miren A. Schinco, J. David Schmidt, Mark J. Seamon, Charles Shieh, Veeraiah Siripurapu, Douglas S. Smink, Robert D. Smink, Bradford Davison Smith, Brian P. Smith, Bruce E. Stabile, Francis P. Sutter, Deebeanne M. Tavani, Paula M. Termuhlen, Julia M. Toto, Christine T. Trankiem, Alexander Uribe, Paul Vesco, R. Matthew Walsh, Michael W. Weaver, Roxane Weighall, Lisa R. Weisfelner, Philip J. Wolfson, Philip Craig Wry, Dennis F. Zagrodnik, Harry G. Zegel, and Michael Zucker

Published
2009
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7. Quantitative analysis of the Landis method

Author

Abhijit S. Pathak, Abraham Noordergraaf, Lawrence F. Muscarella, and Shiro Takashima

Subjects
Capillary action, Microcirculation, Models, Cardiovascular, Reproducibility of Results, Cell Biology, Anatomy, Capillary filtration, Mechanics, Biochemistry, Constriction, Elasticity, Blood capillary, Capillary Permeability, Significant error, Methods, Animals, Cardiology and Cardiovascular Medicine, Quantitative analysis (chemistry), Mathematics
Abstract

Landis developed the single capillary micro-occlusion method for the determination of the capillary filtration coefficient, Lp. More recently, several modified versions of Landis's original procedure have been introduced in an attempt to measure Lp with greater ease and accuracy. Each of the techniques assumes that the capillary is a uniformly cylindrical indestensible tube. Since recently obtained experimental data have demonstrated that the capillary is compliant, a distributed mathematical model of the capillary was developed to reveal the extent to which capillary distensibility influences the measurement of Lp at different sites along the capillary. After assigning physiologic values to this modeled capillary, including Lp and the capillary wall's modulus of elasticity, Landis's method and two of its modified versions were performed on the modeled capillary, with each yielding values for Lp at 10 different locations along the capillary. Comparison of these 10 computed Lp values with the corresponding Lp values defined in the modeled capillary demonstrates that capillary distensibility can introduce significant error into the measurement of Lp.

Published
1993

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