Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in deve...Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein thrombosis.Specifically,there is paucity of data on the association of NASH and venous thromboembolism(VTE),with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients.The mechanism is believed to be a hepatocellular injury,which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors.There has been no prior analysis of the degree of steatosis and fibrosis(measured using transient elastography,commonly known as FibroScan)in NASH and its association with VTE.AIM To examine the association between the degree of hepatic steatosis and fibrosis,quantified by transient elastography,and the incidence of VTE in patients with NASH.METHODS In our case-control study,we included patients with a documented diagnosis of NASH.We excluded patients with inherited thrombophilia,hemoglobinopathy,malignancy,alcohol use disorder,autoimmune hepatitis,and primary biliary cirrhosis.The collected data included age,demographics,tobacco use,recreational drug use,medical history,and vibration controlled transient elastography scores.VTE-specific data included the location,type of anticoagulant,need for hospital stay,and history of VTE recurrence.Steatosis was categorized as S0-S1(mild)and S2-S3(moderate to severe)based on the controlled attenuation parameter score.Fibrosis was classified based on the kilopascal score and graded as F0-F1(Metavir stage),F2,F3,and F4(cirrhosis).χ^(2) and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses,respectively.Furthermore,we performed a logistic regression using VTE as the dependent variable.RESULTS A total of 415 patients were analyzed,and 386 met the inclusion criteria.51 and 335 patients were included in the VTE and non-VTE groups,respectively.Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group(P<0.014).Patients with VTE had a higher body mass index(31.14 kg/m²vs 29.30 kg/m²)and a higher prevalence of diabetes mellitus(29.4%vs 13.1%).The history of NASH was significantly higher in the VTE group(45.1%vs 30.4%,P<0.037).Furthermore,moderate-to-severe steatosis was significantly higher in the VTE group(66.7%vs 47.2%,P<0.009).Similarly,the F2-F4 fibrosis grade had a prevalence of 58.8%in the VTE group compared to 38.5%in the non-VTE group(P<0.006).On logistic regression,using VTE as a dependent variable,diabetes mellitus had an odds ratio(OR)=1.702(P<0.015),and F2-F4 fibrosis grade had an OR=1.5(P<0.033).CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE,especially deep vein thrombosis.There was a statistically significant association between the incidence of VTE,moderate-to-severe steatosis,and fibrosis.All hospitalized patients should be considered for medical thromboprophylaxis,particularly those with NASH.展开更多
February 2,2007—The American College of Physicians and American Academy of Family Physicians announced clinical practice guidelines for the diagnosis and management of venous thromboembolism(VTE),which claims more th...February 2,2007—The American College of Physicians and American Academy of Family Physicians announced clinical practice guidelines for the diagnosis and management of venous thromboembolism(VTE),which claims more than 200,000 lives each year in the United States.展开更多
BACKGROUND Eosinophilia is an increase of more than 0.5×109/L in the number of eosinophils;it is a systemic condition with an unknown etiology and is often accompanied by multiple impaired organ functions.The cli...BACKGROUND Eosinophilia is an increase of more than 0.5×109/L in the number of eosinophils;it is a systemic condition with an unknown etiology and is often accompanied by multiple impaired organ functions.The clinical manifestations of the disease are highly variable and diverse,rendering identification of the diagnosis challenging;hence,diagnosis and treatment are often delayed.Very few reports of this disease exist globally,especially with rare manifestations of cerebral venous sinus thrombosis and hemorrhage.CASE SUMMARY A 32-year-old woman with eosinophilia presented to the hospital with bilateral lower-limb edema as the first clinical manifestation,followed by an extensive maculopapular rash throughout the body.She subsequently developed cerebral venous sinus thrombosis along with bilateral lower-limb deep vein thrombosis.Two weeks earlier,she had received a single course of antibiotics from a local hospital for a low-grade fever and sore throat.After various treatments were administered for anticoagulation,maintaining blood circulation,and relieving blood stasis,the lower extremity edema improved significantly;however,the patient’s eosinophil count gradually increased.She experienced cerebral venous sinus thrombosis,cerebral hemorrhage,and deep vein thrombosis of the lower limbs before being declared brain dead.In this case report,we have elaborated the diagnosis and management of deep vein thrombosis manifested as eosinophilia,thrombocytopenia,and elevated D-dimer levels.CONCLUSION Because proper diagnosis is challenging,clinical vigilance is required for patients with eosinophilia,as it can lead to thrombus formation.展开更多
Cancer patients with venous thromboembolism (VTE) are not rare, and the second death cause in patients with cancer is VTE. Although VTE itself is associated with reduced survival particularly in cancer patients, many ...Cancer patients with venous thromboembolism (VTE) are not rare, and the second death cause in patients with cancer is VTE. Although VTE itself is associated with reduced survival particularly in cancer patients, many oncologists may not place enough importance in positive prevention of VTE. Here, we report the case of a 38-year-old male lung cancer patient with brain, bone and leptomeningeal metastasis who diagnosed as a consequential intracranial venous and mesenteric vein thrombosis. The evolution of headache has not been noted gradually, from which led to the underestimation of headache and without careful consideration on the possibility of suspected intracranial venous thrombosis. The problem of mesenteric vein thrombosis reflects the dilemma resulted from the potential risk of thrombogenesis and the high risk of hemorrhage. Preventive anticoagulation strategies are key means especially in patients with cancer, and the management problems of this condition are discussed.展开更多
Purpose:Venous thromboembolism(VTE)is a major health issue among hip fracture patients.This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-b...Purpose:Venous thromboembolism(VTE)is a major health issue among hip fracture patients.This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient’’s drug compliance and reduce the incidence of VTE in hip fracture patients.Methods:This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE(control group)between January 2008 and November 2012,and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform(study group)between January 2016 and September 2017.All the patients included in the both groups were hip fracture patients who had an age over 50 years,treated with surgery,and hospitalized≥48 h.Patients were excluded if they admitted to hospital due to old fractures,had a severe bleeding after 72 h of admission,diagnosed with any type of VTE,or refused to participate in the study.The information platform was divided into medical,nursing,and patient interface.Based on the information platform,medical practitioners and nurses could perform risk assessments,monitoring management and early warnings,preventions and treatments,health educations,follow-up,and other aspects of nursing interventions for patients.This study compared essential characteristics,drug compliance,VTE occurrence,and mean length of hospitalization between the two groups.Besides,a subgroup analysis was performed in the study group according to different drug compliances.SPSS 18.0 software(IBM Corp.,NY,and USA)was used for statistical analysis.Results:Altogether 1177 patients were included in the control group,and 491 patients in the study group.Regarding baseline data,patients in the study group had more morbidities than those in the control group(p<0.05).The difference of drug compliance between the two groups was statistically significant(p<0.001):761(64.7%)of the patients in the control group and only 30(6.1%)patients in the study group had poor drug compliance.In terms of VTE,10.7%patients(126/1177)in the control group had VTE,and the rate in the study group was 7.1%(35/491),showing a statistically significant difference(p=0.02).Moreover,the average length of hospitalization in the study group was also significantly lower than that in the control group(10.4 daysvs.13.7 days,p<0.001).Subgroup analyses of the study group showed that the incidence of VTE in patients with poor,partial,and good compliances were 56.7%(17/30),5.8%(10/171),and 2.8%(8/290),respectively,revealing a significantly huge difference(p<0.001).Conclusions:Poor drug compliance leads to higher VTE occurrence.The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE.The mobile application may be an effective tool to prevent VTE in hip fracture patients.展开更多
文摘Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.
基金This protocol was developed,reviewed,and sanctioned by the joint institutional review board at MetroWest Medical Center under Approval No.2020-035.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease worldwide.Studies have shown a strong association between nonalcoholic steatohepatitis(NASH)cirrhosis and portal vein thrombosis.Specifically,there is paucity of data on the association of NASH and venous thromboembolism(VTE),with one such study predicting a 2.5-fold increased risk for VTE compared to other liver diseases in hospitalized patients.The mechanism is believed to be a hepatocellular injury,which causes a chronic inflammatory state leading to the unregulated activation of procoagulant factors.There has been no prior analysis of the degree of steatosis and fibrosis(measured using transient elastography,commonly known as FibroScan)in NASH and its association with VTE.AIM To examine the association between the degree of hepatic steatosis and fibrosis,quantified by transient elastography,and the incidence of VTE in patients with NASH.METHODS In our case-control study,we included patients with a documented diagnosis of NASH.We excluded patients with inherited thrombophilia,hemoglobinopathy,malignancy,alcohol use disorder,autoimmune hepatitis,and primary biliary cirrhosis.The collected data included age,demographics,tobacco use,recreational drug use,medical history,and vibration controlled transient elastography scores.VTE-specific data included the location,type of anticoagulant,need for hospital stay,and history of VTE recurrence.Steatosis was categorized as S0-S1(mild)and S2-S3(moderate to severe)based on the controlled attenuation parameter score.Fibrosis was classified based on the kilopascal score and graded as F0-F1(Metavir stage),F2,F3,and F4(cirrhosis).χ^(2) and Mann-Whitney U tests were used for the qualitative and quantitative variable analyses,respectively.Furthermore,we performed a logistic regression using VTE as the dependent variable.RESULTS A total of 415 patients were analyzed,and 386 met the inclusion criteria.51 and 335 patients were included in the VTE and non-VTE groups,respectively.Patients with VTE had a mean age of 60.63 years compared to 55.22 years in the non-VTE group(P<0.014).Patients with VTE had a higher body mass index(31.14 kg/m²vs 29.30 kg/m²)and a higher prevalence of diabetes mellitus(29.4%vs 13.1%).The history of NASH was significantly higher in the VTE group(45.1%vs 30.4%,P<0.037).Furthermore,moderate-to-severe steatosis was significantly higher in the VTE group(66.7%vs 47.2%,P<0.009).Similarly,the F2-F4 fibrosis grade had a prevalence of 58.8%in the VTE group compared to 38.5%in the non-VTE group(P<0.006).On logistic regression,using VTE as a dependent variable,diabetes mellitus had an odds ratio(OR)=1.702(P<0.015),and F2-F4 fibrosis grade had an OR=1.5(P<0.033).CONCLUSION Our analysis shows that NASH is an independent risk factor for VTE,especially deep vein thrombosis.There was a statistically significant association between the incidence of VTE,moderate-to-severe steatosis,and fibrosis.All hospitalized patients should be considered for medical thromboprophylaxis,particularly those with NASH.
文摘February 2,2007—The American College of Physicians and American Academy of Family Physicians announced clinical practice guidelines for the diagnosis and management of venous thromboembolism(VTE),which claims more than 200,000 lives each year in the United States.
文摘BACKGROUND Eosinophilia is an increase of more than 0.5×109/L in the number of eosinophils;it is a systemic condition with an unknown etiology and is often accompanied by multiple impaired organ functions.The clinical manifestations of the disease are highly variable and diverse,rendering identification of the diagnosis challenging;hence,diagnosis and treatment are often delayed.Very few reports of this disease exist globally,especially with rare manifestations of cerebral venous sinus thrombosis and hemorrhage.CASE SUMMARY A 32-year-old woman with eosinophilia presented to the hospital with bilateral lower-limb edema as the first clinical manifestation,followed by an extensive maculopapular rash throughout the body.She subsequently developed cerebral venous sinus thrombosis along with bilateral lower-limb deep vein thrombosis.Two weeks earlier,she had received a single course of antibiotics from a local hospital for a low-grade fever and sore throat.After various treatments were administered for anticoagulation,maintaining blood circulation,and relieving blood stasis,the lower extremity edema improved significantly;however,the patient’s eosinophil count gradually increased.She experienced cerebral venous sinus thrombosis,cerebral hemorrhage,and deep vein thrombosis of the lower limbs before being declared brain dead.In this case report,we have elaborated the diagnosis and management of deep vein thrombosis manifested as eosinophilia,thrombocytopenia,and elevated D-dimer levels.CONCLUSION Because proper diagnosis is challenging,clinical vigilance is required for patients with eosinophilia,as it can lead to thrombus formation.
文摘Cancer patients with venous thromboembolism (VTE) are not rare, and the second death cause in patients with cancer is VTE. Although VTE itself is associated with reduced survival particularly in cancer patients, many oncologists may not place enough importance in positive prevention of VTE. Here, we report the case of a 38-year-old male lung cancer patient with brain, bone and leptomeningeal metastasis who diagnosed as a consequential intracranial venous and mesenteric vein thrombosis. The evolution of headache has not been noted gradually, from which led to the underestimation of headache and without careful consideration on the possibility of suspected intracranial venous thrombosis. The problem of mesenteric vein thrombosis reflects the dilemma resulted from the potential risk of thrombogenesis and the high risk of hemorrhage. Preventive anticoagulation strategies are key means especially in patients with cancer, and the management problems of this condition are discussed.
基金supported by the National Key R&D Program of China(Grant No.2019YFC0840705)the National Key R&D Program of China(Grant No.2018YFC2001405)。
文摘Purpose:Venous thromboembolism(VTE)is a major health issue among hip fracture patients.This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient’’s drug compliance and reduce the incidence of VTE in hip fracture patients.Methods:This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE(control group)between January 2008 and November 2012,and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform(study group)between January 2016 and September 2017.All the patients included in the both groups were hip fracture patients who had an age over 50 years,treated with surgery,and hospitalized≥48 h.Patients were excluded if they admitted to hospital due to old fractures,had a severe bleeding after 72 h of admission,diagnosed with any type of VTE,or refused to participate in the study.The information platform was divided into medical,nursing,and patient interface.Based on the information platform,medical practitioners and nurses could perform risk assessments,monitoring management and early warnings,preventions and treatments,health educations,follow-up,and other aspects of nursing interventions for patients.This study compared essential characteristics,drug compliance,VTE occurrence,and mean length of hospitalization between the two groups.Besides,a subgroup analysis was performed in the study group according to different drug compliances.SPSS 18.0 software(IBM Corp.,NY,and USA)was used for statistical analysis.Results:Altogether 1177 patients were included in the control group,and 491 patients in the study group.Regarding baseline data,patients in the study group had more morbidities than those in the control group(p<0.05).The difference of drug compliance between the two groups was statistically significant(p<0.001):761(64.7%)of the patients in the control group and only 30(6.1%)patients in the study group had poor drug compliance.In terms of VTE,10.7%patients(126/1177)in the control group had VTE,and the rate in the study group was 7.1%(35/491),showing a statistically significant difference(p=0.02).Moreover,the average length of hospitalization in the study group was also significantly lower than that in the control group(10.4 daysvs.13.7 days,p<0.001).Subgroup analyses of the study group showed that the incidence of VTE in patients with poor,partial,and good compliances were 56.7%(17/30),5.8%(10/171),and 2.8%(8/290),respectively,revealing a significantly huge difference(p<0.001).Conclusions:Poor drug compliance leads to higher VTE occurrence.The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE.The mobile application may be an effective tool to prevent VTE in hip fracture patients.
