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An unpleasant sensation at the back of the throat can be a sign that a cold is on the way. But for one Tokyo woman, the cause of the pain was not a sniffle but a live worm that had lodged itself inside one of her tonsils.
Doctors at St Luke’s International hospital in the Japanese capital removed the long black worm with tweezers after the patient had complained of throat pain and irritation, according to a case study published in the American Journal of Tropical Medicine and Hygiene.
An inflammatory bowel disease (IBD) surgery registry that adds IBD-specific variables to general quality measurements for restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) performed for ulcerative colitis (UC) allows a better interpretation of predictive factors for delayed pouch formation, according to a new study.
There is little consensus about RPC-IPAA measurements, and the the ACS National Surgical Quality Improvement Program (NSQIP) cannot accurately classify RPC-IPAA staged approaches, Dr. Samuel Eisenstein of UC San Diego Health, in La Jolla, California, and colleagues note in The American Journal of Surgery.
The procedure is often performed in a staged manner as the operation is complex. Patients may require the initial surgical intervention when they are medically refractory, may be receiving multiple immunosuppressive medications, and experiencing other sequelae.
“Currently,” the authors add, “much of the North American literature comparing RPC-IPAA staged approaches has been limited to single-center retrospective cohorts.”
Extended prophylaxis with a low dose of the anticoagulant rivaroxaban (Xarelto, Janssen) in selected medically ill patients being discharged from hospital reduced both venous and arterial thrombotic events, including a 50% reduction in stroke, without significantly increasing bleeding, according to a new analysis of the MARINER trial.
“These results really bring it home that medically ill patients are at risk from arterial thromboembolic events as well as venous thrombotic events in the immediate postdischarge period, and if we use an individualized approach, then extended anticoagulant treatment is beneficial for reducing both venous and arterial events,” lead author Alex C. Spyropoulos, MD, professor of medicine at the Hofstra Northwell School of Medicine, Hempstead, New York, told Medscape Medical News.
“Our findings have major healthcare implications,” he added. “On a population health basis, use of this therapy in patients selected as having high thrombogenic risk and low bleeding risk could prevent more than 12,000 thrombotic events every year at the cost of less than 3000 major bleeds. That is a very favorable trade-off.”
A striking clinical feature of illness from SARS-CoV-2 is a marked increase in thrombotic and microvascular complications, or COVID-19–associated coagulopathy (CAC).
A new study suggests endothelial cell injury plays a major role in the pathogenesis of CAC, and blood levels of soluble thrombomodulin correlate with mortality.
George Goshua, MD, of Yale University, New Haven, Conn., presented this study as a late-breaking abstract at the virtual annual congress of the European Hematology Association.
Dr. Goshua cited past research showing CAC to be highly prevalent among hospitalized patients. Venous thromboembolism was found in 17% to 69% of patients, despite thromboprophylaxis. Arterial thrombosis has been seen in 3.6% to 4.0% of patients, and autopsy findings have shown microvascular thrombosis in as many as 87% of patients.
For their study, Dr. Goshua and colleagues assessed endothelial cell damage, platelet activation, and hemostatic and fibrinolytic cascade effects of CAC.
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