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Article: Acute Extremity Gangrene in COVID-19 Patients.

Deraje, Vybhav / Gujjalanavar, Rajendra S / Das, Subrata / Janardhan, Raghu / Rao, Pallavi

Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India

2021 Volume 54, Issue 2, Page(s) 237–239

Language	English
Publishing date	2021-06-30
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2118680-7
ISSN	1998-376X ; 0970-0358
ISSN (online)	1998-376X
ISSN	0970-0358
DOI	10.1055/s-0041-1731853
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Acute Extremity Gangrene in COVID-19 Patients

Deraje, Vybhav / Gujjalanavar, Rajendra S. / Das, Subrata / Janardhan, Raghu / Rao, Pallavi

Indian Journal of Plastic Surgery

2021 Volume 54, Issue 02, Page(s) 237–239

Language	English
Publishing date	2021-04-01
Publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2118680-7
ISSN	1998-376X ; 0970-0358
ISSN (online)	1998-376X
ISSN	0970-0358
DOI	10.1055/s-0041-1731853
Database	Thieme publisher's database

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Article: Acute Limb Ischemia: A Catastrophic COVID-19 Sequel Leading to Amputation.

Biswal, Jayanta Kumar / Mohanty, Sujit Kumar / Behera, Satya Narayan / Swain, Santanu Kumar / Sahoo, Ashok Kumar

Cureus

2021 Volume 13, Issue 7, Page(s) e16456

Abstract: ... blood blisters, dry gangrene, or life-threatening acute limb ischemia. Unfortunately, most patients have ... series of two COVID-19 infected patients who were initially discharged from the hospital after proper ... 2019 (COVID-19). COVID-19 symptoms range from mild to moderate to severe and very severe. Fever ...

Abstract	A positive-sense single-stranded ribonucleic acid (RNA) virus causes the novel coronavirus illness 2019 (COVID-19). COVID-19 symptoms range from mild to moderate to severe and very severe. Fever, cough, headache, anosmia, ageusia, body ache, and diarrhoea are mild to moderate grade symptoms, whereas systemic involvements (pneumonia, myocarditis, stroke, and other coagulation abnormalities) are more serious. Except for a few patients who have mild complaints of cough and shortness of breath, the majority of patients are recuperating entirely from the viral infection. Patients with severe to very severe illnesses experience significant lung damage and fibrosis. These are the patients who are more likely to experience extrapulmonary complications after COVID-19. The disease's aberrant presentation may be related to systemic involvement and a hypercoagulable condition with micro and macro-angiopathy. Acute limb ischemia is one of the symptoms of the hypercoagulable condition. Its presentation can be in the form of chilblains, bullae, acral cyanosis, bruising, blood blisters, dry gangrene, or life-threatening acute limb ischemia. Unfortunately, most patients have to undergo amputation due to a delay in presentation or rapidly progressing disease. Here we present a case series of two COVID-19 infected patients who were initially discharged from the hospital after proper treatment but developed acute limb ischemia within the home isolation period and their treatment strategy.
Language	English
Publishing date	2021-07-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.16456
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Article ; Online: Severe acute dried gangrene in COVID-19 infection: a case report.

Novara, E / Molinaro, E / Benedetti, I / Bonometti, R / Lauritano, E C / Boverio, R

European review for medical and pharmacological sciences

2020 Volume 24, Issue 10, Page(s) 5769–5771

Abstract: ... of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC ... and the patient died.: Discussion: In severe cases, COVID-19 could be complicated by acute ... cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID ...

Abstract	Objective: Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes. Case presentation: A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died. Discussion: In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC. Conclusions: In our patient, COVID-19 related coagulopathy was associated with poor prognosis.
MeSH term(s)	Acute Disease ; Aged ; Antiviral Agents/therapeutic use ; Betacoronavirus/isolation & purification ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/drug therapy ; Coronavirus Infections/pathology ; Coronavirus Infections/virology ; Disseminated Intravascular Coagulation/diagnosis ; Disseminated Intravascular Coagulation/etiology ; Doxycycline/therapeutic use ; Female ; Fingers/pathology ; Gangrene/diagnosis ; Gangrene/pathology ; Humans ; Hydroxychloroquine/therapeutic use ; Nasal Cavity/virology ; Nose/pathology ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/pathology ; Pneumonia, Viral/virology ; SARS-CoV-2 ; Severity of Illness Index
Chemical Substances	Antiviral Agents ; Hydroxychloroquine (4QWG6N8QKH) ; Doxycycline (N12000U13O)
Keywords	covid19
Language	English
Publishing date	2020-06-04
Publishing country	Italy
Document type	Case Reports ; Journal Article
ZDB-ID	605550-3
ISSN	2284-0729 ; 1128-3602 ; 0392-291X
ISSN (online)	2284-0729
ISSN	1128-3602 ; 0392-291X
DOI	10.26355/eurrev_202005_21369
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Article: Acute acalculous cholecystitis on a COVID-19 patient: a case report.

Mattone, E / Sofia, M / Schembari, E / Palumbo, V / Bonaccorso, R / Randazzo, V / La Greca, G / Iacobello, C / Russello, D / Latteri, S

Annals of medicine and surgery (2012)

2020 Volume 58, Page(s) 73–75

Abstract: ... of acute cholecystitis on COVID-19 patients. ... Introduction: We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 ... 19 patient.: Presentation of case: A COVID-19 patient was diagnosed with acute ...

Abstract	Introduction: We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient. In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient. Presentation of case: A COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment. SARS-CoV-2 RNA was not found in the bile fluid. Because of deterioration of the patient's clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform. Discussion: Acalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia. The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk. Laparoscopic cholecystectomy was next performed due to no clinical improvement. The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhoea. Conclusions: Although the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients.
Keywords	covid19
Language	English
Publishing date	2020-08-31
Publishing country	England
Document type	Case Reports
ZDB-ID	2745440-X
ISSN	2049-0801
ISSN	2049-0801
DOI	10.1016/j.amsu.2020.08.027
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Article ; Online: Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Thrombosis: Phlegmasia Cerulea Dolens Presenting with Venous Gangrene in a Child.

Visveswaran, Gautam K / Morparia, Kavita / Narang, Shalu / Sturt, Cindy / Divita, Michael / Voigt, Brett / Hawatmeh, Amer / McQueen, Derrick / Cohen, Marc

The Journal of pediatrics

2020 Volume 226, Page(s) 281–284.e1

Abstract: ... of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received ... as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive ... A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented ...

Abstract	A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.
MeSH term(s)	COVID-19/complications ; COVID-19/diagnosis ; COVID-19/pathology ; COVID-19/therapy ; Child ; Female ; Gangrene/diagnosis ; Gangrene/virology ; Humans ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/pathology ; Pulmonary Embolism/therapy ; Pulmonary Embolism/virology ; Thrombophlebitis/diagnosis ; Thrombophlebitis/pathology ; Thrombophlebitis/therapy ; Thrombophlebitis/virology ; Veins/pathology ; Venous Thrombosis/diagnosis ; Venous Thrombosis/pathology ; Venous Thrombosis/therapy ; Venous Thrombosis/virology
Keywords	covid19
Language	English
Publishing date	2020-07-13
Publishing country	United States
Document type	Case Reports ; Video-Audio Media
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2020.07.032
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Severe acute dried gangrene in COVID-19 infection: a case report

Novara, E / Molinaro, E / Benedetti, I / Bonometti, R / Lauritano, E C / Boverio, R

Eur Rev Med Pharmacol Sci

Abstract: ... of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC ... and the patient died. DISCUSSION: In severe cases, COVID-19 could be complicated by acute ... cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID ...

Abstract	OBJECTIVE: Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes. CASE PRESENTATION: A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died. DISCUSSION: In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC. CONCLUSIONS: In our patient, COVID-19 related coagulopathy was associated with poor prognosis.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #547467
Database	COVID19

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Article: Acute acalculous cholecystitis on a COVID-19 patient: A case report

Mattone, E. / Sofia, M. / Schembari, E. / Palumbo, V. / Bonaccorso, R. / Randazzo, V. / La Greca, G. / Iacobello, C. / Russello, D. / Latteri, S.

Annals of Medicine and Surgery

Abstract: ... remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients ... Introduction We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 ... patient Presentation of case A COVID-19 patient was diagnosed with acute acalculous cholecystitis and ...

Abstract	Introduction We report an extremely rare case of acute acalculous cholecystitis on a COVID-19 patient In our knowledge, this is the first report of laparoscopic cholecystectomy performed on a COVID-19 patient Presentation of case A COVID-19 patient was diagnosed with acute acalculous cholecystitis and a multidisciplinary team decided to perform a percutaneous transhepatic biliary drainage (PTBD) as the first treatment SARS-CoV-2 RNA was not found in the bile fluid Because of deterioration of the patient's clinical conditions, laparoscopic cholecystectomy had to be performed and since the gallbladder was gangrenous, the severe inflammation made surgery difficult to perform Discussion Acalculous cholecystitis was related with mechanical ventilation and prolonged total parenteral nutrition, in this case the gangrenous histopathology pattern and the gallbladder wall ischemia was probably caused by vascular insufficiency secondary to severe acute respiratory distress syndrome of COVID-19 pneumonia The percutaneous transhepatic gallbladder drainage (PTBD) was performed according to Tokyo Guidelines because of high surgical risk Laparoscopic cholecystectomy was next performed due to no clinical improvement The absence of viral RNA in the bile highlights that SARS-CoV-2 is not eliminated with the bile while it probably infects small intestinal enterocytes which is responsible of gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhoea Conclusions Although the lack of evidence and guidelines about the management of patient with acute cholecystitis during COVID-19 pandemic, laparoscopic cholecystectomy, at most preceded by PTGBD on high surgical risk patients, remains the gold standard for the treatment of acute cholecystitis on COVID-19 patients
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #734942
Database	COVID19

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Article ; Online: Severe Acute Acrocyanosis and Digital Gangrene as a Sign of Catastrophic COVID-19 Infection

ARUN AGARWAL / Ambika Sharma / Rekha Jakhar / Mudit Agarwal

Journal of Clinical and Diagnostic Research, Vol 15, Iss 4, Pp OD12-OD

2021 Volume 15

Abstract: ... However, extremity ischaemia with acrocyanosis and digital gangrene has not been commonly reported with COVID-19 ... macroangiopathy. This hypercoagulopathy has been identified in a subset of critically ill COVID-19 patients ... subset of critically ill COVID-19 patients, and can have a prognostic role in the disease outcome ...

Abstract	Coronavirus Infection Disease-2019 (COVID-19) may present with different symptoms and complications during its course. Emerging evidence suggests that it induces a hypercoagulable state with micro and macroangiopathy. This hypercoagulopathy has been identified in a subset of critically ill COVID-19 patients. However, extremity ischaemia with acrocyanosis and digital gangrene has not been commonly reported with COVID-19. It is caused due to microangiopathic and immunothrombosis phenomenon, and may be accompanied by microvascular involvement of other organs. Here, a case of critically ill 67-year-old male COVID-19 patient is reported who developed digital acrocyanosis and gangrene in lower limbs while being mechanically ventilated for severe Acute Respiratory Distress Syndrome (ARDS) despite being haemodynamically stable (i.e., not needing vasopressor) and on therapeutic anticoagulation. He subsequently succumbed to his disease due to multiorgan dysfunction. This suggests that extremity ischaemia correlates with poor prognosis in this small subset of critically ill COVID-19 patients, and can have a prognostic role in the disease outcome. It may be the first clinical manifestation even in non-vasculopathic patients.
Keywords	cytokine storm ; hypercoagulopathy ; immunothrombosis ; microangiopathy ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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