Review of cardiovascular involvements in COVID-19

Background: A spectrum of cardiovascular pathologies occurs in patients with COVID-19 and increases the risk of mortality. Risk of mortality is also heightened in cardiovascular disease patients who contact COVID-19. Methodology: Online search for the keywords in PubMed, Medline, Embase, Google scholar was done. Relevant research articles yielded from the searches were reviewed. Results: the searches yielded a total of 172 results, out of which 111 were reviewed. Cardiac involvement was found in 70.6% COVID-19 patients: tachycardia (19%), electrocardiography abnormalities (22%), echocardiography abnormalities (57%), elevated myocardial enzymes (53%), and acute cardiac injury (9%). Eight percent of patients with acute cardiac injury were aged >60 years; 87.5% of them had ≥2 underlying comorbidities (hypertension, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and chronic kidney disease). Novel coronavirus pneumonia was much more severe in the patients with acute cardiac injury than in patients with non-definite acute cardiac injury (P<0.001). Multivariate analyses showed that C-reactive protein (CRP) levels, old age, novel coronavirus pneumonia severity, and underlying comorbidities were the risk factors for cardiac abnormalities in patients with COVID-19. Conclusion: Besides its prominent expression at the level of the respiratory apparatus, COVID-19 is also characterized by a substantial degree of cardiovascular involvement, both in terms of deterioration of pre-existing conditions, and as the effect of inflammation-facilitated acute events. They include ischemic and inflammatory heart disease, ventricular arrhythmias, conduction disturbances, thrombotic events at the level of the lungs, systemic activation of the coagulation cascade and disseminated intravascular coagulation.

Pattern of chest injuries and treatment outcome in a nigerian teaching hospital

Chest injuries are a common type of injuries associated with significant morbidity and mortality. Its occurrence in all parts of the world with high impact on the productive age groups makes it important research area. To evaluate the pattern of chest injury with outcome of treatment in our centre. Retrospective review of patients' data and clinical information from January 2014 to December 2016 in the Surgical Out Patient Department of University of Uyo Teaching Hospital, Uyo, Nigeria. Over the three year period, 442 patients with diagnoses of chest injuries were included with age range 2years to 78years (mean=38.7years) and male: female ratio of 3.5:1. Students, civil servants and motorcyclists/tricyclists operators and drivers were commonly affected (27.6%, 25.1%, 26.9% and 9.3%). Blunt chest injury was commoner than penetrating chest injury (69.7% vs 30.1%); while motor vehicular accident accounted for the majority of chest injury (55.% %) followed by assault (23.1%). Rib fracture was the commonest type of injury (85.5%) followed by haemothorax 29.3%, haemopeumothorax 25.6% and pneumothorax 9.5%. Associated injuries included fracture of upper and lower limb (3.4%), abdominal injury (3.4%) and head injury (2.8%). Majority (89.1%) of the patients were managed either conservatively or with tube thoracostomy with good outcome (96.4%) and mortality rate of 1.1%. Many clinical entities of chest injuries were treated with a low mortality figure of 1.1%

Cardiac Pacemaker Treatment of in Enugu a 5-Year. Review

Background: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation; sometimes after a period of misdiagnosis and inappropriate treatment. Methods: Twenty-three patients who were diagnosed with symptomatic heart block and surgically treated with permanent artificial cardiac pacemaker in National Cardiothoracic Centre; Enugu; between April 2001 and March 2006 had their case notes retrospectively reviewed and information entered into a proforma. This was analyzed. Patients diagnosed with symptomatic heart block but not treated with artificial cardiac pacemaker insertion were excluded from the study. There were eight such patients who could not afford the cost of surgical treatment during the period under review. Results: The mean age of the patients was 70 years and the commonest presentation was shortness of breath (100). Hypertensive heart disease was present in 65of the patients and a history of chronic chloroquine usage was positive in 73of the patients. Predominant pre-treatment pulse rate was in the range of 30-40 per minute (43) while 21of the patients had pulse rate below 30 per minute. These categories of patients commonly had Stoke-Adams syndrome. Sixty-seven per cent of the patients had predominantly systolic hypertension on admission and 16had hypotension. Third degree heart block was present in 65of the patients and 89of all patients needed pre-pacing haemodynamic stabilization with positive inotropic / chronotropic drug(s). Treatment consisted of permanent endocardial pacing in 65and epicardial pacing in 35of the patients with equally good response in symptoms; haemodynamic parameters and electrocardiographic features. Conclusion: Permanent artificial cardiac pacing is the reliable treatment of symptomatic heart block and should be included in the National Health Insurance Scheme list