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%

Overview of Blunt Chest Injury with Multiple Rib Fractures.

Introduction: Thoracic trauma leading to multiple fractured ribs (MFR) remains common. The significant chest pain of multiple rib fractures can be difficult to manage and can lead to decreased pulmonary function, increased hospital stay, and increased health care expenditures. Aims: To evaluate the treatment options available for pain control in blunt chest injury with multiple rib fractures. Study Design: Internet research. Methodology: Literature review on pain management of blunt chest injury associated with multiple rib fractures was done from 1970 to 2014 using manual library search, journal publications on the subject, and Medline. Results: Various modalities have been in use including systemic modalities, regional modalities, transcutaneous modalities and cutaneous modalities. Conclusion: The current research has shown differs modalities available for control of chest pain in blunt chest injury and multiple rib fractures in the ranges of systemic therapy, regional therapy and trans-cutaneous therapy. Summation of evidences favours regional therapy over others.

Comparative Study of Two Sclerosants for Pleurodesis for Incurable Pleural Effusions and Pneumothorax.

Background: Pleurodesis is indicated in thoracic pathologies associated with pleural effusions or pneumothoraces resulting from incurable diseases and therefore risked with high chance of recurrence Objective: To compare the success rates of the oral forms of tetracycline and injectable form of cyclophosphamide as chemical pleurodesants in clinical practice. Materials and Methods: Prospective study. Results: There were 33 patients who underwent pleurodesis of 40 pleural spaces (bilateral in 7 patients) M: F=1:2.3 (10 vs 23) Age range: 15-80 years (mean= 49 years). The primary outcome measure was taken at four weeks post pleurodesis. This was the success rate of the pleurodesis which was taken as non-recurrence of pleural effusion or pneumothorax at four weeks. At one month, 16(80%) of the pleural spaces that underwent pleurodesis with tetracycline hydrochloride were free from recurrence which makes for 80% success rate and 20% (recurrence) failure rate for tetracycline. The equivalent figures for cyclophosphamide were 85% and 15% respectively. Conclusion: The oral form of tetracycline and cyclophosphamide injection can give approximately same outcome as sclerosants for pleurodesis in appropriate patients.

The Relevance of Ascitic Lactate Dehydrogenase (LDH) and Serum Ascites Albumin Gradient (SAAG) in the Differential Diagnosis of Ascites among Patients in a Nigerian Hospital.

Aim: The study aimed to determine the diagnostic values for lactate dehydrogenase (LDH) and serum ascites albumin gradient (SAAG) with maximum sensitivity and minimum false positivity so as to differentiate malignancy-related ascites from non-malignant ascites in South West region of Nigeria. Study Design: This is a cross sectional study to determine the correlation between ascitic fluid LDH and SAAG and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology, surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methods: A total of 75 patients with ascites admitted into Lagos University Teaching Hospital (LUTH) from 2011 to 2013 were enrolled for the study. Thirty seven (7males, 30 females) had malignancy-related ascites while 38(18 males, 20 females) had non-malignant ascites. Levels of LDH and SAAG were determined in all patients with ascites. Statistical analysis was performed using SPSS software application (version 15.0) and p˂0.05 was considered statistically significant and results expressed as mean ± standard deviation. Results: A total of 75 patients were recruited for the study. Twenty-five of them (33.3%) were males while 50(66.7%) were females. The mean age for both sexes was 59.03±13.54 years. Using Receiver Operator Characteristic (ROC) curve, cut-off levels were 11.5 for SAAG and 310 IU/l for LDH. These cut-offs divided the malignant from the non-malignant group. Higher levels of ascitic LDH were seen in the malignant group (900.67±918.45 IU/l) when compared to the non-malignant group (199.29±194.53 IU/l). This was statistically significant (P<0.05). The diagnostic accuracy of LDH was 90.7%. SAAG was lower in the malignant (6.74±4.84 g/L) group when compared to the non-malignant (13.56±7.50 g/L). This was also statistically significant (P<0.05). The diagnostic accuracy of SAAG was 73.3%. Conclusion: It was concluded that measurement of ascitic fluid LDH and SAAG were relevant in differentiating malignant from non-malignant ascites. The determined cut-off values for LDH and SAAG in this study provides the distinctive differential diagnosis between malignant and nonmalignant ascites. Routine analysis of serum and ascitic fluid albumin and LDH will resolve the problem of malignant and non-malignant ascites especially in low-resource areas or in the developing world.

Ascitic Fluid Fibronectin: A Marker to Differentiate Between Malignant and Non-malignant Ascites.

Background and Aims: So far, the differentiation between malignant and non-malignant ascites by laboratory parameters has not been fully achieved yet. Fibronectin is a glycoprotein which plays an important role in cell adhesion, growth, migration, and differentiation. The aim of the study was to assess the accuracy of fibronectin for the diagnosis of malignant ascites and to compare it with conventional use of cytology. Study Design: A cross sectional study to determine the correlation between ascitic fluid fibronectin and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology, surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methods: Ascitic fluid and serum samples from 75 patients were taken. 37 of them (7 males and 30 females) had malignancy-related ascites (Group 1), while the other 38 (18 males and 20 females) had non-malignant ascites (Group 2) respectively. These were analysed for fibronectin, lactate dehydrogenase (LDH), total protein, and albumin. Cytology was also done for all ascitic fluid samples. Results: Mean values of ascitic fluid fibronectin and LDH were higher in malignancy-related ascites (97.5 μg/ml, and 900.60 IU/L) respectively than in non-malignant ascites (47.7 μg/ml, and 199.31 IU/L) respectively (P less than 0.001). Ascitic fluid fibronectin with a cut-off value of 73 μg/ml gave the best diagnostic accuracy with a sensitivity and specificity of 94.7% and 94.6% respectively, while ascitic fluid LDH with a cut-off value of 310 IU/L gave diagnostic accuracy with a sensitivity and specificity of 97.3% and 84.2% respectively. The mean total protein level in the malignant group was 38.72±18.00 g/L and 30.21±15.00 g/L for the non-malignant group. The mean albumin levels were 28.08±10.32 g/L and 31.23±10.01 g/L for the malignant and non-malignant groups respectively. For both total protein and albumin, the P value was statistically insignificant. In this study, cytology yielded a sensitivity of 56.8% and a specificity of 100%. Conclusion: The results of this study suggest that fibronectin concentration in ascitic fluid may be useful in differentiating malignant from non-malignant ascites and could supplement cytology in the differential diagnosis of ascites. Further studies are needed to confirm these results.

Usefulness of Ascitic Fluid Cholesterol and Protein in the Differential Diagnosis of Ascites in Nigeria: Comparison with Conventional Cytology.

Aim: This study was done to assess and evaluate the diagnostic accuracy of cholesterol and protein in differentiating ascites into malignant and non-malignant group in comparison with cytology. Study Design: A cross sectional study to determine the correlation between ascitic fluid cholesterol and protein and malignant and non-malignant ascites. Place and Duration of Study: This study was carried out at the clinics of gastroenterology surgery, and obstetrics/gynecology at the Lagos University Teaching Hospital (LUTH), between August 2011 and July 2013. Methodology: A total of 75 consecutive patients of Nigerian origin with ascites (37 malignant and 38 non-malignant) were studied for total cholesterol and total protein concentration in ascites. Also, cytology was done for all the 75 samples of ascitic fluid. Statistical analyses were carried out using SPSS software (version 15.0), and the level of significance set at p<0.05 and p<0.001. Results: The ascitic fluid cholesterol and protein levels in malignant ascites were higher (values of 103.10±30.00 mg/dL for cholesterol and 38.72±18.00 g/L for protein respectively) than in nonmalignant ascites (values of 33.20±22.00 mg/dL for cholesterol and 30.21±15.00 g/L for protein). The p value for cholesterol was less than 0.001. Cytology had sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of 56.8%, 100%, 100%, 70.4%, and 78.6% respectively. Using a cut-off limit of 72.7 mg/dL, cholesterol had sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of 94.6%, 94.7%, 94.6%, 94.7% and 94.7% respectively. Ascitic fluid total protein had sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy of 37.8%, 86.8%, 73.7%, 58.9%, and 62.7% respectively. Cholesterol was more sensitive than protein and cytology in the differentiating malignant from non-malignant ascites. Conclusion: It was concluded that measurement of cholesterol in ascitic fluid can differentiate between malignant and non-malignant ascites, and can supplement cytology in the differential diagnosis of ascites.

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