COVID-19 related myopericarditis in a 29-year-old patient: A case report

Introduction: The manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, are mainly characterized by respiratory symptoms. However, cardiac manifestations such as acute myopericarditis have been reported to be associated with COVID-19 infection. Case Description: A 29-year-old female patient presented with a 2-day history of fever, cough, runny nose, and myalgia, and tested COVID-19 positive at Penang General Hospital, Pulau Pinang, Malaysia. On day 2 of admission, the patient complained of acute onset central chest pain, radiating to her back, associated with cold sweat, shortness of breath and generalised body ache. On examination, tachycardia and tachypnoea were elicited. The serial electrocardiography (ECG) showed persistent non-specific sinus tachycardia. Troponin T level was elevated at 99 ng/L (normal <15 ng/L) and creatine kinase (CK) was at 10990 U//L (normal: <190 U/L). Her chest radiograph revealed cardiomegaly and otherwise clear lung field. CT pulmonary angiogram demonstrated evidence of bilateral pleural effusion and pericardial effusion and ruled out pulmonary embolism. The diagnosis of myopericarditis was established based on clinical, electrocardiographic, radiological, and biochemical findings. She was treated successfully with IV morphine, oral colchicine, ibuprofen, and oxygen therapy. A follow-up echocardiogram 10 weeks postCOVID demonstrated complete resolution of pericardial effusion, with an election fraction of >70%. Conclusion: COVID-19 patients may develop severe cardiac complications such as myopericarditis. Clinicians should have a high index of suspicion of COVID-related myopericarditis in COVID-19 management. Further study should be implemented to investigate the association between COVID-19 and myopericarditis.

Improved Survival of Advanced Lung Cancer in Singapore Over the Past Decade

<p><b>INTRODUCTION</b>We reviewed changes in clinical characteristics, treatment and survival of lung cancer patients in Singapore over the past decade.</p><p><b>MATERIALS AND METHODS</b>We reviewed all primary lung cancer cases from January 2004 to December 2013. Basic demographic, clinical and treatment data were extracted from the database. Overall survival (OS) was calculated using Kaplan-Meier method; survival curves were compared using log-rank test. Linear regression trend lines were estimated using least squares approach, and Cox regression analyses were performed to identify prognostic factors.</p><p><b>RESULTS</b>Among 6006 lung cancer patients, the median age was 68 years old, 65% were males, 88% were Chinese, 92% had non-small-cell lung cancer and 76% had advanced stage IIIB/IV. There were proportionally more adenocarcinomas diagnosed over the years, while that of squamous cell carcinoma (SCC) and small-cell-lung cancer (SCLC) have remained stable. The median OS of all patients increased from 9.2 months in 2004 to 11.5 months in 2013. This survival improvement was statistically significant among patients with stage IIIB/IV (6.7 to 8.7 months;= 0.005) and adenocarcinoma (12.7 to 15.4 months;= 0.041). There was no improvement in median OS for SCC or SCLC. The use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) (hazard ratio [HR] 0.68; 95% CI, 0.63 to 0.73) and pemetrexed (HR, 0.69; 95% CI, 0.63 to 0.76) were significantly associated with improved OS.</p><p><b>CONCLUSION</b>Survival of patients with advanced stage IIIB/IV lung adenocarcinoma has improved over the past decade, and is potentially associated with the use of EGFR TKI and pemetrexed.</p>